DOI QR코드

DOI QR Code

Socioeconomic burden of sugar-sweetened beverages consumption in Korea

  • Shim, Jee-Seon ;
  • Kang, Nam Hoon ;
  • Lee, Jung Sug ;
  • Kim, Ki Nam ;
  • Chung, Hae Kyung ;
  • Chung, Hae Rang ;
  • Kim, Hung-Ju ;
  • Ahn, Yoon-Sook ;
  • Chang, Moon-Jeong
  • Received : 2018.07.31
  • Accepted : 2018.10.24
  • Published : 2019.04.01

Abstract

BACKGROUND/OBJECTIVES: Excessive sugar consumption may increase the risk for development of several diseases. Although average dietary sugar intake of Koreans is within the recommended level, an increasing trend has been found in all age groups. This study aimed to evaluate the population attributable fractions (PAF) to dietary sugar for disease and death in Korea, and to estimate the socioeconomic effects of a reduction in dietary sugar. MATERIALS/METHODS: The prevalence of sugar-sweetened beverages (SSB) overconsumption (${\geq}20g$ of sugar from beverages) was analyzed using the Korean National Health and Nutrition Examination Survey 2015. Disease-specific relative risks of excessive SSB consumption were obtained through reviewing previous studies. Using the prevalence of SSB overconsumption and each relative risk, PAFs for morbidity and mortality were calculated. Socioeconomic costs of diseases and death attributable to SSB overconsumption were estimated by using representative data on national medical expenditures, health insurance statistics, employment information, and previous reports. RESULTS: Disease-specific PAF to SSB consumption ranged from 3.11% for stroke to 9.05% for obesity and dental caries, respectively. Costs from disease caused by SSB overconsumption was estimated at 594 billion won in 2015. About 39 billion won was estimated to be from SSB consumption-related deaths, and a total of 633 billion won was predicted to have been saved through preventing SSB overconsumption. CONCLUSIONS: Sugars overconsumption causes considerable public burdens, although the cost estimates do not include any informal expenditure. Information on these socioeconomic effects helps both health professionals and policy makers to create and to implement programs for reducing sugar consumption.

Keywords

Dietary sugars;sugar-sweetened beverages;public health;costs

References

  1. Singh GM, Micha R, Khatibzadeh S, Lim S, Ezzati M, Mozaffarian D; Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE). Estimated global, regional, and national disease burdens related to sugar-sweetened beverage consumption in 2010. Circulation 2015;132:639-66. https://doi.org/10.1161/CIRCULATIONAHA.114.010636
  2. Jayalath VH, de Souza RJ, Ha V, Mirrahimi A, Blanco-Mejia S, Di Buono M, Jenkins AL, Leiter LA, Wolever TM, Beyene J, Kendall CW, Jenkins DJ, Sievenpiper JL. Sugar-sweetened beverage consumption and incident hypertension: a systematic review and meta-analysis of prospective cohorts. Am J Clin Nutr 2015;102:914-21. https://doi.org/10.3945/ajcn.115.107243
  3. Imamura F, O'Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, Forouhi NG. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ 2015;351:h3576.
  4. Huang C, Huang J, Tian Y, Yang X, Gu D. Sugar sweetened beverages consumption and risk of coronary heart disease: a meta-analysis of prospective studies. Atherosclerosis 2014;234:11-6. https://doi.org/10.1016/j.atherosclerosis.2014.01.037
  5. Dhingra R, Sullivan L, Jacques PF, Wang TJ, Fox CS, Meigs JB, D'Agostino RB, Gaziano JM, Vasan RS. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation 2007;116:480-8. https://doi.org/10.1161/CIRCULATIONAHA.107.689935
  6. Bernabe E, Vehkalahti MM, Sheiham A, Aromaa A, Suominen AL. Sugar-sweetened beverages and dental caries in adults: a 4-year prospective study. J Dent 2014;42:952-8. https://doi.org/10.1016/j.jdent.2014.04.011
  7. World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva: World Health Organization; 2015.
  8. Hess J, Latulippe ME, Ayoob K, Slavin J. The confusing world of dietary sugars: definitions, intakes, food sources and international dietary recommendations. Food Funct 2012;3:477-86. https://doi.org/10.1039/c2fo10250a
  9. Long MW, Gortmaker SL, Ward ZJ, Resch SC, Moodie ML, Sacks G, Swinburn BA, Carter RC, Claire Wang Y. Cost effectiveness of a sugar-sweetened beverage excise tax in the U.S. Am J Prev Med 2015;49:112-23. https://doi.org/10.1016/j.amepre.2015.03.004
  10. Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. BMJ 2016;352:h6704.
  11. Kelly B, Hughes C, Chapman K, Louie JC, Dixon H, Crawford J, King L, Daube M, Slevin T. Consumer testing of the acceptability and effectiveness of front-of-pack food labelling systems for the Australian grocery market. Health Promot Int 2009;24:120-9. https://doi.org/10.1093/heapro/dap012
  12. Capacci S, Mazzocchi M, Shankar B. Breaking habits: the effect of the french vending machine ban on school snacking and sugar intakes. J Policy Anal Manage 2018;37:88-111. https://doi.org/10.1002/pam.22032
  13. Wrieden WL, Levy LB. 'Change4Life Smart Swaps': quasiexperimental evaluation of a natural experiment. Public Health Nutr 2016;19:2388-92. https://doi.org/10.1017/S1368980016000513
  14. Barragan NC, Noller AJ, Robles B, Gase LN, Leighs MS, Bogert S, Simon PA, Kuo T. The "sugar pack" health marketing campaign in Los Angeles County, 2011-2012. Health Promot Pract 2014;15:208-16. https://doi.org/10.1177/1524839913507280
  15. Overby NC, Klepp KI, Bere E. Introduction of a school fruit program is associated with reduced frequency of consumption of unhealthy snacks. Am J Clin Nutr 2012;96:1100-3. https://doi.org/10.3945/ajcn.111.033399
  16. Lee HS, Kwon SO, Yon M, Kim D, Lee JY, Nam J, Park SJ, Yeon JY, Lee SK, Lee HY, Kwon OS, Kim CI. Dietary total sugar intake of Koreans: based on the Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011. J Nutr Health 2014;47:268-76. https://doi.org/10.4163/jnh.2014.47.4.268
  17. Azais-Braesco V, Sluik D, Maillot M, Kok F, Moreno LA. A review of total & added sugar intakes and dietary sources in Europe. Nutr J 2017;16:6. https://doi.org/10.1186/s12937-016-0225-2
  18. Newens KJ, Walton J. A review of sugar consumption from nationally representative dietary surveys across the world. J Hum Nutr Diet 2016;29:225-40. https://doi.org/10.1111/jhn.12338
  19. Korean Nutrition Society, Ministry of Health and Welfare. Dietary Reference Intakes for Koreans 2015. Seoul: The Korean Nutrition Society; 2015.
  20. Jung J. Action plan for sugars reduction. Food Sci Ind 2016;49:12-6.
  21. Korea Health Industry Development Institute. Sugar Database Compilation for Commonly Consumed Foods 2015. Cheongju: Korea Health Industry Development Institute; 2015.
  22. Kahn R, Sievenpiper JL. Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: we have, but the pox on sugar is overwrought and overworked. Diabetes Care 2014;37:957-62. https://doi.org/10.2337/dc13-2506
  23. Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 2010;33:2477-83. https://doi.org/10.2337/dc10-1079
  24. Greenwood DC, Threapleton DE, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, Burley VJ. Association between sugar-sweetened and artificially sweetened soft drinks and type 2 diabetes: systematic review and dose-response meta-analysis of prospective studies. Br J Nutr 2014;112:725-34. https://doi.org/10.1017/S0007114514001329
  25. Cheungpasitporn W, Thongprayoon C, Edmonds PJ, Srivali N, Ungprasert P, Kittanamongkolchai W, Erickson SB. Sugar and artificially sweetened soda consumption linked to hypertension: a systematic review and meta-analysis. Clin Exp Hypertens 2015;37:587-93. https://doi.org/10.3109/10641963.2015.1026044
  26. Xi B, Huang Y, Reilly KH, Li S, Zheng R, Barrio-Lopez MT, Martinez-Gonzalez MA, Zhou D. Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis. Br J Nutr 2015;113:709-17. https://doi.org/10.1017/S0007114514004383
  27. Kim Y, Je Y. Prospective association of sugar-sweetened and artificially sweetened beverage intake with risk of hypertension. Arch Cardiovasc Dis 2016;109:242-53. https://doi.org/10.1016/j.acvd.2015.10.005
  28. Gordis L. Epidemiology, 3rd ed. Philadelphia, PA: Elsevier Saunders; 2004.
  29. Health Insurance Review and Assessment Service, National Health Insurance Service (KR). 2015 National Health Insurance Statistical Yearbook. Wonju: National Health Insurance Service; 2016.
  30. Statistics Korea. Annual Report on the Cause of Death Statistics. Daejeon: Statistics Korea; 2016.
  31. Lee C, Kim DI, Hong J, Koh E, Kang BW, Kim JW, Park HK, Kim CI. Cost-benefit analysis of sodium intake reduction policy in Korea. Korean J Community Nutr 2012;17:341-52. https://doi.org/10.5720/kjcn.2012.17.3.341
  32. National Health Insurance Service (KR). The Socioeconomic Effects of Major Health Risk Factors and the Evaluation of Effects of Their Regulation Policies. Wonju: National Health Insurance Service; 2015.
  33. National Health Insurance Corporation, Health Insurance Review and Assessment Service (KR). 2015 Survey on Medical Expenditure of Patients Insured by National Health Insurance. Wonju: National Health Insurance Service; 2016.
  34. Ministry of Health and Welfare, Korea Institute for Health and Social Affairs. The Third Korea National Health and Nutrition Examination Survey (KNHANES III). Cheongju: Ministry of Health and Welfare; 2005.
  35. Ministry of Employment and Labor (KR). 2015 Survey Report on Labor Conditions by Employment Type. Sejong: Ministry of Employment and Labor; 2016.
  36. Statistics Korea. 2015 Economically Active Population Survey. Daejeon: Statistics Korea; 2016.
  37. Korea Centers for Disease Control and Prevention. Guide Book for Using the Data from Korea National Health and Nutrition Examination Survey 2013-2015. Cheongju: Korea Centers for Disease Control and Prevention; 2017.
  38. Ministry of Food and Drug Safety (KR). Comprehensive Plan for Reduction of Sugars 2016. Cheongju: Ministry of Food and Drug Safety; 2016.
  39. Wittekind A, Walton J. Worldwide trends in dietary sugars intake. Nutr Res Rev 2014;27:330-45. https://doi.org/10.1017/S0954422414000237
  40. European Food Safety Authority. Scientific opinion on dietary reference values for carbohydrates and dietary fibre. EFSA J 2010;8:1462-539.
  41. Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, D.C.: The National Academies Press; 2002.
  42. Gibson S. Sugar-sweetened soft drinks and obesity: a systematic review of the evidence from observational studies and interventions. Nutr Res Rev 2008;21:134-47. https://doi.org/10.1017/S0954422408110976
  43. Navarrete-Munoz EM, Wark PA, Romaguera D, Bhoo-Pathy N, Michaud D, Molina-Montes E, Tjonneland A, Olsen A, Overvad K, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi G, Katzke VA, Kuhn T, Steffen A, Trichopoulou A, Klinaki E, Papatesta EM, Masala G, Krogh V, Tumino R, Naccarati A, Mattiello A, Peeters PH, Rylander C, Parr CL, Skeie G, Weiderpass E, Quiros JR, Duell EJ, Dorronsoro M, Huerta JM, Ardanaz E, Wareham N, Khaw KT, Travis RC, Key T, Stepien M Freisling H, Riboli E, Bueno-de-Mesquita HB. Sweetbeverage consumption and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). Am J Clin Nutr 2016;104:760-8. https://doi.org/10.3945/ajcn.116.130963
  44. Ministry of Health and Welfare (KR). 2015 Budget of the Ministry of Health and Welfare [Internet]. Cheongju: Ministry of Health and Welfare; 2014 [cited 2018 March 2]. Available from: http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=305131&page=1.
  45. Ministry of Food and Drug Safety (KR). 2015 Overview of budget of the Ministry of Food and Drug Safety [Internet]. Cheongju: Ministry of Food and Drug Safety; 2014 [cited 2018 March 2]. Available from: http://www.mfds.go.kr/index.do?mid=636&pageNo=1&cmd=v&seq=47618.
  46. Korea Centers for Diseases Control and Prevention. 2015 Statistics on Health-Related Behaviors and Chronic Diseases: the 6th Korea National Health and Nutrition Survey and 11th Korean Youth Risk Behavior Survey. Cheongju: Ministry of Health and Welfare; 2016.
  47. Larsson SC, Bergkvist L, Wolk A. Consumption of sugar and sugar-sweetened foods and the risk of pancreatic cancer in a prospective study. Am J Clin Nutr 2006;84:1171-6. https://doi.org/10.1093/ajcn/84.5.1171
  48. Genkinger JM, Li R, Spiegelman D, Anderson KE, Albanes D, Bergkvist L, Bernstein L, Black A, van den Brandt PA, English DR, Freudenheim JL, Fuchs CS, Giles GG, Giovannucci E, Goldbohm RA, Horn-Ross PL, Jacobs EJ, Koushik A, Mannisto S, Marshall JR, Miller AB, Patel AV, Robien K, Rohan TE, Schairer C, Stolzenberg-Solomon R, Wolk A, Ziegler RG, Smith-Warner SA. Coffee, tea, and sugar-sweetened carbonated soft drink intake and pancreatic cancer risk: a pooled analysis of 14 cohort studies. Cancer Epidemiol Biomarkers Prev 2012;21:305-18. https://doi.org/10.1158/1055-9965.EPI-11-0945-T

Acknowledgement

Supported by : Ministry of Food and Drug Safety