Trends in sales of sugar-sweetened beverages and associated type 2 diabetes burden in nine African countries: an ecological time-series analysis

Background: Sugar-sweetened beverages (SSBs) are recognized contributors to the global rise in non-communicable diseases. While the link between SSB intake and adverse health outcomes is well established, long-term data from African countries are limited. Objective: To assess trends in SSB sales and their associations with type 2 diabetes (T2D) burden across nine African countries from 2010 to 2024. Methods: We conducted an ecological time-series analysis using national-level data from Cameroon, Côte d’Ivoire, Ethiopia, Ghana, Kenya, Morocco, Nigeria, South Africa, and Uganda. Annual changes in per capita and total SSB sales, national T2D prevalence, and the number of adults with T2D were analyzed. Country-specific multivariate Vector Autoregressive (MVAR) models estimated associations between SSB sales and T2D outcomes. Results: SSB sales rose across all countries, with the sharpest per capita increases in Cameroon (+173.8%), Nigeria (+119.1%), and Côte d’Ivoire (+88.5%). T2D trends varied: Ethiopia, Morocco, and South Africa showed rising prevalence and case numbers, while Ghana and Nigeria showed declines. Per capita SSB sales were significantly associated with adult T2D burden in Ghana (β = 0.41, p = 0.005) and Ethiopia (β = 0.37, p = 0.039. Total SSB volume was associated with T2D burden in Kenya (β = 0.49, p = 0.046) and with T2D prevalence in Nigeria, Morocco, and Côte d’Ivoire. Conclusions: Rising SSB sales may be contributing to the T2D burden in African countries. This calls for context-specific regulatory measures, such as fiscal taxes and front-of-pack labels.