Consumption patterns

• United States: SSBs are the leading source of added sugar for many age groups. In 2017–2018 the average daily intake of added sugars among U.S. adults was roughly 17 teaspoons (≈68 g)/day, and children and adolescents also average high intakes; SSBs contribute a large fraction of that total.
• Per-capita SSB purchases across U.S. states vary; recent estimates place annual per-capita purchases in the range of ~30–40+ gallons per year in many states, reflecting continued high exposure.
• Global trends: SSB consumption has risen in many middle-income countries and remains a major contributor to the global burden of dietary risk.

Soft drinks promote weight gain?

Liquid calories from soft drinks are poorly compensated for at later meals: people rarely eat less after drinking sugary beverages, so SSBs add energy rather than replace other calories. Meta-analyses and cohort studies show a positive dose–response relationship between SSB intake and weight gain, increased BMI, and obesity risk in children and adults.

Cardiometabolic disease

Multiple prospective cohort studies and meta-analyses report that regular consumption of SSBs increases risk of developing type 2 diabetes, independently of baseline BMI (though BMI mediates part of the risk). A pooled analysis suggested ~25–30% higher risk of type 2 diabetes for people consuming ≥1 serving/day compared with non-consumers.

For cardiovascular disease (CVD), evidence links ≥1 serving/day of SSBs with increased risk of coronary heart disease, stroke and CVD mortality in dose-response fashion; a recent systematic review concluded that habitual SSB intake is associated with CVD outcomes.

Nonalcoholic fatty liver disease (NAFLD)

Fructose — a major component of added sugars in many soft drinks — is metabolized primarily by the liver. High doses of fructose can increase de novo lipogenesis (fat synthesis) in hepatocytes, contributing to hepatic fat accumulation and insulin resistance. Epidemiologic and clinical data link frequent soft drink consumption to higher odds of NAFLD, and experimental models show fructose-driven liver injury pathways.

Dental caries and oral health

The role of free sugars — especially in liquids that bathe teeth repeatedly — in dental caries is well established. WHO guidance recommends limiting free sugars to <10% of energy (ideally <5%) and recommends children under two avoid any sugar-sweetened beverages. Frequent SSB use in infancy and early childhood is strongly associated with increased caries by school age.

Gout

Fructose metabolism increases purine turnover and uric acid production. Large prospective studies in both men and women have shown that frequent soft drink consumption (and other fructose-rich beverages) is associated with higher incidence of gout and with higher serum uric acid levels.

Dental-nutritional displacement

Regular consumption of soft drinks can displace milk and other nutrient-rich beverages, reducing intake of dietary calcium, vitamin D, and other micronutrients — a particular concern in children and adolescents during bone development. Observational cohorts have shown inverse associations between SSB intake and milk consumption, which may influence bone health and overall nutrient adequacy.

Mechanisms of harm

Key mechanisms include:

• Rapid caloric delivery with poor satiety → positive energy balance and weight gain.
• High fructose load to the liver → increased de novo lipogenesis, insulin resistance, NAFLD
• Glycemic variability and oxidative stress → endothelial dysfunction and CVD risk.
• Promotion of cariogenic oral environment
• Fructose-induced uric acid production.