Globally, 9.8% of Diabetes Cases Attributable to Sugary Drinks

Key Points:

• Data from a source called the Global Dietary Database suggests that in 2020, 2.2 million new diabetes cases and 1.2 million new cardiovascular disease cases worldwide stemmed from sugar-sweetened beverages (SSBs).
• The highest burden of new diabetes and cardiovascular disease cases arose in Latin America and the Caribbean.
• Between 1990 and 2020, the highest increase in SSB-attributable cases of these age-related diseases occurred in sub-Saharan Africa, which may have been due to a transition from traditional to Western-style diets.

Sugary drinks, such as sodas, energy drinks, and agua frescas, have been known to contribute to cardiometabolic diseases like diabetes and cardiovascular disease. A report from 2010 even estimated that sugary drink intake was responsible for about 184,000 global deaths. Yet, no research team had reported any assessment of the worldwide burden of cardiometabolic diseases stemming from these sugar-sweetened beverages (SSBs).

Now, published in Nature Medicine, Mozaffarian and colleagues from Tufts University in Boston report evidence suggesting that globally in 2020, 9.8% of new diabetes and 3.1% of new cardiovascular disease cases were attributable to SSBs. Moreover, the highest burden of new, SSB-attributable cases of these two age-related diseases occurred in Latin America and the Caribbean, accounting for 24.4% of diabetes and 11.3% of cardiovascular disease cases in this region, respectively. Furthermore, between 1990 and 2020, the highest increase in SSB-attributable cases for both of these cardiometabolic diseases occurred in Sub-Saharan Africa. Disentangling reasons behind regionally high SSB-attributable cases of these age-related diseases is tricky but may have to do with transitions to Western diets as well as a lack of public policy implementations against SSBs.

“While some policies to curb SSB intakes are currently in place in some countries, our study suggests that more work is needed,” said Mozaffarian and colleagues in their publication. “By highlighting the countries and subpopulations most affected, our research can assist in shaping effective policies and interventions to ultimately reduce the cardiometabolic health burdens of SSBs globally.”

Highest Sugary Drink-Attributable Cardiometabolic Disease Burdens in Latin America and Sub-Saharan Africa

Mozafarrian and colleagues used the Global Dietary Database to survey the SSB consumption and cardiometabolic disease progression of about 2.9 million individuals from 118 countries. This sample represented approximately 87.1% of the global population. With the information from this database, they applied a statistical technique called a comparative risk assessment to model the contribution of SSB intake to cardiometabolic diseases globally and regionally.

Interestingly, the researchers’ model estimated that 2.2 million new diabetes and 1.2 million cardiovascular disease cases were attributable to SSBs globally in 2020. These totals corresponded to 9.8% and 3.1% of new diabetes and cardiovascular disease cases, respectively. Moreover, globally, the researchers estimated that SSBs contributed to about 12.5 million years of healthy life lost to disability—-referred to as cardiometabolic disability-adjusted life years.

To better understand what world region populations receive the brunt of adverse cardiometabolic effects from SSBs, the Tufts researchers turned to data by world region. They found that the burden of new, SSB-attributable diabetes and cardiovascular disease cases was highest in Latin American and Caribbean countries. Accordingly, they estimated that 24.4% of new diabetes and 11.3% of new cardiovascular disease cases were attributable to SSB consumption in this world region. The Tufts researchers speculated that these findings may arise from social circumstances, such as clean water scarcity, that could cause people in this region to consume SSBs rather than water.

Continuing their regional data analyses, the Tufts researchers also found that the largest increases in cardiometabolic disease burden attributable to SSBs arose in sub-Saharan Africa. Along those lines, between 1990 and 2020, SSB-attributable diabetes and cardiovascular disease cases rose 8.8% and 4.4%, respectively. Moreover, the total percentages for SSB-attributable new cases of diabetes and cardiovascular disease were also high—21.5% and 10.5%, respectively. These data could point to a few speculated factors contributing to rising SSB-attributable cardiometabolic disease cases in sub-Saharan Africa—a transition from a traditional to a Western diet and low taxation on SSBs.

Targeted Policies Against Sugary Drinks May Take Generations to Work

The global analysis of new, SSB-attributable cardiometabolic disease cases leaves some open questions for further research. Along those lines, one question is why Latin American and Caribbean populations experience such a high percentage of new diabetes and cardiovascular disease cases attributable to sugary drinks. This likely comes from people’s high intake of SSBs in this region, which is about 7.3 eight-ounce sugary beverages a week, much higher than the 2.6-drink global average. According to speculative analyses from the researchers, this high level of consumption may have something to do with clean water scarcity, where people in this region would turn to soft drinks for hydration. Furthermore, taxation on SSBs in this region may be geared toward revenue generation, rather than reducing SSB consumption.

Another question is why the burden of these cardiometabolic diseases arising from SSB consumption has risen so dramatically in sub-Saharan Africa. According to further speculation from Mozaffarian and colleagues, the answer may lie in the transition of some African countries from a traditional diet to a more Westernized diet that includes sugary drinks. This transition may have led to their high average weekly sugary drink consumption, around 6.5 eight-ounce SSBs per week.

To address rising cardiometabolic disease burdens from SSB consumption, the Tufts researchers propose applying social interventions, such as SSB taxation and/or sugar content limitations, to lower the global burden of these age-related diseases. They add that the efficacy of such interventions may take multiple generations since sugary drink intake during younger years can lead to cardiometabolic diseases later in life. In other words, cardiometabolic damage from SSBs may have already occurred for current generations. That is not to say that lowering SSB intake with effective policies would not contribute to the prevention of cardiometabolic disease progression in people who have already engaged in habitual consumption.

Also, since the global survey presented here links SSB consumption to cardiometabolic diseases, the study’s findings suggest limiting SSB intake may help reduce the risk of diabetes and cardiovascular disease. In that sense, no matter where you live in the world or whether SSBs are popular in your region, lowering SSB consumption or abstaining from drinking SSBs may serve to protect your cardiometabolic health.