Risk of death due to sugar-sweetened drinks

During EPI/NPAM 2013 — Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions — researchers from Harvard School of Public Health, in Boston, reported that drinking large amounts of sugary beverages was associated with an increase in body-mass index (BMI), which in turn was linked with BMI-related deaths from diabetes, cardiovascular disease, and cancer.

First, the details.

• As part of the Global Burden of Disease study, data from 114 national dietary surveys, representing more than 60% of the world’s population were evaluated.
• Outcomes included how changes in consumption of sugary drinks affected BMI, and next, how elevated BMI affected cardiovascular disease, diabetes, and seven obesity-related cancers (breast, uterine, esophageal, gallbladder, colorectal, kidney, and pancreatic cancer).
• Using data from the World Health Organization, the deaths from BMI-related cardiovascular disease, diabetes, and cancer for men and for women aged 20-44, 45-64, and 65 and older were calculated.

And, the results.

• Most deaths (78%) from excess sugary drinks were in low- and middle-income countries.
  • Mexico, which has one of the world’s highest per capita rates of drinking sweetened drinks, had the greatest number of deaths related to this risk factor: 318 deaths per million adults.
  • Japan, with one of the lowest per-capita rates, had the smallest number of deaths attributable to this risk factor: about 10 deaths per million adults.
• In 2010, drinking sugar-sweetened beverages was associated with about:
  • 38,000 deaths from diabetes in Latin American and Caribbean countries
  • 11,000 deaths from cardiovascular deaths in Eastern- and Central-Eurasian countries
  • 25,000 deaths in the US

The bottom line?

The authors concluded, “The bottom line is to [advise patients to] avoid sugar-sweetened drinks, [since we have] more and more evidence that it’s not a good choice.”

Commenting on the study, Dr. Rachel Johnson from the University of Vermont, Burlington, stated that the evidence that sugar-sweetened beverages are associated with excess weight gain is well established. These investigators have taken it a step further by saying the excess weight gain that is attributable to sugary drinks actually increases the risk of death from diabetes, cardiovascular disease, and cancer.

Before we get too carried away by the reported numbers, it’s important to understand whether 25,000 deaths in the US per year due to sugar-sweetened drinks are a significant health risk when compared to the number of people who experience “BMI-related” death each year from all of the diseases reported in this study.

For example, the American Diabetes Association reports that in 2007, diabetes was listed as the underlying cause on 71,382 death certificates and as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths.

And that’s only one of the diseases studied by the Harvard researchers. If you’re interested, look up the annual deaths due to cardiovascular disease and cancer to see how much comparatively smaller the 25,000 deaths in the US number becomes. The real challenge is to find “BMI-related” death data. Are these results significant?

Also, by comparing Mexico (highest sugar-sweetened drink intake) to Japan (lowest) the reduction in “BMI-related” deaths is only about 300 per million annually — possibly less if other confounding factors are in play.

The Canadian Beverage Association counters. “It is over simplistic and naive to believe that one single food or beverage can be held responsible for obesity. In fact, the Canadian government looked at fats, carbohydrates, protein and fiber in the diet and concluded ‘it is not what you eat, but rather, how much — the total number of calories consumed — that significantly contributes to obesity.’”

Here‘s an insightful editorial in The New England Journal of Medicine.

3/21/13 12:46 JR