Sugar-sweetened Beverages

IADR and AADOCR support the following recommendations:

Position Statement on Sugar Sweetened Beverages

Background and Objective

A substantial body of evidence has demonstrated that sugar-sweetened beverages (SSBs) are globally consumed across different age groups^1,2,3 and represent a common risk to a wide range of noncommunicable diseases including oral disorders e.g. dental caries⁴ and erosion⁵. SSB consumption has also been linked to a higher burden of disability-adjusted life years (DALYs), and premature mortality^3,6. Thereby, highlighting the urgency of the issue, governments, civil society organizations, and health professionals must lead and implement strategies to address this public health issue. This IADR and AADOCR statement reviews the current evidence and outlines policy recommendations to guide these efforts.

Definition of SSB

Based on scientific research and international guidelines, IADR and AADOCR define SSBs as beverages sweetened with added sugars* (e.g. sucrose, high-fructose corn syrup, or fruit juice concentrates) such as regular sodas, fruit juices, sports drinks, energy drinks, vitamin water beverages, and coffee and tea beverages^3,7-9. This definition excludes 100% fruit and vegetable juices as well as non-caloric artificially sweetened beverages**.

Prevalence of SSB Consumption

SSBs are consumed above recommended daily limits of free sugars in many high-income countries, and their consumption is rapidly increasing in low- and middle-income countries^3,6,10,11. The highest levels of consumption are found in Latin America and the Caribbean followed by high income countries². Among all risk factors for diseases, SSBs are the only behavioral risk factor with an annual increase in exposure greater than 1% in the 21st century¹².
Consumption of SSBs begins in infancy across diverse regions, reaching an average frequency of twice daily by 12 months of age and four times daily by 24 months^13,14. Based on the Global Dietary Database, which included 185 countries, SSB consumption among children and adolescents aged 3–19 years increased worldwide by 23% between 1990 and 2018^3,15,16. Younger age groups consistently show higher consumption compared with older adults across all world regions³. Globally, men consume slightly more SSBs than women after adjusting for energy intake¹.
By 2021, more than 30% of the global population was exposed to excessive SSB consumption (≥ 50 kcal per 226.8-gram serving, excluding 100% fruit and vegetable juices)¹⁷. Projections indicate that SSB consumption will continue to rise, with a 9.5% increase expected by 2050, significantly contributing to the global burden of non-communicable diseases (NCDs)¹⁷.

Adverse Health Impacts of SSB Consumption

Systematic reviews and meta-analyses provide strong evidence that excessive SSB consumption has detrimental health effects in both children and adults^3,18,19. A key concern is that liquid sugars provide little satiety, while delivering a higher concentration of sugar per milliliter than most foods, which increases the risk of inadvertent overconsumption and excessive caloric intake²⁰.

Health Burden

Strong dose–response evidence links SSB intake with increased all-cause and cardiovascular mortality, underscoring its role in preventable premature death6,21. Beyond mortality, robust evidence demonstrates causal associations between SSB consumption and cardiovascular disease^3,11,16,22, type 2 diabetes^3,11,23,24, obesity^25-27, and certain cancers^28-31.
Among more than 300 human diseases and conditions, oral diseases are the most prevalent NCDs, affecting an estimated 3.5 billion people worldwide³². Within this burden, two oral health disorders are causally linked to SSB consumption: dental caries and dental erosion.

Dental Caries

Dental caries is defined as a biofilm-mediated, sugar driven disease that results in the demineralization of dental hard tissues³³. Untreated dental caries is the most prevalent health condition globally, affecting over 2 billion people with permanent teeth and over 500 million children with untreated caries in primary teeth³². The burden is most significant among socioeconomically disadvantaged groups, resulting in pain, impaired quality of life, and financial strain to families and societies^34-36.
Excessive sugar intake is the primary cause of dental caries, with SSBs being a leading source of added sugars across the life course^37-39. SSBs are commonly introduced in infancy¹³ and contribute substantially to early childhood caries^38,39. Evidence from longitudinal studies38,40 as well as high-certainty systematic reviews^19,41 confirms a clear dose–response relationship between SSB consumption and caries in permanent dentition, regardless of sociodemographic factors and fluoride exposure^{19,38, 40,41}.Futhermore, global dental expenditures reached 710 billion US dollars, and the cost of untreated dental caries in both primary and permanent teeth due to lost productivity exceeded 24 billion US dollars⁴².

Dental Erosion

Dental erosion is defined as the chemical loss of mineralized tooth substance resulting from exposure to acids of non-bacterial origin⁴³. The mean prevalence is between 30% to 50% in deciduous teeth and between 20% and 45% in permanent teeth⁴⁴. Among the various sources of dietary acids, SSBs are the most significant contributor to extrinsic acid exposure, which partially explains the rising prevalence of dental erosion observed in recent decades, particularly among children and adolescents⁴⁵.

Evidence shows that dental erosion can occur even in the primary dentition⁴⁶, and current estimates indicate that more than one-third of adolescents are affected⁴⁵. Although the impacts on quality of life have not been consistently documented in preschool children, severe cases in adults can lead to pain, hypersensitivity, and functional impairment, with consequent adverse effects on oral health–related quality of life⁴⁷.

Policy Statement on Sugar Sweetened Beverages

The International Association for Dental, Oral, and Craniofacial Research (IADR) and the American Association for Dental, Oral, and Craniofacial Research (AADOCR) support avoiding consumption of sugar-sweetened beverages (SSBs) to avoid the intake of free sugars, including added sugars. SSBs have widespread and harmful health impacts across all age groups. They must be treated as a top priority for public policy and regulatory action to protect population health. IADR and AADOCR calls for comprehensive measures to avoid sugar consumption and tackle its underlying social and commercial determinants through the following actions:

Population-level measures:

Globally, over 100 countries have implemented taxes on SSBs to reduce their consumption⁴⁸. Strong and growing evidence demonstrates that SSB taxes are effective in lowering purchases and consumption^49-52, reducing obesity and disease burden, generating revenue, improving productivity, and promoting societal welfare^48,50,53. Simulation studies also demonstrate reductions in dental caries and associated treatment costs^54,55. Long-term benefits are particularly pronounced for low-income groups, children, and young people^18,56,57.
In 2025, the WHO launched the “3 by 35” initiative, urging countries to raise real prices on tobacco, alcohol, and sugary drinks by at least 50% by 2035 through health taxes. The goal is to curb consumption of harmful products while generating revenue for reinvestment in health, education, and social protection⁵⁸.
Unhealthy food and beverage marketing, especially for SSBs, heavily targets children and adolescents across media platforms^59,60. Exposure drives higher consumption and lower risk perception⁶¹. A systematic review showed that marketing of unhealthy foods and beverages is causally linked to weight gain and obesity among children⁵⁹.
Policies restricting SSB marketing, particularly toward youth and via social media, along with public counter-marketing campaigns, have potential to reduce consumption and improve health outcomes^60,61.
Food packaging strongly shapes consumer choices^62,63. Clear warning labels, such as traffic-light systems, help communicate diet-related health risks, reduce sugar intake, and may encourage manufacturers to reformulate products⁶⁴. Since Chile’s pioneering policy in 2016, mandatory front-of-package labeling has expanded globally⁶⁵, with systematic reviews showing reductions in purchases and consumption of sugary foods and beverages^66-68.
Reformulating foods and beverages to reduce sugar lowers population exposure without relying solely on individual behavior^63,69, building on the success of salt reformulation initiatives.

In the UK, efforts to cut sugar in children’s food by 20% led to notable reductions in many products, particularly beverages⁷⁰. A systematic review with meta-analysis confirms that product reformulation significantly decreases sugar intake and supports weight reduction⁶⁹.
The food environment, where people access, prepare, and consume foods, strongly shapes dietary behavior⁶⁰. Today’s environments often promote unhealthy choices, with widespread SSB availability in schools, workplaces, recreational centers, and markets driving consumption⁷¹.
Evidence shows that environmental interventions are effective: limiting SSBs in schools, raising prices, offering healthier default beverages, and promoting alternatives reduce consumption⁶⁸. High-impact strategies include zoning restrictions, bans on marketing to children under 16 and the adoption of healthy default beverage approaches across everyday settings⁷². In schools, workplaces, and homes, making water, plain milk, or other unsweetened options the routine choice, while limiting sugar-sweetened beverages, can reduce habitual exposure, and reinforce healthier norms^11,72. Restricting SSBs in cash-assistance programs for low-income families has also lowered purchases and consumption⁷³.
Environmental efforts to reduce SSB consumption should prioritize increasing access to safe, affordable drinking water in schools, workplaces, and communities as a healthy alternative, supporting the United Nations Sustainable Development Goal 6 of universal water and sanitation access⁷⁴.

Individual-level measures:

Behavioral Strategies

Because SSB consumption is a behavior, individual and family counseling is a natural preventive strategy. High-intensity, face-to-face programs focusing on SSB risks, reduction strategies, and health benefits show modest but positive effects^75,76, especially when grounded in theory-driven models that build motivation, confidence, and self-regulation^76,77. Community engagement and some digital tools⁷⁴ targeting adolescents also show potential for promoting healthy dietary behaviors among adolescents⁷⁸.
However, many interventions reduce consumption without improving clinically relevant outcomes, such as dental caries, or fail to sustain effects^79,80. Since food and beverage choices are shaped by families, peers, schools, workplaces, marketing, and wider economic and political forces, behavior change cannot be viewed simply as an individual decision alone⁷⁶. Moreover, focusing only on behavior change may widen health inequalities⁸¹.
Therefore, SSB counseling should be integrated into routine health professional practice and primary care, with focus on the following recommendations: SSBs should not be offered in the first two years of life in favor of water^14,82, because early sugar introduction modulates taste preferences for sweet foods and drinks later in life and increases the risk of early childhood caries; subsequently, SSBs should continue to be avoided at all ages due to their adverse health effects. Individual behavioral strategies should be aligned with broader efforts to create supportive environments and address the commercial determinants of SSB consumption.

Conclusion

Sugar-sweetened beverages are a leading source of added sugar consumption globally and a major contributor to dental caries, dental erosion, obesity, type 2 diabetes, cardiovascular disease, certain cancers, and premature mortality. Their widespread consumption, often beginning in infancy and disproportionately affecting disadvantaged populations, makes them a pressing target for global health policy.

Accumulating scientific evidence supports the association between reducing SSB consumption and favorable health outcomes across the life span. Yet, sustained change cannot rely solely on individual choices. Structural, population-level interventions are essential to counteract the powerful commercial, social, and environmental drivers of consumption.

The IADR and AADOCR therefore calls for a comprehensive strategy that:

. Implements strong upstream policies, including health taxes, marketing restrictions, mandatory front-of-package labeling, and reformulation, to reduce availability, affordability, and appeal of SSBs.
Creates supportive environments in schools, workplaces, and communities by ensuring universal access to safe water, designating sugar-free zones, and restricting SSB sales in public settings.
Integrates education and counseling into health systems and academic curricula at different levels, equipping health care professionals, families and communities with knowledge and skills, while avoiding approaches that deepen social inequalities.
Aligns cross discipline and cross-sectoral actions, linking oral health with broader prevention of noncommunicable diseases and the pursuit of sustainable development goals.
Encourages further research to rigorously test and further evaluate the relationship between SSB consumption and oral diseases and to develop interventions aimed at reducing SSB consumption and improving health outcomes, particularly oral health, with the goal of informing effective public health strategies.

Coordinated, multi-level, and globally aligned interventions will be needed for sustained reductions in SSB consumption that narrow health equity gaps, and safeguard health, including oral health, for current and future generations.

Recognizing the urgent need to reduce the global consumption of sugar-sweetened beverages, the IADR and AADOCR are committed to leading by example. In alignment with their mission to drive dental, oral, and craniofacial research for health and well-being, the IADR and AADOCR commit to:

Continually institute healthy meeting policies to exclude the use of IADR and AADOCR funds to purchase SSBs.
Continually screen for exclusion of SSB companies to align the Associations’ investments with their missions of driving dental, oral and craniofacial research for health and well-being worldwide.
Work with governments, civil society, and healthcare professionals to develop and promote evidence-based policies that address social and commercial factors influencing SSB consumption and subsequent impacts on oral health.
Support and encourage research to address gaps, particularly in understanding effective interventions across different populations and settings. This becomes even more relevant with under-resourced populations to ensure equitable and culturally adapted interventions.

*Free sugars: All monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and fruit juices and fruit juice concentrates⁸³. The World Health Organization (WHO) defines SSBs as any drink containing free sugars, a category that also includes 100% fruit juices¹⁰.
**Added sugars: Sugars added to food during food processing, sugars used as sweeteners and sugars from honey and concentrated fruit or vegetable juices. Unlike free sugars, added sugars do not include naturally occurring sugars, such as sugars in the intact cell walls of fruit and vegetables, or sugars present in milk⁸⁴.

Adopted 2026

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