摘要：Objectives. We investigated whether taxing sugar-sweetened beverages (SSBs) would improve the diets of households in Brazil. Methods. We used household food consumption data that the Brazilian Institute of Geography and Statistics collected in 2002–2003 from a nationally representative sample of 48 470 Brazilian households. The consumption of SSBs is expressed as the total SSB calories consumed and as the SSB percentage of the total calories purchased. We investigated price elasticity with regression models, controlling for demographic variables, income, and prices of all other foods and drinks. Results. Increases in the price of SSBs led to reductions in consumption. A 1.00% increase in the price of SSBs led to a 0.85% reduction of SSB calories consumed (1.03% reduction for the poor and 0.63% for the nonpoor). Increased income had a positive effect on SSB consumption, but the effect was less than half the size of the price elasticity (0.41% increase in SSB calories consumed for every 1.00% increase in income). Conclusions. High SSB price elasticity in Brazil indicates that a tax on purchased weight or volume would lead to reductions in SSB consumption. In recent years obesity has reached epidemic proportions in developed and many developing countries. 1,2 Concerns about the major diseases linked with obesity, including several cancers, type 2 diabetes, hypertension, and cardiovascular disease, have grown. 3–7 The global diet has experienced concurrent changes, and extensive research has focused on added sugars in food, particularly in beverages. 8,9 Much of the research on sugar-sweetened beverages (SSBs) and their health impact has focused on higher income countries. It is generally shown that a shift from noncaloric to caloric beverages is not associated with any compensation in food intake. 10–12 Numerous rigorous studies of the relationship between caloric beverages and energy intake and weight gain have shown that shifting from a noncaloric beverage to an SSB adds significantly to total energy intake and leads to weight gain. 13,14 Neither satiety nor health outcomes are affected by the type of sweetener used in beverage manufacture (e.g., sucrose vs high-fructose corn syrup). 15–17 Thus regular intake of SSBs, even in small amounts, may lead to weight gain in the long term. 18 Trend studies indicate that increased consumption of SSBs coincides with the occurrence of overweight and obesity. 19,20 In the United States, data from the US Department of Agriculture show an increase of approximately 500.0% in the consumption of soft drinks in the past 30 years, making SSBs a primary source of energy intake among Americans (approximately 7.0% of total calories). 21–24 In Mexico, between 1999 and 2006, the consumption of calories from soft drinks doubled in some age groups and tripled in others, from 100 to 225 kilocalories per day among adolescents and from 81 to 250 kilocalories per day among adult women. 25 In Brazil, the share of soft drinks in household food availability in metropolitan areas increased by 525.0% between 1974 and 2002–2003 (from 0.4% to 2.1% of total calories). 26 Likewise, in the same period the prevalence of overweight (body mass index ≥ 25 kg/m2) in the Brazilian adult population increased from 18.6% to 41.1% among men and from 28.6% to 39.2% among women. 27 Governments across the globe have begun to implement programs and policies to control SSB consumption. Mexico organized a panel to examine SSB and other beverage intake and propose actions to shift from less healthy beverages to a healthier, reduced-calorie beverage profile. 28 France and the United Kingdom have removed SSBs from schools, as have many other countries. Denmark has a 3-tiered tax: high for SSBs, medium for diet beverages, and zero for water. Extensive literature addresses the rationale for taxation and public control of SSBs. 29 Imposing an economic disincentive, such as a tax, on the consumption of SSBs emerges as an attractive proposal, as it would inhibit consumption and raise funds for health promotion. 29 However, few studies have investigated the relationship between the price of SSBs and their consumption, and most of those studies have been conducted in developed countries. 29–33 We aim to help fill this gap by identifying and quantifying the influence of SSB prices on SSB consumption in households in Brazil, a large middle-income country.
