Type 2 Diabetes and Cardiovascular Disease Burdens Attributable to Sugar-Sweetened Beverages Among Adults in 184 Countries

Abstract

Objectives: We aimed to quantify SSB-attributable T2D and CVD burdens among adults 20+ years across 184 countries in 1990 and 2018 globally, regionally, and nationally jointly stratified by age, sex, education level, and urban or rural residence. Methods: A comparative risk assessment model was used to estimate global T2D and CVD burdens attributable to intake of SSBs. We leveraged independent data including population SSB intake from the Global Dietary Database; optimal SSB intake levels; direct and BMI-mediated age-adjusted etiologic effects of SSBs on T2D and CVD from previous meta-analyses and pooled analyses of prospective cohorts; BMI-stratified effects of SSBs on weight gain or loss; population overweight and underweight from the NCD Risk Factor Collaboration; and total T2D and CVD burdens from the Global Burden of Disease study. Results: In 2018, 1.9 million (95% UI 1.8, 2.1) incident T2D cases and 877,858 (80,6455, 949,117) incident CVD cases were attributable to intake of SSBs worldwide. Latin America/Caribbean and Sub-Saharan Africa had the highest proportional SSB-attributable CVD and T2D incident cases. Globally, SSB-attributable T2D and CVD incident cases were higher among males vs. females and urban vs. rural adults globally. High vs. low-educated adults had higher SSB-attributable T2D incidence, but the effect of education on CVD incident cases was less evident. Proportional SSB-attributable T2D and CVD incident cases were higher among younger vs. older adults. From 1990 to 2018, the greatest absolute increases of proportional SSB-attributable incidence in Sub-Saharan Africa (T2D: 8.8% [6.6, 11.1]; CVD: 4.3% [3.1, 5.7]), while Latin America/Caribbean experienced slight decreases. Conclusions: The largest T2D and CVD SSB-attributable burdens in 2018 were in Latin America/Caribbean and Sub-Saharan Africa, with variations by population subgroups. Sub-Saharan Africa experience the greatest increases from 1990 to 2018. By highlighting the regions, countries, and sub-populations most affected, our research can assist in shaping effective policies and interventions to ultimately reduce the burden of cardiometabolic diseases attributed to SSB consumption globally. Funding Sources: Research supported by the Gates Foundation (grant OPP1176682), the AHA (grant 903679), and CONACyT Mexico.