Abstract
SummaryThe aim of this study was to conduct a systematic review and meta‐analysis on the effectiveness of interventions to increase children's water consumption. A systematic literature search was conducted in seven electronic databases. Studies published in English before 18 February 2019 that evaluated any type of intervention that measured change in water consumption among children aged 2 to 12 years by applying any type of design were included. Of the 47 interventions included in the systematic review, 24 reported a statistically significant increase in water consumption. Twenty‐four interventions (17 randomized controlled trials and seven studies with other controlled designs) were included in the meta‐analysis. On average, children in intervention groups consumed 29 mL/d (confidence interval [CI] = 13–46 mL/d) more water than did children in control groups. This effect was larger in eight interventions focused specifically on diet (MD = 73 mL/d, CI = 20–126 mL/d) than in 16 interventions focused also on other lifestyle factors (MD = 15 mL/d, CI = 1–29 mL/d). Significant subgroup differences were also found by study setting and socioecological level targeted but not by children's age group, intervention strategy, or study design. In conclusion, there is evidence that, on average, lifestyle interventions can lead to small increases in children's daily water consumption. More research is needed to further understand the specific intervention elements that have the greatest effect.
Highlights
Water is a healthy alternative to sugar-sweetened beverages (SSBs), of which high consumption has been associated with weight gain[1,2,3] and tooth decay[4,5] in both children and adults
In a previous systematic review by our team, we identified potentially modifiable factors that were associated with children's water consumption; these factors were the child's self-efficacy, parental self-efficacy, and parental restrictive and encouraging feeding practices.[30]
Results from the 24 studies included in the meta-analysis show that the interventions increased water consumption among children (Figure 2)
Summary
Water is a healthy alternative to sugar-sweetened beverages (SSBs), of which high consumption has been associated with weight gain[1,2,3] and tooth decay[4,5] in both children and adults. The total amount of calories consumed may be reduced as water contains no calories, whereas SSBs do.[11,12] Another mechanism supported by Varsamis et al may be that consuming SSBs is linked to elevated glucose responses and sustained elevation in plasma insulin during a day of prolonged sitting,[13] which could lead to higher calorie intake in subsequent meals. A review by Daniels and Popkin suggested that the consumption of water instead of SSBs during or before meal times might reduce the energy intake during the meal.[14]
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