Across the world, the consumption of sugar-sweetened beverages is responsible for about 340,000 deaths each year from Type 2 diabetes and cardiovascular disease, according to a study published Monday that is one of the largest attempts to assess how the spread of Western eating habits is affecting global health.
The study, in the journal Nature, also found that sugary drinks were linked to 2.2 million additional cases of Type 2 diabetes and 1.2 million cases of cardiovascular disease in 2020, with a disproportionate share of those cases concentrated in sub-Saharan Africa and Latin America.
As it happens, those two continents have also experienced the biggest jump in the consumption of soft drinks in recent years as soda companies, faced with declining sales in North America and Europe, have sought new customers in the developing world.
The estimated death toll of 340,000 is a significant increase from previous assessments of how sugar-sweetened drinks affect global health. A 2015 study published in the journal Circulation estimated 184,000 deaths worldwide in 2010 from sugary drink consumption.
The negative health effects of sugar-sweetened drinks — carbonated soda, energy drinks and juices with added sugar — are well-documented. By rapidly flooding the body with empty calories, they often take the place of foods and beverages with more nutritional value.
Regular consumption of the extra sugar in the drinks can lead to obesity, harm liver function and increase the risk of heart disease, hypertension and Type 2 diabetes, an especially insidious disease that can lead to blindness, amputations and premature death.
Dariush Mozaffarian, one of the study’s lead authors and the director of the Food is Medicine Institute at Tufts University, said he hoped the findings would accelerate efforts to curb the consumption of sugar-sweetened beverages, especially in poorer countries whose health care systems are ill-equipped to handle the surge in diet-related disease.
“Regulators and policymakers appropriately respond to tragic deaths, whether an airline crash or terrorism attack, but sugary drinks cause much more death and suffering, yet those deaths don’t move people in the same way because they are hidden,” he said. “That has to change.”
The study is a product of the Global Dietary Database, an ambitious survey of the world’s eating habits funded by the Bill and Melinda Gates Foundation. The database aims to gather standardized information about dietary intake, especially in poorer countries that have traditionally lacked the means to accurately assess the health of their citizens.
The database, started in 2008, is helping scientists understand the growing toll of obesity as highly processed food and drinks reach every corner of the globe and disrupt traditional — and more healthful — eating habits. More than one billion people in the world are obese, according to a recent Lancet study. Among adults, global rates of obesity have more than doubled since 1990 and have quadrupled among children and adolescents.
The Nature study has limitations. The research includes only data between 1990 and 2020 and the study is observational, meaning the findings do not definitively measure the connection between soda consumption and illness. In addition to the Global Dietary Database, the authors incorporated findings of 450 other studies from 181 countries.
Katherine Loatman, executive director of the International Council of Beverages Associations, questioned the study’s findings, noting that the survey results from some countries in the Global Dietary Database were incomplete.
“Our beverage companies are committed to promoting healthy diets and have concerns about the limitations of this study,” she said in an email. “Effective public policies must be built on a strong scientific foundation.”
Dr. Barry M. Popkin, a nutritionist at the University of North Carolina, Chapel Hill, who was not involved in the study, said the findings were consistent with previous research on the global health effects of highly processed food.
“This replicates and reinforces what we already know about sugar-sweetened beverages,” he said, “but the findings highlight their severe costs on health and productivity, especially in Africa and Latin America.”
The study detailed intriguing patterns in the consumption of sugary drinks. For example, researchers found that men had modestly higher rates of soda consumption than women. Intake was higher among the well-educated, especially in sub-Saharan Africa, South Asia and Latin America. In the Middle East and North Africa by contrast, the study found that soda consumption was higher among adults with comparatively lower levels of education.South Asia, Southeast Asia and East Asia had the lowest rates of excess cardiovascular disease and Type 2 diabetes linked to sugary drink consumption, the study found, though the authors noted that the data did not include sugar-sweetened tea and coffee, items that are popular in those parts of the world.
Laura Lara-Castor, a nutritional epidemiologist at the University of Washington and another lead author of the Nature study, said the higher rates of consumption among educated adults in sub-Saharan Africa reflected in part the aspirational lure of soft drink brands associated with Western tastes and style — a result of the sophisticated and well-funded advertising campaigns by multinational beverage companies.
“Consuming these drinks is often a mark of status,” she said.
Despite the study’s grim findings, Dr. Lara-Castor and the other authors said the data also contained reasons for hope. Soda consumption in Latin America and the Caribbean is already beginning to decline, thanks in part to policies like soda taxes, marketing restrictions and package labels that seek to educate consumers about the dangers of products high in added sugar. (In the United States, consumption of sugar-sweetened beverages has dropped since its peak in 2000 but those declines have largely plateaued in recent years.)
More than 80 countries have adopted measures aimed at decreasing sugary drink consumption.
Paula Johns, executive director of ACT Health Promotion, an advocacy group in Brazil, said the Nature study showed that education alone was not enough to dampen consumer zeal for sweetened drinks. In recent years, she said that Brazil had adopted a number of policies that are beginning to dent the nation’s love affair with highly processed food and sugary drinks. They include better school-meal programs, bold front-of-package warnings and a new excise tax on beverages with added sugar.
“There’s no magic bullet,” she said. “But all these policies, taken together, help send the message to the public that sugar-sweetened beverages are really bad for your health.”
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