Sugar sweetened beverages attributable disease burden and the potential impact of policy interventions: a systematic review of epidemiological and decision models

Abstract

Background Around 184,000 deaths per year could be attributable to sugar-sweetened beverages (SSBs) consumption worldwide. Epidemiological and decision models are important tools to estimate disease burden. The purpose of this study was to identify models to assess the burden of diseases attributable to SSBs consumption or the potential impact of health interventions. Methods We carried out a systematic review and literature search up to August 2018. Pairs of reviewers independently selected, extracted, and assessed the quality of the included studies through an exhaustive description of each model’s features. Discrepancies were solved by consensus. The inclusion criteria were epidemiological or decision models evaluating SSBs health interventions or policies, and descriptive SSBs studies of decision models. Studies published before 2003, cost of illness studies and economic evaluations based on individual patient data were excluded. Results We identified a total of 2766 references. Out of the 40 included studies, 45% were models specifically developed to address SSBs, 82.5% were conducted in high-income countries and 57.5% considered a health system perspective. The most common model’s outcomes were obesity/overweight (82.5%), diabetes (72.5%), cardiovascular disease (60%), mortality (52.5%), direct medical costs (57.35%), and healthy years -DALYs/QALYs- (40%) attributable to SSBs. 67.5% of the studies modelled the effect of SSBs on the outcomes either entirely through BMI or through BMI plus diabetes independently. Models were usually populated with inputs from national surveys -such us obesity prevalence, SSBs consumption-; and vital statistics (67.5%). Only 55% reported results by gender and 40% included children; 30% presented results by income level, and 25% by selected vulnerable groups. Most of the models evaluated at least one policy intervention to reduce SSBs consumption (92.5%), taxes being the most frequent strategy (75%). Conclusions There is a wide range of modelling approaches of different complexity and information requirements to evaluate the burden of disease attributable to SSBs. Most of them take into account the impact on obesity, diabetes and cardiovascular disease, mortality, and economic impact. Incorporating these tools to different countries could result in useful information for decision makers and the general population to promote a deeper implementation of policies to reduce SSBs consumption. PROSPERO protocol number CRD42020121025.

Estimating the impact of nutrition and physical activity policies with quasi-experimental methods and simulation modelling: an integrative review of methods, challenges and synergies

“…Most SM evaluations of nutrition policies rely on proximal risk factors, such as body mass index (BMI) and blood pressure, to estimate long-term NCD outcomes. 8 , 57 While this is often a necessary simplification due to data requirements, evidence suggests that dietary quality, food processing and the food-specific combination of micronutrients may be equally important in the aetiology of disease. Currently, much of this complexity is not reflected in SMs.…”

“…This includes prevalence and incidence data for diseases included in the model, as well as individual-level data on dietary intake and physical activity, particularly for microsimulations. 8 , 57 Yet, many countries lack high-quality disease surveillance systems and national surveys needed to parameterize very complex models.…”

High free sugars content in regular and low-calorie sweetened beverages from the argentine market

“…Around 184.000 deaths per year could be attributable to SSBs consumption worldwide. SSBs consumption is strongly associated with increased risk of overweight/obesity, dental caries, type 2 diabetes mellitus, cardiovascular disease, and other health effects 16 .…”

Health and economic burden of disease of sugar-sweetened beverage consumption in four Latin American and Caribbean countries: a modelling study

“…A comparative risk assessment framework was used to estimate the health and economic impact of SSB consumption. The conceptualisation of the model and the selection of outcomes was carried out after a systematic review of the existing models for SSBs 22 and a Policy Dialogue held in Buenos Aires in 2018 that brought together 35 experts and decision makers from seven countries in LAC. 23 These activities were used to inform the development of the model so that it could adequately respond to the information needs of decision makers and contribute to the design and implementation of effective public policies for the control of SSB consumption in the region.…”