Health Benefits of Reducing Sugar-Sweetened Beverage Intake in High Risk Populations of California: Results from the Cardiovascular Disease (CVD) Policy Model

Tekeshe A Mekonnen,David Guzman,Michelle C Odden,Y Claire Wang,Kirsten Bibbins-Domingo,Pamela G Coxson,James Lightwood,Heiner K Berthold

doi:10.1371/journal.pone.0081723

Abstract

BackgroundConsumption of sugar-sweetened beverage (SSB) has risen over the past two decades, with over 10 million Californians drinking one or more SSB per day. High SSB intake is associated with risk of type 2 diabetes, obesity, hypertension, and coronary heart disease (CHD). Reduction of SSB intake and the potential impact on health outcomes in California and among racial, ethnic, and low-income sub-groups has not been quantified.MethodsWe projected the impact of reduced SSB consumption on health outcomes among all Californians and California subpopulations from 2013 to 2022. We used the CVD Policy Model – CA, an established computer simulation of diabetes and heart disease adapted to California. We modeled a reduction in SSB intake by 10–20% as has been projected to result from proposed penny-per-ounce excise tax on SSB and modeled varying effects of this reduction on health parameters including body mass index, blood pressure, and diabetes risk. We projected avoided cases of diabetes and CHD, and associated health care cost savings in 2012 US dollars.ResultsOver the next decade, a 10–20% SSB consumption reduction is projected to result in a 1.8–3.4% decline in the new cases of diabetes and an additional drop of 0.5–1% in incident CHD cases and 0.5–0.9% in total myocardial infarctions. The greatest reductions are expected in African Americans, Mexican Americans, and those with limited income regardless of race and ethnicity. This reduction in SSB consumption is projected to yield $320–620 million in medical cost savings associated with diabetes cases averted and an additional savings of $14–27 million in diabetes-related CHD costs avoided.ConclusionsA reduction of SSB consumption could yield substantial population health benefits and cost savings for California. In particular, racial, ethnic, and low-income subgroups of California could reap the greatest health benefits.

Highlights

Sugar-sweetened beverages (SSB) –soda, fruit punches, sports drinks, sweetened tea, and other carbonated or non-carbonated drinks that are sweetened with sugar–are the largest source of added sugar in the US diet today. [1,2] Data from the National Health And Nutrition Examination Survey (NHANES) suggests that the total daily kilocalories from sugar-sweetened beverage (SSB) is much higher for adults in communities of color than their white counterparts
In response to the growing burden of diet-related chronic diseases, a number of strategies have been proposed and implemented to reduce SSB intake on a population level. Such approaches generally fall in three categories –1) education and information sharing, including both targeted efforts to describe the health effects of excessive SSB consumption, as well as efforts to provide consumers with accurate information through menu labeling to allow them to make healthier choices on their own, 2) restriction, to vulnerable groups like school-age children and including limiting availability of these products within the schools or limiting the ability to market these products directly to children, and 3) taxation, including sales taxes assessed at the point of sale and more recently excise taxes levied on the producer
We examine and project the health and economic benefit of a reduction in SSB intake as might be achieved by an excise tax in California over the decade, using the Cardiovascular Disease (CVD) Policy Model – CA, an established computer simulation of diabetes and heart disease adapted to California

Summary

Introduction

Sugar-sweetened beverages (SSB) –soda, fruit punches, sports drinks, sweetened tea, and other carbonated or non-carbonated drinks that are sweetened with sugar–are the largest source of added sugar in the US diet today. [1,2] Data from the National Health And Nutrition Examination Survey (NHANES) suggests that the total daily kilocalories from SSB is much higher for adults in communities of color than their white counterparts. In response to the growing burden of diet-related chronic diseases, a number of strategies have been proposed and implemented to reduce SSB intake on a population level Such approaches generally fall in three categories –1) education and information sharing, including both targeted efforts to describe the health effects of excessive SSB consumption, as well as efforts to provide consumers with accurate information through menu labeling to allow them to make healthier choices on their own, 2) restriction, to vulnerable groups like school-age children and including limiting availability of these products within the schools or limiting the ability to market these products directly to children, and 3) taxation, including sales taxes assessed at the point of sale and more recently excise taxes levied on the producer. Reduction of SSB intake and the potential impact on health outcomes in California and among racial, ethnic, and low-income sub-groups has not been quantified

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