Estimated Global, Regional, and National Disease Burdens Related to Sugar-Sweetened Beverage Consumption in 2010

Abstract

Background: Sugar-sweetened beverages (SSBs) are consumed globally and contribute to adiposity. However, the worldwide impact of SSBs on burdens of adiposity-related cardiovascular diseases (CVDs), cancers, and diabetes mellitus has not been assessed by nation, age, and sex.

Methods and results: We modeled global, regional, and national burdens of disease associated with SSB consumption by age/sex in 2010. Data on SSB consumption levels were pooled from national dietary surveys worldwide. The effects of SSB intake on body mass index and diabetes mellitus, and of elevated body mass index on CVD, diabetes mellitus, and cancers were derived from large prospective cohort pooling studies. Disease-specific mortality/morbidity data were obtained from Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We computed cause-specific population-attributable fractions for SSB consumption, which were multiplied by cause-specific mortality/morbidity to compute estimates of SSB-attributable death/disability. Analyses were done by country/age/sex; uncertainties of all input data were propagated into final estimates. Worldwide, the model estimated 184 000 (95% uncertainty interval, 161 000-208 000) deaths/y attributable to SSB consumption: 133 000 (126 000-139 000) from diabetes mellitus, 45 000 (26 000-61 000) from CVD, and 6450 (4300-8600) from cancers. Five percent of SSB-related deaths occurred in low-income, 70.9% in middle-income, and 24.1% in high-income countries. Proportional mortality attributable to SSBs ranged from <1% in Japanese >65 years if age to 30% in Mexicans <45 years of age. Among the 20 most populous countries, Mexico had largest absolute (405 deaths/million adults) and proportional (12.1%) deaths from SSBs. A total of 8.5 (2.8, 19.2) million disability-adjusted life years were related to SSB intake (4.5% of diabetes mellitus-related disability-adjusted life years).

Conclusions: SSBs are a single, modifiable component of diet that can impact preventable death/disability in adults in high-, middle-, and low-income countries, indicating an urgent need for strong global prevention programs.

Keywords: cardiovascular diseases; diabetes mellitus; diet; obesity.

Figure 1

Schematic diagram of the relationships between data sources used in the comparative risk assessment modeling framework on which this analysis is based.

Figure 2

Proportion^* of combined mortality from diabetes, CVD, and cancers that is attributable to SSBs in 2010 in three age strata for A) women, and B) men. The color scale of each map indicates the proportional mortality for the given age-sex stratum in each country of the world, highlighting the inverse age gradient.^*Proportional mortality was determined by summing SSB-attributable mortality across the outcomes of interest (diabetes, CVD, and cancers), and then dividing by the total number of deaths caused by these outcome within the population of interest.

Figure 3

The twenty countries^* with highest absolute SSB-attributable mortality in 2010. Mortality is standardized per million adults^**. The 20 countries selected in each age-sex group are those with highest SSB-attributable mortality AND with populations of at least one million. Note that y-axis scales differ in each panel.^*The 47 smaller countries that were excluded because their populations were less than 1 million were: Andorra, Antigua and Barbuda, Bahamas, Bahrain, Barbados, Belize, Bhutan, Brunei Darussalam, Cape Verde, China (Macao SAR), Comoros, Cyprus, Djibouti, Dominica, Equatorial Guinea, Fiji, French Polynesia, Gabon, Gambia, Grenada, Guadeloupe, Guinea-Bissau, Guyana, Iceland, Kiribati, Luxembourg, Maldives, Malta, Marshall Islands, Martinique, Mauritius, Micronesia, Montenegro, Netherlands Antilles, Réunion, Saint Lucia, Saint Vincent and the Grenadines, Samoa, São Tomé and Príncipe, Seychelles, Solomon Islands, Suriname, Swaziland, Timor-Leste, Tonga, Trinidad and Tobago, Vanuatu.^** Population-standardized absolute mortality was calculated by dividing attributable deaths by the adult population of the entity of interest (i.e. country, region, or age-sex groups within a country or region) and then multiplying by one million.