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Sugar consumption and global prevalence of obesity and hypertension: an ecological analysis

  • Mario Siervo (a1), Concetta Montagnese (a2), John C Mathers (a1), Katrina R Soroka (a1), Blossom CM Stephan (a3) and Jonathan CK Wells (a2)...
Abstract
Abstract Objective

The nutrition transition model provides an integrated approach to analyse global changes in food consumption and lifestyle patterns. Whether variability in food availability for consumption, lifestyle and sociodemographic factors is associated with the worldwide prevalence distribution of overweight, obesity and hypertension is unclear.

Design

Ecological analysis.

Setting

Country-specific prevalence estimates of overweight, obesity and hypertension were obtained. Prevalence estimates were then matched to year- and country-specific food and energy availability for consumption of cereals, sugar, sweeteners and honey, vegetable oils, fruits, starchy roots, pulses, total vegetables, alcoholic beverages, total meat, animal fat, eggs, milk, and fish and seafood. The per capita Gross Domestic Product (GDP), urbanization rates and prevalence of physical inactivity for each country were also obtained.

Subjects

The overweight, obesity and hypertension databases included information from 128, 123 and seventy-nine countries, respectively.

Results

Consumption of sugar and animal products were directly associated with GDP and urbanization rates. In a multivariate regression model, physical inactivity (B = 0·01, se = 0·005, P = 0·003), cereal consumption (B = −0·02, se = 0·006, P < 0·001) and sugar consumption (B = 0·03, se = 0·01, P = 0·03) were significant predictors of obesity prevalence. Midpoint age (B = 0·21, se = 0·10, P = 0·02), prevalence of overweight (B = 0·18, se = 0·08, P = 0·02) and consumption of cereals (B = −0·22, se = 0·10, P = 0·02) were significant predictors of hypertension. Women appeared to have a significant obesity excess compared with men.

Conclusions

High sugar consumption and sedentary lifestyle are associated with increased obesity prevalence. The non-linear association of sugar consumption with prevalence of obesity suggests that effective strategies to reduce its consumption may have differential effects in countries at different stages of the nutrition transition.

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*Corresponding author: Email mario.siervo@ncl.ac.uk
References
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1. World Health Organization (2003) Diet, Nutrition and the Prevention of Chronic Diseases. Joint WHO/FAO Expert Consultation. WHO Technical Report Series no. 916. Geneva: WHO.
2. Padwal R, Straus SE & McAlister FA (2001) Cardiovascular risk factors and their effects on the decision to treat hypertension: evidence based review. BMJ 322, 977980.
3. Lavie CJ, Milani RV & Ventura HO (2009) Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 53, 19251932.
4. Finucane MM, Stevens GA, Cowan MJ et al. (2011) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet 377, 557567.
5. Danaei G, Finucane MM, Lin JK et al. (2011) National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants. Lancet 377, 568577.
6. Kearney J (2010) Food consumption trends and drivers. Phil Trans R Soc Lond B Biol Sci 365, 27932807.
7. Popkin BM (2004) The nutrition transition: an overview of world patterns of change. Nutr Rev 62, 7 Pt 2, S140S143.
8. Popkin B & Ng SW (2007) The nutrition transition in high- and low-income countries: what are the policy lessons? Agric Econ Res 37, 199211.
9. Popkin BM (2006) Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr 84, 289298.
10. Hu FB (2011) Globalization of diabetes. Diabetes Care 34, 12491257.
11. Ng SW, Norton EC & Popkin BM (2009) Why have physical activity levels declined among Chinese adults? Findings from the 1991–2006 China Health and Nutrition Surveys. Soc Sci Med 68, 13051314.
12. Popkin BM (1999) Urbanization, lifestyle changes and the nutrition transition. World Dev 27, 19051916.
13. Schmidhuber J & Shetty P (2005) The nutrition transition to 2030. Why developing countries are likely to bear the major burden. Food Econ Acta Agric Scand Sect C 2, 150166.
14. Organisation for Economic Co-operation and Development & Food and Agriculture Organization of the United Nations (2011) Sugar. In OECD–FAO Agricultural Outlook 2011–2020, pp. 119132. Paris: OECD/FAO.
15. Popkin BM & Nielsen SJ (2003) The sweetening of the world's diet. Obes Res 11, 13251332.
16. Food and Agriculture Organization of the United Nations, Economic and Social Development Department (2006) Sugar. Rome: FAO.
17. Barclay A & Brand-Miller J (2011) The Australian paradox: a substantial decline in sugars intake over the same timeframe that overweight and obesity have increased. Nutrients 3, 491504.
18. Welsh JA, Sharma AJ, Grellinger L et al. (2011) Consumption of added sugars is decreasing in the United States. Am J Clin Nutr 94, 726734.
19. Lustig RH, Schmidt LA & Brindis CD (2012) Public health: the toxic truth about sugar. Nature 482, 2729.
20. Bray G, Nielsen SJ & Popkin BM (2004) Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 79, 537543.
21. Johnson RK, Appel LJ, Brands M et al. (2009) Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 120, 10111020.
22. Du S, Mroz TA, Zhai F et al. (2004) Rapid income growth adversely affects diet quality in China – particularly for the poor! Soc Sci Med 59, 15051515.
23. Du S, Lu B, Zhai F et al. (2002) A new stage of the nutrition transition in China. Public Health Nutr 5, 169174.
24. Misra A, Singhal N, Sivakumar B et al. (2011) Nutrition transition in India: secular trends in dietary intake and their relationship to diet-related non-communicable diseases. J Diabetes 3, 278292.
25. Rivera JA, Barquera S, González-Cossío T et al. (2004) Nutrition transition in Mexico and in other Latin American countries. Nutr Rev 62, 7 Pt 2, S149S157.
26. Amuna P & Zotor FB (2008) Epidemiological and nutrition transition in developing countries: impact on human health and development. Proc Nutr Soc 67, 8290.
27. Vorster HH, Kruger A & Margetts BM (2011) The nutrition transition in Africa: can it be steered into a more positive direction? Nutrients 3, 429441.
28. Walker P, Rhubart-Berg P, McKenzie S et al. (2005) Public health implications of meat production and consumption. Public Health Nutr 8, 348356.
29. Song Y, Manson JE, Buring JE et al. (2004) A prospective study of red meat consumption and type 2 diabetes in middle-aged and elderly women. Diabetes Care 27, 21082115.
30. Popkin BM & Du S (2003) Dynamics of the nutrition transition toward the animal foods sector in China and its implications: a worried perspective. J Nutr 133, 11 Suppl. 2, 3898S3906S.
31. Food and Agriculture Organization of the United Nations (2001) Food Balance Sheets. A Handbook. Rome: FAO.
32. Ruxton CH, Gardner EJ & McNulty HM (2010) Is sugar consumption detrimental to health? A review of the evidence 1995–2006. Crit Rev Food Sci Nutr 50, 119.
33. World Health Organization (2010) Global Recommendations on Physical Activity for Health. Geneva: WHO.
34. Kohl HW, Craig CL, Lambert EV et al. (2012) The pandemic of physical inactivity: global action for public health. Lancet 380, 294305.
35. Lichtenstein AH, Appel LJ, Brands M et al. (2006) Diet and lifestyle recommendations revision 2006. Circulation 114, 8296.
36. McMichael A (2000) The urban environment and health in a world of increasing globalization: issues for developing countries. Bull World Health Organ 78, 11171225.
37. Wells JC (2012) Obesity as malnutrition: the role of capitalism in the obesity global epidemic. Am J Hum Biol 24, 261276.
38. Guillén MF (2001) Is globalization civilizing, destructive or feeble? A critique of five key debates in the social science literature. Annu Rev Sociol 27, 235260.
39. Stephan BC, Wells JC, Brayne C et al. (2010) Increased fructose intake as a risk factor for dementia. J Gerontol A Biol Sci Med Sci 65, 809814.
40. Malik VS, Popkin BM, Bray GA et al. (2010) Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes. Diabetes Care 33, 24772483.
41. de Koning L, Malik VS, Kellogg MD et al. (2012) Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men/clinical perspective. Circulation 125, 17351741.
42. Stanhope KL (2012) Role of fructose-containing sugars in the epidemics of obesity and metabolic syndrome. Annu Rev Med 63, 329343.
43. Ha V, Sievenpiper JL, de Souza RJ et al. (2012) Effect of fructose on blood pressure: a systematic review and meta-analysis of controlled feeding trials. Hypertension 59, 787795.
44. Sievenpiper JL, de Souza RJ, Mirrahimi A et al. (2012) Effect of fructose on body weight in controlled feeding trials: a systematic review and meta-analysis. Ann Intern Med 156, 291304.
45. Stanhope KL, Schwarz JM, Keim NL et al. (2009) Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest 119, 13221334.
46. Aeberli I, Gerber PA, Hochuli M et al. (2011) Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial. Am J Clin Nutr 94, 479485.
47. Lustig RH (2006) Childhood obesity: behavioral aberration or biochemical drive? Reinterpreting the First Law of Thermodynamics. Nat Clin Pract Endocrinol Metab 2, 447458.
48. Wells JC & Siervo M (2011) Obesity and energy balance: is the tail wagging the dog? Eur J Clin Nutr 65, 11731189.
49. Taubes G (2009) The Diet Delusion: Challenging the Conventional Wisdom on Diet, Weight Loss and Disease. London: Vermilion.
50. Johnson RK, Appel LJ, Brands M et al. (2009) Dietary sugars intake and cardiovascular health. Circulation 120, 10111020.
51. Samuel VT (2011) Fructose induced lipogenesis: from sugar to fat to insulin resistance. Trends Endocrinol Metab 22, 6065.
52. Mah E, Noh SK, Ballard KD et al. (2011) Postprandial hyperglycemia impairs vascular endothelial function in healthy men by inducing lipid peroxidation and increasing asymmetric dimethylarginine:arginine. J Nutr 141, 19611968.
53. Siervo M, Corander M, Stranges S et al. (2011) Post-challenge hyperglycaemia, nitric oxide production and endothelial dysfunction: the putative role of asymmetric dimethylarginine (ADMA). Nutr Metab Cardiovasc Dis 21, 110.
54. Brown IJ, Stamler J, Van Horn L et al. (2011) Sugar-sweetened beverage, sugar intake of individuals, and their blood pressure. Hypertension 57, 695701.
55. Wells JCK, Marphatia AA, Cole TJ et al. (2012) Associations of economic and gender inequality with global obesity prevalence: understanding the female excess. Soc Sci Med 75, 482490.
56. Collishaw N & Lopez A (1995) Prevalence of cigarette smoking in developing countries. Tob Control 4, 327328.
57. Klein S, Allison DB, Heymsfield SB et al. (2007) Waist circumference and cardiometabolic risk: a consensus statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Am J Clin Nutr 85, 11971202.
58. Taylor FC, Satija A, Khurana S et al. (2011) Pepsi and Coca Cola in Delhi, India: availability, price and sales. Public Health Nutr 14, 653660.
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