Sugary drinks are a public health concern because they have been widely associated with obesity and cardiometabolic diseases, which are among the leading causes of death and years lost to disability globally. Many national guidelines recommend limiting added sugars to less than 5 to 10% of daily calories, and because sodas add no nutritional value, some countries tax their consumption to help their residents meet this goal.

The study is the latest snapshot of how adults in 185 countries imbibe sugar-sweetened beverages, specifically: soft drinks, energy drinks, fruit juices, punch, lemonade, and aguas frescas that contain over 50 calories per serving (8 ounces). Intakes varied widely by world region. For instance, in 2018, the average person consumed 2.7 servings of sugary drinks per week, but this ranged from 0.7 servings per week in South Asia to 7.8 servings per week in Latin America and the Caribbean.

Global intakes were observed to be higher in males versus females and in younger versus older people, but the role of education and rural/urban residency was influenced more by region of origin. Consumption of sugar-sweetened beverages were more likely among adults with higher versus lower education in Sub-Saharan Africa, South Asia, and Latin America/Caribbean, while the opposite was seen in Middle East/North Africa. Overall, some of the highest sugary drink intakes in the world were among urban, highly educated adults in Sub-Saharan Africa (12.4 servings per week) and in Latin America/the Caribbean (8.5 servings per week).

At the national level, the countries where people consumed the highest number of sugary drink servings per week included Mexico (8.9), Ethiopia (7.1), the United States (4.9), and Nigeria (4.9), compared to India, China, and Bangladesh (0.2 each).

“We were struck by the wide variations by world regions in 2018; that Latin America/Caribbean had the largest intakes at all time points despite an overall decrease overtime; and that Sub-Saharan Africa had the greatest increases across all time points,” says first author Laura Lara-Castor, a PhD candidate in the Nutrition Epidemiology and Data Science program at the Friedman School. “These results suggest that more work is needed, especially around successful interventions such as marketing regulations, food labeling, and soda taxes.”

Information from the Global Dietary Database—which aggregates hundreds of survey results about what people eat and drink—also revealed a relationship between sugary beverages and socio-economic status. Between 1990 and 2018, the largest increase in consumption was in Sub-Saharan Africa (+2.99; +81.9%). Intakes rose then fell in high-income countries, and decreased then increased in Latin America/Caribbean, both returning close to 1990 levels by 2018. Other world regions had more modest, steady increases over time. Similar patterns were observed by sex, age, education, and area of residence.

While the study did not identify the reasons for these trends, the researchers hypothesize the changes could be related to the effectiveness of targeted marketing tactics from the soda and food industry, the association of Western diets with high status, as well as access to water. “Soda can reach the farthest places, and in countries where clean water is less accessible, these beverages might be the only thing available to drink at times,” says Lara-Castor.

“Sugar-sweetened beverage intake has increased in the past few decades despite efforts to decrease their appeal,” says Dariush Mozaffarian, a cardiologist and Jean Mayer Professor of Nutrition at the Friedman School. “Some populations are especially vulnerable, and our findings provide evidence to inform the need and design of national and more targeted policies to reduce their intake worldwide.”

The researchers say more work is needed to assess sugary drink intake in children and adolescents, to measure the impact of soda taxes globally, and to better understand differences across each country’s subpopulations. The team also wants to explore how other sweet beverages, such as milk, coffees and teas, factor into consumption habits.

Research reported in this article was supported by the Gates Foundation, the American Heart Association, and the National Council for Science and Technology in Mexico. Complete information on authors, funders, methodology, and conflicts of interest is available in the published paper.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

Researchers reported these findings on April 19, 2023 in The BMJ/British Medical Journal.

“In these two prospective cohorts of men and women with type 2 diabetes in the United States, we found that higher SSB [sugar sweetened beverages] intake was associated with higher all cause mortality and CVD incidence, whereas intakes of coffee, low fat milk, and plain water were inversely associated with CVD incidence and mortality, the authors said.

As background, the authors noted that diet has a major role in the management of diabetes among adults with type 2 diabetes, but that little is known about the relationship between consumption of specific types of beverages and death or CVD.

The investigators evaluated data from the (USA) Nurses’ Health Study: 1980-2018; and (USA) Health Professionals Follow-Up Study: 1986-2018. The 15,486 male and female subjects each had been diagnosed with type 2 diabetes at baseline .

The researchers evaluated data on each subject for beverage consumption using a validated food frequency questionnaire, which was updated every two to four years during follow-up.

The primary outcome of the analysis was all-cause mortality.

During an average of 18.5 years of follow-up, the investigators identified 3,447 (22.3%) subjects with incident CVD, and they documented 7,638 (49.3%) deaths.

After adjusting for lifestyle and medical history, the researchers reported that subjects consuming the highest amount of sugar sweetened beverages (more than 1 serving a day) had a 20% increased risk of death from any cause compared with subjects with the lowest intake (less than 1 serving a month).

They also found that high intake of other non-sugary beverages (up to 6 servings a day) was associated with lower mortality, notably 26% lower for coffee, 21% for tea, 23% for plain water, and 12% for low fat milk.

Sugar sweetened beverages intake was associated with a 25% higher risk of CVD and a 29% higher risk of CVD related death.  Coffee and low fat milk consumption were associated with an 18% and 12% lower risk of CVD, respectively.

Compared with subjects who maintained the same level of coffee consumption after receiving their diabetes diagnosis, those who drank more coffee achieved an 18% lower all-cause death rate during follow-up. The researchers saw similar results for consumers of tea, and low fat milk.

The authors concluded, “Individual beverages showed divergent associations with all cause mortality and CVD outcomes among adults with type 2 diabetes. Higher intake of SSBs [sugar sweetened beverages] was associated with higher all cause mortality and CVD incidence and mortality, whereas intakes of coffee, tea, plain water, and low fat milk were inversely associated with all cause mortality. These findings emphasize the potential role of healthy choices of beverages in managing the risk of CVD and premature death overall in adults with type 2 diabetes.”