Sugary drinks are driving new cases of diabetes and cardiovascular disease, particularly in sub-Saharan Africa, Latin America and the Caribbean, according to a study published in Nature this week.

One in five new type 2 diabetes cases in Sub-Saharan Africa and a quarter of those in Latin America and the Caribbean are attributable to sugary drinks, according to researchers from Tufts University’s School of Nutrition Science and Policy.

They estimate that 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease occur globally each year due to the consumption of sugary beverages.

Around 11% of new cardiovascular diseases in the Caribbean and over 10% in sub-Saharan Africa are also the result of these drinks. 

The researchers compiled data about 184 countries between 1990 and 2020 using the Global Dietary Database, including 450 surveys with data on sugary drinks totaling 2.9 million individuals from 118 countries.

Biggest increase in sub-Saharan Africa

The biggest increases in diabetes and CVD occurred in sub-Saharan Africa, reflecting changes in the consumption patterns of the region.

Colombia, Mexico, and South Africa have been particularly hard hit.  Almost half (48%) of Colombia’s new diabetes cases, 30% of Mexico’s cases and 27.6% of South Africa’s cases were attributable to sugary drinks.

Meanwhile, sugary drinks were to blame for 23% of Colombia’s CVD cases, 14,6% of those in South Africa and 13,5% of Mexico’s cases. 

“Sugar-sweetened beverages are heavily marketed and sold in low- and middle-income nations. Not only are these communities consuming harmful products, but they are also often less well equipped to deal with the long-term health consequences,” says Professor Dariush Mozaffarian, senior author on the paper and director of Tufts’ Food is Medicine Institute.

‘Clarion call’ to cut consumption

The study describes its findings as “a clarion call that the ‘nutrition transition’ from traditional toward Western diets has already occurred in much of the [sub-Saharan] region”, yet most African nations have not implemented any measures to curb sugary drinks intakes, “perhaps owing to both industry opposition and previous lack of credible country-specific data”.

Those most at risk varied from region to region. In Latin America, the Caribbean, South Asia and sub-Saharan Africa better educated people were most at risk. But in the Middle East and North Africa, lower educated people consumed more sugary drinks. Younger people and men were also more at risk.

There were “modest decreases” in cardio-metabolic burdens related to sugary drinks in Latin America and the Caribbean, which is consistent with slowly decreasing consumption of sugary drinks.

“Nations in this region have implemented several policy efforts targeting sugar-sweetened beverages, including taxes, marketing regulations, front-of-package warnings and education campaigns,” the researchers note.

However, the impact of sugary drinks on health remains high and absolute burdens per million adults continue to rise “owing to continuing increased rates in obesity, type 2 diabetes and CVD” as well as other risks such as high consumption of refined grain and physical inactivity.

Taxes on sugary drinks

The authors call for public health campaigns, regulation of sugary drink advertising, and taxes on sugar-sweetened beverages.  

Mexico, which has one of the highest per capita rates of sugary drink consumption in the world, introduced a tax on the beverages in 2014. 

South Africa followed suit with a tax called a Health Promotion Levy in April 2018, taxing all sugary drinks with over 4 grams of sugar per 100 millilitres. 

Colombia’s tax on sugary drinks, which took effect on November 1, 2023, also varies according to the amount of added sugar in the drink:

“Much more needs to be done, especially in countries in Latin America and Africa where consumption is high and the health consequence severe,” says Mozaffarian, who is also Professor of Nutrition. 

Due to their liquid form, sugary drinks are “rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain”, according to the study.

“High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain.”

Image Credits: Heala_SA/Twitter, Kerry Cullinan.