Sugar-Sweetened Beverage Sales Fall in Europe but Climb in Much of Middle East

June 01, 2016

INNSBRUCK, AUSTRIA — While consumption of sugar-sweetened beverages has recently fallen in most of Western Europe, a new survey suggests, a number of Middle Eastern countries showed dramatic increases from 2010 to 2015[1]. Per capita consumption in 2015, in fact, was much higher in several Middle Eastern countries than in any European country in the analysis, which estimated consumption levels based on sugar-sweetened–beverage sales at bars, restaurants, and retail outlets.

"In the vast majority of Western European countries, the sales are actually going down," an exception being Denmark, where sugar-sweetened–beverage sales climbed over the 5 years of the analysis, according to Dr Benoit Arsenault (Institut Universitaire de Cardiologie et de Pneumologie de Québec, QC).

On the other hand, the sales levels are "heterogeneous" across the Middle East and North Africa. "In many [such] countries they are on the rise, and quite substantially, whereas in other countries they were stable for the past 5 years," Arsenault said when presenting the results this week here at the European Atherosclerosis Society 2016 Congress.

Saudi Arabia showed by far the highest per capita consumption of sugar-sweetened beverages in 2015 and ranked third, behind only Lebanon and Oman, in increasing consumption from 2010 to 2015. Kuwait, Qatar, and Israel were alone among the 18 Middle Eastern or North African countries to show a decline in the analysis.

Although consumption remained high in much of Western Europe, with the Netherlands and Belgium ranking fourth and fifth among the highest sugar-sweetened–beverage consumers among all countries in 2015, the analysis was remarkable for showing essentially no growth or a drop-off in consumption in nearly all its countries over 5 years. Of note, Italy and Greece were among the bottom five for 2015 consumption in Western Europe, and compared with them only Portugal showed a steeper drop over 5 years.

The Analysis in Perspective

"I think they did as good a job as probably anyone could do," Dr Alice Lichtenstein (Tufts University, Medford, MA), not connected with the current study, told heartwire from Medscape. But as the researchers pointed out, she said, the analysis is limited in using sales data rather than true consumption. It also relies on different data-collection methodologies across the range of countries, so that the numbers in some countries "are more complete than in others."

"This won't tell us exactly how much sugar-sweetened beverages are consumed in one country vs another country," she said. But it does estimate the vast geographic expanse of a trend that likely contributes to world's epidemic of obesity. The message, according to Lichtenstein, is that "for almost all countries now, developing and developed," people have excess body weight, and although sugar-sweetened beverages "are not the total reason," there's plenty of evidence that their high consumption levels contribute.

The current analysis did not attempt to correlate sugar-sweetened–beverage consumption with geographic rates of cardiovascular disease, diabetes, or obesity.

Findings Mirrored Elsewhere

Expanding on the current data to include a broader, more granular analysis he expects to report fully in the future, Arsenault told heartwire that the findings in other Western countries mirrored those from Western Europe.

"We found the exact same thing in North America and in Australia—we found that countries from the West had a quite substantial decrease, in some cases, in sugar-sweetened–beverage sales, in contrast to countries from emerging markets, such as [in] the Middle East. We also found a similar tendency in some Asian countries, he said, pointing to Vietnam in particular, in which "there was a spectacular progression of sugar-sweetened–beverage sales."

No-sugar or low-sugar–sweetened beverages were not included in the current analysis, but the broader data showed it as "remarkably stable" throughout the world during the study period, Arsenault said—an exception being Sweden, where it increased by 4 L per person from 2010 to 2015.

Also surprising in the larger database: the "spectacular rise," he said, in consumption of a subset of sugar-sweetened beverages, "sports drinks" or "energy drinks." It climbed, often sharply, in every country analyzed except Finland. That "offsets, to some extent," the declines in sales of other sugar-sweetened beverages in most Western countries.

Sugar-Sweetened–Beverage Sales 2015 (L/Person), by Region

Countries Western Europe Middle East and North Africa
Top 5 Countries
  Netherlands: 93 Saudi Arabia: 120.1
  Belgium: 91.4 Lebanon: 106.5
  Germany: 83.8 Oman: 105.5
  Switzerland: 81.7 Bahrain: 88.7
  Luxembourg: 80.6 Israel: 80.1
Bottom 5 Countries
  Italy: 52.6 Egypt: 25.6
  France: 50.9 Morocco: 21.1
  Greece: 39.4 Qatar: 19.2
  Cyprus: 30.3 Jordan: 16.3
  Malta: 25.3 Yemen: 4.8

Lichtenstein also pointed out that the analysis did not account for sales of whole juices, despite a calorie and sugar content on par with soft drinks; sugared "fruit drinks"; and other sugar-sweetened beverages; and so for that reason, as well, doesn't tell the whole story.

Arsenault said whole juice was excluded because he and his colleagues believe sugar-sweetened–beverage consumption "is a marker of an overall poor dietary pattern and nutritional quality." And there is evidence, he said, that consumption of 100% fruit juices, "even in children, is actually associated with a positive pattern of good nutritional quality."

Absolute Change, by Region, in Sugar-Sweetened–Beverage Sales, 2010–2015 (L/Person)

Countries Western Europe Middle East and North Africa
Top 5 Countries
  Denmark: 4.5 Libya: 33.0
  Luxembourg: 1.0 Bahrain: 25.2
  Belgium: 0.5 Saudi Arabia: 22.5
  Switzerland: -0.9 United Arab Emirates: 13.6
  Netherlands: -1.1 Iraq: 11.2
Bottom 5 Countries
  Spain: -9.0 Yemen: 1.0
  Norway: -11.2 Egypt: -0.4
  Italy: -14.6 Kuwait: -3.1
  Greece: -17.1 Qatar: -5.0
  Portugal: -19.0 Israel: -6.1

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