The Lancet Diabetes & Endocrinology: The global diet is getting sweeter, particularly when it comes to beverages

December 01, 2015

A Personal View, published today in The Lancet Diabetes & Endocrinology journal, highlights that the global diet is getting sweeter, particularly when it comes to beverages. This Personal View paper is written by Professor Barry M Popkin, School of Public Health, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA, and Dr Corinna Hawkes, City University London, UK.

Previous research has shown that consuming foods and beverages with added caloric sweeteners is linked to an increased risk of weight gain, heart disease, diabetes and stroke. Currently, 68% of packaged foods and beverages in the USA contain caloric sweeteners, 74% include both caloric and low-calorie sweeteners, and just 5% are made with low-calorie sweeteners only. The added sugar comes from hundreds of different versions of sugar, all of which have the same equal health effect, says Professor Popkin.

He expects that in the absence of intervention, the rest of the world will move towards a similar pervasiveness of added sugars in the entire packaged food and beverage supply, with added sugars of all kinds increasing rapidly in the diets of people living in developing countries, while many high-income countries, despite being among the highest sugar consumers, are beginning to see a slight decline in sugar consumption.

After analysing nutritional datasets from around the world, the authors found that trends in sales of sugar-sweetened beverages around the world are increasing in terms of calories sold per person per day and volume sold per person per day.

They say: "Consumption is rising fastest in low- and middle-income countries in Latin America, the Caribbean, Africa, the Middle East, Asia and Oceania. The four regions with the current highest consumption are Latin America, North America, Australasia and Western Europe, though intakes are beginning to decline in the latter three."

Because of the major health risks, particularly weight gain and increased risk of diabetes, hypertension and many cardiovascular problems associated with added caloric sweetener consumption, the World Health Organization (WHO) is promoting major initiatives to reduce intake. Many governments have already implemented policies with this goal, including taxation, reduction of availability in schools, restrictions on marketing of sugary foods to children, public awareness campaigns and front-of-pack labeling.

Evidence of the effectiveness of these actions shows they are moving in the right direction, but the authors suggest governments should view them as a learning process and improve their design over time.

For example, one current challenge for policy makers is the absence of a consensus on the healthiness of fruit juices and beverages containing low-calorie sweeteners. Future research may better inform decisions about whether these are good substitutes for sugar-sweetened beverages, as the literature suggests fruit juice consumption may have adverse health effects; and while there are well-conducted studies suggesting low-calorie diet sweeteners have positive effects, no global consensus exists strongly in favour of either of these potential substitutes.

While the latest data show that many countries consume high levels of sugar-sweetened beverages, and other countries with lower intakes are seeing steep increases, the authors did find that consumption seems to be decreasing in countries with taxes on such products (e.g., Mexico, Finland, Hungary and France).

The authors conclude: "We have...shown from trends data that consumption seems to be decreasing in countries with taxes on sugar-sweetened beverages (eg, Mexico, Finland, Hungary, and France). WHO, major scientific bodies, and most countries recognise the importance of reducing consumption of sugar-sweetened beverages to improve public health. The evaluation of not only sugar taxes, but also new marketing controls and front-of-pack labelling, is important and represents one of the next frontiers-- namely, can these policies effectively reduce consumption of sugar-sweetened beverages and intake of total added sugars?"

Professor Popkin and his group of scholars linked with the Global Food Research Program of UNC's School of Public Health and Carolina Population Center are actively involved incomprehensive evaluations underway on the effects of taxes on sugar-sweetened beverages in Berkeley, California, Mexico and Chile, among other cities and countries in which they are working.

The Lancet

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