Sugary drinks may explain 180 000 deaths worldwide each year

Marlene Busko

March 19, 2013

New Orleans, LA (corrected) - A large, international epidemiologic study reports that slurping back large amounts of sugary beverages was associated with an increased body-mass index (BMI), which in turn was linked with BMI-related deaths from diabetes, CVD, and cancer[1].

Specifically, the researchers found that in 2010, 132 000 deaths from diabetes, 44 000 deaths from CVD, and 6000 deaths from cancer in the world could be attributed to drinking sugar-sweetened soft drinks, fruit juice, or sports beverages.

The study by Dr Gitanjali Singh (Harvard School of Public Health, Boston, MA) and colleagues was reported at EPI|NPAM 2013 , the Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions.

"It is a [surprisingly] large number of deaths—tens of thousands of deaths—that are being caused by consuming sugary beverages," Singh said in an interview. Three-quarters of these BMI-related deaths were from diabetes, which "suggests that limiting sugary-beverage intake is an important step in reducing diabetes deaths," she noted.

"Uphill battle" to change patient habits, public policy

The study reinforces the need for clinicians to encourage patients to drink fewer sugary beverages, Singh said. In addition, even though "it's certainly an uphill battle [to change public policy]—it's one that . . . physicians, cardiologists, public-health scientists, [and] policy makers . . . really need to advocate for and show support for," she noted.

As part of the Global Burden of Disease study, the researchers obtained data from 114 national dietary surveys, representing more than 60% of the world's population.

Based on data from large prospective cohort studies, they determined how changes in consumption of sugary drinks affected BMI, and next, how elevated BMI affected CVD, diabetes, and seven obesity-related cancers (breast, uterine, esophageal, gallbladder, colorectal, kidney, and pancreatic cancer). Using data from the World Hea l th Organization, they calculated the number of deaths from BMI-related CVD, diabetes, and cancer for men and for women aged 20-44, 45-64, and 65 and older.

Average sugary-drink consumption varied tremendously—from less than one drink (8 oz) a day in elderly Chinese women to more than five drinks (40 oz) a day in younger Cuban men.

Most deaths (78%) from excess sugary drinks were in low- and middle-income countries.

Mexico, which has one of the world's highest per capita rates of drinking sweetened drinks, had the greatest number of deaths related to this risk factor: 318 deaths per million adults.

In contrast, Japan, with one of the lowest per-capita rates of imbibing these beverages, had the smallest number of deaths attributable to this risk factor: about 10 deaths per million adults.

In 2010, drinking sugar-sweetened beverages was associated with about:

  • 38 000 deaths from diabetes in Latin American and Caribbean countries.

  • 11 000 deaths from CVD in Eastern- and Central-Eurasian countries.

  • 25 000 deaths in the US.

"Sugar-sweetened beverages are a major cause of preventable deaths due to chronic diseases, not only in high-income countries, but also in low and middle-income countries," the group concludes.

Bottom line: Advise patients to avoid sugary drinks

"The evidence base that sugar-sweetened beverages are associated with excess weight gain is well established; what these investigators have done is to take it a step further by saying the excess weight gain that is attributable to sugary drinks actually increases the risk of death from diabetes, CVD, and cancer," A merican H eart A ssociation (AHA) spokesperson Dr Rachel K Johnson (University of Vermont, Burlington) commented.

Study strengths include its large scope, but since it was an epidemiologic study, it does not demonstrate cause and effect, Johnson noted. Nevertheless, "it is certainly a [biologically] plausible association, and we should take it seriously," she added.

According to Johnson, "The bottom line is to [advise patients to] avoid sugar-sweetened drinks, [since we have] more and more evidence that it's not a good choice."

It is "particularly problematic" that satiety mechanisms don't kick in with beverages in the same way as with solid foods. "If you have a sugary drink at 4 o'clock, you're not as likely to cut back on what you eat for dinner in the same way you would if you'd had a snack of solid food at 4 o'clock," she said.

The AHA recommends that adults don't exceed 450 calories (36 oz) a week from sugar-sweetened beverages. In a 2012 statement position statement, as reported by heart wire , the AHA and American Diabetes Association stated that nonnutritive artificial sweeteners can be a tool to help people lower their added sugar and calorie intake, as long as they don't eat extra calories to compensate for the lower calories in the diet drinks.

The authors had no conflict of interest related to this study.
EDITOR'S NOTE: This story when published incorrectly stated that the AHA recommendation for sugar-sweetened beverages be limited to 450 calories per day. The error has been corrected.

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