Sweet drinks, sour outcomes: a global health wake-up call

Sugary drinks are fueling rising rates of diabetes and heart disease worldwide—and what must be done to curb their devastating impact?

Study: Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries. Image Credit: Stokkete / Shutterstock

In a recent study published in the journal Nature Medicine, an international team of researchers, including the Global Dietary Database collaboration, examined the global health burden associated with sugar-sweetened beverage (SSB) consumption, focusing on its contribution to type 2 diabetes (T2D) and cardiovascular diseases (CVD).

Background

Excessive consumption of sugar-sweetened beverages is recognized as a major dietary risk factor linked to non-communicable diseases, including T2D and CVD. Previous studies have highlighted the contributions of high sugar-sweetened beverage intake to obesity, weight gain, and impaired glucose metabolism and the increased risk of these conditions.

While global dietary trends show rising sugar-sweetened beverage consumption, especially in low- and middle-income countries, comprehensive assessments of the population-level impacts remain limited. Existing research has identified associations between sugar-sweetened beverage intake and cardiometabolic risks. However, a detailed quantification of this association across diverse populations is lacking.

Additionally, key sociodemographic disparities, such as those related to age, sex, education, and urbanicity, often remain unexplored. The study further highlights temporal trends, such as increases in SSB-attributable burdens from 1990 to 2020, particularly in sub-Saharan Africa. Understanding these variations is critical for estimating the disease burden attributable to sugar-sweetened beverage intake and designing targeted public health strategies to address this growing health challenge.

About the Study

The present study conducted a comparative risk assessment to estimate the global burden of T2D and CVD attributable to sugar-sweetened beverage consumption. The framework integrated diverse input parameters, including population demographics, sugar-sweetened beverage intake distributions, and disease-specific risk factors.

The researchers used data from the Global Dietary Database and other authoritative sources, encompassing 184 countries. This approach incorporated over 450 dietary surveys involving 2.9 million individuals, making it one of the most comprehensive datasets available. The inputs used in the analysis included population-level sugar-sweetened beverage consumption data, optimal intake levels derived from meta-analyses, and the direct and body mass index (BMI)-mediated effects of sugar-sweetened beverages on disease risk.

For dietary assessments, the study used individual-level survey data from nationally representative samples. The researchers also employed Bayesian hierarchical models to estimate the mean sugar-sweetened beverage intakes across stratified demographic subgroups, which accounted for variability and uncertainty. These estimates were expressed in standard serving sizes (8 oz) and adjusted for age, sex, education, and urbanicity.

Additionally, disease burden estimates, including incidence, mortality, and disability-adjusted life years (DALYs), were derived using input data on background T2D and CVD rates from the Global Burden of Disease studies from 2019 and 2021. Monte Carlo simulations were employed to assess uncertainty, providing robust 95% confidence intervals for all estimates. Risk estimates were based on established epidemiological evidence linking sugar-sweetened beverage intake to T2D, ischemic stroke, and ischemic heart disease.

The researchers adjusted the effects for potential confounders such as BMI and other sociodemographic factors. Age-specific relative risks were also calculated to reflect the impact of metabolic factors at different life stages.

Results

The study found that sugar-sweetened beverage consumption significantly contributed to the global burden of T2D and CVD. In 2020, SSB consumption was associated with 2.2 million new T2D cases (9.8% of all global cases) and 1.2 million new CVD cases (3.1% of all cases). It identified considerable variation in the health impacts related to sugar-sweetened beverage consumption across regions, with higher burdens observed in countries with elevated intake levels and sociodemographic disparities.

Globally, sugar-sweetened beverage consumption was associated with a notable proportion of T2D and CVD cases, accounting for substantial disease incidence, mortality, and DALYs. Among adults aged 20 years and older, the findings revealed that T2D burdens were predominantly driven by both the direct effects of sugar-sweetened beverages and their role in weight gain.

Moreover, cardiovascular impacts were similarly influenced by sugar-sweetened beverage-related weight changes and the direct etiologic effects of sugar consumption. For instance, SSBs contributed to 12.5 million cardiometabolic DALYs in 2020, including 6.9% of all T2D-related DALYs and 3.0% of all CVD-related DALYs. The study showed that younger populations and urban residents often exhibited higher relative burdens than older adults or rural residents, reflecting patterns of sugar-sweetened beverage consumption.

The attributable disease burden was especially pronounced in countries with high sugar-sweetened beverage intake, such as Mexico and the United States. Conversely, nations with lower sugar-sweetened beverage consumption showed reduced impacts, significantly highlighting the role of country-wide dietary patterns in shaping health outcomes.

Notably, from 1990 to 2020, sub-Saharan Africa experienced an 8.8 percentage point increase in SSB-related T2D burdens and a 4.4 percentage point increase in CVD burdens, underlining the rapid dietary shifts occurring in the region.

The findings also revealed disparities based on sex, education, and urbanicity, emphasizing the importance of targeted interventions. For instance, individuals with lower educational attainment were more vulnerable to the adverse effects of sugar-sweetened beverages, likely due to limited access to health information and resources.

By incorporating both direct and BMI-mediated pathways, the researchers provided a comprehensive understanding of sugar-sweetened beverage-related health risks. These findings bring attention to the urgent need for global and regional strategies, including public health campaigns and regulatory policies, to reduce sugar-sweetened beverage consumption and mitigate its health impacts.

Conclusions

Overall, the results highlighted the significant global health burden of sugar-sweetened beverage consumption, particularly its contribution to T2D and CVD. The study emphasizes that targeted policies, such as SSB taxes, front-of-package labeling, and education campaigns, can significantly mitigate these burdens. By quantifying these impacts across diverse populations, the researchers emphasized the need for targeted public health interventions and policy measures to reduce sugar-sweetened beverage intake.

Addressing this preventable dietary risk can significantly alleviate the growing burden of non-communicable diseases worldwide, improving health outcomes and reducing disparities across regions and demographics. Given the ongoing rise in SSB-related burdens in low- and middle-income countries, particularly sub-Saharan Africa, immediate action is essential.