Taxation of beverages as strategy against heart disease

The recent decision of the Federal Government of Nigeria to introduce 10% taxation on sugar-sweetened beverages has generated a lot of controversies, comments and reactions from the wider population including the manufacturers of high sugar beverages. Some have expressed the view that it is an anti-people policy that is meant to bring hardship to an average Nigerian.

Unfortunately, the positive side of this policy from the health perspective, especially cardiovascular disease (CVD) which is one of the Non-Communicable Diseases (NCDs), has not been given the importance that it deserves which is the focus of this article.

In Nigeria, the six main Non-Communicable Diseases (NCDs) are cardiovascular disease (heart disease), diabetes, cancer, chronic respiratory disease, sickle cell disease and mental health. Cardiovascular disease remains the leading cause of death and a major cause of illness and disability in Nigeria. While CVD has the highest occurrence in adults, hypertension is the number one cause of CVD. It was reported by the World Health Organization (WHO) in 2014 that no fewer than 38.1 percent (76.2 million) Nigerians lived with hypertension while 5.77% (11.2 million) were living with diabetes mellitus. According to WHO, Nigeria, in the last couple of years has been undergoing epidemiological changes with a significant increase in NCD risk factors which include unhealthy diet, tobacco, physical inactivity, alcohol, obesity, air and noise pollution. Obesity is one of the gravest public health challenges facing the world today, Nigeria inclusive. Overweight and obesity are major risk factors for several NCDs including hypertension, coronary heart disease (CHD), diabetes and cancers. In 2014, NCDs caused 24% of total deaths in Nigeria of which cardiovascular disease accounted for 7% while cancer and diabetes accounted for 3% and 2% respectively.

Many of the drivers of the high prevalence of NCDs are diet-related and the evidence points to poor dietary habits throughout the life-course, beginning in the womb and continuing throughout adulthood. Lately, the evidence on the links between diet and CVD has been strengthened from various global studies which have called for an urgent need to shift national policy towards a cardiovascular health-promoting diet to align with public health priorities. One of the dietary habits found to significantly contribute to the risk of developing obesity, diabetes and heart disease is the consumption of sweetened sugar beverages (SSB). SSB are non-alcoholic beverages that contain caloric sweeteners such as sucrose (sugar) or high–fructose corn syrup. The main categories of SSBs are carbonated soft drinks, energy drinks, sports drinks, less than 100 percent fruit or vegetable juices, ready-to-drink teas and coffees, sweetened waters, and milk-based drinks. The above-listed products as well as sweets, candies, cakes, and cookies, are major contributors to free sugar consumption. Limiting consumption of such food products as much as possible is highly desirable, especially for those struggling to maintain a healthy weight and lifestyle. Therefore, limiting free sugars consumption as much as possible would have a beneficial impact on the cardiovascular health of the population.

Epidemiological studies have shown that individuals who consume a higher amount of added sugar than the recommended less than 10 percent of the total calories (WHO), especially sugar from sugar-sweetened beverages (SSBs), tend to gain more weight and have a higher risk of obesity, type 2 diabetes mellitus, dyslipidemias, hypertension and cardiovascular disease. Results from these studies seem to suggest that the risk of hypertension may increase with increased long-term consumption of SSBs while lowering intake of sugars may lower blood pressure, especially when the blood pressure is managed over a long period of time. The effects have been found to be most evident when sugars are consumed in excess and accompanied by weight gain. Evidence suggests that the increased risk is mainly associated with fructose-containing sugars, especially the associated cardio-metabolic disturbances such as the cluster of risk factors representing the metabolic syndrome (abdominal obesity, atherogenic, dyslipidemia, raised blood pressure, insulin resistance with or without glucose intolerance), pro-inflammatory state, and a pro-thrombotic state.

The rising obesity, hypertension and diabetes epidemics in Nigeria are significant public health problems that will impose a heavy health and economic burden on the Nigerian population in addition to the double-burden of disease in Nigeria. Excess SSB consumption generates both personal cost that individual consumer imposes on themselves through increasing the risk of acquiring NCDs in the future; and costs that consumers impose on others essentially in the form of public health care cost and lost productivity. A window of opportunity for intervention is to harness the link between sugar-sweetened beverage (SSB) consumption with obesity and (NCDs).

To be continued tomorrow
Dr. Akinroye is the executive director of, Nigerian Heart Foundation.