Effect of sugar-sweetened beverage taxation on sugars intake and dental caries: an umbrella review of a global perspective
BMC Public Health volume 23, Article number: 986 (2023)
As part of the Global Strategy on Oral health, the World Health Organization (WHO) is exploring cost-effective interventions for oral health, including taxation on sugar-sweetened beverages (SSBs). To inform this process, this umbrella review aimed to identify the best available estimates pertaining to the impact of SSB taxation on the reduction of sugars intake, and the sugars-caries dose–response, such that estimates of the impact of SSB taxation on averting dental caries in both high (HIC) and low and middle (LMIC) countries be available.
The questions addressed were: (1) what are the effects of SSB taxation on consumption of SSBs and (2) sugars? (3) What is the effect on caries of decreasing sugars? and (4) what is the likely impact of a 20% volumetric SSB tax on the number of active caries prevented over 10 years? Data sources included PubMed, Embase, Web of Science, Scopus, CINAHL, Dentistry and Oral Sciences Source, Cochrane Library, Joanna Briggs Institute (JBI) Systematic Review Register, and PROSPERO. The review was conducted with reference to JBI guidelines. The quality of included systematic reviews was assessed using AMSTAR to identify best evidence.
From 419 systematic reviews identified for questions 1 & 2, and 103 for question 3, 48 (Questions 1 & 2) and 21 (Question 3) underwent full text screening, yielding 14 and five included reviews respectively. Best available data indicated a 10% tax would reduce SSB intake by 10.0% (95% CI: -5.0, 14.7%) in HIC and by 9% (range -6.0 to 12.0%) in LMIC, and that a 20% tax would reduce free sugars intake on average by 4.0 g/d in LMIC and 4.4 g/d in HIC. Based on best available dose response data, this could reduce the number of teeth with caries per adults (HIC and LMIC) by 0.03 and caries occurrence in children by 2.7% (LMIC) and 2.9% (HIC), over a 10-year period.
Best available data suggest a 20% volumetric SSB tax would have a modest impact on prevalence and severity of dental caries in both HIC and LMIC.
In response to the World Health Assembly Resolution on Oral Health (WHA74.5) a Draft Global Strategy on Oral Health has been developed . This includes the Strategic Objective ‘to enable all people to achieve the best possible oral health and target and reduce the social and commercial determinants and risk factors of oral diseases and conditions.’ The Global Strategy on Oral health, aims to recommend cost-effective oral health interventions by 2024. This will form part of the updated Appendix 3 of the WHO Global action plan on the prevention and control of non-communicable diseases (NCDs). WHO Member States will be guided in developing national responses to promote oral health and reduce oral health inequalities and diseases including dental caries; globally.
Dental caries is the most prevalent oral disease . The role of dietary sugars in its aetiology is well established [3, 4]. A WHO recommendation, for minimising lifelong risk of dental caries, is to limit free sugars intake to below 5% of energy intake. This puts forth an important strategy for caries prevention . Addressing the universally high free sugars intake, is an important part of the Global Strategy on Oral Health , yet public health measures to reduce sugars consumption are rare [6, 7]. To make a tangible difference, oral health policy and action plans need to move away from approaches that rely entirely on individual dietary behaviour change for free sugars reduction. Creating social and economic structures to support people to make behaviour changes will require taking bold action to focusing on upstream interventions to limit free sugars intake [8,9,10]. One such measure is the implementation of taxation on sugar-sweetened beverages (SSB).
SSB are a common source of dietary free sugars, with an average global consumption by children of 326 ml/day (ranging from 115 ml/day in Australia to 710 ml/day in China) . In European countries SSB contribution to free sugars varies between 0–65%  and in the US SSB contribute to added sugars intake by 16–23% . These data suggest that lowering SSB intake could significantly impact on free sugars intake. The WHO recognises, and provides guidance on, the implementation of taxes on SSB as an evidence-based policy to prevent obesity and non-communicable diet-related diseases . SSB taxes have been introduced in several countries around the world to incentivise healthy beverage choice . A wealth of evidence suggests that this has a positive impact on obesity prevention , though little attention has focused on the impact on the global impact on dental caries.
Within-country-based modelling studies aiming to predict the impact of taxation of SSB on subsequent levels of dental caries are largely from high income countries (HIC) [16,17,18,19]. However, a diversity of approaches and assumptions has led to vast between-study differences in effect sizes and irreproducible results. The impacts of SSB taxation on development of dental caries in low- and middle-income countries (LMIC) have not been broadly reported . The challenges in publishing in mainstream journals of HIC faced by authors from LMIC, may explain this observation. With a view to assisting WHO in the identification of cost-effective interventions, an independent assessment of the evidence pertaining to the predicted impact of SSB taxation on dental caries in both HIC and LMIC on prevention of dental caries was conducted. For this purpose, an Umbrella Review approach was chosen. An umbrella review is a review of systematic reviews  that captures the vast amount of evidence contained in systematic reviews and studies to access research evidence and inform decision-making. They provide a summary of existing research syntheses related to a given topic or question and are also applied when there is a need for “fast” evidence in reduced timeframes. Umbrella reviews can be used to summarize more than one research synthesis e.g., for different populations or geographic locations. Using an umbrella review approach, the aims of this study were first, to identify the available data pertaining to the impact of SSB taxation on consumption of SSB (i.e., the price elasticity of demand (PED) and sugars, and of the impact of the reduced sugars intake on the development of dental caries; and second, to utilise these data as model parameters to assess the impact of SSB taxation on caries prevention in both LMIC and HIC. The objectives were first, to conduct an umbrella review to identify the best available evidence pertaining to the PED of SSB and the impact of taxation on sugars consumption, and of sugars consumption on the development of dental caries; and second, to use these data to estimate the potential impact of introducing a 20% SSB volumetric tax on averting dental caries.
A preliminary search for previous umbrella reviews on the topic was conducted in PubMed and Web of Science and no existing reviews were identified. The protocol for this umbrella review was registered on PROSPERO in January 2022 (CRD 42022293187) . The review was guided by the Methodology for Joanna Briggs Institute (JBI) Umbrella Reviews . The following questions were addressed:
What are the effects of SSB taxation on SSB on PED/ consumption?
What is the effect of SSB taxation on consumption of sugars?
What are the effects of decreasing sugars consumption on levels of dental caries?
What is the likely effect of a 20% volumetric tax on averting dental caries over a 10-year period?
Studies of healthy populations (i.e., reviews that do not specifically target participants with disease), all age groups, race, gender and geographic locations were included. Data pertaining to the above questions was explored by age group (adults, children (for dental caries outcomes children were further classified according to whether outcomes related to the primary dentition, the permanent dentition or both), geographic location (country), income classification of included countries (high, middle, and low), socioeconomic status of participants and type of tax. To facilitate best-possible context-specificity, where possible, the evidence was mapped according to the WHO Regions.
Intervention/exposure and outcomes
For Questions 1 and 2, systematic reviews of studies that measured the impact of any type of tax to SSB including ad valorem, volumetric tax, or nutrient based tax (based on the sugars content of the drink) were included. Different levels of taxes, including excise tax and sales tax, applied by government, manufacturer, or retailer, were considered.
For Question 1, the outcome was measure of SSB consumption measured as sales, household consumption level, and data on consumption from surveys of dietary intake. SSB included beverages with added sugars, e.g., carbonated and still beverages and sweetened fruit juices, excluding beverages sweetened exclusively with artificially sweeteners. Reports on change in consumption expressed as amount (e.g., mL/day, week, or year, or change in energy intake (EI) from SSB) or units of frequency from which amount can be derived, were included. Data on change in consumption of SSB derived from data on PED including own price elasticity (OPE) and cross price elasticity (CPE) of SSB were included.
For Question 2, the outcome measure was a quantitative change in the intake of sugars (free sugars) expressed as grams, kilograms or ounces per day, week, or year, or the amount of sugars expressed as a percent of EI. Outcomes also included data on the change in energy intake when expressed as Kcal or kJ, MJ per day, month or year, which allowed for conversion to a quantified amount of sugars using the Atwater Factor of 4 kcal/gram sugars .
For Question 3, systematic reviews were included if they reported data pertaining to a quantified measure of sugars intake or change in sugars intake. Sugars intake included total sugars (and any component of) i.e., free sugars, added sugars, sucrose, non-milk extrinsic sugars, expressed as g or kg/day or /year or as a percentage of EI, or a per capita population intake or availability. Systematic reviews that reported solely on the frequency of sugars consumption were excluded.
For Question 3, the outcome was a measure of dental caries. This included decayed, missing and filled teeth (DMFT (for permanent teeth), dmft (for primary teeth)), decayed, missing and filled surfaces (DMFS (for permanent teeth), dmfs (for primary teeth)), decayed, extracted due to caries, filled teeth (deft), or comparisons between caries and no caries or higher caries vs. lower caries.
Sources of information
Online biomedical databases, including PubMed, Embase, Web of Science, Scopus, CINAHL, and Dentistry and Oral Sciences Source were searched. Registries for systematic reviews, including Cochrane Library, the JBI Systematic Review Register and the PROSPERO Library, were searched. Databases were selected from available sources through The University of Adelaide library, aiming for broad geographical coverage. There were no restrictions placed on language and study duration. The date limit was from 2000 to end 2021 (to broadly cover the period since the introduction of taxes on SSBs . The search strategy is presented in Additional file 1. In addition to the search, known experts were contacted by email to identify any further systematic reviews. The inclusion/exclusion criteria and outcome measures for each review question are described below.
Types of study included
The umbrella review included exclusively systematic reviews with or without evidence synthesis, e.g., meta-analysis. For Questions 1 and 2, systematic reviews which examined the effects of SSB taxes on SSB consumption, included both naturalistic (explore the impact of real-world taxes) and modelling studies (hypothetical tax) that used cross sectional or longitudinal (before after) or time series data on price and consumption, or data from experimental intervention studies. Systematic reviews of studies with exclusively qualitative data were excluded.
For Question 3, systematic reviews which exclusively examined the effects of amount of sugars intake or changing sugars intake on dental caries levels of change in dental caries development were included. Reviews that incorporate text and opinion as their primary source of evidence were excluded.
Articles identified by searches were initially screened independently in duplicate by two authors to exclude systematic reviews clearly outside of scope. Potentially eligible reviews underwent full text review by independent duplicate assessment for inclusion. Differences between reviewers’ results were resolved by discussion. Reviews that were excluded at full-text screening are presented in Additional file 2. One reviewer extracted relevant data using a modified version of the JBI data extraction form  and a second reviewer checked data. Completed data extraction forms for included reviews are presented in Additional file 3 (Questions 1 and 2) and Additional file 4 (Question 3). Where pooled analysis was not available to answer a review question, data from original studies within systematic reviews was extracted and summarised.
Quality of included data
The quality of eligible systematic reviews and evidence syntheses was assessed in duplicate using AMSTAR (A Measurement Tool to Assess Systematic Reviews) which is based on an 11-point scale. An AMSTAR score of 8–11 is categorised as high quality, 4–7 is moderate quality and 0–3 low quality . Any disagreement between reviewers was resolved by involvement of a third reviewer. Assessments were conducted independently in duplicate by two reviewers without conflicting interest (e.g., not an author of the review) and any discrepancy between reviewers were resolved by discussion.
The approach to the presentation of findings from included systematic reviews included a tabulated summary of identified reviews that was presented in reverse chronological order and included information on AMSTAR rating. This was supported by a narrative summary that used a ‘best available evidence’ approach where data from the most recent high quality systematic review was described first, followed by a comparison with data from moderate quality reviews or earlier published reviews. Evidence synthesis from the most recent best quality systematic review was used to inform subsequent outputs. To enable a more detailed assessment and interpretation of the evidence when meta-analysis from SRs were not available, further data extraction of the characteristics and findings of primary studies included in the SRs was carried out. In this instance, data extracted included: author year, country of data collection, sample size, age, objectives, intervention or exposure, outcome, and quality assessment.
Estimated impact on levels of dental caries
The impact of SSB taxation on intake of free sugars was estimated in two ways. First, from the identified estimates of the impact of SSB taxation on the consumption of SSB (PED data from Question 1) together with available information on the level of SSB consumption in HIC and LMIC . Second, using the identified estimated of the impact of SSB taxation on intake of energy and sugars (Question 2). In the absence of data from meta-analysis pertaining to sugars intake and dental caries, estimates of sugars reduction and the best available data were used. This included identified data on the dose response between sugars and development of dental caries, (identified in Question 3) to estimate the impact of a 20% volumetric SSB tax on the number of caries prevented in both children and adults over a period of 10 years (Question 4). The identified data for HIC and for LMIC were applied separately.
Figure 1 presents the PRISMA flow diagram. For Questions 1 & 2, from all databases combined, 419 systematic reviews were identified following de-duplication. Following title and abstract screening, 48 systematic reviews were retained for full text screening. Following full text screening, 14 systematic reviews were included. Four were rated as high quality [15, 27,28,29] nine as moderate quality [30,31,32,33,34,35,36,37,38] and one as low quality . Two reviews did not make a declaration of conflict of interest [38, 39]. For question 3, from all databases combined, 100 systematic reviews were identified following de-duplication. Following title and abstract screening 21 reviews were retained for full text screening from which two systematic reviews were included; a further three systematic reviews were identified through known experts in the field giving five systematic reviews. Two reviews were rated as high quality [3, 4] and three as moderate quality [12, 40, 41]. One review did not make a declaration of conflicts of interests . Reasons for exclusions of full texts are provided in Fig. 1 and Additional file 2.
Question 1: Impact of taxation on SSB consumption and PED
Of the 14 systematic reviews identified that had data relevant to Question 1, eight included a narrative account only and six conducted evidence synthesis by pooling data or meta-analysis. Systematic reviews included data from the African, European, Southeast Asian, and Western Pacific WHO Regions as well as The Region of The Americas. A summary of included reviews along with the AMSTAR rating is provided in Table 1. Details of the AMSTAR rating for each included review is provided in Additional file 5. A summary of the original studies included in the 14 reviews, including the quality appraisal for these studies, is provided in Additional file 6.
Data from high-income countries
Of the systematic reviews with quantitative evidence synthesis, Teng et al. , which included data from HIC, and had a high AMSTAR rating, showed that a 10% tax on SSB reduced consumption by 10.0% (95% CI: -5.0, 14.7%) (PED 1.0 (95% CI: -0.5, -1.47)). The analysis by Afshin et al. , also with a high AMSTAR rating, was based on pooled data from studies in the US only and showed a 10% tax would reduce consumption by 7.0% (95% CI: -3.0,-10.0%). The review of Powell et al.  had a moderate AMSTAR rating and was based on US-based price elasticity studies and showed the overall OPE was -1.21 (95% CI: -0.7, -2.26) implying that a 10% tax would reduce consumption by 7.1–22.6% (average reduction 12.1%), and a 20% tax by 14.2–45.2% (average reduction 24.2%). The review of Andreyeva et al. , with a moderate AMSTAR rating and based on US data only, showed, based on mean price elasticity estimates (95% CI: -0.8, 1.0) that a 10% tax would reduce SSB consumption by 8–10%.
Data from low- and middle-income countries
The best available evidence synthesis for LMIC was provided by the review of Nakhimovsky et al.  which had a Moderate AMSTAR rating. This synthesis standardised data across studies and showed that a 10% tax would reduce consumption by 6–12% (average reduction 9.0%, PED 0.90 (range: -0.6 to -1.2)). The review by Cabrera Escobar et al. , which had a moderate AMSTAR rating, included both HIC and LMIC and showed in a meta-analysis of data from the USA, Mexico, Brazil, and France that overall OPE was -1.3 (95% CI: -1.085, -1.509), thus indicating that a 10% tax would reduce consumption by 10.9, 15.1% (average reduction 13.0%). A summary of the data on percent change in SSB consumption is provided in Table 2.
Data by age group and SES
Only the review by Teng et al.  presented pooled data by age group, finding no significant difference. In an earlier review, Thow et al.  reported that the impact of taxes ranging from 5 to 30% on SSB consumption was proportional to tax applied. However, the impact on EI was higher in adults (range: 10.0 to 48.0%) compared with children (range: 5.0 to 8.0%) in due of considerable substitution (e.g. with milk). The systematic reviews of Maniadakis et al. , Thow et al.  (HIC), and of Nakhimovsky et al.  (LMIC) showed SSB taxes to be more regressive in lower income groups. However, difference by SES was not found in the analysis of HIC by Teng et al. , which included some studies where a 5% tax led to a greater reduction in consumption in higher SES groups. Further data on the impact of SSB tax on consumption by age and SES can be found in the summary of original studies in Additional file 6.
Only one systematic review provided data on percentage reduction of SSB consumption by type of tax, which varied but was not statistically significant . Average reductions with a 10% tax level were 2.3% (95% CI: -11.2, 7.4) for an ad valorem tax, 10.2% (95% CI: -4.1, -15.9%) for volumetric; and 14.0% (95% CI: -7.5%, -20.1%) for a nutrient-based tax based on a sugars concentration threshold.
Question 2: Systematic reviews that enabled estimation of the impact of SSB tax on sugars consumption
Two included systematic reviews reported data on the impact of SSB tax on EI, which enabled the estimation of the impact of SSB tax on sugars intake [29, 36]. Nakhimovsky et al. , by using data from LMIC reported that a 10% tax would reduce EI by a median of 18.0 (range: -5.0, -39.0) KJ/person/day or by 4.3 ( range: -1.2 to -9.3) Kcal/person/day. Based on the Atwater conversion factor (4.0 kcal/ (17.0 kJ)/g sugar) , this reduction is equivalent to 1.1 (range: 0.3 to 2.3) g sugars/person/day. Maniadakis, et al.  based on data from HIC, estimated that a 10% increase in price/tax would reduce EI by a maximum of 50 kcal/person/day or, 450 per month. This reduction is equivalent to 12.5 g/d and 112.5 g/month decrease in sugars intake. Of the original studies included in the identified systematic reviews, 16 had data that enabled the impact of SSB taxation on intake of sugars to be determined (summarised in Additional file 7). Nine of these studies provided data that enabled the impact of a 20% tax on SSB on free sugars intake to be estimated, showing decreases ranging from 1.8 g to 11.0 g grams sugars/person/day, with the average decrease in LMIC being 4 g/d and in HIC 4.4 g/d.
Question 3. The effects of decreasing sugars consumption on levels of dental caries
The five included systematic reviews are summarised in Table 3. One review  was an update of an earlier review . None of the included systematic reviews provided a meta-analysis pertaining to the impact of amount of sugars intake on the development of dental caries. However, data from included original studies relating to the dose response relationship are summarised in Table 4. The best available data, based on study design came from cohort studies with low risk of bias (RoB). For adults, this was provided by the analysis of Bernabé et al. , which showed that for each 10 g intake of total sugars DMFT increased 0.09 over the 11-year follow up period. For children, the best available data for the primary dentition came from the analysis of Turck et al.  (Moderate RoB), which showed an increase in dmft of 1.64 between ages 3 and 6 for each 10 g/day sucrose consumption. The best available data for the permanent dentition of children came from the Michigan Study (low RoB) [105, 106] which showed a 1% increase for each 5 g of sugar in children over a three-year follow-up period.
Question 4. The likely effect of a 20% volumetric tax on averting dental caries over a 10-year period
Table 5 tabulates the best available data pertaining to the impact of taxation on SSB consumption, sugars intake, and the dose response between amount of sugars intake and development of caries. Estimates for the impact of a 20% volumetric SSB tax on caries development for both HIC and LMIC are presented.
Through an umbrella review of the best available evidence, the findings of this study suggest that over a ten-year period, a 20% volumetric tax to SSB would reduce the per capita caries count (number of teeth affected by caries) in adults in both HIC and LMIC by approximately 0.03. In children the per capita caries count (number of tooth surfaces affected by caries) would reduce by 0.16 and 0.18, and the caries occurrence by 2.7% and 2.9% in LMIC and HIC respectively.
It has been recognised that no single action will be effective in reducing sugars intake to recommended threshold levels and that this is unlikely to be achieved by interventions that rely on individuals changing behaviour alone . This umbrella review has indicated that SSB taxation alone would have a modest impact on disease levels. Moreover, these reductions in dental disease would likely have notable cost benefits due to the high direct costs incurred in treating dental caries and the indirect costs associated with the disease .
Findings in context of previous findings
Most modelling studies of the effect of SSB taxation on caries have reported on the impact on consumption of SSB but not reported the impact on quantitative measures of dietary sugars consumption per se [18,19,20]. However, Schwendicke et al.  using consumption data from the German National Nutrition Survey indicated a 20% tax had variable impacts across gender and SES groups. The most affect sugars intake being in lower income males (up to an average of 13.7 g/day in males aged 20–29 and 5.7 g/day in females aged 15–19 years). Three [29, 34, 36] of the four [27, 29, 34, 36] systematic reviews identified in this umbrella review that included analyses by SES also showed taxes to be more regressive in lower SES groups.
It has been suggested that taxes are most effective when price change is passed to the consumer . However, few data were identified on the impact of different types of taxation. Only one high quality systematic review showed that nutrient based taxes were most effective, an observation also noted by the WHO . Nutrient based taxes are not, however, always passed to the consumer; SSB taxation in the UK , which was a tiered system, based on different sugars thresholds, drove product reformulation to lower the sugars content of drinks available for purchase. The UK SSB has thus resulted in a dual benefit of lowering sugars of products available and deterring consumers from buying drinks with higher sugars content.
Despite the advantage of umbrella reviews in being a method of review to capture large amounts of evidence in a short time frame, there are several limitations to be acknowledge. First, despite a broad search strategy, potentially relevant studies may have been omitted for example the databases selected did not include all databases available in LMIC e.g. African Index Medicus (AIMS), Index, Medicus for the Eastern Mediterranean Region (IMEMR). Moreover, the process of screening, data extraction and analysis take time meaning that any relevant systematic reviews published after the search cut-off date and before publication of the umbrella review will be omitted. In this review, screening, extracting and quality appraisal of systematic reviews were carried out independently in duplicate. However, inadvertent systematic error during selection, appraisal or extraction cannot be ruled out. Umbrella reviews, by nature, are subject to limited coverage of evidence because if a study has not been included in a published systematic review, an umbrella review will not include it. In extracting data from this umbrella review, the estimates for caries reduction for LMIC may be conservative because the identified data on the dose response between sugars intake and development of dental caries came exclusively HIC. Sugars exposure may have a greater effect on caries in populations with less exposure to fluoride  and increased likelihood of undernutrition . This umbrella review identified systematic reviews with data from most regions of the world, including the African, European, Southeast Asian, Western Pacific and The Region of the Americas. The data sources used in included systematic reviews covered a broad range of databases including those capturing publications from both HIC and LMIC for example Web of Science, SciElo and LILACS, However, some database capturing data from LMIC e.g. the African Index Medicus, Index Medicus for the Eastern Mediterranean Region were not searched by any review. Future systematic and umbrella reviews should select databases to ensure optimum geographic representation and to ensure all available data from LMIC are captured.
Most systematic reviews reported the impact of SSB taxation on EI with few studies reporting the direct impact on intake of sugars. Restricting included data to original studies identified in the included systematic reviews only may have missed some original data on the impact of taxation on sugars intake. However, to conduct a systematic review of original studies was beyond the scope of this analysis. In the present analysis, Atwater Factors were used to derive intake of sugars from reported changes in EI. This approach assumes that any change in EI is accounted for by a change in intake of sugars, which would underestimate the impact on sugars in scenarios where SSB were replaced with drinks containing energy from nutrients other than sugars (e.g., with milk substitution). For example, although Fletcher et al.  reported no impact of taxation on the intake of energy, due to substitution with other sources of energy, this does not equate to no reduction in intake of sugars.
In addition to data from the original studies on the average effect of SSB taxation on sugars intake, published pooled estimates of the mean consumption for HIC and for LMIC  were also used to estimate the impact on sugars intake. However, it must be noted that there is considerable variation in SSB intake between HIC and LMIC, which was not captured in this analysis.
Based on published data, this umbrella review has provided an indication of the reduction in dental caries that might result from SSB taxation in HIC and LMIC. Further cost-effective analysis based on these data will determine the likely impact on cost benefit to healthcare services in LMIC and HIC. The current study has also identified few data from LMIC exploring the dose response between amount of sugars intake and development of dental caries showing that identified data from LMIC pertaining to amount of sugars and dental caries are cross sectional. There is a need for more, well-conducted cohort studies, especially from LMIC, to explore the dose–response relationship between amount of sugars intake and development of dental caries.
Through an umbrella review, the best available evidence pertaining to the impact of SSB taxation on sugars intake and levels of dental caries in both HIC and LMIC has been identified. Evidence indicates a 20% tax would reduce sugars intake by 20.0% in HIC and 18.0% in LMIC, and per capita sugars intake by 4.0 g or more a day. This one intervention alone has a modest positive impact on oral health by reducing caries counts in both adults in both HIC and LMIC by 0.03, and caries prevalence in children by 2.7% and 2.9% for HIC and LMIC respectively.
Availability of data and materials
All data generated or analysed during this study are included in this published article [and its supplementary information files].
A Measurement Tool to Assess Systematic Reviews
Cumulated Index to Nursing and Allied Health Literature
Cross price elasticity
Decayed missing and filled tooth surfaces (permanent teeth)
Decayed missing and filled tooth surfaces (primary teeth)
Decayed missing and filled permanent teeth
Decayed missing and filled primary teeth
Joanna Briggs Institute
Low- and middle-income countries
Own price elasticity
Price elasticity of demand
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
International Prospective Register of Systematic Reviews
Risk of bias
World Health Assembly
World Health Organization
World Health Organization. Discussion paper draft global strategy on oral health. 2021.
Kassebaum NJ, Smith AGC, Bernabe E, Fleming TD, Reynolds AE, Vos T, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res. 2017;96(4):380–7.
Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res. 2014;93(1):8–18.
Moores CJ, Kelly SAM, Moynihan PJ. Systematic review of the effect on caries of sugars intake: ten-year update. J Dent Res. 2022;101(9):1034–45.
World Health Organization. Guideline on sugars intake for adults and children. Geneva: World Health Organization; 2015.
World Health Organization. WHO manual on sugar-sweetened beverage taxation policies to promote healthy diets. Geneva: World Health Organization; 2022.
Benzian H, Guarnizo-Herreno C, Kearns C, Muriithi MW, Watt RG. The global oral health workforce reply. Lancet. 2021;398(10318):2245–6.
Moynihan P, Miller C. Beyond the chair: public health and governmental measures to tackle sugar. J Dent Res. 2020;99(8):871–6.
Benzian H, Listl S. Global oral health in the international health policy spotlight-challenges and new opportunities for sustainable improvement. Bundesgesundheitsbla. 2021;64(7):871–8.
Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S, et al. Ending the neglect of global oral health: time for radical action. Lancet. 2019;394(10194):261–72.
Ooi JY, Wolfenden L, Sutherland R, Nathan N, Oldmeadow C, McLaughlin M, et al. A systematic review of the recent consumption levels of sugar-sweetened beverages in children and adolescents from the World Health Organization regions with high dietary-related burden of disease. Asia Pac J Public Health. 2022;34(1):11–24.
Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch-Ernst KI, Knutsen HK, et al. EFSA panel on nutrition, novel foods and food allergens (NDA). Scientific Opinion on the Tolerable upper intake level for dietary sugars. EFSA J. 2022;20(2):7074–337. https://doi.org/10.2903/j.efsa.2021.7074.
Marriott BP, Hunt KJ, Malek AM, Newman JC. Trends in intake of energy and total sugar from sugar-sweetened beverages in the United States among children and adults, NHANES 2003–2016. Nutrients. 2019;11(9):2004. https://doi.org/10.3390/nu11092004. PMID: 31450689; PMCID: PMC6770750.
Teng A, Snowdon W, Tin STW, Genc M, Na’ati E, Puloka V, et al. Progress in the Pacific on sugar-sweetened beverage taxes: a systematic review of policy changes from 2000 to 2019. Aust NZ J Publ Heal. 2021;45(4):376–84.
Itria A, Borges SS, Rinaldi AEM, Nucci LB, Enes CC. Taxing sugar-sweetened beverages as a policy to reduce overweight and obesity in countries of different income classifications: a systematic review. Public Health Nutr. 2021;24(16):5550–60.
Briggs ADM, Mytton OT, Elhussein A, Scarborough P. Econometric and comparative risk assessment scenario modelling of the proposed UK sugary drink tax on health. Lancet. 2016;388:S10. https://doi.org/10.1016/S0140-6736(16)32246-2.
Schwendicke F, Thomson WM, Broadbent JM, Stolpe M. Effects of taxing sugar-sweetened beverages on caries and treatment costs. J Dent Res. 2016;95(12):1327–32.
Jevdjevic M, Trescher AL, Rovers M, Listl S. The caries-related cost and effects of a tax on sugar-sweetened beverages. Public Health. 2019;169:125–32.
Sowa PM, Keller E, Stormon N, Lalloo R, Ford PJ. The impact of a sugar-sweetened beverages tax on oral health and costs of dental care in Australia. Eur J Public Health. 2019;29(1):173–7.
Urwannachotima N, Hanvoravongchai P, Ansah JP, Prasertsom P, Koh VRY. Impact of sugar-sweetened beverage tax on dental caries: a simulation analysis. BMC Oral Health. 2020;20(1):76. https://doi.org/10.1186/s12903-020-1061-5.
Aromataris E, Fernandez RS, Godfrey C, Holly C, Khalil H, Tungpunkom P. Chapter 10: Umbrella reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI. 2020. Available from: https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-11.
Hijishafiee MA, Kapellas K. Effects of taxation of sugar-sweetened beverages on consumption of sugars sweetened beverages, sugars consumption, and risk of dental caries: an umbrella review protocol. CRD42022293187. 2021. https://www.crd.york.ac.uk/prospero.
Merrill A, Watt BK. Energy value of foods: basis and derivation. USDA Agricultural Handbook No 74. Washington DC: US Government Printing Office. 1973.
Obesity Evidence Hub. Prevention: tax and pricing. In: Countries that have taxes on sugar sweetened beverages (SSBs). 2023. https://www.obesityevidencehub.org.au/collections/prevention/countries-that-have-implemented-taxes-on-sugar-sweetened-beverages-ssbs.
Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid-Based Hea. 2015;13(3):132–40.
Shea BJ, Bouter LM, Peterson J, Boers M, Andersson N, Ortiz Z, et al. External validation of a Measurement Tool to Assess Systematic Reviews (AMSTAR). PLoS One. 2007;2(12):e1350.
Teng AM, Jones AC, Mizdrak A, Signal L, Genc M, Wilson N. Impact of sugar-sweetened beverage taxes on purchases and dietary intake: Systematic review and meta-analysis. Obes Rev. 2019;20(9):1187–204.
Afshin A, Penalvo JL, Del Gobbo L, Silva J, Michaelson M, O’Flaherty M, et al. The prospective impact of food pricing on improving dietary consumption: a systematic review and meta-analysis. PLoS One. 2017;12(3):e0172277. https://doi.org/10.1371/journal.pone.0172277.
Nakhimovsky SS, Feigl AB, Avila C, O’Sullivan G, Macgregor-Skinner E, Spranca M. Taxes on sugar-sweetened beverages to reduce overweight and obesity in middle-income countries: a systematic review. PLoS One. 2016;11(9):e0163358.
Sobhani S, Babashahi M. Taxation for reducing purchase and consumption of sugar-sweetened beverages: a systematic review. Int Arch Health Sci. 2019;6(2):65–72.
Bergallo P, Castagnari V, Fernandez A, Mejia R. Regulatory initiatives to reduce sugar-sweetened beverages (SSBs) in Latin America. PLoS One. 2018;13(10):e0205694.
Redondo M, Hernandez-Aguado I, Lumbreras B. The impact of the tax on sweetened beverages: a systematic review. Am J Clin Nutr. 2018;108(3):548–63.
Backholer K, Sarink D, Beauchamp A, Keating C, Loh V, Ball K, et al. The impact of a tax on sugar-sweetened beverages according to socio-economic position: a systematic review of the evidence. Public Health Nutr. 2016;19(17):3070–84.
Thow AM, Downs S, Jan S. A systematic review of the effectiveness of food taxes and subsidies to improve diets: Understanding the recent evidence. Nutr Rev. 2014;72(9):551–65.
Cabrera Escobar MA, Veerman JL, Tollman SM, Bertram MY, Hofman KJ. Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis. BMC Public Health. 2013;13(1):1072. https://doi.org/10.1186/1471-2458-13-1072.
Maniadakis N, Kapaki V, Damianidi L, Kourlaba G. A systematic review of the effectiveness of taxes on nonalcoholic beverages and high-in-fat foods as a means to prevent obesity trends. Clinicoeconomic Outc. 2013;5:519–43.
Powell LM, Chriqui JF, Khan T, Wada R, Chaloupka FJ. Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes. Obes Rev. 2013;14(2):110–28.
Andreyeva T, Chaloupka FJ, Brownell KD. Estimating the potential of taxes on sugar-sweetened beverages to reduce consumption and generate revenue. Prev Med. 2011;52(6):413–6.
Niebylski ML, Redburn KA, Duhaney T, Campbell NR. Healthy food subsidies and unhealthy food taxation: A systematic review of the evidence. Nutrition. 2015;31(6):787–95.
SACN. Carbohydrates and health report supporting document; systematic review of the evidence carbohydrates and oral health. Scientific Advisory Committee on Nutrition; 2015. https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report.
Mahboobi Z, Pakdaman A, Yazdani R, Azadbakht L, Montazeri A. Dietary free sugar and dental caries in children: a systematic review on longitudinal studies. Health Promot Perspect. 2021;11(3):271–80.
Fletcher JM, Frisvold DE, Tefft N. The effects of soft drink taxes on child and adolescent consumption and weight outcomes. J Public Econ. 2010;94(11–12):967–74.
Alvarado M, Unwin N, Sharp SJ, et al. Assessing the impact of the Barbados sugar-sweetened beverage tax on beverage sales: an observational study. Int J Behav Nutr Phy. 2019;16:13. https://doi.org/10.1186/s12966-019-0776-7.
Silver LD, Ng SW, Ryan-Ibarra S, Taillie LS, Induni M, Miles DR, et al. Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: a before-and-after study. Plos Med. 2017;14(4):e1002283. https://doi.org/10.1371/journal.pmed.1002283.
Briggs ADM, Mytton OT, Kehlbacher A, Tiffin R, Rayner M, Scarborough P. Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK: econometric and comparative risk assessment modelling study. BMJ. 2013;347:f6189.
Briggs ADM, Mytton OT, Madden D, O’Shea D, Rayner M, Scarborough P. The potential impact on obesity of a 10% tax on sugar-sweetened beverages in Ireland, an effect assessment modelling study. BMC Public Health. 2013;13:860. https://doi.org/10.1186/1471-2458-13-860.
Nakamura R, Mirelman AJ, Cuadrado C, Silva-Illanes N, Dunstan J, Suhrcke M. Evaluating the 2014 sugar-sweetened beverage tax in Chile: an observational study in urban areas. Plos Med. 2018;15(7):e1002596. https://doi.org/10.1371/journal.pmed.1002596.
Veerman JL, Sacks G, Antonopoulos N, Martin J. The impact of a tax on sugar-sweetened beverages on health and health care costs: a modelling study. PLoS One. 2016;11(4):e0151460.
Long MW, Gortmaker SL, Ward ZJ, Resch SC, Moodie ML, Sacks G, et al. Cost effectiveness of a sugar-sweetened beverage excise tax in the U.S. Am J Prev Med. 2015;49(1):112–23.
Zhong Y, Auchincloss AH, Lee BK, Kanter GP. The short-term impacts of the Philadelphia beverage tax on beverage consumption. Am J Prev Med. 2018;55(1):26–34.
Sturm R, Powell LM, Chriqui JF, Chaloupka FJ. Soda taxes, soft drink consumption, and children’s body mass index. Health Aff (Millwood). 2010;29(5):1052–8.
Lin BH, Smith TA, Lee JY, Hall KD. Measuring weight outcomes for obesity intervention strategies: the case of a sugar-sweetened beverage tax. Econ Hum Biol. 2011;9(4):329–41.
Colchero MA, Rivera-Dommarco J, Popkin BM, Ng SW. In Mexico, evidence of sustained consumer response two years after implementing a sugar-sweetened beverage tax. Health Aff (Millwood). 2017;36(3):564–71.
Barrientos-Gutierrez T, Zepeda-Tello R, Rodrigues ER, Colchero MA, Rojas-Martinez R, Lazcano-Ponce E, et al. Expected population weight and diabetes impact of the 1-peso-per-litre tax to sugar sweetened beverages in Mexico. PLoS One. 2017;12(5):e0176336.
Basu S, Vellakkal S, Agrawal S, Stuckler D, Popkin B, Ebrahim S. Averting obesity and type 2 diabetes in India through sugar-sweetened beverage taxation: an economic-epidemiologic modeling study. Plos Med. 2014;11(1):e1001582.
Fletcher JM, Frisvold D, Tefft N. Taxing soft drinks and restricting access to vending machines to curb child obesity. Health Aff (Millwood). 2010;29(5):1059–66.
Manyema M, Veerman LJ, Chola L, Tugendhaft A, Sartorius B, Labadarios D, et al. The potential impact of a 20% tax on sugar-sweetened beverages on obesity in South African adults: a mathematical model. PLoS One. 2014;9(8):e105287.
Colchero MA, Guerrero-Lopez CM, Molina M, Rivera JA. Beverages sales in Mexico before and after implementation of a sugar sweetened beverage tax. PLoS One. 2016;11(9):e0163463.
Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. BMJ. 2016;352:h6704.
Colantuoni F, Rojas C. The impact of soda sales taxes on consumption: evidence from scanner data. Contemp Econ Policy. 2015;33(4):714–34.
Waterlander WE, Mhurchu CN, Steenhuis IHM. Effects of a price increase on purchases of sugar sweetened beverages. Results from a randomized controlled trial. Appetite. 2014;78:32–9.
Falbe J, Thompson HR, Becker CM, Rojas N, McCulloch CE, Madsen KA. Impact of the berkeley excise tax on sugar-sweetened beverage consumption. Am J Public Health. 2016;106(10):1865–71.
Aguilar A, Gutierrez E, Seira E. The effectiveness of sin food taxes: evidence from Mexico. J Health Econ. 2021;77:102455.
Capacci S, Allais O, Bonnet C, Mazzocchi M. The impact of the French soda tax on prices and purchases. An ex post evaluation. PLoS One. 2019;14(10):e0223196.
Caro JC, Corvalan C, Reyes M, Silva A, Popkin B, Taillie LS. Chile’s 2014 sugar-sweetened beverage tax and changes in prices and purchases of sugar-sweetened beverages: an observational study in an urban environment. Plos Med. 2018;15(7):e1002597.
Castello JV, Lopez-Casasnovas G. Impact of SSB taxes on consumption. Barcelona: Universitat Pompeu Fabra; 2018.
Colchero MA, Molina M, Guerrero-Lopez CM. After Mexico implemented a tax, purchases of sugar-sweetened beverages decreased and water increased: difference by place of residence, household composition, and income level. J Nutr. 2017;147(8):1552–7.
Fletcher JM, Frisvold DE, Tefft N. Non-linear effects of soda taxes on consumption and weight outcomes. Health Econ. 2015;24(5):566–82.
Batis C, Rivera JA, Popkin BM, Taillie LS. First-year evaluation of Mexico’s tax on nonessential energy-dense foods: an observational study. Plos Med. 2016;13(7):e1002057.
Alvarado M, Kostova D, Suhrcke M, Hambleton I, Hassell T, Samuels TA, et al. Trends in beverage prices following the introduction of a tax on sugar-sweetened beverages in Barbados. Prev Med. 2017;105:S23–5.
Block JP, Chandra A, McManus KD, Willett WC. Point-of-purchase price and education intervention to reduce consumption of sugary soft drinks. Am J Public Health. 2010;100(8):1427–33.
Brown DM, Tammineni SK. Managing sales of beverages in schools to preserve profits and improve children’s nutrition intake in 15 Mississippi Schools. J Am Diet Assoc. 2009;109(12):2036–42.
Duffey KJ, Gordon-Larsen P, Shikany JM, Guilkey D, Jacobs DR, Popkin BM. Food Price and diet and health outcomes 20 years of the CARDIA study. Arch Intern Med. 2010;170(5):420–6.
Gordon-Larsen P, Guilkey DK, Popkin BM. An economic analysis of community-level fast food prices and individual-level fast food intake: a longitudinal study. Health Place. 2011;17(6):1235–41.
Grogger J. Soda taxes and the prices of sodas and other drinks: evidence from Mexico. Mexico: Bureau of Economic Research, Inc; 2015.
Ritter-Burga PI. Essays on obesity and oral health in developing countries. University of Chicago USA: ProQuest Dissertations & Theses Global. 2016.
Barquera S, Hernandez-Barrera L, Tolentino ML, Espinosa J, Ng SW, Rivera JA, et al. Energy intake from beverages is increasing among Mexican adolescents and adults. J Nutr. 2008;138(12):2454–61.
Claro RM, Levy RB, Popkin BM, Monteiro CA. Sugar-sweetened beverage taxes in Brazil. Am J Public Health. 2012;102(1):178–83.
Paraje G. The effect of price and socio-economic level on the consumption of Sugar-Sweetened Beverages (SSB): the case of ecuador. PLoS One. 2016;11(3):e0152260.
Ni Mhurchu C, Eyles H, Schilling C, Yang Q, Kaye-Blake W, Genc M, et al. Food prices and consumer demand: differences across income levels and ethnic groups. PLoS One. 2013;8(10):e75934.
Zhen C, Wohlgenant MK, Karns S, Kaufman P. Habit formation and demand for sugar-sweetened beverages. Am J Agr Econ. 2011;93(1):175–93.
Zhen C, Finkelstein EA, Nonnemaker JM, Karns SA, Todd JE. Predicting the effects of sugar-sweetened beverage taxes on food and beverage demand in a large demand system. Am J Agr Econ. 2014;96(1):1–25.
Finkelstein EA, Zhen C, Nonnemaker J, Todd JE. Health care reform impact of targeted beverage taxes on higher- and lower-income households. Arch Intern Med. 2010;170(22):2028–34.
Bahl R, Bird R, Walkerm MB. The uneasy case against discriminatory excise taxation; soft drink taxation in Ireland. Public Finance Review. 2003;31:510–33.
Gustavsen G. Public policies and the demand for carbonated soft drinks: a censored quantile regression approach. Copenhagen: European Association of Agricultural Economists; 2005.
Fletcher JM, Frisvold D, Tefft N. Can Soft drink taxes reduce population weight? Contemp Econ Policy. 2010;28(1):23–35.
Smith TA, Lin BH, Lee JY. Taxing calorie sweetened beverages: poteintal effects on beverage consumption, calorie intake, and obesity. Washington DC: Department of Agriculture Economic Research Service; 2010.
Dharmasena S, Capps O. Intended and unintended consequences of a proposed national tax on sugar-sweetened beverages to combat the U.S. obesity problem. Health Econ. 2012;21(6):669–94.
Lopez RA, Fantuzzi KL. Demand for carbonated soft drinks: implications for obesity policy. Appl Econ. 2012;44(22):2859–65.
Wang YC, Coxson P, Shen YM, Goldman L, Bibbins-Domingo K. A penny-per-ounce tax on sugar-sweetened beverages would cut health and cost burdens of diabetes. Health Affair. 2012;31(1):199–207.
Bonnet C, Requillart V. Sugar policy reform, tax policy and price transmission in the soft drink industry. Working Paper No. 4. Transparency of Food Pricing (TRANSFOP) project. Brussels: Toulouse School of Economics. 2012.
Dharmasena S, Davies GC, Capps OJ, editors. Partial versus genearl equilibrium calorie and revenue effects of a sugar-sweetened beveraged tax. Pittsburgh: Joint Annula Meeting of the Agricultural and Applied Economics Association and the North-eastern Agricultural and Applied Economics Association; 2011 July 24–26; 2011.
Gustavsen GW, Rickertsen K. The effects of taxes on purchases of sugar-sweetened carbonated soft drinks: a quantile regression approach. Appl Econ. 2011;43(6):707–16.
Finkelstein EA, Zhen C, Bilger M, Nonnemaker J, Farooqui AM, Todd JE. Implications of a sugar-sweetened beverage (SSB) tax when substitutions to non-beverage items are considered. J Health Econ. 2013;32(1):219–39.
Brown MG, Lee J-Y, Seale JL. Demand relationships among juice beverages: a differential demand system approach. J Agric Appl Econ. 1994;26(2):417–29.
Brown MG. Impact of income on price and income responses in the differential demand system. J Agric Appl Econ. 2008;40(2):593–608.
Dharmasena S, Capps O. On Taxing sugar-sweetened beverages to combat the obesity problem. Denver: Agricultural and Applied Economics Association, Canandian Agricultrual Economics Society, and Western Agricultral Economics Association Joint Annual Meeting; 2010.
Dharmasena S, Capps O. Demand interrelationships of at home non¬alcoholic beverage consumpion in the United States. Milwaukee: Demand interrelationships of at home non¬alcoholic beverage consumpion in the United States. Agricultural and Applied Economics Association and American Council on Consumer Interests Joint Annual Meeting; July 28, 2009; 2009.
Pofahl GM, Capps O, Clauson A. Demand for non-alcoholic beverages: evidence from the ACNielsen Home Scan Panel. Providence: American Agricultural Economics Association Annual Meeting; July 24–27; 2005.
Yen ST, Lin B-H, Smallwood DM, Andrews M. Demand for nonalcoholic beverages: The case of low-income households. Agribusiness. 2004;20(3):309–21.
Zheng Y, Kaiser HM. Estimating asymmetric advertising response: an application to U.S. nonalcoholic beverage demand. J Agric Appl Econ. 2008;40(3):837–49.
Zheng Y, Kaiser HM. Advertising and U. S. nonalcoholic beverage demand. Agric Resour Econ Rev. 2008;37(2):147–59.
Sturm R, Datar A. Regional price differences and food consumption frequency among elementary school children. Public Health. 2011;125(3):136–41.
Bernabe E, Vehkalahti MM, Sheiham A, Lundqvist A, Suominen AL. The shape of the dose-response relationship between sugars and caries in adults. J Dent Res. 2016;95(2):167–72.
Burt BA, Eklund SA, Morgan KJ, Larkin FE, Guire KE, Brown LO, et al. The effects of sugars intake and frequency of ingestion on dental-caries increment in a 3-year longitudinal-study. J Dent Res. 1988;67(11):1422–9.
Szpunar SM, Eklund SA, Burt BA. Sugar consumption and caries risk in schoolchildren with low caries experience. Community Dent Oral. 1995;23(3):142–6.
Rugg-Gunn AJ, Hackett AF, Appleton DR, Jenkins GN, Eastoe JE. Relationship between dietary habits and caries increment assessed over two years in 405 English adolescent school children. Arch Oral Biol. 1984;29(12):983–92.
Rugg-Gunn AJ, Hackett AF, Appleton DR. Relative cariogenicity of starch and sugars in a 2-year longitudinal study of 405 English schoolchildren. Caries Res. 1987;21(5):464–73.
Ruottinen S, Karjalainen S, Pienihakkinen K, Lagstrom H, Niinikoski H, Salminen M, et al. Sucrose intake since infancy and dental health in 10-year-old children. Caries Res. 2004;38(2):142–8.
Karjalainen S, Soderling E, Sewon L, Lapinleimu H, Simell O. A prospective study on sucrose consumption, visible plaque and caries in children from 3 to 6 years of age. Commun Dent Oral Epidemiol. 2001;29(2):136–42.
Burt BA, Szpunar SM. The Michigan study: the relationship between sugars intake and dental caries over three years. Int Dent J. 1994;44(3):230–40.
Barrington G, Khan S, Kent K, Brennan DS, Crocombe LA, Bettiol S. Obesity, dietary sugar and dental caries in Australian adults. Int Dent J. 2019;69(5):383–91.
Rosier BT, van Loveren C, Zaura E, Loos BG, Keijser BJF, Crielaard W, et al. Caries incidence in a healthy young adult population in relation to diet. JDR Clin Trans Res. 2017;2(2):142–50.
Chi DL, Hopkins S, O’Brien D, Mancl L, Orr E, Lenaker D. Association between added sugar intake and dental caries in Yup’ik children using a novel hair biomarker. BMC Oral Health. 2015;15(1):121.
Olczak-Kowalczyk D, Turska A, Gozdowski D, Kaczmarek U. Dental caries level and sugar consumption in 12-year-old children from Poland. Adv Clin Exp Med. 2016;25(3):545–50.
Saw WS, Nik-Shanita S, Zahara BAM, Tuti MND, Poh BK. Dietary intake assessment in adults and its association with weight status and dental caries. Pak J Nutr. 2012;11:1066–72.
Mitrakul K, Asvanund Y, Arunakul M, Srisuchat N, Chotthanakarn N, Praisuwanna N, et al. Assessing associations between caries prevalence and body mass index and nutritional data among children aged 6–12 years. Southeast Asian J Trop Med Public Health. 2016;47(1):152–9.
Public Health England. Sugars reduction: the evidence for action. London: HMSO; 2015.
Kastenbom L, Falsen A, Larsson P, Sunnegardh-Gronberg K, Davidson T. Costs and health-related quality of life in relation to caries. BMC Oral Health. 2019;19:187. https://doi.org/10.1186/s12903-019-0874-6.
World Health Organization. Fiscal policies for diet and prevention of non-communicable diseases: technical meeting report. Geneva: World Health Organization; 2016.
Pell D, Mytton O, Penney TL, Briggs A, Cummins S, Penn-Jones C, et al. Changes in soft drinks purchased by British households associated with the UK soft drinks industry levy: controlled interrupted time series analysis. BMJ. 2021;372:n254.
Ha DH, Spencer AJ, Moynihan P, Thomson WM, Do LG. Excess risk of dental caries from higher free sugars intake combined with low exposure to water fluoridation. J Dent Res. 2021;100(11):1243–50.
Tanner L, Craig D, Holmes R, Catinella L, Moynihan P. Does dental caries increase risk of undernutrition in children? Jdr Clin Transl Res. 2022;7(2):104–17.
The authors thank library liaison officer Vikki Langton for assistance with the search strategies and Dr. Benoit Varenne, Oral Health Programme Officer, WHO for comments the manuscript.
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Data extraction forms for included systematic reviews addressing Questions 1 and 2.
Data extraction forms for included systematic reviews addressing Question 3.
AMSTAR results for included systematic reviews and evidence syntheses.
Summary of original studies identified in included reviews addressing Question 1.
Details of original studies with data on sugars intake.
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Hajishafiee, M., Kapellas, K., Listl, S. et al. Effect of sugar-sweetened beverage taxation on sugars intake and dental caries: an umbrella review of a global perspective. BMC Public Health 23, 986 (2023). https://doi.org/10.1186/s12889-023-15884-5
- Sugar-sweetened beverages
- Umbrella review
- Oral health
- Low-middle income countries
- High-income countries