Scientists develop recommendation score to evaluate global healthy hydration messaging

04 Sep 2024 --- Researchers from Virginia Tech, US, studied the clarity of healthy beverage guidelines for 93 countries that enacted sugary beverage tax legislation from 2000 to 2023 to find ways to encourage drinking water instead as a strategy to reduce obesity and chronic diseases.

“It’s important for us to understand how sugary beverage tax legislation is aligned with national food-based dietary guidelines that promote water and other healthy beverages such as milk and 100% juice,” says Nicole Leary, Ph.D., Department of Human Nutrition, Foods, and Exercise and lead researcher on the project. 

“We looked at how robust dietary guidelines could complement other policy, system and environmental change strategies for governments to promote policy coherence and socially normalize water as the default healthy beverage.”

Of the 93 countries that had targeted sugary beverage taxes in 2023, 58 countries had food-based dietary guidelines. Forty-eight countries had complementary messages that encouraged water and discouraged sugary beverages.

Healthy hydration score

The researchers analyzed the text and graphic recommendations in national dietary guidelines from various countries to see how they encourage people to replace sugary drinks such as soda with water. They designed a tool that assigns a healthy hydration recommendation score from 0 to 12.

Governments can use the score to improve their message clarity, justification, actionability, specificity and visual content to encourage healthier hydration and discourage sugary beverage intake. Countries were ranked according to the score, which factored in access and visual content of the guidelines.

Bolivia, Peru and Brunei scored the highest, while the US had a medium score of 7. The next edition of the Dietary Guidelines for Americans and the US Department of Agriculture’s MyPlate, will be released in 2025. The updated guidelines could strengthen the recommendation for water across the — lifespan starting at birth to support healthy aging. 

“We need to be actively promoting people drinking water at each meal. When governments develop policies, they should ensure that national dietary guidelines align with and support a national sugary beverage tax,” says Vivica Kraak, associate professor in human nutrition, foods, and exercise and senior researcher on the paper. 

“Our study has important implications for United Nations organizations, including the Food and Agriculture Organization and World Health Organizations, to provide countries support to develop culturally adapted, evidence-informed dietary guidelines that encourage healthy hydration, and normalize clean, safe and free water as the beverage of choice.”

The research was recently published in Nutrients and partially funded by Vivica Kraak’s US Department of Agriculture National Institute for Food and Agriculture Hatch Research Project.

Approach to health risks

The consumption of sugary beverages has increased worldwide and accelerated health challenges, including obesity, type 2 diabetes, heart disease and tooth decay. Drinking water, instead of sugary drinks, helps reduce the risk of obesity and other health problems, the researchers claim.

The researchers recommend that governments develop and promote strong, healthy hydration recommendations to reduce health risks for populations globally.

Additional recommendations include drinking at least eight glasses of water daily and limiting consumption of soda, fruit, energy and sports drinks. The researchers also advise governments to enact taxes on sugar-sweetened beverages and earmark the revenue for health promotion programs that encourage drinking water. They strongly suggest limiting the intake of artificial and zero-calorie sweeteners.

Meanwhile, a study of nearly 99,000 postmenopausal women throughout two decades has found an 85% increased risk of developing liver cancer and a 68% increased risk of chronic liver disease mortality when consuming one sugar-sweetened beverage daily compared to those consuming less than three monthly.

In addition, researchers recommend applying a mandatory sugar levy to a broader range of products contributing to sugar intake based on the success of the UK’s soft drinks industry levy. The experts suggest increasing the levy and reducing the sugar content threshold to improve its effectiveness.