What people eat and drink is one of the most important determinants of health and health equity – and reducing the consumption of sugar-sweetened drinks such as soda is a “priority concern” given their link to obesity, cardiovascular disease, type 2 diabetes, cancer, and dental caries, according to the researchers behind a recent study.

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In the open access study, published in Nature Communications, scientists estimated intakes among adults between 1990 and 2018 in 185 countries, stratifying the results by age, sex, education, and rural/urban residence, using data from the Global Dietary Database.

The data showed that intakes were higher in men than women and younger people drank more sugary drinks than older people. People with higher levels of education also drank more and people who live in urban areas drink more sugary beverages than those in rural areas.

Globally, the biggest increase in consumption between 1990 and 2018 was in Sub-Saharan Africa. Variations by education and urbanicity were also largest in Sub-Saharan African countries.

“Sugar-sweetened drink intakes increased between 1990 and 2018 by 0.37 servings a week, with the largest increase in Sub-Saharan Africa, and an overall decrease in Latin America/Caribbean,” the researchers wrote. “These new findings on global sugar-sweetened beverage intakes, trends, and inequities inform intervention, surveillance, and policy actions worldwide, highlighting the growing problem of sugar-sweetened beverages for public health in Sub-Saharan Africa.”

For the purpose of this study, sugar-sweetened drinks were defined as any beverage with added sugars and more than 50 kcal per 8 oz serving. This included commercial or homemade beverages, soft drinks, energy drinks, fruit drinks, punch, lemonade, and aguas frescas (a popular sweetened drink in Mexico and other Latin American countries). It excluded 100% fruit and vegetable juices, non-caloric artificially sweetened drinks, and sweetened milk.

Sub-Saharan Africa: An appealing target for industry marketing

“With its economic growth and increasing middle class, Sub-Saharan Africa has become an appealing target for industry marketing of sugar-sweetened beverages,” the researchers wrote. The drink industry has also tended to focus intensive marketing campaigns to traditionally marginalised populations, they added.

Among the 25 most populous countries included in the study, the largest differences in sugary drink intake in high versus low-educated adults were in Pakistan, Nigeria, and Ethiopia, wher more-educated adults tended to have more than three servings a week compared to less-educated adults.

The researchers hope that the results will be used to inform food policy makers on dietary guidelines and encourage preventative measures such as sugar taxes, warning labels, and marketing restrictions.

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There is a need to focus such efforts on specific subgroups and demographics such as younger adults globally, higher educated adults in Sub-Saharan Africa, and lower educated adults from the Middle East and North Africa, they said.

Taxes: An effective way to reduce sugary drink intake

The World Health Organization (WHO) recommends taxing sugar drinks to reduce consumption, describing fiscal policies as one of the main evidence-based policy measures to reduce intake.

To date, there are sugary drink taxes in place in 108 countries around the world, covering 52% of the world’s population, but most (71) of these policies were implemented or updated after 2017, therefore their impact is not reflected in the data of this study.

While South Africa has a sugary drink tax in place, no other country in the Sub-Saharan African region has one.

The authors of this study were critical of the food and drink industry’s efforts to undermine or derail efforts to tax sugary drinks.

“Many of these efforts have been blunted by strong food industry opposition techniques including disqualification of research findings, biased industry-funded research, misleading summaries, marketing techniques, and false claims on the potential adverse social consequences such as massive job losses,” they wrote.