Sugar-sweetened drinks linked to 1 in 10 new diabetes cases

Global study links sugar-sweetened beverages to millions of diabetes and heart disease cases, with developing regions facing the greatest burden

In a recent article in Nature Medicine, researchers provided a comprehensive and updated assessment of the worldwide burden of cardiovascular diseases (CVD) and type 2 diabetes (T2D) driven by sugar-sweetened beverage (SSB) consumption.

Their findings indicate that SSB consumption contributed to 1.2 million additional cases of CVD and 2.2 million cases of T2D, accounting for 3.1% and 9.8% of new cases worldwide, respectively.

Background

SSBs are linked to weight gain and cardiometabolic diseases like CVD and T2D. These drinks are quickly digested, leading to less fullness, weight gain, and increased calorie intake. High sugar levels in SSBs can cause insulin resistance, fat build-up in the liver and muscles, and metabolic issues.

Additionally, SSBs may replace healthier foods, further harming health. These factors increase the risk of conditions like hypertension and diabetes, which contribute to heart disease.

Past studies have shown that SSB intake was responsible for significant global deaths, including an estimate that suggested that it was implicated in 184,000 deaths in 2010. However, many assessments used general data on sugar availability rather than individual dietary habits, limiting accuracy.

Improved understanding of these issues can inform policy and surveillance actions to reduce the disease burden of SSBs at multinational, subnational, and national levels, thereby reducing global inequities.

About the study

Researchers aimed to provide a detailed global assessment of the burden of SSBs on CVD and T2D, focusing on how these burdens vary by demographic factors like education and urban versus rural living.

Monte Carlo simulations measured uncertainty in the Population Attributed Fraction (PAF) estimate. This involved accounting for uncertainties in various parameters, such as SSB intake, disease burdens, and relative risk (RR) estimates for the link between SSBs and health outcomes.

For each combination of SSB intake and disease, researchers randomly sampled 1,000 times from probability distributions, ensuring results stayed within realistic bounds (proportions between 0 and 1, intake above zero). These random samples helped calculate PAFs and the related disease burden, with 95% uncertainty intervals (UIs) derived from the 2.5th and 97.5th percentiles of the simulations.

They analyzed findings at the national level using the Sociodemographic Development Index (SDI), a measure that considers income, education, and fertility rates, for the years 1990 and 2020. SSB-related disease burdens between 1990 and 2020 were compared by calculating differences in proportional and absolute terms.

While sex and age standardizations were excluded to reflect real-world population changes, researchers also conducted stratified analyses based on these demographics.

Findings

In 2020, adults worldwide consumed an average of 2.6 servings of SSBs per week, with significant regional variations. The Caribbean and Latin America had the highest intake, while South Asia had the lowest. SSB consumption was higher among men and younger adults. Education level also influences intake, with higher consumption among more educated individuals in certain regions like Latin America and sub-Saharan Africa.

SSB intake significantly contributed to the global burden of CVD and T2D. In 2020, SSBs were responsible for approximately 2.2 million additional T2D cases and 1.2 million additional CVD cases. This accounted for 9.8% of all new T2D cases and 3.1% of new CVD cases globally. SSBs were also implicated in 12.5 million cardiometabolic disability-adjusted life years (DALYs) and over 338,000 deaths.

The impact of SSBs on T2D and CVD varied by region. Latin America and the Caribbean had the highest proportional burden, while South Asia had the lowest. Men, younger adults, and urban populations experienced higher incidence rates of SSB-related T2D and CVD. Interestingly, education played a role, with higher burdens seen among more educated individuals in some regions.

From 1990 to 2020, the proportion of T2D cases attributed to SSBs increased, while the proportion of CVD cases showed a slight decrease.

Conclusions

This study provides updated global estimates of the health impacts of SSBs on CVD and T2D in 2020. It found that SSBs contributed to 2.2 million new T2D cases and 1.2 million CVD cases, resulting in about 340,000 deaths. The health impacts varied by region and demographic factors, with the highest increases in sub-Saharan Africa and significant burdens in Latin America.

Higher education levels were linked to greater SSB-related health burdens in some regions, while urban and rural residents were affected differently. SSB consumption trends, such as rising intakes in low- and middle-income countries, have been influenced by industry marketing and lack of regulation.

The study emphasizes the need for robust public health policies, including taxes and marketing restrictions, to reduce SSB intake. Findings from this study will help shape policies to reduce SSB consumption and address health inequalities globally, offering targeted strategies for different regions and populations.