A new study revealed that sugar-sweetened beverage intake among children and adolescents aged 3 to 19 years may have increased by 22.9% globally between 1990 and 2018. The research, analyzing data from 185 countries, found significant regional variations and correlations with obesity rates.

In the study, as reported in The BMJ, investigators examined data from the Global Dietary Database and incorporated 1,224 dietary surveys from 185 countries, covering 99% of the global population. Among these, 450 surveys from 118 countries provided sugar-sweetened beverage data, representing 2.9 million individuals. The dietary assessment methods included 24-hour recalls (24% of surveys) and food frequency questionnaires (61% of surveys).

Sugar-sweetened beverages were defined as beverages with added sugars and ≥ 209 kJ (50 kcal) per 237g serving, excluding 100% fruit juices, artificially sweetened drinks, and sweetened milk. Intakes were reported as 248g (8 oz) servings weekly and adjusted to age-specific daily caloric intakes.

A Bayesian hierarchical model estimated mean sugar-sweetened beverage consumption across 264 population strata, stratified by age, sex, parental education, and urban/rural residence. The model incorporated survey characteristics, country-year specific covariates, and used 4000 Monte Carlo iterations to determine uncertainty intervals.

Among the key findings were:

• Mean global sugar-sweetened beverage intake increased from 2.92 servings/week in 1990 to 3.6 servings/week in 2018
• Largest regional increase was in sub-Saharan Africa (106% increase)
• Highest intakes in 2018 were in Latin America and the Caribbean (9.1 servings/week)
• 56 countries (30.3%) had mean intakes ≥ 7 servings/week, affecting 238 million young individuals (10.4% of global youth population)
• Intakes were higher in older age groups and urban areas
• Positive correlation was found between sugar-sweetened beverage intake and obesity prevalence in 1990 (r = 0.28, P < .001) and 2018 (r = 0.23, P < .001).

From 1990 to 2018, the global sugar-sweetened beverage intake increased by 0.68 servings/week (95% UI = 0.54–0.85). Sub-Saharan Africa saw the largest increase (2.17 servings/week, 106%). High-income countries experienced an initial increase followed by a decrease to near-1990 levels by 2018.

Regional breakdown in 2018:

• Latin America and the Caribbean: 9.1 servings/week
• Middle East and North Africa: 7.3 servings/week
• High-income countries: 5.0 servings/week
• Central and Eastern Europe/Central Asia: 4.0 servings/week
• Southeast and East Asia: 2.1 servings/week
• South Asia: 1.3 servings/week.

Time trend analysis:

• 1990 to 2005: Global increase of 0.33 servings/week (11.0%)
• 2005 to 2018: Global increase of 0.35 servings/week (10.7%).

The intake of sugar-sweetened beverages increased with age globally. In 2018, the global averages were:

• Age 3 to 4 years: 1.8 servings/week
• Age 5 to 9 years: 3.2 servings/week
• Age 10 to 14 years: 4.3 servings/week
• Age 15 to 19 years: 4.6 servings/week.

The highest intakes were among individuals aged 15 to 19 years in Latin America and the Caribbean (11.5 servings/week) and lowest among those aged 3 to 4 years in Southeast and East Asia (0.9 servings/week). No statistically significant differences were observed between male and female individuals.

Further, urban residents had higher intakes of sugar-sweetened beverages compared with rural residents (4.6 vs 2.7 servings/week). Globally, the children of parents with a higher level of education in urban areas had the highest intakes (5.15 servings/week). Parental education level impact (2018 global data):

• Low education (0 to 6 years): 3.2 servings/week
• Medium education (> 6 to 12 years): 3.8 servings/week
• High education (> 12 years): 4.6 servings/week.

Among the 25 most populous countries, Mexico had the highest intake in 2018 (10.1 servings/week), whereas India and Bangladesh had the lowest (0.3 servings/week each). Notable trends included:

• United States: Increased from 6.8 servings/week in 1990 to 9.75 in 2005, then decreased to 6.2 in 2018
• Uganda: Increased from 0.17 servings/week in 1990 to 6.9 in 2018 (5,573% increase)
• Brazil: Decreased from 8.43 servings/week in 1990 to 5.14 in 2018 (39% decrease).

The correlation between national sugar-sweetened beverage intakes and sociodemographic development index changed from positive in 1990 to null in 2018 (r = –0.001, P = .99), suggesting a potential reversal in the association.

The investigators cited projections that economic costs associated with overweight and obesity could increase from $2.0 trillion in 2020 to $18 trillion by 2060.

Limitations of the study included that the research relied on self-reported dietary data, which may have introduced bias. Limited data availability for some countries and time periods, particularly in lower-income nations, affected estimate precision. The exclusion of sweetened milk and 100% fruit juices from the sugar-sweetened beverage definition may have impacted the results, especially for younger age groups.