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Epidemiology and Population Health

Sugar-sweetened beverage intake and relative weight gain among South African adults living in resource-poor communities: longitudinal data from the STOP-SA study



This study examines the prospective association between sugar-sweetened beverages (SSB) consumption and change in body weight over a 4–5-year period in a socio-economically disadvantaged South African population.


This is a longitudinal study involving 800 adults (212 men, 588 women); 247 from the original METS (Modelling the Epidemiological Transition Study) cohort (N = 504) and 553 of the original 949 members of the PURE (Prospective Urban and Rural Epidemiology) Study. Both cohorts were drawn from low-income, socio-economically disadvantaged communities. Mean follow-up duration and age were 4.5 (SD 0.45) and 50.0 (SD 11.8) years, respectively. Harmonised measurements included body mass index, self-reported moderate-to-vigorous physical activity, and intake of meat, snacks and ‘take-aways’, fruits and vegetables and SSB (in servings/week). Multivariate logistic regression models were developed to determine the extent to which SSB consumption predicted relative weight gain, after controlling for potential confounders and known predictors.


Nearly a third (29%) of participants had a relative weight change ≥5.0%; higher in the non-obese compared to the obese group (32% vs. 25%; p = 0.026). The average SSB consumption was 9.9 servings/week and was higher in the food insecure compared to the food secure group (11.5 vs. 9.0 servings/week; p = 0.006); but there were no differences between women and men (10.3 vs. 9.1 servings/week; p = 0.054). Mean SSB consumption was higher in the group who gained ≥5% weight compared to those who did not (11.0 vs. 8.7; p = 0.004). After adjustment, SSB consumption of 10 or more servings/week was associated with a 50% greater odds of gaining at least 5% body weight (AOR: 1.50, 95% CI (1.05–2.18)).


These results show that higher intake of SSB predicts weight gain in a sample of South Africans drawn from low-income settings. Comprehensive, population-wide interventions are needed to reduce SSB consumption in these settings.

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Data availability

All the data contained within the manuscript are available from the corresponding author upon reasonable request.


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The authors would like to acknowledge the research teams, research assistants and the participants of the PURE Study and METS. The Division of Exercise Science and Sports Medicine of Department of Human Biology, University of Cape Town, the School of Public Health, University of the Western Cape, and the National Research Foundation (NRF) that funded the study. METS is funded in part by the National Institute of Health (1R01DK80763), and the PURE study is funded in part by the Population Health Research Institute (McMaster University, Hamilton, Canada), NRF and Medical Research Council of South Africa. Opinions, findings, conclusions and recommendations expressed in this paper are those of the authors and the funders accept no liability whatsoever in this regard. We also acknowledged Tolu Oni of the Department of Public Health and Family Medicine, University of Cape Town for supporting the use of part of data for this study for sugar tax advocacy.

Author contributions

EVL conceptualised the study; EVL, AL, OA, LD, NL, TP, KJO, KB and TP designed the study, KJO and EVL harmonised the datasets, KJO, EVL, FO involved in data analyses, interpretation and writing of the manuscript. RVD, FO, LM, TK-A, KB, SW and HD were involved in the development and or reviewing of the manuscript draughts.

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Correspondence to E. V. Lambert.

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