Sugar-sweetened beverages (SSB) are beverages sweetened with added sugar. Because a substantial amount is usually added, they have been described as "liquid candy". Added sugars include brown sugar, corn sweetener, corn syrup, dextrose (also known as glucose), fructose, high-fructose corn syrup, honey, invert sugar (a mixture of fructose and glucose), lactose, malt syrup, maltose, molasses, raw sugar, sucrose, trehalose, and turbinado sugar. Naturally occurring sugars, such as those in fruit or milk, are not considered to be added sugars. Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. Consumption of sugar-sweetened beverages is linked to weight gain and an increased risk of cardiovascular disease mortality. According to the CDC, consumption of sweetened beverages is also associated with unhealthy behaviors like smoking, not getting enough sleep and exercise, and eating fast food often and not enough fruits regularly. Artificially sweetened beverages (ASB) are defined as those containing non-nutritive sweeteners and are marketed as a replacement for sugar-sweetened beverages. Similar to sugar-sweetened beverages, they are linked to weight gain and an increased risk of cardiovascular disease mortality.
Prevalence of sweetened beverage consumption Humans have been drinking sweet beverages for thousands of years in the form of fruit juice, mead, and sweetened wine. A lemon drink sweetened with sugar was first documented in Mamluk Egypt between the tenth and thirteenth centuries. Sweetened hot chocolate was developed in Europe in the 17th century. The increase in consumption of sweetened beverages over the past several decades has been described as a worldwide health problem, but it is particularly visible in the United States, where many modern drinks, like sodas, originated. In the US, sweetened beverages such as most sodas are the most widely consumed type of foods containing added sugar, and they account for about a third of all consumption of added sugars (about half if counted together with fruit juice; about twice the amount that is gained from the categories of "desserts" and "sweets"). They represent about 7% of total energy intake, where they can account for up to 15% in children, and have been described as the "largest single food source of calories in the US diet". The consumption of sweetened beverages has increased in the US since the 1970s, accounting for a significant portion (perhaps as high as a half) of the rise in caloric intake among the American populace. Some more recent research suggests that the added sugar consumption in the US has started declining in the 21st century, due to a related decrease in the consumption of sweetened beverages, encouraged by the government health awareness initiative and other programs. In 1999, sugar consumption in the U.S. peaked at nearly half a pound per person per day, but has declined since then. High fructose syrup (HFCS) consumption, which in 1999 amounted to over 65 lb per person per year, largely in the form of sugar-sweetened beverages, dropped to 39.5 lb by 2021. According to the Centers for Disease Control, the Behavioral Risk Factor Surveillance System Survey found that 30.1% of American adults consume at least one sugar-sweetened beverage daily.
Health effects of sugar-sweetened beverages There is an association between increased consumption of sweetened beverages and weight gain leading to obesity, coronary heart disease, diabetes, liver disease, dental implications, and gout. Reducing consumption of sugar-sweetened beverages can reduce the risk of unhealthy weight gain in adults. The World Health Organization (WHO) has developed guidance on free sugars, based on the impact of free sugar intake on weight gain and dental issues. For a normal calorie diet, calories from added sugars should be less than 10 percent of the daily calorie limit. Eating habits that include a lesser amount of added sugars, which can be from reduced intake of sugary drinks, can be associated with reduced risk of CVD in adults, and moderate evidence indicates that these eating patterns are associated with reduced risk of obesity, type 2 diabetes, and some types of cancer in adults.
Obesity Along with the increase in the prevalence of obesity, the consumption of carbohydrates, particularly in the form of added sugars, has increased. Sugar-sweetened beverages contribute to the overall energy density of diets. There is a correlation between drinking sugar-sweetened beverages and gaining weight or becoming obese. Sugar-sweetened beverages show lower satiety values for the same calories compared to solid foods, which may cause one to consume more calories. A 2023 review found that sweetened beverage consumption promotes higher body mass index and body weight in both children and adults.
Oral health Oral health can be harmed by sugar-sweetened beverages, especially by acid erosion and dental caries. Frequency of sugar sweetened beverages results in dental caries, which are caused when Streptococcus bacteria within the plaque metabolize the sugar, releasing various acids as waste compounds. The acids lower salivary pH and dissolve the enamel. Acid erosion is the loss of tooth enamel caused by acid attack. When consuming carbonated sugar-sweetened beverages, acid contacts the teeth, attacking the enamel. Over time, the enamel erodes, leading to dental caries. Erosion of tooth enamel begins at a pH of 5.5, and ingredients found in sugar-sweetened beverages such as phosphoric acid and citric acid significantly contribute to the demineralization of the enamel. Consumption of sports and energy drinks have been linked to tooth damage. This is especially common in adolescents who consume about 30–50% of the beverages that are on the market. Studies suggest that energy drinks may cause twice as much damage to teeth as sports drinks. Citric acid, found in many sugar-sweetened beverages, causes stripping of the enamel. Fruit juices generally contain lower amounts of sugar than carbonated sugar-sweetened beverages. The acidity levels found in fruit juices vary, with citrus-based juices having the lowest pH levels, leading to a higher risk of cavities with enamel exposure.
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