Mortality due to sugar-sweetened beverage consumption: A global, regional, and national comparative risk assessment

Abstract

Background: Sugar-sweetened beverages (SSBs) are consumed globally and contribute to adiposity. However, the worldwide quantitative impact of sugar-sweetened beverages on burdens of adiposity-related cardiovascular disease (CVD), adiposity-related cancers, and diabetes has not been systematically assessed. Methods: We used comparative risk assessment (CRA) methods and data on SSB intake collected as part of the Global Burden of Diseases (GBD) study. In a multi-year effort we contacted experts worldwide to obtain data from 114 national dietary surveys, covering > 80% of the population. We extracted these data, adjusting for consistency, comparability, and bias. A Bayesian hierarchical model was used to impute missing data. Etiologic effects of change in SSB intake on change in BMI and of elevated BMI on CVD, diabetes, and cancers were pooled from large prospective cohort studies. We used country-, age-, sex-, and cause-specific mortality data from the World Health Organization. Findings: In 2010 SSB intake ranged from 65 y old to >5 servings/day in Cuban men < 45 y old. Worldwide, 655,000 (95% CI: 578,000-693,000) deaths were attributable to SSB consumption, including 369,000 (323,000-419,000) due to diabetes, 258,000 (204,000-276,000) due to CVD, and 28,000 (19,000-35,000) due to cancers. Proportional mortality due to SSBs ranged from 65 y in Japan to over 60% in adults aged < 45 y in Mexico (Figure). Absolute mortality attributable to SSBs was highest in adults > 65 in Latin America and the Caribbean, where it reached over 1500 deaths per million population. Among the world's 15 most populous countries, Mexico had the largest absolute and proportional (45%) deaths due to SSBs. Conclusions: SSBs are a major cause of preventable deaths due to chronic diseases, not only in high-income countries, but in low and middle-income countries as well. These findings provide the most comprehensive quantitative estimates of this burden to inform global prevention programs.