title: Gradual reduction of sugar in soft drinks without substitution as a strategy to reduce overweight, obesity, and type 2 diabetes: a modelling study.
abstract: BACKGROUND
  Sugar-sweetened beverages are a major source of free sugar intake in both children and adults, and are an important contributor to obesity and obesity-related diseases, including type 2 diabetes. We proposed an incremental and stepwise reduction in free sugars added to sugar-sweetened beverages by 40% over 5 years without the use of artificial sweeteners and assessed the effect of the proposed strategy on energy intake and weight status.
  
  
  METHODS
  In this modelling study, we used nationally representative data from the National Diet and Nutrition Survey rolling programme (NDNS RP) from 2008-12 and British Soft Drinks Association annual reports to calculate sugar-sweetened beverage consumption (both with and without fruit juices) and its contribution to free sugar and energy intake in the UK population. We then estimated the predicted reduction in energy intake resulting from the proposed strategy at an individual level. We further predicted the reduction in steady-state bodyweight for each adult using a weight loss model. By scaling up the distribution of the predicted bodyweight in the NDNS RP to the UK adult population, we estimated reductions in the number of overweight and obese adults, and the number of adults with type 2 diabetes.
  
  
  RESULTS
  A 40% reduction in free sugars added to sugar-sweetened beverages over 5 years would lead to an average reduction in energy intake of 38·4 kcal per day (95% CI 36·3-40·7) by the end of the fifth year. This would lead to an average reduction in steady-state bodyweight of 1·20 kg (1·12-1·28) in adults, resulting in a reduction in the prevalence in adults of overweight by 1·0 percentage point (from 35·5% to 34·5%) and obesity by 2·1 percentage points (from 27·8% to 25·7%). This reduction would lead to a reduction of roughly 0·5 million adults from being overweight and 1 million adults from being obese, which in turn would prevent about 274,000-309,000 incident cases of obesity-related type 2 diabetes over the two decades after the predicted reduction in bodyweight is achieved. If fruit juices were excluded from the category of sugar-sweetened beverages (because of potential challenges for reformulation), the corresponding reductions in energy intake and steady-state bodyweight would be 31·0 kcal per day (95% CI 28·6-33·7) and 0·96 kg (0·88-1·04), respectively. These reductions would result in a 0·7 percentage point (0·3 million) reduction in overweight and a 1·7 percentage point (0·8 million) reduction in obesity, which would in turn prevent about 221,000-250,000 cases of type 2 diabetes over two decades after the predicted reduction in bodyweight is achieved. The predicted effect was greater in adolescents, young adults, and individuals from low-income families (who consume more sugar-sweetened beverages).
  
  
  CONCLUSIONS
  An incremental reduction in free sugars added to sugar-sweetened beverages without the use of artificial sweeteners is predicted to reduce the prevalence of overweight, obesity, and type 2 diabetes. The proposed strategy should be implemented immediately, and could be used in combination with other approaches, such as taxation policies, to produce a more powerful effect.
  
  
  BACKGROUND
  None.
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Beijing, China. Electronic address: mayuanpku@gmail.com.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Feng J
authors.initials: FJ
authors.lastname: He
authors.affiliation: Department of Probability and Statistics, School of Mathematical Sciences, Peking University Beijing, China.
authors.forename: Yunjian
authors.initials: Y
authors.lastname: Yin
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Kawther M
authors.initials: KM
authors.lastname: Hashem
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Graham A
authors.initials: GA
authors.lastname: MacGregor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002253:Carbonated Beverages; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D019422:Dietary Sucrose / Q000008:administration & dosage*; D002149:Energy Intake; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009765:Obesity / Q000628:therapy*; D055815:Young Adult
chemical_list: D019422:Dietary Sucrose