Background Sugar-sweetened beverages (SSBs), fruit juice, and milk are components of diet of major public health interest. To-date, assessment of their global distributions and health impacts has been limited by insufficient comparable and reliable data by country, age, and sex. Objective To quantify global, regional, and national levels of SSB, fruit juice, and milk intake by age and sex in adults over age 20 in 2010. Methods We identified, obtained, and assessed data on intakes of these beverages in adults, by age and sex, from 193 nationally- or subnationally-representative diet surveys worldwide, representing over half the world's population. We also extracted data relevant to milk, fruit juice, and SSB availability for 187 countries from annual food balance information collected by the United Nations Food and Agriculture Organization. We developed a hierarchical Bayesian model to account for measurement incomparability, study representativeness, and sampling and modeling uncertainty, and to combine and harmonize nationally representative dietary survey data and food availability data. Results In 2010, global average intakes were 0.58 (95%UI: 0.37, 0.89) 8 oz servings/day for SSBs, 0.16 (0.10, 0.26) for fruit juice, and 0.57 (0.39, 0.83) for milk. There was significant heterogeneity in consumption of each beverage by region and age. Intakes of SSB were highest in the Caribbean (1.9 servings/day; 1.2, 3.0); fruit juice consumption was highest in Australia and New Zealand (0.66; 0.35, 1.13); and milk intake was highest in Central Latin America and parts of Europe (1.06; 0.68, 1.59). Intakes of all three beverages were lowest in East Asia and Oceania. Globally and within regions, SSB consumption was highest in younger adults; fruit juice consumption showed little relation with age; and milk intakes were highest in older adults. Conclusions Our analysis highlights the enormous spectrum of beverage intakes worldwide, by country, age, and sex. These data are valuable for highlighting gaps in dietary surveillance, determining the impacts of these beverages on global health, and targeting dietary policy.
Bibliographical noteFunding Information:
The authors would like to provide the following disclosures: Dr. Mozaffarian reports research grants from GlaxoSmithKline, Sigma Tau, Pronova, and the National Institutes of Health for a completed investigator-initiated, not-for-profit, randomized clinical trial of fish oil supplements for the prevention of post-surgical complications; ad hoc travel reimbursement and/or honoraria for one-time scientific presentations or reviews on diet and cardiometabolic diseases from Bunge, Pollock Institute, Quaker Oats, and Life Sciences Research Organization (each modest); ad hoc consulting fees from McKinsey Health Systems Institute, Foodminds, and Nutrition Impact (each modest); Unilever North America Scientific Advisory Board membership (modest); and royalties from UpToDate, for an online chapter on fish oil (modest). Harvard University has filed a provisional patent application, that has been assigned to Harvard University, listing Dr. Mozaffarian as a co-inventor to the US Patent and Trademark Office for use of trans-palmitoleic acid to prevent and treat insulin resistance, type 2 diabetes, and related conditions (Patent name: “Use of trans-palmitoleate in identifying and treating metabolic disease”; Patent number: 8,889,739). All other authors declare that they have no conflicts of interest. This information does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.
This work was undertaken as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. The results in this paper are prepared independently of the final estimates of the Global Burden of Diseases, Injuries, and Risk Factors study. We thank the Russia Longitudinal Monitoring Survey Phase 2, funded by the USAID and NIH (R01-HD38700), Higher School of Economics and Pension Fund of Russia, and the University of North Carolina Population Center (5 R24 HD050924) (Source: "Russia Longitudinal Monitoring survey, RLMS-HSE”), conducted by HSE and ZAO “Demoscope” together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology RAS (RLMS-HSE sites: http://www.cpc.unc.edu/projects/rlms , http://www.hse.ru/org/hse/rlms ) for sharing data with us. We thank Barbara Bowman, MS, PhD, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Patricia Constante Jamie, PhD, School of Public Health, University of São Paulo, Sao Paolo, Brazil; Karen Lock, PhD, London School of Hygiene and Tropical Medicine, London, UK; and Joceline Pomerleau, PhD, London School of Hygiene and Tropical Medicine, London, UK for advising and guidance on initial search strategy. We thank Louise Dekker, MSc, Jenna Golan, MPH, Shadi Kalantarian, MD, MPH, Liesbeth Smit, PhD, and Georgina Waweru Harvard School of Public Health, Boston, MA, USA for assistance with data collection.
© 2015 Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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