Sugary Beverages and Diabetes in Kuwait

The Middle East Initiative offers funding each year to Harvard faculty for research proposals on major policy issues affecting the region. MEI has awarded 53 research grants to Harvard faculty since 2001, including three during 2017 award cycle. These research grants are generously supported through the Kuwait Program at Harvard Kennedy School and the Emirates Leadership Initiative at Harvard Kennedy School. Priority topic areas include education reform, economic development, political reform, and science and technology, among others. 

The prevalence of type 2 diabetes (T2D) and childhood obesity in Kuwait and the US is among the highest in the world, and public health experts project the rates to continue growing. In an effort to better understand these epidemics and to develop evidence- based policies to fight their effects in Kuwait, Dr. Frank Hu, Chair of the Department of Nutrition, Professor of Nutrition and Epidemiology at the Harvard T.H. Chan School of Public Health and Professor of Medicine at Harvard Medical School, and his co-contributors, Dr. Hala AlEssa, Principal Investigator in Kuwait and Postdoctoral Research Fellow at the Department of Nutrition at the Harvard T.H. Chan School of Public Health, and Dr. Jaako Tuomilehto, Chief Scientific Officer at the Dasman Diabetes Institute in Kuwait, look to sugary beverages as a leading culprit.

In 2015, 20% of Kuwaiti adults were diabetic, compared to 11% in the US, according to the International Diabetes Federation. By 2040, public health experts expect healthcare costs related to diabetes to rise to $1.9 and $349 billion USD in Kuwait and the US, respectively. Given such statistics, researchers have turned their attention to sugar sweetened-beverages (SSBs) – which include soda, sports drinks, energy drinks, fruit drinks, and sweetened waters. According to Dr. Hu, researchers have previously linked SSB consumption with weight gain, T2D rates, coronary heart disease, and other health issues. Dr. Hu and his team took their project, Sugary Drinks and Health in Kuwait, a step further, examining the potential for differential effects of added versus natural fructose on the rise of T2D.

The project – the first research study on SSB consumption and potential policies to limit consumption among Kuwaiti and Gulf-state adolescents – relied on collaboration between the Harvard T.H. Chan School of Public Health and the Dasman Diabetes Institute in Kuwait. Supported by the Middle East Initiative, Professor Hu’s team aimed to fulfill two primary goals: 1) to investigate the perceptions and behaviors of SSB consumption and attitudes regarding potential SSB-limiting policies in Kuwait, and 2) to study the effects of the form (liquid vs solid) and source (natural vs added) of fructose consumed in relation to the risk of T2D in Kuwait and the US, respectively.

Using a mixed-methods approach and a cross-sectional design, the project synthesized studies in both Kuwait and the US to meet its research objectives. Dr. AlEssa led eight focus group discussions in public schools in Kuwait to examine the effects of obesity and gender on SSB consumption and to explore the attitudes of adolescents regarding potential policies to limit SSBs. Meanwhile, the research team analyzed the association between natural, added, and total fructose in beverages and the risk of T2D in 117,000 adults in the US in the Nurses’ Health Study (NHS), the Nurses’ Health Study II (NHSII), and the Health Professionals Follow-Up Study (HPFS). 

According to Dr. AlEssa, the project findings demonstrated that while improved access to clean water and more hygienic water fountains impacted student beverage choices in schools, adolescents in Kuwait would be reluctant to cut back on SSBs, even if faced with price hikes and warning labels. Moreover, students’ responses on the proposed consumption reduction policies and their suggestions for other policies – including using social media to dissuade Kuwaitis from purchasing SSBs – highlighted the role of parents and broader culture in their decisions. Furthermore, the results of the NHS-NHSII-HPFS analysis indicated that while whole fruit consumption is associated with a lower risk of T2D, liquid fructose consumption – whether from SSBs or fruit juice – is associated with a higher risk of T2D.

While these findings provide only a glimpse of the insight from the project, Drs. Hu, AlEssa, and Tuomilehto will publish their research in detail in the future. As Dr. Hu and his research team prepare the manuscript for the Sugary Drinks and Health in Kuwait project, the team also looks to the implications of its findings for public health in both Kuwait and in the US. e research team plans to include supplemental policy recommendations in the manuscript and to share its findings in a workshop with the public with the hope of affecting change in two epicenters of the T2D and obesity epidemics.

Read the full 2017-2018 Mosaic

<p>This article appeared in MEI's 2017-2018 Mosaic. The full issue of Mosaic can be found here!</p>

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