PEDIATRICOBESITY

REVIEWARTICLE doi:10.1111/j.2047-6310.2013.00173.x

Does consumption of high-fructose corn syrup

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beverages cause obesity in children?
R. E. Morgan
School of Nursing, University of Pennsylvania, Philadelphia, PA, USA

Received 1 August 2012; revised 25 March 2013; accepted 26 March 2013

What is already known about this subject
• High Fructose Corn Syrup (HFCS) consumption in the
form of beverages has increased among U.S. school-aged
children.
• HFCS is a common sweetener found in the U.S. food
supply including fruit juices, soft drinks, and sport drinks.
• Obesity exposes school-aged children to preventative
health risks.
What this study adds
• There is inconclusive scientific evidence to definitively
link HFCS beverage consumption in school-aged children
to obesity.
• Consumption of HFCS beverages in children may
displace consumption of milk.
• Many entities contribute to childhood yet limitation of
sweetened beverages may decrease obesity in children.

Summary
The consumption of high-fructose corn syrup (HFCS) beverages has increased since the 1970s. At the same
time, childhood obesity is on the rise, causing children to be at risk of heart disease, diabetes and other
diseases. Healthcare providers have attributed childhood obesity to the consumption of HFCS in the form of
beverages. This article will look at the available research and determine if there is scientific evidence
underlying the idea that sweetened soft drinks, especially those containing HFCS, could cause or contribute
to childhood obesity. A thorough literature search was performed using the ISI Web of Sciences, PubMed
and Scopus databases within the years 2006–2012. The search generated 19 results. The articles were
screened, and six were deemed eligible: four systematic reviews and two meta-analyses. Two systematic
reviews found that there is no relationship between consumption of HFCS beverages and obesity in children.
The other two systematic reviews found possible links between HFCS and childhood obesity. The meta-
analysis articles found that consumption of HFCS beverages can contribute to childhood obesity, and
limitation of sweetened beverages may help decrease obesity in children. Available research studies dem-
onstrate inconclusive scientific evidence definitively linking HFCS to obesity in children.

Keywords: Childhood obesity, high-fructose corn syrup, soda consumption, sugar-sweetened

beverages.

Introduction has been suggested that HFCS is metabolized dif-

ferently from glucose in the body, which may con-
Childhood obesity is on the rise and is reported by tribute to obesity.
the World Health Organization (WHO) to affect 35 In the United States, HFCS was first introduced as
million children in developed countries. According to a food sweetener in the 1960s. Due to cheap corn
the WHO, overweight and obese children are more prices in the 1970s, HFCS was inexpensively made
likely to be obese into adulthood and more likely to from the cornstarch to be used in the US food
develop diabetes and cardiovascular diseases at a supply, and its use became widespread (1). By 1985,
younger age. There is concern that high-fructose 35% of the food supply was sweetened with HFCS
corn syrup (HFCS) increases the risk of obesity in instead of the glucose-based sweeteners used pre-
children compared with other caloric sweeteners. It viously (2). At the same time that HFCS was being
Address for correspondence: Ms RE Morgan, 150 Main St. Franklin, NJ 07416, USA. E-mail: morganruthe@gmail.com
© 2013 The Author
Pediatric Obesity © 2013 International Association for the Study of Obesity. Pediatric Obesity 8, 249–254
 250 | R. E. Morgan
used in the food supply, rates of obesity were
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increasing (2). Today, HFCS is found in breakfast
cereals, beverages, breads, sauces, spreads, salad
dressings, canned fruits, snack foods, desserts,
meat and fish products, condiments, dairy products,
frozen dinners, soups and other products (3).
In the United States, soft drinks and other sugar-
sweetened beverages (SSBs) such as sodas, iced
teas and some fruit juices contain HFCS as the main
sweetener. There was a 123% increase in soft drink
consumption between the 1970s and 1990s, with
the estimate being highest at 196% for 14- to
17-year-old boys. At the same time that the SSB
intake increased, milk consumption decreased,
especially in children (4). The concern is that con-
sumption of beverages containing HFCS increases
the risk of obesity among children, which can lead to
diabetes and other health concerns. This systematic
review will critically examine the scientific evidence
underlying the idea that sweetened soft drinks, espe-
cially those containing HFCS, could cause or con-
tribute to childhood obesity.
Literature search
A thorough literature search was performed using
the ISI Web of Sciences, PubMed and Scopus data-
bases within the years 2006–2012. The databases
were searched using the combined keywords: fruc-
tose syrup, HFCS, obesity, children. All searches
were limited to children aged 6–12, human subjects,
United States, English language and article as docu-
ment type. The search generated 19 results after
search limitations and duplicates were removed. The
articles were screened, and six were deemed eligi-
ble: four systematic reviews and two meta-analyses.
Selection of articles was made based on including
systematic reviews with primary endpoint evaluations
directly related to the key points including HFCS,
obesity and children of school age. Appendix 1 sum-
marizes pertinent details about the included articles,
such as year of publication, design, sample, review
or study question, measurement, conclusion and
GRADE. The strength of the recommendation and
quality of evidence in Appendix 1 table was deter-
mined by utilizing The Center for Evidenced Based
Medicine (CEBM) to evaluate the level of evidence
and grade the recommendation. Only level 1 articles
were included in the review based on the CEBM
grading system.
Review of the literature
Bachman et al. conducted a systematic review to
examine four possible mechanisms by which sweet-
© 2013 The Author
Pediatric Obesity © 2013 International Association for the Study of Obesity. Pediatric Obesity 8, 249–254
ened beverages could cause or contribute to obesity
in children (5). They sought to determine if there is a
relationship between sweetened beverage consump-
tion and increased overweight or obesity, excess
caloric intake, glycaemic index and glycaemic load,
lack of effect of liquid calories on satiety and milk
displacement.
Bachman et al. reviewed 21 studies examining the
effects of increases in sweetened beverage con-
sumption and energy intake (5). Of these studies,
nine were longitudinal, six were cross-sectional,
three were prospective cohort and three were experi-
mental. The first table of their study showed a sig-
nificant increase in energy intake when there is
increased sweetened beverage consumption, com-
pared to other children who consumed less. The
second table demonstrates that there is a significant
positive research relationship between sweetened
beverage consumption and increased body mass
index (BMI) or weight gain. In the third table, the
authors present studies finding a negative or insig-
nificant relationship. The findings were thus inconclu-
sive and failed to demonstrate that sweetened
beverage consumption increases BMI in children.
However, the researchers did determine that con-
sumption of diet sodas was associated with over-
weight children.
Bachman et al.'s proposed mechanism linking
sweetened beverage consumption with obesity in
children is the idea that sweetened beverages’
glycaemic load exacerbates circulating insulin and
increases the risk of adiposity (5). The authors
reviewed the literature without stating how the
research articles were obtained and did independ-
ent research to test the hypothesis in adults. The
results did not show consistent relationships
between hyperglycaemia, hyperinsulinaemia and
weight gain. The evidence that the gastrointestinal
mechanism effects carbohydrate digestion was
inconsistent.
Two additional mechanisms by which sweetened
beverages could cause or contribute to obesity in
children were proposed by Bachman et al. (5) for
further research: The first of these is the idea that
liquid calories induce lower satiety, which leads to
increased caloric intake. Bachman et al. examined
eight experimental studies and found inconsistent
evidence to demonstrate that liquid calories have a
different effect than solids on caloric consumption.
The second is the idea that sweetened beverage
consumption displaces milk intake, which decreases
the consumption of calcium, which has obesity-
lowering properties. Bachman et al. found no studies
to support the hypothesis (5).

Malik et al. conducted a systematic review to
determine if SSB intake causes weight gain (6). The
review focused on the relationship between SSBs
and weight gain. Six of the cross-sectional studies
involving children and adolescents found a significant
positive correlation between SSBs and obesity
and/or weight gain. The power of significance is not
written in a statistical manner, giving the data less
statistical importance. Four of the prospective cohort
studies involving children found significant positive
associations between the intake of SSBs and greater
overweight or obesity.
Although Malik et al. failed to demonstrate a posi-
tive relationship between SSBs and weight gain,
there is also evidence to suggest there is no relation-
ship (6). However, the authors did not report statis-
tical strengths, which limits the strength of their
recommendations. Malik et al. ultimately concluded
that the association between SSBs and weight gain
is still unclear and stated that more research is
needed, including studies with larger sample sizes
and those that examine dietary considerations and
other lifestyle determinants (6).
Bray performed a literature review to determine if
fructose and high-fructose syrup are legitimate
health hazards (1). Bray searched the Medline data-
base for articles on fructose, beverages and obesity.
Bray did not state the limits of the search or how
many articles were used in the review. The research
studies utilized in the review were those that sup-
ported the effects of fructose on obesity.
Bray examined several meta-analyses to determine
how soft-drink consumption impacts energy intake,
body weight and cardiometabolic disease risk (1).
One of the meta-analyses concluded that a high
intake of calorically sweetened beverages is a deter-
minant for obesity without stating the statistical
strength. Based on these studies, Bray concluded
that, ‘body weight effect size increases were smaller
than the effects on energy intake, as soft drinks are
only one source of calories’ (1).
Bray did not adequately support his hypothesis
that HFCS consumption is hazardous to the cardi-
ometabolic health of children and adults (1). Only
studies that supported this hypothesis were
included, the literature reviews were not in a table
format, and the work is not as credible as it would
have been, had the author done his own meta-
analysis. Nevertheless, Bray concluded that there is
an association between HFCS consumption and
risk of overweight, diabetes and cardiometabolic
disease.
Libuda and Kersting reviewed studies to examine
the strength of the scientific evidence base for a
Pediatric Obesity © 2013 International Association for the Study of Obesity. Pediatric Obesity 8, 249–254
HFCS and obesity in children | 251
causal relationship between soft drink consumption
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and excess weight gain in childhood and to identify
the underlying mechanisms (7). The focus of the
studies was childhood and adolescence. There were
a total of 14 cohort studies from 2001 to 2009 in the
review, and 4 intervention studies from the United
States, England, Brazil and Chili were included. The
authors did not list the databases used. Seven of the
cohort studies found a ‘significant relationship
between soft drink or soda consumption and differ-
ent parameters of body weight status (7)’. However,
‘five of the other studies observed no significant
association of soft drink consumption with body
weight in children’ (7). The intervention studies found
that replacement of soft drinks with non-caloric bev-
erages may prevent obesity, although more research
is needed. The authors did not list the studies in a
table to help the reader understand the strength and
reliability of the findings.
Libuda and Kersting discussed three biological
mechanisms that may explain soft drink consump-
tion's cause of obesity (7). The first mechanism dis-
cussed was an increase in energy intake associated
with SSB consumption. The evidence demonstrated
that energy intake from SSBs is not well compen-
sated for in older children and can therefore cause an
increase in total energy intake.
The second mechanism presented by Libuda and
Kersting was that HFCS increases adipogenesis (7).
They asserted that HFCS in beverages may be asso-
ciated with weight gain, but not more than sucrose.
Interestingly, however, they did note that fructose,
contrary to glucose, does not provide satiety signals
and may therefore increase food intake.
Libuda and Kersting's third mechanism was the
interrelation between HFCS and other dietary and
lifestyle factors (7). Milk or other beverages such as
fruit juice may also be causes of weight gain,
although milk is considered to be more beneficial.
Poor diet and low physical activity are also associ-
ated with soft drink consumption. Libuda and
Kersting concluded that the evidence that soft drink
consumption causes weight gain is inconclusive (7).
Forshee et al. searched PubMed and ISI Web of
Science to examine the evidence that HFCS causes
weight gain (8). The authors found four ecological
studies that neither supported nor invalidated the
hypothesized relationship between HFCS availability
and BMI. Forshee et al. reviewed six cross-sectional
studies, and two demonstrated a positive associa-
tion between HFCS soft drink consumption and
obesity (8). Of the seven longitudinal studies exam-
ined, only one found a significant BMI increase.
Three potential mechanisms were discussed, includ-
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 252 | R. E. Morgan
ing HFCS beverages not stimulating satiety signals,
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but how or why was left unclear. The second poten-
tial mechanism is that HFCS increases the fructose:
glucose ratio in the food supply, causing adverse
metabolic effects that lead directly or indirectly to
weight gain; however, the fructose : glucose ratio
has not changed in the US food supply since the
introduction of HFCS in the 1960s, and this would
not explain the increase in obesity seen more
recently. The third potential mechanism is the idea
that because HFCS is ‘sweeter’ than sucrose, and
more sweetness is reinforcing, this leads to an over-
consumption of HFCS containing foods and subse-
quent weight gain. However, it was found that HFCS
and sucrose have similar monosaccharide composi-
tions and sweetness values. The authors found no
evidence to prove that HFCS contributes to over-
weight and obesity differently than other energy
sources.
Olsen and Heitman conducted a systematic review
of prospective and experimental studies to evaluate
the association between calorically sweetened bev-
erage intake and changes in obesity (9). They con-
ducted a literature search with the MEDLINE and
Scirus databases, excluding cross-sectional studies
and those not conducted on humans. Inclusion cri-
teria were soft drink or calorically sweetened bever-
age exposure and any weight-related changes as
outcome. The authors reviewed 19 studies, including
14 prospective and 5 experimental studies. Eight of
the fourteen prospective studies cited demonstrated
significant associations between calorically sweet-
ened beverage intake and obesity. Three of the five
experimental studies yielded positive effects of
calorically sweetened beverages on changes in body
weight and fat.
Olsen and Heitman concluded that there is an
association between calorically sweetened beverage
intake and weight change, but whether that associa-
tion is due to increased energy intake is unknown (9).
Significantly, the authors mentioned that the sugar
industry and/or soft drink associations have finan-
cially supported the studies that have not found
calorically sweetened beverage intake to be associ-
ated with obesity. These industry-funded studies
were not included in their literature review due to a
potential conflict of interest. Ultimately, Olsen and
Heitman's review demonstrates that SSBs have an
association with obesity (9).
Discussion and conclusions
The HFCS consumption in the form of beverages has
risen dramatically since the 1960s, and children and
© 2013 The Author
Pediatric Obesity © 2013 International Association for the Study of Obesity. Pediatric Obesity 8, 249–254
adolescents are the major consumers. At the same
time, obesity in children has increased. Currently, soft
drinks, which contain HFCS, contribute to 8% of the
total energy intake in children and adults (6). Health-
care providers have long suspected that HFCS bev-
erages contribute to obesity in young children.
However, available research studies demonstrate
inconclusive scientific evidence definitively linking
HFCS to obesity in children. Studies demonstrating
positive associations between consumption of bev-
erages sweetened with HFCS and obesity exist, yet
one cannot ignore the studies that found no asso-
ciation. This research compiles the results of system-
atic reviews and meta-analysis that can help further
research endeavours in the area of HFCS contribu-
tions to obesity as well as general mechanisms.
Many of the studies looked at mechanisms to
explain how HFCS intake might lead to obesity and
had similar hypotheses. A common hypothesis was
that HFCS beverage consumption decreases satiety,
leading individuals to consume more calories,
causing obesity. More research is needed to deter-
mine whether and how sweetened beverages influ-
ence food intake. The other major theme found in
many of the reviews was that HFCS drink consump-
tion has largely replaced milk consumption in chil-
dren and adolescents, thereby contributing to
obesity. Further research on the relationship between
SSB consumption and body weight is needed. Spe-
cifically, researchers should consider the serving
sizes of SSBs, the consumption of other beverages
and foods, as well as activity levels. Taken together,
all of the studies reviewed in this article demonstrate
that there are more factors involved than HFCS bev-
erage consumption in childhood obesity.
The research demonstrates that the potential
causal mechanisms underlying childhood obesity are
complex. Therefore, it would seem that increased
rates of obesity among US children should not be
blamed on a single entity, HFCS consumption in
drinks. Although the studies presented did show
possible relationship between HFCS beverages and
obesity, one cannot ignore the studies that showed
no support of such a relationship. All these studies
are limited due to the inability of the researcher to
completely limit or account for intake of other foods
with HFCS or fructose consumption. There are other
factors that play vital roles in the development of
obesity in children. The amount and type of calories
consumed per day and physical activity need to be
taken into consideration. Currently, the American
Academy of Pediatrics (AAP) warns against consum-
ing soda, fruit drinks and sport drinks and has rec-
ommendations for the amounts of fruit juice children

should consume by age. The result of this examina-
tion of the current scientific literature encourages
healthcare providers to continue to follow AAP
guidelines until more research is available, as well as
continuing to recommend other health-promoting
activities, such as exercise. Healthcare providers
need to especially warn against HFCS beverages
consumption in children who are at risk of obesity
based on physical activity levels and diet.
Conflict of interest
statement
No conflict of interest was declared.
References
1. Bray GA. Soft drink consumption and obesity: it is all
about fructose. Curr Opin Lipidol 2010; 21: 51–57.
2. Marriott BP, Cole N, Lee E. National estimates of dietary
fructose intake increased from 1977–2004 in the United
States. J Nutr 2009; 6: 12285–12355.
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HFCS and obesity in children | 253
3. Moeller SM, Fryhofer SA, Osbahr AJ, III, Robinowitz CB.
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The effects of high fructose syrup. J Am Coll Nutr 2009;
28: 619–628.
4. Hu FB, Malik VS. Sugar-sweetened beverages and risk
of obesity and type 2 diabetes: epidemiologic evidence.
Physiol Behav 2010; 100: 47–54.
5. Bachman CM, Baranowski T, Nicklas TA. Is there an
association between sweetened beverages and adiposity?
Nutr Rev 2006; 64: 153–174.
6. Malik VS, Schulze MB, Hu FB. Intake of sugar-
sweetened beverages and weight gain: a systematic
review. Am J Clin Nutr 2006; 84: 274–288.
7. Libuda L, Kersting M. Soft drinks and body weight
development in childhood: is there a relationship? Curr
Opin Clin Nutr Metab Care 2009; 12: 596–600.
8. Forshee RA, Storey ML, Allison DB, et al. A critical
examination of the evidence relating high fructose corn
syrup and weight gain. Cric Rev Food Sci Nutr 2007; 47:
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Appendix 1
Table A1 Are high-fructose corn syrup drinks causing childhood obesity?
254 |

Source Design Sample Review or study question/ Measurement Conclusion Grade*

hypothesis

© 2013 The Author

Forshee et al., 2007 Systematic review High-fructose corn syrup, obesity, Examine the relationship between PubMed HFCS does not appear to contribute High quality
(8) sucrose and beverages high-fructose corn syrup or ‘soft to overweight and obesity any
drinks’ and weight gain differently than do other energy
sources
Malik et al., 2006 (6)
Systematic review Sugar-sweetened beverages, soft What is the association between Medline Sugar-sweetened beverages is not Moderate quality
R. E. Morgan

drinks, soda, fruit drinks, weight sugar-sweetened beverages associated with weight gain or
gain, obesity, added sugar, energy intake and weight gain obesity
compensation
Olsen and Heitmann, Systematic review Soft drinks obesity children', What is the association of calorically Scirus, Medline Calorically sweetened beverages High quality
2008 (9) ‘sugar-sweetened beverages sweetened beverages and obesity can be regarded as a determinant
obesity children’, ‘soft drinks for obesity
obesity’, ‘sugar-sweetened
beverages obesity’, ‘soft drinks
weight change’, ‘sugar-sweetened
beverages weight change’,
‘dietary intake beverages obesity
risk’
Bachman et al., 2006 Systematic review Does not state What is the association between Does not state Inconclusive results; assigning High quality
(5) sweetened beverages and possible links between sweetened
increased overweight or obesity beverage consumption and
adiposity requires research that
compares and contrasts specific
mechanisms, especially in
populations at risk for obesity,
while controlling for likely
confounding variable
Libuda and Kersting, Meta-analysis childhood, obesity, soft drinks, Is there a causal relationship Does no state Limiting soft drinks is approach for High quality
2009 (7) sugar-sweetened beverages, between soft drink consumption search engines prevention obesity in childhood;
weight gain and excess weight gain in however, the cause of overweight
childhood and can we identify and obesity is multifactorial, the
potential underlying mechanisms. limitation of soft drink
consumption needs to be

Pediatric Obesity © 2013 International Association for the Study of Obesity. Pediatric Obesity 8, 249–254
incorporated in a complex
strategy for obesity prevention
Bray, 2010 (1) Meta-analysis Beverages, health risk, high-fructose Is fructose harmful to our health Medline In amounts currently consumed Moderate quality
corn syrup, obesity, sucrose, fructose is hazardous to the
weight gain cardiometabolic health of many
children, adolescents and adults

*GRADE = quality of evidence. High quality = further research is very unlikely to change our confidence in the estimate effect. Moderate Quality = further research if performed is likely to have an important impact and may change
our confidence in the estimate effect.
HFCS, high-fructose corn syrup.