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Denial Ejaz Maqbool have completed his bachelor degree in ‘’ Diet and Nutritional Science’ from University of Lahore(Islamabad Campus)

Introduction:

Beverages containing added sugars like corn syrup, sugar substitutes, soda, pop, cola, lemonade, sucrose, brown sugar, dextrose, invert sugar, molasses, fruit juice concentrates, honey, etc. are termed as Sugar-Sweetened Beverages. Sweetened milks, energy and sports drinks, non-diet sodas are some examples of these beverages.

 

 

 

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Effects on Health:

With increase in consumption of SSBs across the globe, the number of people affected by above-mentioned diseases have increased immensely, therefore, SSBs have become a serious threat to health of human population. Health professionals are continuously asking to reduce the usage and asking authorities to make and implement regulation & laws related to them.

Because SSBs contain a lot of additional sugars and calories, therefore, their role as an important risk factor of obesity has gained a lot of attention and health-concerns around the globe. In past few decades, the consumption of SSBs has increased dramatically worldwide, irrespective of age-group. One concern that is often ignored with respect to SSBs is that they provide empty calories and no nutritional value, so they are often looked in different interventions of public health.

American Heart Association (AHA) and American Diabetes Association (ADA) have collectively said that there is not enough data to support the fact that when additional sugars are used, they benefit body weight or heart-related issues. However, this statement does not mean that evidence do not even exist related to this question. There are number of prestigious organizations or research institutes that are convinced of SSB’s health-damaging effects and are asking to reduce their consumption to prevent many NCDs. These include ADA, AHA, AAP (American Academy of Pediatrics), AMA (American Medical Association), USDA (United States Department of Agriculture), WHO, and others.

According to a systematic review of epidemiological and experimental evidence by Malik et al., weight gain and obesity is caused by greater consumption of SSBs. As shown by cohort studies of children published in 2013, there is about 55% risk to become over-weight or obese due to higher consumption of SSB.

Consumption in Pakistan:

In Pakistan, the most commonly used beverages are soft or soda drinks. According to some income expenditure surveys done in Pakistani households, approximately 60-70% of households consume non-alcoholic beverages across the country.

SSBs of approximately PKR 387 billion were consumed in Pakistan throughout the year 2015 which account for about 4426 million beverages in quantity. Despite the enormous production and utilization of SSBs in Pakistan, taxes of only PKR 38 billion was paid by the industry (PANAH).

Beverage industry is an important source of income for Pakistani Government in the form of sales tax (domestic) and excise duty (federal), making it an important sector of Pakistan’s income. If we look at consumption pattern of SSBs among Pakistani households, it has been shown that consumption is directly linked with wealth of household. It means that the more wealth a household has, more will be the consumption of SSBs. According to analysis of household expenditures in Pakistan, it has been shown that SSBs have become an important part of food consumption, with healthier household having larger share. It has also been shown that the consumption of SSBs among poor households has increased between 2014-16 than 2006-08.

SSBs and NCDs Relation As per IDF report 10th Edition, 33 million people are living with diabetes and Pakistan now ranked 3rd highest with people living with diabetes and counting, with an estimation of every 4th Person to be diabetic (Type-2) according to National Diabetes Survey of Pakistan (2016-17). SSBs have been linked to number of non-communicable diseases (NCDs) by many researches worldwide. These diseases include CVDs, kidney disorders, HTN, diabetes, liver disorders, etc. According to a survey done in Pakistan, approximately 2200 people die due to the NCDs yearly and SSBs are now listed as one of major risk factor of these diseases. Almost 4 out of every 10 Pakistani adults are over-weight or obese as found in NCDs survey done between 2014-15.

In Pakistan, approximately every one in four adult males (age > 20 years) and one in three adult females (age > 20 years) are over-weight or obese. This accounts for 9th most number of obese individuals globally. Diabetes has also become an epidemic in recent years in Pakistan. As per International Diabetes Federation Report, 10th edition 31% people are diabetic in Pakistan. In addition more than 10 million are living with impaired Glucose tolerance or can be categorized as pre diabetic.

In 2016, CVDs are the number one cause of deaths in Pakistan accounting for about 29% of deaths. SSBs are closely associated with these health issues, therefore they are an important target for health interventions.

Different metabolic disorders are linked with the consumption of SSBs such as diabetes (type-2) and metabolic syndrome. They are also linked to over-weight and obesity, which are further risk factors for a number of NCDs including CVDs, diabetes, some types of cancers, psychological and social issues, pregnancy complications, lungs-related issues, gout, non-alcoholic fatty liver disease, etc. They are also responsible for different oral health problems in adolescents like dental erosion, dental carries, cavities, etc. Increased levels of triglycerides and uric acid are also sometimes linked to the consumption of SSBs.

Bone mass loss, hypertension, insomnia, osteoporosis in old age, are also attributed to continuous consumption of sugar-sweetened beverages. They are also involved in over-stimulation of nervous system, according to AAP (American Academy of Pediatrics) and therefore, adolescents should avoid their consumption.

Strategies to Reduce Consumption:

The use of SSBs should be discouraged to minimize the health-problems and costs. One strategy that can be applied is to increase the taxes on beverages which can result in decreased consumption and plus an increased revenue for Pakistan. Pakistan has applied very low taxes on SSBs and its industry as compared to countries like India, Maldives, Saudi Arabia, UAE and Qatar.

World Bank and World Health Organization (WHO) have also recommended to impose high taxes on SSBs so that their use and health issues can be minimized. Tax-imposing strategy has been successful in decreasing use of cigarettes, especially in youth, who care more about prices of cigarettes. The revenue generated from these taxes can be used in improving health sector of country.

Public policy interventions are needed to be implemented to change food-related behaviors and patterns of people. Other strategies include increasing nutrition labelling and restriction of their marketing, especially for children. Access to soft drinks, especially of large portion size, should be also decreased to decrease their consumption. Effective laws should also be introduced and implemented to change social norms andimprove food and beverage consumption patterns.

References

⦁ Hu FB, Malik VS. Sugar-sweetened beverages and risk of obesity and type 2 diabetes:
epidemiologic evidence. Physiology & behavior. 2010; 100:47–54.
⦁ National Cancer Institute. Sources of Calories from Added Sugars among the US Population, 2005– 06. Risk Factor Monitoring and Methods Branch Web site. Applied Research Program. Mean intake of added sugars & percentage contribution of various foods among us population.
⦁ Brownell KD, Farley T, Willett WC, Popkin BM, Chaloupka FJ, Thompson JW, et al. The publichealth and economic benefits of taxing sugar-sweetened beverages. The New England journal ofmedicine. 2009; 361:1599–1605.
⦁ ale Rudd Center for Food Policy and Obesity. Sugar-Sweetened Beverage Taxes and SugarIntake: Policy Statements, Endorsements, and Recommendations.
⦁ Fletcher JM, Frisvold D, Tefft N. Taxing soft drinks and restricting access to vending machines tocurb child obesity. Health affairs. 2010; 29:1059–1066.
⦁ Ministry of Finance (2016) Pakistan Economic Survey2015-16. Islamabad: Economic Adviser’s Wing, FinanceDivision, Government of Pakistan.
⦁ Pakistan Bureau of Statistics (2007 – 2017) Household IntegratedEconomic Survey 2015-16. Islamabad: Government ofPakistan.
⦁ World Health Organization (2018) Non-communicable DiseasesCountry Profiles 2018 – Pakistan.
⦁ Amir, AH, Ul-Haq Z, Mahar SA et al. (2019) DiabetesPrevalence Survey of Pakistan (DPS-PAK): prevalence oftype 2 diabetes mellitus and prediabetes using HbA1c: apopulation-based survey from Pakistan.
⦁ Malik VS, Popkin BM, Bray GA et al. (2010) Sugar-sweetenedbeverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 121, 1356–1364.
⦁ Bomback AS, Derebail VK, Shoham DA et al. (2010)Sugar-sweetened soda consumption, hyperuricemia, andkidney disease. Kidney Inter 77, 609–616.
⦁ Malik VS & Hu FB (2015) Fructose and cardio metabolichealth: what the evidence from sugar-sweetened beveragestells us. J Am Coll Cardiol 66, 1615–1624.
https://diabetesatlas.org/atlas/tenth-edition/
https://diabetesatlas.org/atlas/tenth-edition/ 

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