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. 2025 Jul 9;17:259. doi: 10.1186/s13098-025-01845-y

Global burden of high sugar-sweetened beverage consumption among young adults

Chenliang Ge 1, Jingwei Xiong 2, Rui Zhu 3, Zhenchen Hong 4, Yan He 1,✉
PMCID: PMC12239271  PMID: 40635083

Abstract

Background and aims

High sugar-sweetened beverage (SSB) consumption is a growing public health concern linked to obesity and chronic diseases. This study analyzed global trends and disparities in high SSB consumption among young adults aged 15–39 years from 1990 to 2021, using data from the Global Burden of Disease (GBD) Study 2021.

Methods and results

High SSB consumption was defined as intake of beverages with ≥ 50 kcal per 226.8-gram serving, excluding 100% fruit and vegetable juices. We calculated the prevalence and estimated annual percentage change (EAPC) to track temporal trends and identify significant shifts. The global prevalence of high SSB consumption among young adults increased from 6.58% in 1990 to 11.13% in 2021. Females consistently exhibited a higher prevalence compared to males. In 2021, high SDI countries had the highest prevalence (30.83%), while low SDI countries had the lowest prevalence (2.91%). High-middle SDI countries experienced the fastest increase in SSB consumption, with an EAPC of 2.99%. A strong positive correlation was found between national SDI and SSB prevalence in 2021 (ρ = 0.78, p < 2.2e-16).

Conclusion

Rising global SSB consumption among young adults highlights the need for targeted public health interventions, especially considering disparities across gender, SDI levels, and regions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13098-025-01845-y.

Keywords: Sugar-Sweetened beverages, Young adults, Global prevalence, Sociodemographic index, Global burden of disease study

Introduction

The global consumption of sugar-sweetened beverages (SSBs), encompassing a range of drinks such as sodas, energy drinks, and sweetened teas, has experienced a significant surge in recent decades. This trend, fueled by shifting dietary habits, aggressive marketing strategies, and broader societal shifts, has raised considerable concern among public health experts worldwide [1, 2]. SSBs are often characterized by high sugar content, calories, and a lack of essential nutrients, contributing to a myriad of adverse health effects. Regularly consuming these beverages has been linked to an elevated risk of developing obesity, type 2 diabetes, cardiovascular diseases, and dental caries [3, 4].

The prevalence of high SSB consumption is particularly alarming among young adults (aged 15–39 years), a demographic crucial for future global health and well-being. Studies have indicated that this age group had a high prevalence of SSB consumption, with consumption patterns influenced by a complex interplay of factors, including age, gender, socioeconomic status, cultural norms, and educational level [5–7]. While some research has explored the burden of high SSB consumption among young adults, often focusing on specific regions or age groups, a comprehensive understanding of the global prevalence, trends, and associated disparities remains limited [8].

This study aims to address this gap by leveraging data from the Global Burden of Disease (GBD) Study 2021, a comprehensive and regularly updated effort to quantify health loss associated with diseases, injuries, and risk factors globally [9]. We will analyze the global, regional, and national prevalence of high SSB consumption among young adults aged 15–39 years from 1990 to 2021, exploring the trends over time and investigating disparities across sex, socio-demographic index (SDI), and geographic location. By elucidating the evolving landscape of high SSB consumption among this crucial demographic, this research aims to contribute valuable data to inform evidence-based policies and programs aimed at reducing SSB intake and mitigating the associated health risks for young adults worldwide.

Methods

Data sources and variable definitions

This study draws on the comprehensive repository of the GBD Study 2021 to analyze the prevalence and trends of high SSB consumption among young adults aged 15–39 years globally. The GBD Study, a collaborative international effort involving a network of over 9000 researchers, provides a systematic and standardized approach to quantifying health loss attributable to a wide range of diseases, injuries, and 88 risk factors across 204 countries and territories from 1990 to 2021 [10, 11].

The GBD 2021 methodology for estimating the burden attributable to risk factors, including high SSB consumption, is extensive and has been detailed [12, 13]. GBD synthesizes data from a multitude of sources, including national health and nutrition surveys, household consumption and expenditure surveys, food availability data, industry sales data, and published epidemiological studies, to model exposure levels to dietary risk factors. These diverse data inputs undergo rigorous processing, including standardization of definitions and data quality assessment, to ensure comparability across different populations and time periods. GBD then employs advanced statistical modeling techniques to integrate these data, impute missing values, account for covariates like SDI, and generate consistent estimates of prevalence of risk factors by age, sex, location, and year, accompanied by 95% uncertainty intervals (UIs). These UIs are generated by GBD using simulation techniques, specifically by taking 1000 draws from the posterior distribution of each estimated parameter. This approach allows the UIs to capture the comprehensive uncertainty arising from multiple sources, including sampling variability in input data, adjustments made for non-standard data definitions or methodologies, and the inherent uncertainty within the statistical models themselves. The 95% UI indicates a range of plausible values for the true estimate [14].

For this analysis, data for the 15–39 year age range were extracted for both sexes combined and stratified by sex (female and male). SDI, a composite measure reflecting a country’s socioeconomic development, is calculated using lag-distributed income per capita, average years of schooling, and fertility rates among women younger than 25 years¹². Diet high in sugar-sweetened beverages, as defined by GBD, is any intake (in grams per day) of beverages with ≥ 50 kcal per 226.8-gram serving, including carbonated beverages, sodas, energy drinks, and fruit drinks, but excluding 100% fruit and vegetable juices [15, 16].

Descriptive analysis

To provide a comprehensive understanding of the global burden of high SSB consumption among young adults, we conducted a descriptive analysis of the prevalence estimates for the years 1990 and 2021. These estimates were calculated for both sexes combined and then stratified by sex to examine potential gender disparities. To assess socioeconomic inequalities in SSB consumption patterns, we further stratified prevalence estimates by SDI, categorized into five levels: high, high-middle, middle, low-middle, and low. This stratification allowed for a nuanced examination of how consumption patterns relate to a country’s level of development. Geographical variations in prevalence were explored by analyzing estimates for the seven GBD super-regions and for individual countries and territories. This analysis aimed to identify nations exhibiting particularly high or low prevalence rates in 2021, as well as those demonstrating the most pronounced changes (either increases or decreases) in prevalence over the three-decade span.

Trend analysis

We employed estimated annual percentage change (EAPC) to quantify the temporal trends in consumption of SSBs prevalence among young adults aged 15–39 years globally. The EAPC represents the average annual rate of change in prevalence over the study period [17]. Assuming a linear relationship between the natural logarithm of the prevalence rate (ln[prevalence]) and the calendar year, EAPC was calculated using linear regression models [18]. Specifically, the equation ln(prevalence) = α + β * year + σ was used, where β represents the regression coefficient and σ represents the error term. The EAPC was then derived using the formula: EAPC = 100 * (exp(β) − 1). The 95% confidence intervals (CIs) for the EAPCs were calculated based on the standard error of the regression coefficient β from the linear regression model. A 95% CI for the EAPC that does not span zero suggests a statistically significant change in prevalence over time. A negative EAPC indicates a declining trend, while a positive EAPC indicates an increasing trend [19]. We calculated EAPCs to assess overall global trends, as well as trends stratified by sex (female and male), SDI, GBD region, and individual country.

To further investigate the temporal patterns of consumption of SSBs prevalence and identify statistically significant changes in trends, we employed joinpoint regression analysis [20, 21]. This method models the trend as a series of joined linear segments, with each segment representing a period of constant percentage change. The points where the segments connect are referred to as “joinpoints” and indicate statistically significant shifts in the trend. For each segment, an annual percentage change (APC) was calculated using the formula: APC = [(yx+1 - yx) / yx] * 100 = (eβ1 − 1) * 100, where β1 is the slope of the regression line obtained from the equation ln(y) = β0 + β1x, with y representing the prevalence and x representing the year. Joinpoint regression analysis was conducted using Joinpoint software (Version 4.9.1.0; Statistical Research and Applications Branch, National Cancer Institute, https://surveillance.cancer.gov/joinpoint/) [22, 23]. The Joinpoint software identifies points where a statistically significant change in trend has occurred and calculates the APC for each segment along with its 95% CI. These CIs are derived from the regression model fitted to each segment, and an APC with a 95% CI not including zero is considered to indicate a statistically significant trend for that specific period.

Correlation analysis

To investigate the relationship between socioeconomic development and high SSB consumption patterns, we performed Spearman’s rank correlation analysis. This non-parametric method was used to assess the association between each country’s SDI in 2021 and both the prevalence of a “Diet high in sugar-sweetened beverages” in 2021 and the EAPC of this dietary habit from 1990 to 2021. Scatter plots were generated to visualize these correlations, with Spearman’s rank correlation coefficients (ρ) and corresponding p-values included to quantify the strength and statistical significance of the relationships.

Results

Global prevalence of high SSB consumption

The global prevalence of high SSB consumption among young adults aged 15–39 years increased significantly from 6.58% (95% UI, 5.19 to 7.27) in 1990 to 11.13% (95% UI, 9.03 to 12.03) in 2021 (Table 1). This corresponds to an increase in the number of young adults with high SSB consumption from an estimated 144,220,306 in 1990 to 331,098,302 in 2021. The EAPC in prevalence over this period was 1.95% (95% CI, 1.88 to 2.03) (Fig. 1; Table 1).

Table 1.

Global prevalence, estimated number, and estimated annual percentage change (EAPC) of high SSB consumption among young adults (15–39 years), 1990–2021, by gender, SDI, and GBD region

Group Prevalence (95% CI) Number (95% CI) EAPC (95% CI)
1990 year 2021 year 1990 year 2021 year
Global

6.58

(5.19 to 7.27)

11.13

(9.03 to 12.03)

144,220,306

(113754314 to 159343712)

331,098,302

(268626924 to 357871749)

1.95

(1.88 to 2.03)
Gender
Female

6.96

(5.34 to 7.85)

11.72

(9.4 to 12.96)

75,400,167

(57850128 to 85041856)

171,712,401

(137721550 to 189879925)

1.93

(1.85 to 2.01)
Male

6.2

(4.94 to 6.99)

10.54

(8.65 to 11.65)

68,724,658

(54758034 to 77481510)

159,122,868

(130589451 to 175880590)

1.98

(1.9 to 2.06)
SDI level
High-middle SDI

6.07

(4.72 to 6.69)

12.68

(10.2 to 14.51)

27,469,022

(21359767 to 30274754)

55,825,876

(44907250 to 63882765)

2.99

(2.75 to 3.22)
High SDI

16.65

(12.6 to 19.25)

30.83

(24.22 to 34.55)

57,769,581

(43717521 to 66790656)

108,904,137

(85554920 to 122044694)

2.03

(1.91 to 2.15)
Low-middle SDI

2.79

(2.32 to 3.15)

5.28

(4.44 to 5.97)

12,649,868

(10518887 to 14282109)

42,371,611

(35630673 to 47908810)

2.31

(2.18 to 2.43)
Low SDI

2.26

(1.74 to 2.76)

2.91

(2.39 to 3.38)

4,165,372

(3206968 to 5086915)

13,067,699

(10732578 to 15178290)

1.04

(0.85 to 1.24)
Middle SDI

4.63

(3.72 to 5.33)

10.17

(8.45 to 11.33)

34,846,867

(27997915 to 40115292)

94,325,741

(78372912 to 105084626)

2.86

(2.75 to 2.97)
Region
Andean Latin America

8.66

(6.31 to 11.54)

14.59

(11.46 to 17.89)

1,339,155

(975759 to 1784509)

3,950,906

(3103316 to 4844531)

1.91

(1.68 to 2.15)
Australasia

19.97

(14.62 to 25.36)

28.24

(20.77 to 34.73)

1,628,329

(1192097 to 2067823)

2,956,984

(2174807 to 3636545)

1.48

(1.29 to 1.67)
Caribbean

10.82

(7.92 to 14.01)

14.87

(11.46 to 18.47)

1,608,355

(1177280 to 2082537)

2,706,741

(2086029 to 3362038)

1.4

(1.23 to 1.57)
Central Asia

6.51

(4.87 to 8.37)

9.45

(6.98 to 12.12)

1,852,338

(1385697 to 2381577)

3,533,057

(2609602 to 4531285)

2.09

(1.5 to 2.69)
Central Europe

14.95

(11.54 to 17.85)

27.03

(20.57 to 31.04)

7,003,836

(5406306 to 8362440)

9,465,837

(7203561 to 10870128)

2.67

(2.41 to 2.92)
Central Latin America

17.65

(12.68 to 23.34)

24.53

(18.24 to 31.12)

12,049,169

(8656287 to 15933575)

24,815,181

(18452054 to 31481795)

1.04

(0.98 to 1.11)
Central Sub-Saharan Africa

5.67

(3.45 to 9.28)

4.19

(2.89 to 5.99)

1,177,216

(716296 to 1926731)

2,266,627

(1563377 to 3240357)

-0.79

(-1.28 to -0.3)
East Asia

1.32

(1 to 1.71)

6.59

(4.96 to 8.5)

7,467,323

(5657063 to 9673578)

31,569,266

(23760783 to 40719084)

6.23

(5.9 to 6.55)
Eastern Europe

5.62

(4.29 to 7.09)

8.6

(6.62 to 10.76)

4,820,191

(3679470 to 6080988)

5,690,904

(4380673 to 7120248)

2.33

(1.81 to 2.86)
Eastern Sub-Saharan Africa

2.39

(1.85 to 2.99)

3.58

(2.82 to 4.31)

1,694,267

(1311462 to 2119606)

6,271,637

(4940228 to 7550491)

1.63

(1.52 to 1.73)
High-income Asia Pacific

9.81

(7.58 to 12.28)

16.39

(13.3 to 19.78)

6,621,282

(5116139 to 8288415)

8,283,408

(6721740 to 9996693)

1.76

(1.61 to 1.91)
High-income North America

22.59

(16.06 to 28.57)

45.38

(34.72 to 54.64)

25,597,988

(18198481 to 32374259)

55,900,949

(42769523 to 67307797)

2.2

(1.86 to 2.55)
North Africa and Middle East

7.07

(5.87 to 8.26)

14.25

(11.63 to 16.26)

9,461,746

(7855792 to 11054317)

36,232,931

(29571157 to 41343681)

2.51

(2.43 to 2.6)
Oceania

4.83

(3.67 to 6.18)

4.74

(3.35 to 6.36)

128,303

(97489 to 164165)

267,071

(188753 to 358349)

-0.42

(-0.56 to -0.28)
South Asia

2.63

(2.17 to 3.01)

5.32

(4.54 to 6.12)

11,351,512

(9366077 to 12991655)

42,077,435

(35908187 to 48404869)

2.27

(2.14 to 2.41)
Southeast Asia

2.29

(1.83 to 2.66)

5.18

(4.15 to 5.87)

4,511,407

(3605185 to 5240324)

14,365,506

(11509044 to 16279057)

2.79

(2.71 to 2.88)
Southern Latin America

22.63

(16.17 to 27.58)

38.79

(27.44 to 44.96)

4,317,632

(3085113 to 5262054)

10,006,150

(7078339 to 11597744)

1.8

(1.64 to 1.97)
Southern Sub-Saharan Africa

7.9

(5.85 to 10.33)

12.12

(9.18 to 14.94)

1,707,609

(1264496 to 2232861)

4,125,166

(3124507 to 5084981)

1.78

(1.66 to 1.91)
Tropical Latin America

12.01

(8.37 to 15.58)

22.94

(17.03 to 29.25)

7,724,005

(5383008 to 10019984)

20,258,231

(15039132 to 25830570)

2.43

(2.28 to 2.58)
Western Europe

16.99

(13.17 to 19.08)

24.82

(18.7 to 27.84)

24,485,994

(18980609 to 27498103)

32,209,584

(24267494 to 36128719)

1.36

(1.28 to 1.43)
Western Sub-Saharan Africa

1.07

(0.82 to 1.37)

3.06

(2.25 to 4.06)

765,842

(586907 to 980564)

5,850,983

(4302193 to 7763068)

3.91

(3.58 to 4.24)
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Note: Data are presented as percentages with 95% uncertainty intervals (UI). EAPC represents the average annual percentage change in prevalence from 1990 to 2021. SDI represents the socio-demographic index. GBD refers to the Global Burden of Disease Study

Fig. 1.

Fig. 1

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Global prevalence and estimated annual percentage change (EAPC) of high SSB consumption among young adults (15–39 years), 1990 and 2021, by gender and SDI Level. A: Displays the prevalence of high SSB consumption in 1990 and 2021 and the EAPC for global and stratified by gender. B: Displays the prevalence of high SSB consumption in 1990 and 2021 and the EAPC for all SDI levels

Gender differences in high SSB consumption

Females consistently exhibited a higher prevalence of high SSB consumption compared to males in both 1990 and 2021. In 1990, the prevalence among females was 6.96% (95% UI, 5.34 to 7.85), representing an estimated 75,400,167 young women with high SSB consumption. In contrast, the prevalence among males was 6.20% (95% UI, 4.94 to 6.99), with an estimated 68,724,658 young men exhibiting high SSB consumption. By 2021, the prevalence had risen to 11.72% (95% UI, 9.40 to 12.96) for females, corresponding to an estimated 171,712,401 individuals. The prevalence among males reached 10.54% (95% UI, 8.65 to 11.65) in 2021, representing an estimated 159,122,868 young men with high SSB consumption. While the prevalence increased for both genders, the EAPC was slightly lower for females (1.93%, 95% CI 1.85 to 2.01) than for males (1.98%, 95% CI 1.90 to 2.06) (Fig. 1; Table 1).

Socioeconomic disparities in high SSB consumption

The prevalence of high SSB consumption among young adults aged 15–39 years varied significantly across SDI levels. As shown in Table 1, high SDI countries had the highest prevalence in both 1990 (16.65%, 95% UI 12.60 to 19.25) and 2021 (30.83%, 95% UI 24.22 to 34.55), corresponding to an estimated 57,769,581 and 108,904,137 young adults with high SSB consumption, respectively. The EAPC for high SDI countries from 1990 to 2021 was 2.03% (95% CI, 1.91 to 2.15). While high SDI countries had higher baseline prevalence, middle SDI countries experienced the most rapid annual increases in prevalence from 1990 to 2021 (EAPC 2.86%, 95% CI 2.75 to 2.97). In 1990, the prevalence in middle SDI countries was 4.63% (95% UI 3.72 to 5.33), with an estimated 34,846,867 young adults exhibiting high SSB consumption. By 2021, the prevalence had risen to 10.17% (95% UI 8.45 to 11.33), corresponding to an estimated 94,325,741 young adults. High-middle SDI countries showed a similar trend, with an EAPC of 2.99% (95% CI 2.75 to 3.22) from 1990 to 2021. The prevalence increased from 6.07% (95% UI 4.72 to 6.69) in 1990, representing an estimated 27,469,022 young adults, to 12.68% (95% UI 10.20 to 14.51) in 2021, corresponding to an estimated 55,825,876 young adults. Low-middle and low SDI countries had relatively lower prevalence rates and EAPCs compared to high and middle SDI countries. However, the prevalence in both groups still showed an upward trend over time (Fig. 1; Table 1).

Region disparities in high SSB consumption

The prevalence of high SSB consumption among young adults varied substantially across GBD regions, with distinct patterns of change observed over time. In 2021, high-income North America had the highest prevalence (45.38%, 95% UI 34.72 to 54.64), affecting an estimated 55,900,949 young adults, followed by Southern Latin America (38.79%, 95% UI 27.44 to 44.96) with 10,006,150 affected individuals, and Australasia (28.24%, 95% UI 20.77 to 34.73) with 2,956,984 young adults. East Asia exhibited the most significant increase in prevalence from 1990 to 2021 (EAPC 6.23%, 95% CI 5.90 to 6.55), with the number of affected young adults rising from an estimated 7,467,323 to 31,569,266. Western Sub-Saharan Africa also showed a substantial increase (EAPC 3.91%, 95% CI 3.58 to 4.24), with the number of affected individuals growing from 765,842 to 5,850,983. Central Sub-Saharan Africa and Oceania were the only regions to experience declines in prevalence, with EAPCs of -0.79% (95% CI -1.28 to -0.30) and − 0.42% (95% CI -0.56 to -0.28), respectively. These findings highlight the diverse regional landscape of high SSB consumption among young adults, with certain regions facing a more rapid escalation of this public health concern.

Country disparities in high SSB consumption

A detailed examination of high SSB consumption patterns among young adults across individual countries and territories revealed substantial geographical variation. The prevalence of this dietary habit varied considerably, reflecting the diverse sociocultural, economic, and environmental factors that influence dietary choices. A closer look at the top and bottom 5 countries within each GBD region in terms of both prevalence in 2021 and EAPC from 1990 to 2021 provides a more nuanced understanding of these variations (Supplementary table, Figs. 2, 3 and 4):

Fig. 2.

Fig. 2

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Global prevalence of high SSB consumption among young adults (15–39 years) in 1990. This map illustrates the geographical distribution of high SSB consumption prevalence among young adults aged 15–39 years in 1990. Darker shades of red indicate a higher prevalence, highlighting regional variations in the consumption of high-SSB beverages

Fig. 3.

Fig. 3

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Global prevalence of high SSB consumption among young adults (15–39 years) in 2021. This map illustrates the geographical distribution of high SSB consumption prevalence among young adults aged 15–39 years in 2021. Darker shades of red indicate a higher prevalence, highlighting regional variations in the consumption of high-SSB beverages

Fig. 4.

Fig. 4

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Estimated annual percentage change (EAPC) in the prevalence of high SSB consumption among young adults (15–39 years), 1990–2021. This map depicts the EAPC in high SSB consumption prevalence among young adults aged 15–39 years globally from 1990 to 2021. Warmer colors (red and orange) represent a higher EAPC, indicating a faster annual increase in prevalence, while cooler colors (yellow and green) indicate slower increases or declines

Central Europe, Eastern Europe, and Central Asia: In 2021, Poland (30.91%, 95% UI 22.81 to 38.43) and Romania (35.79%, 95% UI 26.37 to 44.02) had the highest prevalence of high SSB consumption among young adults in this region. Other countries with high prevalence included Georgia (7.44%, 95% UI 4.32 to 12.13), Slovenia (26.13%, 95% UI 17.09 to 36.24), and Bulgaria (24.89%, 95% UI 18.44 to 32.12). The most rapid increases in prevalence from 1990 to 2021 were observed inTurkmenistan (3.96%, 95% CI 3.47 to 4.46), Azerbaijan (4.79%, 95% CI 4.02 to 5.58), and Romania (4.22%, 95% CI 3.92 to 4.53). Conversely, the lowest prevalence rates in 2021 were found in Ukraine (3.35%, 95% UI 2.41 to 4.37), Belarus (4.83%, 95% UI 2.88 to 7.76), Republic of Moldova (3.35%, 95% UI 1.96 to 5.60), Tajikistan (2.03%, 95% UI 1.22 to 3.43), and Armenia (4.04%, 95% UI 2.57 to 6.18). Belarus had the lowest EAPC (0.48%, 95% CI -0.01 to 0.96), followed by Serbia (0.48%, 95% CI 0.19 to 0.78), Tajikistan (0.90%, 95% CI 0.44 to 1.37), and Ukraine (1.13%, 95% CI 0.43 to 1.84).

High Income: In 2021, the United States of America (48.14%, 95% UI 36.37 to 58.25) and Monaco (59.20%, 95% UI 41.42 to 74.46) had the highest prevalence of high SSB consumption, followed by Ireland (38.98%, 95% UI 27.93 to 48.23), Belgium (33.01%, 95% UI 23.19 to 40.56), and Australia (29.52%, 95% UI 21.18 to 36.89). The Republic of Korea (EAPC 4.86%, 95% CI 4.43 to 5.29) and Singapore (EAPC 2.90%, 95% CI 2.83 to 2.97) experienced the most significant increases in prevalence over the study period. In contrast, Japan (15.68%, 95% UI 11.41 to 19.97) and Republic of Korea (17.82%, 95% UI 13.20 to 23.33) had the lowest prevalence in 2021. The most substantial declines were observed in Cyprus (EAPC −0.54 %, 95% CI -0.74 to -0.33).

Latin America and Caribbean: In 2021, Argentina (41.52%, 95% UI 29.75 to 49.69) and Cuba (31.76%, 95% UI 20.13 to 45.49) had the highest prevalence of high SSB consumption in this region, followed by Uruguay (32.00%, 95% UI 21.62 to 41.14), Chile (33.49%, 95% UI 22.11 to 42.61), and United States Virgin Islands (28.68%, 95% UI 16.39 to 43.13). Peru (3.63%, 95% CI 3.35 to 3.90) exhibited the most substantial increases in prevalence. Haiti (3.57%, 95% UI 1.96 to 5.98) and Antigua and Barbuda (5.55%, 95% UI 3.11 to 9.15) had the lowest prevalence in 2021.

North Africa and Middle East: In 2021, Saudi Arabia (49.81%, 95% UI 36.88 to 63.13) and Qatar (33.76%, 95% UI 20.27 to 49.69) reported the highest prevalence of high SSB consumption in this region. Other countries with high prevalence included United Arab Emirates (31.44%, 95% UI 21.55 to 45.40), Kuwait (22.19%, 95% UI 13.04 to 33.39), and Bahrain (18.74%, 95% UI 10.74 to 30.43). Oman (EAPC 4.25%, 95% CI 3.85 to 4.66) and Morocco (EAPC 3.59%, 95% CI 3.41 to 3.76) showed the most significant increases in prevalence from 1990 to 2021. Yemen (1.53%, 95% UI 0.95 to 2.38), Palestine (2.02%, 95% UI 1.29 to 3.24), and Afghanistan (1.91%, 95% UI 1.19 to 3.15) had the lowest prevalence in 2021. The United Arab Emirates (EAPC − 0.34%, 95% CI -0.58 to -0.10) and Libya (EAPC − 0.36%, 95% CI -0.74 to 0.01) showed declines in prevalence over the study period.

South Asia: Nepal (1.52%, 95% UI 0.97 to 2.34) and Bhutan (1.67%, 95% UI 1.04 to 2.61) had the lowest prevalence of high SSB consumption among young adults in South Asia in 2021. India (EAPC 2.39%, 95% CI 2.19 to 2.59) experienced the most rapid increase in prevalence from 1990 to 2021.

Southeast Asia, East Asia, and Oceania: In 2021, Nauru (10.04%, 95% UI 5.47 to 16.14), Guam (37.70%, 95% UI 23.30 to 54.84), and Cook Islands (29.36%, 95% UI 15.79 to 45.47) had the highest prevalence of high SSB consumption in this region. Myanmar (EAPC 4.93%, 95% CI 4.64 to 5.21) and Viet Nam (EAPC 4.43%, 95% CI 4.19 to 4.66) exhibited the most rapid annual increases in prevalence from 1990 to 2021. Cambodia (3.10%, 95% UI 1.73 to 5.00) and Lao People’s Democratic Republic (3.58%, 95% UI 2.00 to 5.92) had the lowest prevalence in 2021. Northern Mariana Islands (EAPC − 0.52%, 95% CI -0.75 to -0.28) experienced declines in prevalence over the study period.

Sub-Saharan Africa: In 2021, Equatorial Guinea (19.84%, 95% UI 10.91 to 31.85), Gabon (13.25%, 95% UI 7.01 to 21.85), and South Africa (14.79%, 95% UI 10.97 to 18.50) had the highest prevalence of high SSB consumption. Equatorial Guinea (EAPC 8.88%, 95% CI 7.88 to 9.89) and Ghana (EAPC 6.21%, 95% CI 5.74 to 6.68) exhibited the most substantial increases in prevalence. Burundi (2.33%, 95% UI 1.37 to 3.77) and Gambia (2.26%, 95% UI 1.36 to 3.58) had the lowest prevalence in 2021. Democratic Republic of the Congo (EAPC − 2.15%, 95% CI -2.78 to -1.52) exhibited declines in prevalence.

Temporal patterns of high SSB consumption prevalence

Joinpoint regression analysis was employed to identify statistically significant changes in high SSB consumption prevalence trends over time. The analysis revealed fluctuations in the annual percentage change (APC) across various segments. Globally, the most rapid increase in prevalence was observed between 2005 and 2008, with an APC of 3.1% (95% CI 2.8 to 3.2). For females, the fastest growth occurred between 2004 and 2009, with an APC of 2.8% (95% CI 2.7 to 3.0). Similarly, the most rapid increase for males was also observed between 2004 and 2009, with an APC of 2.9% (95% CI 2.8 to 3.0) (Fig. 5A).

Fig. 5.

Fig. 5

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Temporal trends in the prevalence of high SSB consumption among young adults (15–39 years), 1990–2021, by gender and SDI Level. A: This panel illustrates the temporal trends in high SSB consumption prevalence among young adults globally, stratified by gender. Both males and females exhibit an overall increasing trend in prevalence over the study period, with some fluctuations in the rate of increase across different segments. B: This panel displays the temporal trends in high SSB consumption prevalence among young adults globally, stratified by SDI level. High SDI countries had the highest prevalence in both 1990 and 2021, while middle SDI countries experienced the most rapid increases over time. Low SDI countries showed relatively stable prevalence until 2005, after which an increasing trend is observed. All SDI groups show an overall upward trend, highlighting the persistent global challenge of high SSB consumption

Joinpoint regression analysis revealed varying temporal patterns in high SSB consumption prevalence among young adults across different SDI levels. High SDI countries showed an overall upward trend, with the most rapid increase occurring between 1995 and 2001 (APC 2.9%, 95% CI 2.9 to 3.0). High-middle SDI countries also experienced an overall increase, with the fastest growth observed between 2003 and 2009 (APC 5.1%, 95% CI 4.9 to 5.3). In contrast, low SDI countries initially experienced a decline in prevalence from 1990 to 1997 (APC − 0.9%, 95% CI -1.0 to -0.8) before showing a subsequent increase, with the most rapid growth occurring between 2005 and 2014 (APC 2.0%, 95% CI 2.0 to 2.1). Low-middle SDI countries and middle SDI countries both exhibited consistent increases in prevalence throughout the study period, with the fastest growth occurring between 2006 and 2012 (APC 3.6%, 95% CI 3.5 to 3.8) and 2003 and 2012 (APC 3.8%, 95% CI 3.8 to 3.9), respectively (Fig. 5B).

Correlation analysis

Spearman’s rank correlation analysis was conducted to investigate the relationship between socioeconomic development, as measured by a country’s SDI, and high SSB consumption patterns. Figure 6A illustrates the correlation between national SDI in 2021 and the prevalence of high SSB consumption among young adults in the same year. A strong positive correlation was observed (ρ = 0.78, p < 2.2e-16), indicating that countries with higher SDI scores tended to have higher prevalence rates of high SSB consumption. Figure 6B displays the correlation between national SDI in 2021 and the EAPC of high SSB consumption prevalence from 1990 to 2021. A weak negative correlation was found (ρ = -0.12, p = 0.089), suggesting that there was no statistically significant association between SDI and the rate of change in high SSB consumption prevalence over time.

Fig. 6.

Fig. 6

Open in a new tab

Correlation between SDI and high SSB consumption among young adults (15–39 years). Spearman’s rank correlation analysis was used to assess the association between national SDI in 2021 and both the prevalence of high SSB consumption in 2021 (A) and the estimated annual percentage change (EAPC) in prevalence from 1990 to 2021 (B). The blue line represents the regression line, and the shaded area indicates the 95% confidence interval. ρ represents Spearman’s rank correlation coefficient

Discussion

This study provides a comprehensive analysis of high SSB consumption prevalence among young adults aged 15–39 years from 1990 to 2021. Our analysis, utilizing data from the GBD Study 2021, revealed a significant global increase in prevalence, rising from 6.58% in 1990 to 11.13% in 2021. We observed a consistent gender disparity, with females exhibiting higher prevalence rates than males across both time points [5]. Furthermore, socioeconomic development emerged as a crucial factor, with high SDI countries displaying the highest prevalence in both 1990 and 2021. Notably, middle SDI countries, those undergoing rapid economic transitions, experienced the most rapid annual increases in prevalence [24, 25]. The study also revealed substantial regional variations in prevalence and temporal trends, highlighting the diverse global landscape of high SSB consumption among young adults.

Our findings align with previous research documenting the rising global prevalence of high SSB consumption and its association with socioeconomic factors [1, 5, 16]. However, our study provides a more granular analysis, focusing on a specific age group (15–39 years) crucial for future global health and highlighting the rapid increases in prevalence within middle SDI countries. This emphasis on a demographic undergoing significant lifestyle changes amid economic transitions offers valuable insights for targeted interventions and public health policies. Additionally, our analysis of temporal trends using joinpoint regression analysis reveals fluctuations in the rate of increase over time, providing a more nuanced understanding of the evolving patterns of high SSB consumption. This deeper analysis allows for a more precise assessment of the effectiveness of existing interventions and guides the development of more targeted strategies to mitigate this growing public health concern.

The global surge in high SSB consumption among young adults is a multifaceted phenomenon driven by a complex interplay of socioeconomic, cultural, lifestyle, and policy factors. Economic development and urbanization, while leading to rising incomes and greater access to SSBs [1, 26, 27] also drive shifts in dietary patterns towards increased consumption of processed foods and sugary drinks, often facilitated by transformed food environments with easy access to heavily marketed SSBs [28, 29]. Simultaneously, the globalization of Western dietary patterns [30] reinforced by pervasive marketing that portrays SSBs as desirable and modern [31] has normalized their consumption, particularly among young adults seeking social acceptance and conformity [32]. Moreover, increasingly sedentary lifestyles, characterized by reduced physical activity and increased screen time, contribute to an energy imbalance, weight gain, and unhealthy snacking behaviors, further fueling the demand for SSBs [33–35]. Compounding these challenges, the lack of effective regulatory policies, including comprehensive food labeling, restrictions on marketing to children, and disincentivizing taxation policies, allows SSBs to remain readily available and affordable, hindering efforts to curb consumption [36–38]. Addressing this complex issue necessitates a multi-pronged approach that combines public awareness campaigns, evidence-based policies, and efforts to create environments that support healthy dietary choices.

The consistent finding of higher high SSB consumption prevalence among females compared to males across various regions and time points suggests a complex interplay of biological and sociocultural factors contributing to this gender disparity. While biological factors such as hormonal differences, body fat distribution, and genetic predispositions may play a role in influencing taste preferences or metabolic responses to sugary drinks [39, 40] sociocultural factors likely exert a more substantial influence. Gender-specific dietary habits, shaped by social norms and cultural expectations, can contribute to differences in food choices. Furthermore, women often face greater pressure to conform to societal ideals of thinness, leading to restrictive dieting practices that may inadvertently increase cravings for sugary treats and beverages [41].

Disparities in high SSB consumption across different SDI levels reflect the influence of economic development, food environments, and cultural norms. High-income countries, characterized by greater purchasing power and more readily available SSBs [42] often exhibit higher prevalence rates. Conversely, low-income countries often face challenges related to food security and limited access to nutritious, affordable alternatives, potentially driving higher consumption of less expensive, albeit unhealthy, options like SSBs [43]. Moreover, cultural factors, such as the perceived social status associated with certain food and beverage choices, can influence consumption patterns, leading to variations across countries with different levels of socioeconomic development [44].

Regional variations in high SSB consumption are shaped by a complex interplay of dietary traditions, economic factors, and policy landscapes. Traditional dietary patterns and cultural preferences for certain flavors and beverages can influence SSB intake. Furthermore, economic development levels within a region can impact food environments, shaping the availability and affordability of both healthy and unhealthy options [45]. Lastly, policy contexts, including regulations on SSB marketing and sales, taxation policies, and public awareness campaigns, play a crucial role in shaping consumption behaviors and can contribute to regional variations in prevalence [37].

The high and rising prevalence of high SSB consumption among young adults poses a significant threat to global public health, carrying profound consequences for both individual well-being and healthcare systems. Excessive SSB intake is strongly linked to a range of adverse health outcomes, including obesity, type 2 diabetes, cardiovascular disease, and dental caries, contributing to increased morbidity, mortality, and reduced quality of life [4, 46]. This escalating burden of diet-related chronic diseases associated with high SSB consumption translates to increased healthcare costs, reduced workforce productivity, and substantial economic losses for societies [47, 48]. Addressing this public health challenge requires comprehensive, multi-sectoral strategies tailored to different populations and contexts. Effective interventions include educational campaigns to raise awareness of the health risks associated with high SSB consumption, fiscal policies such as taxation to disincentivize consumption [37] clear and compelling warning labels on SSB products, and improvements to food environments that promote access to healthy, affordable alternatives [49]. Implementing these interventions, however, is often met with challenges, including industry opposition, consumer resistance to policy changes, and the need for culturally sensitive and contextually appropriate approaches [50].

Our findings underscore the urgent need for robust, multi-pronged strategies to curb the rising SSB consumption among young adults. Governments could strengthen fiscal policies, such as tiered SSB taxation based on sugar content [51] and implement stricter regulations on SSB marketing, particularly towards youth [52]. Clear front-of-pack labeling [53] and restricting SSB availability in schools and public institutions are also crucial [54]. Health organizations should intensify targeted health education campaigns, leveraging digital platforms popular among young adults, and integrate SSB consumption screening and brief counseling into routine healthcare. Community-led initiatives promoting access to free drinking water and healthier beverage options can create supportive environments. Special attention is warranted for populations in middle-SDI countries, which demonstrated the most rapid increases in SSB consumption. Policies in these regions should proactively address the shifting dietary patterns driven by urbanization and increased SSB availability, learning from global best practices [55]. Interventions must be equitable, ensuring that vulnerable groups are not disproportionately affected and have access to affordable healthy alternatives. Addressing this global challenge effectively requires a coordinated, multi-sectoral approach.

Strengths and limitations

This study benefits from several strengths, including its comprehensive global scope, utilization of a large and robust dataset from the GBD Study 2021, and robust statistical analysis using joinpoint regression and Spearman’s correlation. The focus on young adults, a demographic often overlooked in SSB research, provides valuable insights into the trends shaping future global health. However, the study also has limitations. The reliance on secondary data from the GBD Study means that we are limited by the data collection methods and definitions used in that study. We cannot account for potential variations in SSB consumption within countries or over shorter time periods. Furthermore, while we have explored associations with SDI, we cannot establish causal relationships between socioeconomic factors and high SSB consumption. Future research could delve into more nuanced individual-level data, exploring cultural preferences, marketing influences, and the impact of specific policy interventions on consumption patterns.

Conclusion

In conclusion, this study highlights the alarmingly high and rising prevalence of high SSB consumption among young adults globally, with significant variations across gender, socioeconomic development levels, and geographical regions. Our findings underscore the urgent need for comprehensive and tailored interventions to curb this trend and mitigate the associated health risks. Addressing the complex interplay of socioeconomic, cultural, lifestyle, and policy factors driving high SSB consumption requires collaborative efforts from governments, public health agencies, healthcare providers, and communities worldwide. Implementing evidence-based strategies such as taxation, marketing restrictions, clear warning labels, and promotion of healthy alternatives, coupled with sustained public awareness campaigns, is crucial to create supportive environments that empower individuals to make healthier beverage choices and improve overall dietary patterns. Failure to address this growing public health challenge will have profound consequences for the health and well-being of individuals and the sustainability of healthcare systems globally.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1 (203KB, doc)

Author contributions

Dr. Ge and Dr. He had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The study was conceptualized and designed by Ge and He. Acquisition, analysis, or interpretation of data was performed by He, Ge, Xiong, Zhu, and Hong. The manuscript was drafted by Ge, Xiong, Zhu, Hong, and He, and underwent critical revision for important intellectual content by He, Ge, Xiong, Zhu, and Hong. Statistical analysis was conducted by Ge, Xiong, Zhu, and Hong. Administrative, technical, or material support was provided by He and Ge.

Funding

No funding.

Data availability

Data used in the analyses can be obtained from the Global Health Data Exchange Global Burden of Disease Results Tool (https://ghdx.healthdata.org/gbd-results-tool).

Declarations

Ethical approval

Not required.

Dissemination to participants and related patient and public communities

The research findings will be disseminated to the wider community by press releases, social media platforms such as WeChat, presentations at international fora, reports to relevant government agencies, and academic societies.

Conflict of interest

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare no financial relationships with any organizations that might have an interest in the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1 (203KB, doc)

Data Availability Statement

Data used in the analyses can be obtained from the Global Health Data Exchange Global Burden of Disease Results Tool (https://ghdx.healthdata.org/gbd-results-tool).

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