Title: Magnitude of sugar-sweetened beverage consumption and associated factors among
women aged 15-49 years old in two Sub-Saharan African Countries
Version: 1 Date: 18 Aug 2023
Reviewer:  Aléxia Vieira de Abreu Rodrigues
Reviewer's report:
Congratulations on the study. Below, a brief comment on some points of reflection for the debate
on the consumption of sugar-sweetened beverages  and its relationship with income and food
insecurity. I also highlight a measure that has been adopted in some countries to reduce the
consumption of  sugar-sweetened beverages  .
With the increase in consumption of  sugar-sweetened beverages and the associated health risks,
the study “Sugar-Sweetened Beverage Consumption and associated factors among women aged
10-49 years old in two Sub-Saharan African Countries” by analyzing the factors associated
with the consumption of  sugar-sweetened beverages   among women, it contributes to the
recognition of the profile of the population with the highest consumption of these products in
low- and middle-income countries.The consumption of  sugar-sweetened beverages  may be
related to the urbanization process, appreciation of the consumption of such products (status),
commercialization, accessibility and limited availability of healthier options and the price of
food, which is related to the type of drink. commercialized product (fruit concentrate, powder
for preparing beverages) and with the type of sugar or sweetener used (fructose concentrate,
refined sugar (derived from sugar cane) and natural and artificial sweeteners.
In low-income countries, higher consumption of  sugar-sweetened beverages   has been
described among higher-income people, however, in high-income countries, consumption is
higher among lower-income people (1,2), which may be associated with the type of beverage.
consumed sugar, its social value and price. Especially in low-income countries, price and income
are important factors in food choice and determine food insecurity. In addition, food insecurity
is associated with the family's instability in having enough food at the beginning and end of the
month, which can determine food choices, impacting the quality of the diet (2).
A measure that has been adopted in high-middle-income countries, such as Chile e México
(3,4), is the increase in the rate, regulating the price of these products, in order to reduce the
consumption of  sugar-sweetened beverages  . Despite being upper-middle income countries,
they are countries with high social and economic inequality. Brazil, by committing to the United
Nations, in the Decade of Action for Nutrition, it undergoes a process of legislative efforts related
to the taxation of  sugar-sweetened beverages   (5).
(1) Warren, C., Hobin, E., Manuel, D.G. et al. Socioeconomic position and consumption of
sugar-sweetened beverages  , sugar-sweetened beverages and 100% juice among Canadians:
a cross-sectional analysis of the 2015 Canadian Community Health Survey–Nutrition. Can J
Public Health 113, 341–362 (2022). https://doi.org/10.17269/s41997-021-00602-8
(2) Bruce MA, Thorpe RJ Jr, Beech BM, Towns T, Odoms-Young A. Sex, Race, Food
Security, and Sugar Consumption Change Efficacy Among Low-Income Parents in an Urban
Primary Care Setting. Fam Community Health. 2018 Apr/Jun;41 Suppl 2 Suppl, Food
Insecurity and Obesity(Suppl 2 FOOD INSECURITY AND OBESITY):S25-S32. doi: 10.1097/
FCH.0000000000000184. PMID: 29461313; PMCID: PMC5824648.
(3) Nakamura R, Mirelman AJ, Cuadrado C, Silva-Illanes N, Dunstan J, Suhrcke M (2018)
Evaluating the 2014 sugar-sweetened beverage tax in Chile: An observational study in urban
areas. PLoS Med 15(7): e1002596. https://doi.org/10.1371/journal.pmed.1002596
(4) Pedraza LS, Popkin BM, Batis C, Adair L, Robinson WR, Guilkey DK, Taillie LS. The
caloric and sugar content of beverages purchased at different store-types changed after the  sugar-
sweetened beverages   taxation in Mexico. Int J Behav Nutr Phys Act. 2019 Nov 12;16(1):103.
doi: 10.1186/s12966-019-0872-8. PMID: 31718664; PMCID: PMC6849184.
(5) Mariath AB, Martins APB. Década da Ação em Nutrição e tributação de bebidas
açucaradas no Brasil: onde estamos? Cad Saud Public. 2021 Jul 14; 37(7): doi: https://
doi.org/10.1590/0102-311X00157220
Below are some points for revision.
Section : Methods
1. Please clarify the sample selection. In “Population and sampling procedure” the description
of the application of the questionnaires in the population of both countries was confusing.
“The female-child questionnaire was administered to all women aged 10-49 in sub-selected
households, and to caregivers of children under five in all selected households, with one form
per child”. Does the survey select only households with a child? That is, are the data available
and analyzed in this study from women with children at home? This is particularly important
as it characterizes the study sample.
2. In “Dependent Variable” insert the description of the variable of consumption of  sugar-
sweetened beverages  on the day before the interview, is it binary (yes or no) or was another
way of categorizing adopted? Also inform the description of the variable “Savory or fried snack
consumpt”, yes or no?
3. To create the variable “Minimum Dietary Diversity” which questionnaire questions were
selected and make up the subgroup of 10 foods? I understand that they are questions from the
same IPUM-PMA question where the question for the dependent variable (sugar consumption)
and the consumption of snacks or fried snacks were selected, right? And that this selection of
10 foods follows the FAO reference - “Minimum Dietary Diversity for Women”. However, it
would be interesting to score and explain the 10 questions selected to measure dietary diversity.
4. In “Data management and analysis” is alert that “Respondents with missing data were
excluded from the analysis” This criterion was adopted only for the non-response to the question
about sugar consumption or considered the selection:“None of the above” or  “No response” o
the IPUM-PMA questionnaire question?
5. Also in "Data management and analysis", explain why the value p # 0.25 was adopted in the
bivariate analysis?
6.Inform in “Table 1” the value of the Confidence Interval, as well as in “Table 2” and in the
text of the section “Management and analysis of data”.
7. In “Figure 1”, consider informing the Confidence Interval for food insecurity and a wealth
index.