Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries

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Lara-Castor, L
O’Hearn, M
Cudhea, F
Miller, V
Shi, P
Zhang, J
Sharib, JR
Cash, SB
Barquera, S
Micha, R
Mozaffarian, D
Hakeem, R
Mirzaei, M
Nikiema, L
Manary, M
et al.
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2025
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Abstract

The consumption of sugar-sweetened beverages (SSBs) is associated with type 2 diabetes (T2D) and cardiovascular diseases (CVD). However, an updated and comprehensive assessment of the global burden attributable to SSBs remains scarce. Here we estimated SSB-attributable T2D and CVD burdens across 184 countries in 1990 and 2020 globally, regionally and nationally, incorporating data from the Global Dietary Database, jointly stratified by age, sex, educational attainment and urbanicity. In 2020, 2.2 million (95% uncertainty interval 2.0–2.3) new T2D cases and 1.2 million (95% uncertainty interval 1.1–1.3) new CVD cases were attributable to SSBs worldwide, representing 9.8% and 3.1%, respectively, of all incident cases. Globally, proportional SSB-attributable burdens were higher among men versus women, younger versus older adults, higher- versus lower-educated adults, and adults in urban versus rural areas. By world region, the highest SSB-attributable percentage burdens were in Latin America and the Caribbean (T2D: 24.4%; CVD: 11.3%) and sub-Saharan Africa (T2D: 21.5%; CVD: 10.5%). From 1990 to 2020, the largest proportional increases in SSB-attributable incident T2D and CVD cases were in sub-Saharan Africa (+8.8% and +4.4%, respectively). Our study highlights the countries and subpopulations most affected by cardiometabolic disease associated with SSB consumption, assisting in shaping effective policies and interventions to reduce these burdens globally.

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Nature Medicine

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© The Author(s) 2025, corrected publication 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Biomedical and clinical sciences

Health sciences

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Lara-Castor, L; O’Hearn, M; Cudhea, F; Miller, V; Shi, P; Zhang, J; Sharib, JR; Cash, SB; Barquera, S; Micha, R; Mozaffarian, D; Hakeem, R; Mirzaei, M; Nikiema, L; Manary, M; et al., Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries, Nature Medicine, 2025

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