Risk assessmentindependent cross-checkabstract checked I-SOD-127 standard review
Sugary drinks may cause millions of diabetes cases worldwide
Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries.
Overview
Lara-Castor L et al.. Nat Med 2025 · PMID 39762424 · DOI 10.1038/s41591-024-03345-4
A global model estimated that sugary drinks accounted for about 10% of new type 2 diabetes cases in 2020, with high burdens in the Middle East and North Africa.
Does the study support the specific claim? Yes · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Estimate the global disease burden from sugary drinks.
- How was the study done?
Risk-assessment model across 184 countries.
- How many people, animals or samples were studied?
Population data.
- What was actually found?
2.2 million new diabetes and 1.2 million new heart disease cases attributed to sugary drinks in 2020.
- How large was the observed effect?
9.8% of new T2D cases.
- What do the results mean in everyday life?
Reducing sugary drinks could prevent many cases, including in the Arab region.
- What are the study's limitations?
Relies on causal assumptions.
- What does it say about Elawady's specific claim?
Supports the public-health relevance of the claim.
- Do the results apply to Germany and Europe?
Includes Europe.
- What can explicitly not be concluded from this study?
Cannot itself prove causation.
Scientific in-depth review
1. Full reference
- Authors
- Lara-Castor L et al.
- Journal
- Nat Med
- Year
- 2025
- Identifier
- PMID 39762424 DOI 10.1038/s41591-024-03345-4
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26
- Retracted
- no
- Corrections
Author Correction published: Nat Med 2025;31(2):696, doi 10.1038/s41591-025-03524-x (PMID 39870818); content of correction not reviewed.
- Extent checked
- abstract only
- Conflicts of interest and funding
Investigators report no pharmaceutical funding for the report; authors report Gates Foundation, AHA and other research funding outside the work (PubMed record)
2. Research question
How many new T2D and CVD cases are attributable to SSB intake globally, regionally and nationally?
3. Study design and population
- Study design
- Risk assessment – Comparative risk assessment model using Global Dietary Database intakes and meta-analysed relative risks
- Population
Adults in 184 countries
- Country
Global (including Middle East and North Africa)
- Period
1990 and 2020
- Sample size
184 countries
- Inclusion and exclusion criteria
Not applicable
4. Methods and endpoints
- Exposure / intervention
SSB intake by age, sex, education, urbanicity
- Comparator
Counterfactual of no SSB intake
- Endpoints
SSB-attributable T2D and CVD incidence
- Statistical methods
Comparative risk assessment with uncertainty intervals
5. Actual results
- Results
In 2020, 2.2 million (2.0-2.3) new T2D cases and 1.2 million (1.1-1.3) new CVD cases worldwide were attributable to SSBs (9.8% and 3.1% of incident cases). Full text: Middle East and North Africa had 1,001 SSB-attributable new T2D cases per million adults and the highest SSB-attributable CVD incidence (815 per million).
- Absolute risks
Attributable cases per million adults reported by region (see results)
- Authors' conclusion
Highlights countries and subpopulations most affected by SSB-related cardiometabolic disease.
6. Strengths
- Global coverage including MENA
- Stratified estimates
7. Weaknesses
- Model assumes causal relative risks from cohorts
- Intake data partly modelled
- Correction published
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Modelling study; outputs depend on causal assumptions.
9. Assessment of the statistical interpretation
Attributable burden is conditional on the assumed causal RR; it is not independent evidence of causation.
10. Relevance to the specific claim
Regional context for C-SOD-01: estimates a substantial SSB-attributable diabetes burden in the Middle East and North Africa.
11. Independent contrary findings
Causality assumption.
12. Transferability to Germany and Europe
Includes European estimates.
13. Overall methodological judgement
Useful for magnitude and regional relevance, not for causal inference.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | indirect |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Egypt-specific intake data quality.