Evidence-based systematic review on the association between sugar-sweetened beverages tax and childhood obesity
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摘要:
目的 通过检索国内外已有研究文献，综合分析评价含糖饮料征税对儿童肥胖发生的影响，为中国儿童肥胖防控政策的制定提供证据支持。 方法 采用系统评价方法，检索中国知网(CNKI)、维普网(VIP)、万方数据知识服务平台(Wanfang Data)、PubMed、Medline、SpringerLink、Web of Science、Science Direct等8个中外文献数据库检索至2020年11月30日国内外公开发表的相关研究文献，2016年及之后的高质量系统评价研究文献直接采纳，2016年之前的高质量系统评价文献与之后的相关文献进行合并后分析。 结果 共纳入文献12篇，包括5项系统评价或Meta分析研究、1项队列研究和6项横断面研究。综合分析表明，若对含糖饮料征税低于5%，对儿童肥胖预防效果较小甚至没有效果；若对含糖饮料征税增加至20%，对儿童肥胖的发生具有一定预防作用。从成本效益分析来看，采取含糖饮料税收政策，具有一定净效益。 结论 对含糖饮料征税有利于降低儿童肥胖的发生风险。 Abstract:Objective To evaluate the impact of sugar-sweetened beverages (SSBs) tax on childhood obesity by literatures reveiew, and to provide evidence support for childhood obesity prevention and control strategies in China. Methods A systematic review method was used to search relevant literatures published to November 30, 2020 from 8 databases including CNKI, VIP, Wanfang Data, PubMed, Medline, SpringerLink, Web of Science, and Science Direct. The high-quality system reviews published since 2016 were included directly, and those published before 2016 were rereviewed before combined with other literatures. Results Twelve studies including 5 systematic reviews (or Meta-analysis), 1 cohort study and 6 cross-sectional studies were included. Comprehensive analysis showed that the prevention effect on childhood obesity was small or even ineffective if the tax on SSBs lower than 5%, a certain protective effect on childhood obesity could be shown if the tax on SSBs increased to 20%. From the perspective of cost-benefit analysis, the implementation of SSBs tax showed certain net benefits. Conclusion SSBs tax can help reduce the risk of childhood obesity. -
Key words:
- Obesity /
- Child /
- Evidence-based medicine /
- Beverages /
- Taxes
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表 1 含糖饮料征税与儿童超重肥胖关系的系统评价
Table 1. Relations between a tax on sugar-sweetened beverages and overweight and obesity in children: systematic reviews
第一作者 研究类型 样本国家 年龄 研究内容 结果 结论 Park[10] 综述(2008年1—7月发表的14项研究) 美国、爱尔兰、英国、南非、澳大利亚、德国、哥伦比亚、墨西哥 青少年及成年人 含糖饮料征税对肥胖及心脏健康的影响 3%~5%的低税率与BMI降低无显著相关，税率每增加1%，BMI仅降低0.003 kg/m2。不同国家税收3.3%~20%，超重肥胖率降低0.7%~4%，体重降低0.41~1.16 kg或BMI减少0.003 kg/m2。 保护 Redondo[11] 系统综述(2011—2017年发表的17项研究) 美国、墨西哥 ≥2岁 含糖饮料征税对其消费的影响 5项自然试验研究显示，Berkeley征税8%，墨西哥征税10%，均可显著降低含糖饮料消费；对苏打饮料征税5%，5.5%，均无显著作用。12项基于试验的购买行为或意愿研究显示，税率越高，消费量有不同程度降低。 保护 Escobar[12] Meta分析(2000年1月—2013年1月发表的9项研究) 美国、墨西哥、巴西、法国 ≥2岁 含糖饮料征税对膳食、体重及肥胖的影响 价格越高，需求越低。含糖饮料价格弹性-1.30(95%CI=-1.09~1.51)，4项关于价格的研究(3项美国、1项墨西哥)中，含糖饮料价格越高，对果汁0.39(95%CI=0.01~0.77)和牛奶0.13(95%CI=-0.09~0.34)的需求越高、对无糖饮料的需求越低-0.42(95%CI=-0.63~-1.22)。美国6项研究均提示，价格提高有利于降低BMI及超重肥胖率。 保护 Thow[13] 系统综述(2009年1月—2012年3月发表的16项研究) — ≥2岁 含糖饮料征税对饮料消费的影响 对含糖饮料征税5%~30%，饮料消费量减少5%~48%。其中4项模型研究分析发现，5%~20%征税可减少含糖饮料消费，成人减少能量摄入10%~48%，儿童减少能量摄入5%~8%。 保护 Gortmaker[14] 系统评价及模型研究 美国 儿童 不同肥胖干预措施成本效益 对7种儿童肥胖干预措施的实施效果分析成本效益，仅含糖饮料征税、减少宣传不健康食品的税收补贴以及实施校园食物饮料营养标准三项具有成本效益。对含糖饮料税每投入1美元可节约30.78美元(95%UI: 6.07~112.94)。 具有净效益 
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表 2 含糖饮料征税与儿童超重肥胖关系的队列研究和模型研究
Table 2. Relations between a tax on sugar-sweetened beverages and overweight and obesity in children: cohort studies and modeling studies
第一作者 研究类型 样本国家 年龄/岁 研究内容 结果 结论 Bourke[15] 模型研究 印度尼西亚 ≥5 0.3美元/L(约20%)含糖饮料税对BMI及糖尿病的影响 每人每天可减少能量摄入17 kJ，男女超重率分别降低2.9%，1.4%，肥胖率分别降低7.3%，3.9%。高收入人群受益更多。 保护 Nomaguchi[16] 模型研究 澳大利亚 ≥20 20%含糖饮料税对生产力的影响 肥胖率减少1.96%，劳动生产力增加7.51亿澳元，无薪部门(包括家务劳动者、志愿者和社区工作者)潜在生产力收益增加11.72亿澳元；20%含糖饮料税不仅有利于健康改善，还能提高生产力。 保护 Schwendicke[17] 模型研究 德国 15~79 20%含糖饮料税对超重肥胖率的影响 征税对20~29岁人群BMI降低最为显著，60岁以上人群效果最差，总体而言，超重肥胖率分别减少3%~4%。含糖饮料征税对超重肥胖防控具有显著效果。 保护 Veerman[18] 模型研究 澳大利亚 ≥20 20%含糖饮料税对人群健康及医疗保健费用的影响 成人饮料消费减少12.6%，男女能量摄入分别减少16，9 kJ/d，BMI分别减少0.1，0.06 kg/m2，肥胖率分别减少2.7%，1.2%；健康调整寿命年分别增加112 000，56 000人年，2型糖尿病新发病例每年减少800例，节约医疗支出6.09亿澳元。 保护及具有净效益 Sturm[19] 队列研究(2004) 美国 9~12 饮料征税与BMI 4.2%苏打饮料税使每周消费量减少0.006次，BMI下降0.085 kg/m2，税率每增加1%，每周饮料消费减少0.004次，BMI下降0.013 kg/m2。税收和消费量、BMI之间的关系不显著。但是对超重肥胖、低收入家庭、非裔美国、长时间观看电视的儿童，税收显著降低BMI 0.22~1.41 kg/m2，税率每增加1%BMI下降0.03~0.25 kg/m2。 无 Ford[20] 横断面模型研究(2009—2012) 美国 2~5 含糖饮料征税对学龄前儿童膳食质量的影响 20%征税后，总能量摄入减少28 kcal/d，膳食质量略有下降。 保护 Basu[21] 模型研究 印度 25~65 20%含糖饮料税的健康效果 超重肥胖率和2型糖尿病发生率分别减少3.0%(95%CI=1.6%~5.9%)、1.6%(95%CI=1.2%~1.9%)。如果含糖饮料消费呈非线性增长，超重肥胖率和2型糖尿病发生率可分别减少4.2%(95%CI=2.5%~10.0%)、2.5%(95%CI=1.0%~2.8%)。 保护
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