They may be refreshing and satisfying, but soft drinks, processed juices, and even sweetened coffee are increasingly resulting in a range of undesirable side effects. As well as being high in calories, these drinks also increase the risk of chronic disease due to imbalances they cause in the body.
Worldwide, excessive consumption of sugar-sweetened beverages directly contributed to 2.2 million new cases of type 2 diabetes (when the body produces insulin, the hormone responsible for absorbing glucose, but does not use it properly) and 1.2 million cases of cardiovascular disease in 2020, according to an international survey published in Nature Medicine in January, in which Brazilians participated. In Brazil, consumption is classified as intermediate-high, with the country placing 34th worldwide and 6th in Latin America and the Caribbean, one of the regions where the problem is most severe. Fourteen million people have been diagnosed with type 2 diabetes nationwide and 24.4% of new cases, as well as 11.3% of cardiovascular diseases, are associated with the consumption of sugary drinks. According to the Brazilian Ministry of Health, roughly 400,000 people die every year from cardiovascular disease, primarily heart attacks, including cases with other causes, such as smoking and high cholesterol.
The problem is particularly concerning because sugar-sweetened drinks are so readily available in many food establishments. The good news, from a public health perspective, is that soft drink production has fallen from 16.9 billion liters in 2010 to 12.6 billion liters in 2021, while annual consumption per capita fell from 88.9 liters to 59.5 liters in the same period, according to the Brazilian Association of Soft Drink and Non-Alcoholic Beverage Industries (ABIR) (see infographics).
The survey presented in Nature Medicine gathered data from 184 countries, covering 2.9 million individuals, representing 87.1% of the world population. The country that consumes the most sugary drinks is Colombia, at approximately 600 milliliters (mL) per day, while China is at the other extreme, with an average consumption of 7 mL per day.
The statistics included factors such as age, gender, education level, and place of residence in each country. To address the lack of data in some locations, a mathematical model combined information from different levels—national, regional, and global—to generate more accurate predictions. “This method allows us to deal with differences between available data and uncertainties in the samples, making the estimates more reliable,” explains study leader and nutritionist Laura Lara-Castor, who is currently doing a postdoctoral fellowship at the University of Washington, USA.
The study estimated that Brazilian adults consume an average of 4.1 240-mL servings of sugar-sweetened beverages per week, equivalent to almost one small glass (140 mL) per day. In 2020, a team led by nutritionist Regina Fisberg of the University of São Paulo (USP) arrived at higher numbers for the city of São Paulo: adolescents drank an average of 668.4 mL of sugar-sweetened beverages per day, adults drank 502.6 mL, and people over 60 years old drank 358.2 mL.
Teenagers
The survey, published in the journal Revista Brasileira de Epidemiologia in February 2020, found that consumption was higher among overweight adolescents, physically active adults, and lower-income elderly people. Households with a lower per-capita income tend to consume more sweetened coffee and tea, while teenagers with higher purchasing power drink more sweetened fruit juices. The findings reinforce the global trend presented in Nature Medicine: younger people in urban areas with a higher level of education are at a higher risk of developing type 2 diabetes and cardiovascular disease due to the consumption of sugary drinks.
“Among teenagers, the higher the income, the higher the consumption of sugar-sweetened beverages,” points out Amanda de Moura Souza, a nutritionist from the Institute of Public Health at the State University of Rio de Janeiro (UERJ) whose research was used in the analysis published in Nature Medicine. “This trend changes in adulthood, when people with greater purchasing power have greater access to health services and are more able to change their lifestyle to adopt a healthier diet and do more physical exercise, which alleviates the problem.”
Fisberg, who also collaborated on the work presented in Nature Medicine, issues a warning: “The effect of sugary drinks on diabetes is considerable because they are sugars that are released quickly into the blood.” Sugars such as sucrose (refined sugar) can quickly raise blood glucose levels and exacerbate type 2 diabetes. Fructose, one of the main components of sucrose, is primarily metabolized in the liver. Too much fructose causes inflammation and fat accumulation in the liver cells, impairing its functioning.
Sugar consumption can also lead to high blood pressure by altering blood levels of compounds such as uric acid, a nitric oxide inhibitor that helps to relax blood vessels and balance blood pressure. Another effect is an increase in triglycerides, which modify the structure of low-density cholesterol, leading to the formation of fatty plaques that cause strokes and heart attacks.
33% drop in soft drink consumption in Brazil from 2010 to 2021, helping to reduce the incidence of metabolic diseases
Consumption of sugar-sweetened beverages is still high in Brazil and the downward trend has slowed in recent years. According to a 2024 article in Revista de Saúde Pública, regular consumption of sugary drinks fell from 30.9% in 2007 to 14% in 2021, while the average daily intake dropped from 430.4 mL to 287.4 mL. Between 2015 and 2021, however, the downward trend slowed. “The consumption of fruits and vegetables, which had been growing in previous years, also began to fall, indicating that something affected the population’s diet in general,” observes nutritionist Luiza Eunice Sá da Silva of the Federal University of Minas Gerais (UFMG), who led the study.
Experts have recommend a combination of measures to reduce the consumption of sugar-sweetened beverages, from improving the National School Meals Program, which is fundamental for education and food security in childhood, to raising taxes on certain goods. The World Health Organization (WHO) states that taxing sugary drinks is one of the public health measures with the greatest cost-benefit ratio.
The impact could be significant. It is estimated that an additional 20% tax on sugar-sweetened beverages, which are already subject to taxes of 36.56% in Brazil, would increase product prices, reduce sales and consumption, and prevent 37,303 new cases of diabetes in men, 56,757 in women, 5,386 deaths among men, and 6,075 among women in the next 10 years, according to a study published in Diabetes Research and Clinical Practice in September 2022. Over 20 years, the increase in taxes would result in a 12.4% reduction in new cases of the disease and a 13.7% drop in deaths associated with diabetes in men and 12.7% in women.
“We are talking about chronic diseases that are occurring earlier and earlier,” says nutritionist Carla Cristina Enes of the Pontifical Catholic University of Campinas, leader of the study. “As well as the reduced quality of life for patients and their families, there is an overload on the public health system.”
The recommendations are set to be followed. Last year, the federal government approved tax reforms aimed at creating a single nationwide tax and a selective tax on products considered harmful to health, including soft drinks and other sugary beverages, with the intention of discouraging consumption.
The story above was published with the title “Sweet, but not so sweet” in issue 351 of May/2025.
Project
Lifestyle and biochemical and genetic markers as cardiometabolic risk factors: Health survey in the city of São Paulo (n° 17/05125-7); Grant Mechanism Thematic Project; Principal Investigator Regina Mara Fisberg (USP); Investment R$5,019,338.71.
Scientific articles
LARA-CASTOR, L. et al. Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries. Nature Medicine. Vol. 31, pp. 552–64. Jan. 2025.
NUCCI, L. B. et al. Impact of a reduction in sugar-sweetened beverage consumption on the burden of type 2 diabetes in Brazil: A modeling study. Diabetes Research and Clinical Practice. Vol. 192, 110087. Oct. 2022.
PAN-AMERICAN HEALTH ASSOCIATION. Tributação de bebidas açucaradas é uma das medidas de maior custo-benefício para a saúde, afirma Opas. Aug. 2021.
SILVA, L. E. S. da et al. Updating trends in sweetened beverages consumption in Brazil from 2007 to 2021. Revista de Saúde Pública. Vol. 58, no. 1. Mar. 2024.
SOUZA, A. M. et al. ERICA: Intake of macro and micronutrients of Brazilian adolescents. Revista de Saúde Pública. Vol. 50, no. 1. Feb. 2016.
