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A new study from Tufts University’s Friedman School of Nutrition Science and Policy, published in the journal Nature Medicine on January 6, 2025 has revealed alarming global health impacts of sugar-sweetened beverages. The research estimated that in 2020 alone, sugary drinks contributed to 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease.
The findings are not entirely new; several studies have found that sweetened drinks with low nutrient content or empty calories are more likely to cause type 2 diabetes than sugary foods. But the results of the study are particularly concerning for developing countries.
The study is the first looking at cardiometabolic burdens attributable to sugar-sweetened beverages globally and stratified by age, sex, education level and area of residence, lead author Laura Lara-Castor told Down To Earth.
“I was impressed to observed the variations in the regional patterns of education, showing that higher vs lower educated adults tend to have greater burdens in Latin America and Caribbean, South Asia, and Sub-Saharan Africa, but that this was opposite in Middle East and Nort Africa, and the effect was less evident in other regions,” Lara-Castor said.
In sub-Saharan Africa, more than 21 per cent of new diabetes cases were linked to sugary drink consumption. In Latin America and the Caribbean, nearly 24 per cent of new diabetes cases and over 11 per cent of cardiovascular disease cases were attributed to sweetened drinks.
Colombia, Mexico and South Africa faced some of the most severe impacts. In Colombia, nearly half of all new diabetes cases were linked to sugary drinks, while Mexico reported nearly one-third of new diabetes cases linked to sugary drinks. South Africa saw 27.6 per cent of new diabetes cases and 14.6 per cent of cardiovascular disease cases tied to sugary beverages.
The research, which covered 118 countries and represented 87 per cent of the world’s population, found that in 2020, adults consumed an average of 2.6 servings of sugary drinks per week. Consumption varied widely between regions.
Sugar-sweetened beverages are drinks that contain added sugars and provide at least 50 calories per 8-ounce (236-millilitres) serving. This includes soft drinks, energy drinks, fruit drinks, punch, lemonade and aguas frescas, whether homemade or bought. However, 100 per cent fruit and vegetable juices, artificially sweetened drinks and sweetened milk are not included in this category.
Sugary drinks are quickly digested, causing blood sugar spikes and providing little nutritional value. Over time, regular consumption leads to weight gain, insulin resistance and other metabolic problems linked to diabetes and heart disease, two of the leading global causes of death.
The health impacts of consuming sugary beverages are severe. In 2020, sweetened drinks were linked to 2.2 million new cases of type 2 diabetes, representing 9.8 per cent of all new cases globally, the study said. They also contributed to 1.2 million new cases of cardiovascular disease, making up 3.1 per cent of global cases.
The death toll was equally alarming, with 80,278 deaths from diabetes (5.1 per cent) and 257,962 deaths from cardiovascular diseases (2.1 per cent) attributable to sugary drink consumption, the research stated.
The overall health impact of sugary drinks was striking too, with sugary drinks contributing to 12.5 million disability-adjusted life years — a measure of years lost due to ill-health or premature death.
“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,” Dariush Mozaffarian, senior author of the study and director of the Food is Medicine Institute at Tufts, said in a statement.
Multinational and local producers of sugar-sweetened beverages are also investing heavily in low- and middle-income countries in the wake of declining sales in wealthy countries, a 2016 study by nonprofit Center for Science in the Public Interest found.
These companies are spending several billion dollars a year in countries such as Brazil, China, India and Mexico to build bottling plants, create distribution networks and advertise their products to maximise sales. As incomes rise in developing countries, sugary drinks become more accessible and appealing, further compounding the problem.
The Tufts University study also found that men and younger adults are more likely to consume these beverages than women and older individuals.
The authors of the study urged global action to curb sugary drink consumption, proposing measures such as public health campaigns, restrictions on advertising and taxes on sweetened drinks.
Some countries have already taken steps in this direction. Mexico, which has one of the highest per capita consumption rates globally of sugary drinks, introduced a sugar tax in 2014. Early evidence suggests it has reduced consumption, especially among low-income populations. In December 2017, South African parliament passed a tax bill on sugary drinks.
“Much more needs to be done, particularly in regions like Latin America and Africa, where consumption is high and the health consequences severe,” Mozaffarian added.
Globally, sweetened drinks were responsible for 10 per cent of all new diabetes cases (2.2 million cases); 3 per cent of all new cardiovascular disease cases (1.2 million cases); 12.5 million years of lost healthy life due to diabetes and heart disease and 80,278 diabetes-related deaths and 257,962 heart disease deaths, the paper found.
The highest consumption rates were observed in Colombia, where adults averaged 17.4 servings per week. In contrast, countries like India, China and Bangladesh recorded the lowest consumption, averaging just 0.2 servings per week. This is in contrast with the 2019 findings published in the journal The Lancet, which found India is second among the top five global markets for sugary beverage manufacturers.
The study highlighted the urgent need for coordinated efforts to reduce sugary drink intake worldwide. “If we do not act promptly, we will see continued rise in the attributable cardiometabolic burdens. This will continue to impose not only a decreased quality of life of the people with the disease and their caregivers, but also to the countries’ economy given a decreased individual productivity and increased medical expenses,” Lara-Castor said.