Subscribe Now Subscribe Today
Research Article
 

Consumption of Sugar-Sweetened Soft Drinks Among Saudi Adults: Assessing Patterns and Identifying Influencing Factors Using Principal Component Analysis



Nada Benajiba and Samira M. Mahboub
 
Facebook Twitter Digg Reddit Linkedin StumbleUpon E-mail
ABSTRACT

Background and Objective: Previous studies showed that the Saudi population is one of the largest consumers of soft drinks in the Middle East. However, most of these studies explored patterns with very little focus on the factors that influence soft drink consumption. The present study aimed to identify factors associated with sweetened soft drink consumption in Saudi adults and the association between different factors using principal component analysis (PCA). Materials and Methods: A cross-sectional study was performed from July-September 2016 in Saudi Arabia, in which 1,194 eligible adult Saudi participants answered an online questionnaire. Data were collected on the amount and frequency of soft drinks consumed and factors that can influence consumption. All responses were categorized using a 5-points Likert scale. Statistical analysis was performed using SPSS and PCA was performed using orthogonal rotation with a varimax option to identify influencing factors. Results: Sixteen percent of the participants reported that they consumed soft drinks daily or frequently (3-6 times/week). The correlation coefficient between frequency and quantity of consumption was R2 = 0.39 (p<0.0001). Barlett’s test was significant and the KMO test was 0.8. PCA revealed two components with approximately 56.1% combined variance: 14.7% constituted “individual” grouping factors of eating at home and watching TV/electronic device use and 41.4% were attributable to “social-environmental” grouping factors, such as availability, affordability, advertising and social gathering. Conclusion: Patterns of sweetened soft drinks consumption in adult Saudis were complex and influenced by socio-environmental and individual factors. A comprehensive approach focusing on these factors is needed to limit soft drink consumption.

Services
Related Articles in ASCI
Similar Articles in this Journal
Search in Google Scholar
View Citation
Report Citation

 
  How to cite this article:

Nada Benajiba and Samira M. Mahboub, 2019. Consumption of Sugar-Sweetened Soft Drinks Among Saudi Adults: Assessing Patterns and Identifying Influencing Factors Using Principal Component Analysis. Pakistan Journal of Nutrition, 18: 401-407.

DOI: 10.3923/pjn.2019.401.407

URL: https://scialert.net/abstract/?doi=pjn.2019.401.407
 
Received: January 11, 2019; Accepted: March 03, 2019; Published: April 15, 2019


Copyright: © 2019. This is an open access article distributed under the terms of the creative commons attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

INTRODUCTION

Sweetened soft drinks are a major source of added simple sugars in the human diet1. Several epidemiological studies demonstrated that these drinks are one of the main contributors to obesity and related health problems globally1-3. Indeed, a clear association was demonstrated between soft drink intake and increased energy intake, body mass index (BMI) and diabetes worldwide3. Saudi Arabia is the country with the largest soft drink consumption in the Middle East region according to a 2015 Euromonitor International report4. This high consumption could be explained by the hot climate, which demands cool drinks, a large youth market and the adoption of food products that are produced and consumed in the Western world. Notably, there has been a corresponding rise in the rates of obesity and diabetes in Saudi Arabia. Saudi Arabia is among the top 10 countries of the prevalence of obesity and diabetes, with overall rates of 33.7 and 23.7%, respectively5-7. To address this menace, the Saudi government launched the National Transformation Program in 2016 to enhance the health status of the Saudi population, with a priority of reducing the obesity incidence by 1% by 20208. Sweetened soft drinks were subjected to selective taxation as an additional measure with the goal of decreasing the population’s consumption of these drinks. However, dietary behaviours are the result of the influence of various independent factors and their synergic interactions9. For instance, factors such as availability, affordability, food preference and lifestyle, may affect the quantity and frequency of sweetened soft drink consumption10-11. Therefore, evaluations of dietary patterns should be performed as a broader picture instead of a single factor effect. Consistent with this suggestion, current research focusing on nutrition and behaviour is shifting from a classical approach to exploratory approaches based on statistical dimension-reduction methods to examine dietary patterns12. Principal component analysis (PCA) is the most-used dimension-reduction method to derive dietary patterns12.

The effects of different factors on a specific dietary pattern vary between communities and nations13-15. Therefore, successful interventions for optimal changes to a given dietary pattern should be tailored to the target populations. Few studies examined the consumption of sweetened soft drinks in Saudi Arabian adults and most studies are descriptive with very little focus on factors that influence consumption16-19. Therefore, the present study identified these factors and assessed associations of different factors on the frequency or amount of sweetened soft drinks consumed in Saudi adults. The PCA method was used as a dimension-reduction analysis to provide an in-depth exploration on how these factors should be considered.

Methods
Study design and subjects:
A cross-sectional study was performed from July-September 2016 as a countrywide survey using an online questionnaire. A total of 1,348 eligible Saudi adults (1,037 females and 311 males) aged 20-60 years were recruited using the snowball technique. Participants who were diabetic, diagnosed with osteopenia and/or osteoporosis, under specific diets to lose weight, or residing outside Saudi Arabia did not participate in the study. Information on the objective of the research study, the nature of expected participation and the eligibility criteria were made available to the respondents. They were also informed of their right to accept or refuse participation and the ability to withdraw at any time while answering the questionnaire. Only participants who gave consent were allowed to answer the survey questions. All responses were confidential and all data analyses were performed anonymously. Any participant with incomplete answers was excluded (n = 154) from the study.

Research instrument: The online questionnaire was comprised of the following sections:

Socio-demographic information including age, sex, monthly income, marital status and educational level.
Sweetened soft drink consumption patterns: This contained information on the quantity and frequency of consumption. The quantity at each instance of soft drink consumption was determined as ½ can, 1 can, 2 cans or more than 2 cans. Frequency of consumption was estimated using a 5-score scale. A score of 1 indicated no consumption and a score of 5 indicated everyday consumption.
Factors influencing soft drinks consumption patterns were availability, affordability, social gathering, TV/electronic device use, advertising and eating outside or inside the home. These factors were identified as probable causes in previous studies15,20-21. Participants were asked to score on a scale of 1-5 how much they agreed or disagreed that a given factor increased the likelihood or frequency of soft drink consumption. The response categories used a 5-point Likert scale: (1) I strongly disagree, (2) I disagree, (3) I neither disagree nor agree, (4) I agree and (5) I strongly agree22.
Before performing the large-scale online survey, the questionnaire was tested using two focus groups of 20 individuals each to guarantee its simplicity and clarity for the respondents. The questionnaire reliability was demonstrated using Cronbach’s coefficient alpha (α = 0.72) (CI: 95%).

Ethical approval: Ethical approval was obtained in May 2016 from the Research Ethics Committee of College of Health and Rehabilitation Sciences (REC-CHRS) (Ethics number Z-F002) at Princess Nourah University (Riyadh, KSA).

Statistical analysis: Sample characteristics were described using means and standard deviation (SD) for continuous variables and percentages for categorical variables. One-way ANOVA was used to assess differences between groups based on frequency of consumption and the scoring of the factors. The chi-square test was applied to assess correlations between different parameters. A p-value of <0.05 was used as the significance cut-off.

The studied factors were entered into a principal component analysis (PCA) procedure using orthogonal rotation with a varimax option to drive the optimal non-correlated components. The correlation matrix of the standardized factors was considered to agree on the number of components to retain based on eigenvalue >1.0 and interpretability. Before running the PCA, the Barlett’s test and the Kaiser-Meyer-Olkin (KMO) test were used to evaluate the relevance of the data for PCA. The obtained components were interpreted based on the included factors. All statistical analyses were performed using SPSS software (version 24.0).

RESULTS

A total of 1,348 Saudi adults participated in the survey and 1,194 participants (~89%) completed the questionnaire. Demographic characteristics and patterns of sweetened soft drink consumption of the studied population is presented in Table 1. Nearly 75% were women and more than half were aged between 20-29 years. Fifty percent of the participants were single and 46.3% were married. Most of the participants had university degrees (71.9%) and approximately 10% had postgraduate degrees. Different levels of economic status were observed in the study sample, in which 41.3% reported a monthly income less than 5000 Saudi Riyals (SR), which is equivalent to US $1,333/month.

A total of 85.8% of the participants in this study reported consumption of sweetened soft drinks and only 14.2% reported no consumption. Analysis of the frequency of consumption found that 6% consumed soft drinks daily and 26.8% consumed soft drinks at least once weekly. A total of 38.7% of the participants reported drinking one can of soft drink and only 4% of participants consumed two cans or more each time. Correlation analyses between the frequency and quantity of consumption revealed a significant moderate positive correlation between these factors ® = 0.39, p<0.0001). The next analyses determined how and what factors influenced the consumption of soft drinks among the participants. The most common factor was influenced the consumption when eating outside of the home, followed by habit and affordability (38.5, 25.8 and 24.1%, respectively).

Table 1: Demographic characteristics and patterns of sweetened soft drink consumption of the studied population
Correlation between frequency and quantity of consumption* R2 = 0.39, p<0.0001, SAR: Saudi Riyals, *Correlation was calculated using Chi-squared test

Table 2: Factors influencing sweetened soft drink consumption among participants (n = 1194)
Results are presented as percentage of the total population for each factor. Response categories used a 5-point Likert scale

Table 3: Correlation ® between different factors influencing sweetened soft drink consumption among participants (n = 1194)
All correlations are significant (p<0.05), except at home eating with habits. Correlations were assessed using Pearson’s test

Notably, the lowest percentages for consumption were observed when eating at home and watching TV/using electronic devices (10.3 and 11.6%, respectively). Affordability, availability and advertising were almost equally distributed amongst the different scorings (Table 2).

The present study also observed a correlation between the frequency of consumption of sweetened soft drinks and its related factors (Table 3). All factors positively correlated to consumption frequency and this correlation was statistically significant for all factors. The strongest correlation was observed for eating at home, followed by availability and TV/electronic device use R = 0.295, R = 0.196 and R = 0.188, respectively). Notably, strong correlations between the other factors were also detected, including habits and eating outside of the home R = 0.571), affordability and availability R = 0.558) and availability and social gathering R = 0.501).

The next analyses used principal component analysis (PCA) of the factors that influenced soft drink consumption in Saudi adults to identify the major components (Fig. 1). The Kaiser-Meyer-Olkin measurement of sampling adequacy was 0.8, which indicates that the patterns of correlations were relatively compact and the factor analysis will yield distinct and reliable components. Bartlett's Test of Sphericity was highly significant (p = 0.000), which indicated that PCA was appropriate for this study. PCA identified two components that were related to sweetened soft drink consumption. The first component (Component-1) was characterized by high factor loadings for social gathering, availability, affordability, advertising, habits and eating outside of the home, which were labelled as “socio-environmental factors”. The second component (Component-2) identified by PCA was characterized by high factor loadings for eating at home and TV/electronic device use, which were labelled “Individual factors”. Together, these components explained 41.3 and 16.4% of the variations in sweetened soft drink consumption, respectively.

DISCUSSIONS

The present study examinee factors that affected sweetened soft drink consumption in Saudis adults using PCA-based one-dimension reduction analysis. This analysis provided a comprehensive understanding of how different factors collectively caused Saudi adults to become excessive consumers of these drinks. The present study demonstrated that 85.8% of adults in Saudi Arabia consumed sweetened soft drinks and 43% consumed one can (330 mL) or more each time. This finding supports the evidence that Saudi Arabia is the largest consumer of soft drinks in the Middle East region4. This consumption is occurring despite the well-established association of sweetened soft drink consumption with serious health problems, such as increased risk of type 2 diabetes mellitus, dental caries, metabolic syndrome and cardiovascular diseases23-25. A previous study suggested that each can of soft drink consumed per day increased the risk of obesity by 60%26.

The present study demonstrated a significant positive correlation between the frequency of consumption of sweetened soft drinks and the amount consumed each time.

Fig. 1: Results of principal component analysis of factors influencing sweetened soft drink consumption in adult Saudis
 
Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization. Kaiser-Meyer-Olkin Measure of Sampling Adequacy: 0.802, p-value: 0.000, Component 1 was labelled “socio-environmental factors” and component 2 was “Individual factors”. These components explained 41.3 and 16.4% of variation in sweetened soft drink consumption, respectively

This result suggests that reducing the frequency of consumption should be targeted, rather than quantity, to reach an overall substantial decrease in consumption. Therefore, attempts to decrease sweetened soft drink consumption among adults in Saudi Arabia requires the investigation of possible related factors that affect consumption frequency. Potential factors influencing consumption frequency in adults in this study were investigated using PCA, which reduced the multiple variables included as determinants of soft drink consumption into major components. The results of the analyses identified two main components, which were labelled as individual factors and socio-environmental factors. Individual factors included personal lifestyles, such as eating at home and TV/electronic devise use and socio-environmental factors included social gathering, availability, affordability, advertisements, habits and eating outside of the home. The socio-environmental factors explained 41.3% of the overall variance and the individual factors explained only 14.6% of the overall variance. Socio-environmental factors were more strongly correlated to the consumption frequency of sweetened soft drinks than individual lifestyle factors. These socio-environmental factors may have appeared due to the rapid social evolution in the last three decades in Saudi Arabia towards a Western lifestyle, which includes access to supermarket beverages, eating outside of the home, social norms related to the consumption of unhealthy beverages and the widespread advertisement of soft drinks27. This finding suggests that attempts to limit sweetened soft drink consumption by adult Saudis should primarily focus on the modification of socio-environmental factors in addition to changes in personal lifestyle. Efforts to tackle soft drink consumption frequency should primarily concentrate on socio-environmental factors using governmental policies and regulations to control availability, advertising and cost. Individual factors should also be targeted using nutrition education campaigns as complementary efforts to help curb soft drink consumption.

The present study demonstrated that soft drink availability and affordability were significantly associated with an increased frequency of consumption. Bere et al.28 reported that the availability of soft drinks at home was associated with increased consumption, which is consistent with our finding. They stated that increased distance to a shop tended to reduce the odds of drinking regular and diet soft drinks28. Van Der Horst et al.29 revealed an inverse correlation between soft drink consumption and a 200-300 m distance to the nearest store. This result suggests that availability is an important determinant in the modification of soft drink consumption. The affordability of soft drinks positively correlated with a high consumption of soft drinks in secondary school students in Australia25, which is consistent with our results. Students who had at least $40 AU per week to spend on themselves were more likely to consume a high amount of soft drinks than those who had less than $10 AU. Similar findings were reported in children aged 13-14 years, in whom the cost and availability of soft drinks were significantly associated with increased consumption26. For advertising, food marketing is known to stimulate individuals’ purchase requests20. The present study demonstrated that advertisements significantly correlated with the consumption frequency of soft drinks. Scully et al.25 documented that advertisements encouraging soft drink consumption were the second-most effective way to influence adolescent’s ability to control their behaviour in USA25, which is consistent with the results of the present study.

The present study confirmed a positive association between watching TV and increased frequency of soft drink consumption. Watching TV for more than two hours per day was associated with high soft drink consumption in secondary school students25, which is consistent with the result of the present study.

CONCLUSION

In conclusion, the present research confirmed that sweetened soft drink consumption among Saudi adults was high and demonstrated that consumption frequency and quantity were significantly associated. The results of the current study also revealed that these patterns of consumption were influenced by two main categories of components obtained by PCA: socio-environmental and individual. Therefore, nutrition education campaigns alone are not sufficient to tackle the high sweetened soft drink consumption frequency in Saudi adults and these efforts should be combined with governmental efforts and regulations that target the availability, affordability and advertising of soft drinks. Increasing alternative healthy food is needed to further reduce sweetened soft drink consumption among Saudis.

SIGNIFICANCE STATEMENT

The present study, first time, identified the socio-environmental and individual factors that influence sweetened soft drink consumption, which was not explored in previous studies. Therefore, new policies on reducing the high consumption of sweetened soft drinks in Saudi adults may be formulated and implemented.

ACKNOWLEDGMENTS

The authors express their appreciation to The Data Clinic Team at The Health Sciences Research Center of Princess Nourah University for their assistance in performing the statistical analyses.

REFERENCES
1:  Curhan, G.C. and J.P. Forman, 2010. Sugar-sweetened beverages and chronic disease. Kidney Int., 77: 569-570.
CrossRef  |  Direct Link  |  

2:  Basu, S., M. McKee, G. Galea and D. Stuckler, 2013. Relationship of soft drink consumption to global overweight, obesity and diabetes: A cross-national analysis of 75 countries. Am. J. Public Health, 103: 2071-2077.
CrossRef  |  Direct Link  |  

3:  Ma, Y., F.J. He, Y. Yin, K.M. Hashem and G.A. MacGregor, 2016. Gradual reduction of sugar in soft drinks without substitution as a strategy to reduce overweight, obesity and type 2 diabetes: A modelling study. Lancet Diabetes Endocrinol., 4: 105-114.
CrossRef  |  Direct Link  |  

4:  Euromonitor International, 2015. Soft drinks in Saudi Arabia. Country Report, pp: 1-7.

5:  Alqarni, S.S.M., 2016. A review of prevalence of obesity in Saudi Arabia. J. Obes. Eat. Disord., 2: 1-6.
CrossRef  |  Direct Link  |  

6:  International Diabetes Federation, 2014. IDF diabetes atlas update poster, 2014. 6th Edition. International Diabetes Federation, Brussels, Belgium.

7:  Naeem, Z., 2015. Burden of diabetes mellitus in Saudi Arabia. Int. J. Health Sci., 9: V-VI.
PubMed  |  Direct Link  |  

8:  Kingdon of Saudi Arabia, 2018. The national transformational program 2020. https://vision2030.gov.sa/sites/default/files/NTP_En.pdf.

9:  Schneider, K. and I. Hoffmann, 2011. Nutrition ecology-a concept for systemic nutrition research and integrative problem solving. Ecol. Food Nutr., 50: 1-17.
CrossRef  |  Direct Link  |  

10:  Thorpe, M.G., C.M. Milte, D. Crawford and S.A. McNaughton, 2016. A comparison of the dietary patterns derived by principal component analysis and cluster analysis in older Australians. Int. J. Behav. Nutr. Phys. Activity, Vol. 13, No. 1. 10.1186/s12966-016-0353-2

11:  Benajiba, N. and R.S. Eldib, 2018. Exploring attitudes related to sweetened soft drinks consumption among adults in Saudi Arabia. Nutr. Food Sci., 48: 433-441.
CrossRef  |  Direct Link  |  

12:  Varraso, R., J. Garcia-Aymerich, F. Monier, N. Le Moual and J. De Batlle et al., 2012. Assessment of dietary patterns in nutritional epidemiology: Principal component analysis compared with confirmatory factor analysis. Am. J. Clin. Nutr., 96: 1079-1092.
CrossRef  |  Direct Link  |  

13:  Kearney, J., 2010. Food consumption trends and drivers. Philos. Trans. R. Soc. Biol. Sci., 365: 2793-2807.
CrossRef  |  Direct Link  |  

14:  James, D., 2004. Factors influencing food choices, dietary intake and nutrition-related attitudes among African Americans: Application of a culturally sensitive model. Ethnicity Health, 9: 349-367.
CrossRef  |  Direct Link  |  

15:  Leng, G., R.A.H. Adan, M. Belot, J.M. Brunstrom and K. de Graaf et al., 2017. The determinants of food choice. Proc. Nutr. Soc., 76: 316-327.
CrossRef  |  PubMed  |  Direct Link  |  

16:  Al-Raddadi, R., S. Bahijri, A. Borai and Z. AlRaddadi, 2018. Prevalence of lifestyle practices that might affect bone health in relation to vitamin D status among female Saudi adolescents. Nutrition, 45: 108-113.
CrossRef  |  Direct Link  |  

17:  Hammad, L.F. and N. Benajiba, 2017. Lifestyle factors influencing bone health in young adult women in Saudi Arabia. Afr. Health Sci., 17: 524-531.
CrossRef  |  Direct Link  |  

18:  Alsubaie, A.S.R., 2017. Consumption and correlates of sweet foods, carbonated beverages and energy drinks among primary school children in Saudi Arabia. Saudi Med. J., 38: 1045-1050.
CrossRef  |  PubMed  |  Direct Link  |  

19:  Al-Faris, N.A., J.Z. Al-Tamimi, M.O. Al-Jobair and N.M. Al-Shwaiyat, 2015. Trends of fast food consumption among adolescent and young adult Saudi girls living in Riyadh. Food Nutr. Res., Vol. 59, No. 1. 10.3402/fnr.v59.26488

20:  Pettigrew, S., M. Jongenelis, K. Chapman and C. Miller, 2015. Factors influencing the frequency of children's consumption of soft drinks. Appetite, 91: 393-398.
CrossRef  |  Direct Link  |  

21:  Pollard, J., S.F.L. Kirk and J.E. Cade, 2002. Factors affecting food choice in relation to fruit and vegetable intake: A review. Nutr. Res. Rev., 15: 373-387.
Direct Link  |  

22:  Likert, R., 1932. A technique for the measurement of attitudes. Arch. Psychol., 140: 1-55.
Direct Link  |  

23:  Hu, F.B., 2009. Sugar-sweetened soft drinks consumption and risk of type 2 diabetes and cardiovascular risk. CMR J., 2: 15-18.
Direct Link  |  

24:  Hendel-Paterson, M., S.A. French and M. Story, 2004. Parental attitudes towards soft drink vending machines in high schools. J. Am. Dietetic Assoc., 104: 1597-1600.
CrossRef  |  Direct Link  |  

25:  Scully, M., B. Morley, P. Niven, D. Crawford, I.S. Pratt and M. Wakefield, 2017. Factors associated with high consumption of soft drinks among Australian secondary-school students. Public Health Nutr., 20: 2340-2348.
CrossRef  |  Direct Link  |  

26:  Hector, D., A. Rangan, J. Louie, V. Flood and T. Gill, 2009. A NSW centre for public health nutrition project for NSW Health. http://www.cphn.mmb.usyd.edu.au.

27:  Hijazi, N., B. Abalkhail and A. Seaton, 2000. Diet and childhood asthma in a society in transition: A study in urban and rural Saudi Arabia. Thorax, 55: 775-779.
CrossRef  |  Direct Link  |  

28:  Bere, E., E.S. Glomnes, S.J. te Velde and K.I. Klepp, 2008. Determinants of adolescents’ soft drink consumption. Public Health Nutr., 11: 49-56.
CrossRef  |  Direct Link  |  

29:  Van der Horst, K., A. Timperio, D. Crawford, R. Roberts, J. Brug and A. Oenema, 2008. The school food environment: Associations with adolescent soft drink and snack consumption. Am. J. Preventive Med., 35: 217-223.
CrossRef  |  Direct Link  |  

©  2020 Science Alert. All Rights Reserved