Article Text

Original research
Health and economic burden of disease of sugar-sweetened beverage consumption in four Latin American and Caribbean countries: a modelling study
  1. Andrea Alcaraz1,
  2. Ariel Esteban Bardach1,2,
  3. Natalia Espinola1,
  4. Lucas Perelli1,
  5. Federico Rodriguez Cairoli1,
  6. Althea La Foucade3,
  7. Cid Manso de Mello Vianna4,
  8. Giovanni Guevara5,
  9. Kimberly-Ann Gittens-Baynes3,
  10. Paula Johns6,
  11. Vyjanti Beharry3,
  12. Darío Javier Balán1,
  13. Alfredo Palacios1,
  14. Federico Augustovski1,2,
  15. Andres Pichon-Riviere1,2
  1. 1Health Techonology Assessment and Economic Evaluation Department, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
  2. 2Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
  3. 3Centre for Health Economics, The University of the West Indies at St Augustine, St Augustine, Tunapuna-Piarco, Trinidad and Tobago
  4. 4Health Economics Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
  5. 5Universidad Católica de El Salvador, Santa Ana, El Salvador
  6. 6ACT Promoção da Saúde, Sao Paulo, Brazil
  1. Correspondence to Dr Andrea Alcaraz; aalcaraz{at}


Objective Overweight and obesity are important contributors to the non-communicable disease burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of type 2 diabetes mellitus (T2DM), cardiovascular disease, cancer and other conditions. The objective of this study was to estimate the burden of disease attributable to the consumption of SSBs and the costs to the healthcare systems in Argentina, Brazil, El Salvador, and Trinidad and Tobago.

Design Following a systematic review of models, a comparative risk assessment framework was developed to estimate the health and economic impact associated with the consumption of SSBs.

Setting Argentina, Brazil, El Salvador, and Trinidad and Tobago.

Participants Overall population.

Primary and secondary outcome measures The model estimated the effects of SSB consumption on health through two causal pathways: one mediated by body mass index (BMI) and health conditions associated with BMI and another that reflected the independent effects of SSB consumption on T2DM and cardiovascular diseases.

Results The model results indicated that for all four countries, in 1 year, SSB consumption was associated with 18 000 deaths (3.2% of the total disease-related deaths), seven million disease events (3.3% of the total disease-related events), a half-million DALYs and US$2 billion in direct medical costs. This included 1.5 million cases of overweight and obesity in children/adolescents (12% of the excess weight cases) and 2.8 million cases in adults (2.8%); 2.2 million cases of type 2 diabetes (19%); 200 000 cases of heart disease (3.8%); 124 000 strokes (3.9%); 116 000 cases of musculoskeletal disease (0.2%); 102 000 cases of kidney disease (0.9%); and 45 000 episodes of asthma (0.4%). The Trinidad and Tobago population were the most affected by disease events.

Conclusions The study results indicate that the consumption of SSBs is associated with a significant burden of disease and death in Latin America and the Caribbean.

  • General diabetes

Data availability statement

Data are available on reasonable request.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available on reasonable request.

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  • Twitter @AndreaIECS, @AlfrePalacios13

  • Contributors AA: guarantor, project administration, research conceptualisation, research design, modelling, analysis, discussion and writing. AEB: research conceptualisation, research design, modelling, analysis, discussion and writing. NE: modelling lead, research conceptualisation, research design, discussion and writing. LP, FRC, AP and FA: research conceptualisation, research design, analysis, discussion and writing. ALF, CMdMV, GG, K-AG-B, PJ, VB and DJB: research conceptualisation, research design, analysis, review and editing. AP-R: modelling lead, research conceptualisation, research design, analysis, discussion and writing.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.