Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Epidemiology and Population Health

Mortality attributable to sugar sweetened beverages consumption in Mexico: an update



In 2010, sugar sweetened beverages (SSBs) were estimated to cause 12% of all diabetes, cardiovascular disease (CVD) and obesity-related cancer deaths in Mexico. Using new risk estimates for SSBs consumption, we aimed to update the fraction of Mexican mortality attributable to SSBs, and provide subnational estimates by region, age, and sex.


We used an established comparative risk assessment framework. All-cause mortality estimates were calculated from a recent pooled cohort analysis. Age- and sex-specific relative risks for SSBs-disease relationships were obtained from updated meta-analyses. Demographics and nationally representative estimates of SSBs intake were derived from the National Health and Nutrition Survey 2012; and mortality rates, from the National Institute of Statistics and Geography. Attributable mortality was calculated by estimating the population attributable fraction of each disease, with uncertainty in data inputs propagated through Monte Carlo probabilistic sensitivity analyses.


In Mexican adults 20 years and older, 6.9% (95%UI: 5.4–8.5) of all cause-mortality was attributable to SSBs, representing 40,842 excess deaths/year (95%UI: 31,950–50,138). Furthermore, 19% of diabetes, CVD and obesity-related cancer mortality was attributable to SSBs (95%UI: 11.0–26.5), representing 37,000 excess deaths/year (95%UI 21,240–51,045). Of these, 35.6% were diabetes-related (95%UI 16.4–52.0). Proportional burden was highest in the South (22.8%), followed by the Center (18.0%) and North (17.4%). Men aged 45–64-years in the Center region had highest proportional mortality (37.2%), followed by 20–44-year-old men living in the South (35.7%) and both men and women aged 20–44 living in the Center (34.4%).


Utilizing current evidence linking SSBs to cardiometabolic disease and obesity-related cancers, earlier estimates of Mexican mortality attributable to SSBs could have been underestimated. Mexico urgently needs stronger policies to reduce SSBs consumption and reduce these burdens.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    Malik VS, Popkin BM, Bray GA, Despres JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010;121:1356–64.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Singh GM, Micha R, Khatibzadeh S, Lim S, Ezzati M, Mozaffarian D, et al. Estimated global, regional, and national disease burdens related to sugar-sweetened beverage consumption in 2010. Circulation. 2015;132:639–66.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Hu FB, Malik VS. Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence. Physiol Behav. 2010;100:47–54.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Imamura F, O'Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. Brit Med J. 2015;351:h3576.

    PubMed  Google Scholar 

  5. 5.

    Micha R, Shulkin ML, Penalvo JL, Khatibzadeh S, Singh GM, Rao M, et al. Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: Systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE). PLoS ONE 2017;12:e0175149.

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Xi B, Huang Y, Reilly KH, Li S, Zheng R, Barrio-Lopez MT, et al. Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis. Br J Nutr. 2015;113:709–17.

    CAS  PubMed  Google Scholar 

  7. 7.

    Institute for Health Metrics and Evaluation. Global burden of diseases, risk factors, and injuries 2010 study. USA: University of Washington; 2010.

  8. 8.

    WHO. Guideline: sugars intake for adults and children. Geneva: WHO; 2015.

  9. 9.

    Euromonitor International. Euromonitor international’s passport global market. UK: Euromonitor International; 2012.

  10. 10.

    Singh GM, Micha R, Khatibzadeh S, Shi P, Lim S, Andrews KG, et al. Global, regional, and national consumption of sugar-sweetened beverages, fruit juices, and milk: a systematic assessment of beverage intake in 187 countries. PLoS ONE 2015;10:e0124845.

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Sanchez-Pimienta TG, Batis C, Lutter CK, Rivera JA. Sugar-sweetened beverages are the main sources of added sugar intake in the mexican population. J Nutr. 2016;146:1888S–96S.

    CAS  PubMed  Google Scholar 

  12. 12.

    Aburto TC, Pedraza LS, Sanchez-Pimienta TG, Batis C, Rivera JA. Discretionary foods have a high contribution and fruit, vegetables, and legumes have a low contribution to the total energy intake of the Mexican population. J Nutr. 2016;146:1881S–7S.

    CAS  PubMed  Google Scholar 

  13. 13.

    Rojas-Martinez R, Basto-Abreu A, Aguilar-Salinas CA, Zarate-Rojas E, Villalpando S, Barrientos-Gutierrez T. Prevalence of previously diagnosed diabetes mellitus in Mexico. Salud Publica Mex. 2018;60:224–32.

    PubMed  Google Scholar 

  14. 14.

    Secretaria de Salud. Dirección General de Evaluación del Demespeño Informe sobre la Salud de los Mexicanos. Mexico: Secretaria de Salud; 2015.

  15. 15.

    Romero-Martinez M, Shamah-Levi T, Franco-Nuñez A, Villalpando-Hernandez S, Cuevas-Nasu L, Gutierrez JP, et al. National Health and Nutrition Survey 2012 design and coverage. Salud Pública Mex. 2013;55:s332–s40.

    PubMed  Google Scholar 

  16. 16.

    Cámara de Diputados del Honorable Congreso de la Union. Ley del impuesto especial sobre producción y servicios. Mexico: Diario Oficial de la Federación; 2016.

  17. 17.

    Geografía INdEy. Estadística de defunciones generales. Síntesis metodológica. 2014.

  18. 18.

    Malik VS, Li Y, Pan A, De Koning L, Schernhammer E, Willett WC, et al. Long-term consumption of sugar-sweetened and artificially sweetened beverages and risk of mortality in US adults. Circulation. 2019;139:2113–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Khatibzadeh S, Micha R, Afshin A, Rao M, Yakoob MY, Dariush M. Abstract: Major dietary risk factors for chronic diseases: a systematic review of the current evidence for causal effects and effect sizes. Circulation. 2012;125(Suppl10):AP060.

    Google Scholar 

  20. 20.

    Luger M, Lafontan M, Bes-Rastrollo M, Winzer E, Yumuk V, Farpour-Lambert N. Sugar-sweetened beverages and weight gain in children and adults: a systematic review from 2013 to 2015 and a comparison with previous studies. Obesity Facts. 2017;10:674–93.

    PubMed  PubMed Central  Google Scholar 

  21. 21.

    Singh GM, Danaei G, Farzadfar F, Stevens GA, Woodward M, Wormser D, et al. The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS ONE 2013;8:e65174.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78.

    PubMed  Google Scholar 

  23. 23.

    Taguri M, Matsuyama Y, Ohashi Y, Harada A, Ueshima H. Doubly robust estimation of the generalized impact fraction. Biostatistics. 2012;13:455–67.

    PubMed  Google Scholar 

  24. 24.

    Zepeda-Tello R, Camacho-Garcia-Formenti D. Pifpaf: potential impact fraction and population attributable fraction for cross-sectional data. CRAN R Package Documentation. 2017.

  25. 25.

    Simin Liu JoAnnE, Manson JulieE, Buring MeirJ, Stampfer WalterC, Willett, Ridker PM. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002;75:492–8.

    PubMed  Google Scholar 

  26. 26.

    Collaboration TGBoMRFfCD. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2014;2:634–47.

    Google Scholar 

  27. 27.

    López-Olmedo N, Popkin BM, Taillie LS. The socioeconomic disparities in intakes and purchases of less-healthy foods and beverages have changed over time in urban Mexico. J Nutr. 2018;148:109–16.

    PubMed  PubMed Central  Google Scholar 

  28. 28.

    Gómez-Dantés H, Fullman N, Lamadrid-Figueroa H, Cahuana-Hurtado L, Darney B, Avila-Burgos L, et al. Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2016;388:2386–402.

    PubMed  Google Scholar 

  29. 29.

    Salud Sd. Estrategia Nacional para la Prevención y el Control del Sobrepeso, la Obesidad y la Diabetes. Mexico City: Salud Sd; 2013.

  30. 30.

    Colchero MA, Rivera-Dommarco J, Popkin BM, Ng SW. In Mexico, evidence of sustained consumer response two years after implementing a sugar-sweetened beverage tax. Health Affairs.2017;36:564–71.

    PubMed  Google Scholar 

  31. 31.

    Colchero MA, Zavala JA, Batis C, Shamah-Levy T, Rivera-Dommarco JA. Changes in prices of taxed sugar-sweetened beverages and nonessential energy dense food in rural and semi-rural areas in Mexico. Salud Publica Mex. 2017;59:137–46.

    PubMed  Google Scholar 

  32. 32.

    Barrientos-Gutierrez T, Zepeda-Tello R, Rodrigues ER, Colchero MA, Rojas-Martinez R, Lazcano-Ponce E, et al. Expected population weight and diabetes impact of the 1-peso-per-litre tax to sugar sweetened beverages in Mexico. PLoS ONE 2017;12:e0176336.

    PubMed  PubMed Central  Google Scholar 

  33. 33.

    Barrientos-Gutiérrez T, Colchero MA, Sánchez-Romero LM, Batis C, Rivera-Dommarco J. Posicionamiento sobre los impuestos a alimentos no básicos densamente energéticos y bebidas azucaradas. Salud Pública de México; 2018. vol. 60, p. 586.

  34. 34.

    Basto-Abreu A, Braverman-Bronstein A, Camacho-Garcia-Formenti D, Zepeda-Tello R, Popkin BM, Rivera-Dommarco J, et al. Expected changes in obesity after reformulation to reduce added sugars in beverages: a modeling study. PLoS Med. 2018;15:e1002664.

    PubMed  PubMed Central  Google Scholar 

  35. 35.

    Kaufer-Horwitz M, Tolentino-Mayo L, Jáuregui A, Sánchez-Bazán K, Bourges H, Martínez S, et al. Sistema de etiquetado frontal de alimentos y bebidas para México: una estrategia para la toma de decisiones saludables. Salud Pública de México. 2018;60:479.

    PubMed  Google Scholar 

  36. 36.

    Pérez-Ferrer C, Barrientos-Gutierrez T, Rivera-Dommarco JA, Prado-Galbarro FJ, Jiménez-Aguilar A, Morales-Ruán C. et al. Compliance with nutrition standards in Mexican schools and their effectiveness: a repeated cross-sectional study. BMC Public Health. 2018;18:1411.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    Murray CJL, Dias RH, Kulkarni SC, Lozano R, Stevens GA, Ezzati M. Improving the comparability of diabetes mortality statistics in the United States and Mexico. Diabetes Care. 2008;31:451–8.

    PubMed  Google Scholar 

  38. 38.

    Hu H, Huff CD, Yamamura Y, Wu X, Strom SS. The relationship between native american ancestry, body mass index and diabetes risk among Mexican-Americans. PLoS ONE 2015;10:e0141260.

    PubMed  PubMed Central  Google Scholar 

  39. 39.

    Yikyung Park KWD, Kipnis V, Thompson FE, Potischman N, Schoeller DA, Baer DJ, et al. Comparison of self-reported dietary intakes from the automated self-administered 24-h recall, 4-d food records, and food-frequency questionnaires against recovery biomarkers. Am J Clin Nutr. 2018;107:80–93.

    PubMed  PubMed Central  Google Scholar 

Download references


This paper was funded by the Bloomberg Philanthropies and supported by a grant from the Bill & Melinda Gates Foundation (PI Mozaffarian), and from the National Heart, Lung, and Blood Institute (grant number R00HL124321). Tonatiuh Barrientos was supported by the Lown Scholars program from Harvard University.

Author information



Corresponding author

Correspondence to Tonatiuh Barrientos-Gutierrez.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

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

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Braverman-Bronstein, A., Camacho-García-Formentí, D., Zepeda-Tello, R. et al. Mortality attributable to sugar sweetened beverages consumption in Mexico: an update. Int J Obes 44, 1341–1349 (2020).

Download citation

Further reading


Quick links