Targeting Overconsumption of Sugar-Sweetened Beverages vs. Overall Poor Diet Quality for Cardiometabolic Diseases Risk Prevention: Place Your Bets!

Abstract

Chronic overconsumption of sugar-sweetened beverages (SSBs) is amongst the dietary factors most consistently found to be associated with obesity, type 2 diabetes (T2D) and cardiovascular disease (CVD) risk in large epidemiological studies. Intervention studies have shown that SSB overconsumption increases intra-abdominal obesity and ectopic lipid deposition in the liver, and also exacerbates cardiometabolic risk. Similar to the prevalence of obesity and T2D, national surveys of food consumption have shown that chronic overconsumption of SSBs is skyrocketing in many parts of the world, yet with marked heterogeneity across countries. SSB overconsumption is also particularly worrisome among children and adolescents. Although the relationships between SSB overconsumption and obesity, T2D, and CVD are rather consistent in epidemiological studies, it has also been shown that SSB overconsumption is part of an overall poor dietary pattern and is particularly prevalent among subgroups of the population with low socioeconomic status, thereby questioning the major focus on SSBs to target/prevent cardiometabolic diseases. Public health initiatives aimed specifically at decreasing SSB overconsumption will most likely be successful in influencing SSB consumption per se. However, comprehensive strategies targeting poor dietary patterns and aiming at improving global dietary quality are likely to have much more impact in addressing the unprecedented public health challenges that we are currently facing.

Keywords: abdominal obesity; cardiovascular diseases; diet quality; sugar-sweetened beverages; type 2 diabetes.

Figure 1

Schematic representation of factors associated with sugar-sweetened beverage (SSB) consumption.

Figure 2

2002–2014 changes in sugar-sweetened beverage sales presented in litres per capita, and 2002–2014 changes in the percentage of the population who is either overweight or obese (body mass index ≥ 25 kg/m²) in selected countries from various regions of the world. Sugar-sweetened beverages were defined as the sum of on trade (bars, cafés, restaurants, etc.) and off trade (grocery stores, independent retailers, etc.) sales in any sugar-sweetened sodas (regular cola carbonates, lemonade/lime carbonates, ginger ale, tonic water, and orange carbonates), juice drinks (up to 24% juice), and nectars (25–99% juice), as well as sports drinks and energy drinks. Low-calorie cola carbonates and 100% fruit juices were not included. Data on body mass index changes were obtained from the World Health Organisation website.