Contribution of the intake of soft drinks and alcoholic beverages on overweight and obesity among adults in the Health District of Biyem-Assi: a cross-sectional study

Contribution of the intake of soft drinks and alcoholic beverages on overweight and obesity among adults in the Health District of Biyem-Assi: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Contribution of the intake of soft drinks and alcoholic beverages on overweight and obesity among adults in the Health District of Biyem-Assi: a cross-sectional study Dorelle Melvine DJOMO TCHOKOTE, Sylvain Raoul SIMENI NJONNOU, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9276547/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background The global rise in overweight and obesity represents a major public health concern. Consumption of soft drinks and alcoholic beverages has been investigated as potential factors, though evidence remains limited and sometimes contradictory. This study aimed to assess the role of soft drinks and alcoholic beverage consumption in the occurrence of overweight and obesity. Methods A cross-sectional, community-based survey was conducted in the Biyem-Assi Health District (Yaoundé, Cameroon) using a two-stage stratified cluster sampling method. Data were collected using standardized questionnaires. The body mass index classification established was used to define overweight and obesity. Logistic regression was performed to assess the relationships between beverage intake and weight status. Results Among 970 participants, the age distribution revealed a mean age of 35.49 years, with females (59.9%) being mostly represented. Frequent soft drink and alcohol intake consumption was predominantly reported by males (78.5%) and individuals with lower income levels ( p < 0.001), with SSB and industrial beer being the most consumed soft drink and alcoholic beverage, respectively. Five hundred and ninety-six participants were either overweight or obese, yielding a prevalence of 61.4% [95% CI: 0.58–0.64], with a notably higher rate among women (70.9%) ( p 50 years (aOR = 9.13; p < 0.001), and higher income. Soft drink consumption significantly increased the odds of overweight/obesity (aOR = 2.00; [95% CI: 1.09–3.66]; p = 0.024), as did alcohol use (aOR = 2.34; [95% CI: 1.21–4.53]; p = 0.012). Conclusion The consumption of SSBs and industrial beer was widespread, particularly among younger adults and males. After adjusting for sociodemographic variables, these consumption patterns were significantly associated with overweight or obesity. Factors such as sex, age, education level, and income were identified as key determinants of excess weight. Soft drink Alcohol beverage Overweight Obesity Sociodemographic factors Figures Figure 1 Figure 2 I. Introduction Obesity refers to an abnormal or excessive accumulation of body fat that surpasses the physiological requirements of the body and adversely affects overall health [ 1 ]. Recognized as a chronic and often difficult-to-control condition, obesity poses significant management challenges. Many individuals affected by it struggle to adopt and maintain healthier eating patterns, often hindered by low motivation and the pervasive availability of energy-dense, nutrient-poor foods and beverages [ 2 , 3 ]. Obesity is commonly classified into two major forms: gynoid (characterized by fat accumulation around the hips and thighs) and central (marked by fat distribution around the abdominal area). The development of obesity typically results from a persistent energy imbalance where caloric intake exceeds energy expenditure, which not only drives weight gain but also contributes to the onset of several psychological and metabolic disorders as a critical public health concern in modern society [ 1 , 4 ]. Sugar-sweetened beverages (SSBs), particularly carbonated soft drinks, are defined as drinks containing at least two grams of added sugars or high-fructose corn syrup per 240 mL serving [ 5 ]. The growing intake of such beverages has become a significant contributor to increased dietary energy consumption. In a study by Chan [ 6 ], high SSB intake was linked to elevated body mass index (BMI), with further associations identified between frequent consumption and the risk of obesity, type 2 diabetes mellitus (T2DM), and dental decay. These beverages are thought to promote weight gain not only due to their high sugar content but also because they provide low satiety and poor caloric compensation [ 6 , 19 , 20 ]. Furthermore, there is a robust positive relationship between soft drink consumption and the overall prevalence of overweight and obesity [ 21 ]. Alcoholic beverages, commonly categorized as beer, wine, and spirits, have also been studied for their potential contribution to obesity. However, the evidence remains mixed, likely due to the interplay of various individual and behavioral factors [ 6 ]. Despite this complexity, numerous studies suggest that excessive alcohol consumption is positively associated with increased likelihood of being overweight, obese, or exhibiting central obesity [ 22 ], irrespective of the type of alcohol consumed or whether it is consumed with meals [ 23 ]. The prevalence of overweight/obesity is escalating rapidly across Sub-Saharan Africa, including Cameroon, largely fueled by accelerating urbanization, lifestyle transitions, and evolving dietary patterns. In Cameroon, recent data reveal that adult obesity rates have nearly doubled, rising from 4.9% in 2000 to 9.5% in 2016 [ 7 – 11 ] and 50.1% in 2022 [ 38 ]. A major driving force behind this surge is the increased intake of energy-dense foods and beverages, often coupled with a decline in physical activity levels [ 4 ]. To formulate effective public health responses, it is essential to identify and address specific risk factors, particularly the consumption of sugar-sweetened and alcoholic beverages. Overweight/obesity also serves as a key modifiable risk factor for numerous non-communicable diseases (NCDs), including type 2 diabetes, cardiovascular disorders, and various forms of cancer [ 20 , 25 ]. With the burden of NCDs steadily increasing in Cameroon, the need for focused research to inform preventive strategies is more urgent than ever. While some investigations have explored obesity within specific Cameroonian subpopulations, there remains a dearth of data from certain geographic contexts, especially semiurban zones such as Biyem-Assi [ 10 – 11 ]. Generating localized evidence from these underrepresented areas is critical for crafting tailored and impactful public health policies. To formulate effective public health responses, it is essential to identify and address specific risk factors, particularly the consumption of sugar-sweetened and alcoholic beverages. Moreover, despite the growing incidence of overweight/obesity, Cameroon’s National Health Development Plan has yet to adequately incorporate overweight/obesity prevention measures aimed at semiurban populations [ 12 ]. Gaining a deeper understanding of the prevalence and drivers of overweight/obesity in these settings is thus vital for informing evidence-based policymaking, designing community-specific interventions, and ensuring effective disease control efforts. II. Methods 2.1. Study design A community-based cross-sectional study was conducted in the Biyem-Assi Health District (BAHD), where adults were selected via a cluster random stratified sampling. This study combined two components: a descriptive component aiming to determine the prevalence of obesity and overweight, and an analytical nested case-control study. The cases were individuals with a Body Mass Index (BMI ≥ 25 kg/m²), and the controls were healthy weight individuals (BMI 18.5–24.9 kg/m²). The study was carried out from August 2024 to June 2025, with a period of recruitment of 3 weeks and 2 days, i.e. , from March 25 to April 17. 2.2. Study site The study was conducted in the Biyem-Assi Health District in Yaoundé, in the Centre Region of Cameroon. The Health District of Biyem-Assi is cosmopolitan with a diverse cultural influence. As such, results obtained would be inferred to the general population as a whole. The Biyem-Assi health district covers an estimated population for the ongoing year of 434,550 inhabitants (both sexes). Being in a semi-urban area, the Biyem-Assi health district is of a lesser cultural influence. Also, the high population density has maximized the rate of participant inclusion. The Health District comprises fourteen Health Areas covering an area of 72 km 2 . 2.3. Population study and selection criteria The targeted population was adults aged 21 years and older residing in the Health District of Biyem-Assi for at least 1 year. The population source was the population of the Health District of Biyem-Assi. 2.3.1. Selection criteria Eligibility criteria Adults aged 21 years and older residing in the Health District of Biyem-Assi. For the descriptive part of the study, we included those who gave their free consent, adults residing in the Health District of Biyem-Assi in 2025. We excluded all those above 21 years who presented a medical condition like diabetes, thyroid conditions, hypophyseal, or adrenal diseases, pregnant or nursing, ongoing weight loss or gain programs, incompletely filled data or who withdrew their consent. For the analytical part, we included adults who were willing to participate and provide informed consent for both cases and controls. Also, we included as cases, adults who had a confirmed diagnosis of overweight/obesity (BMI ≥ 25 kg/m²) and as controls healthy weight individuals (BMI 18.5–24.9 kg/m²). We excluded from our inclusion of cases individuals with chronic illnesses affecting weight, individuals on weight-loss medication, and excluded from our inclusion of controls individuals with a history of eating disorders, and individuals with chronic illnesses that may affect dietary habits. 2.3.2. Sample size estimate The sample size was calculated using Cochrane’s formula. According to a study done by Nansseu et al. (2022) [ 38 ], the prevalence of overweight and obesity among adults in Cameroon is 50.1% with a precision of 5%, and a significance level of 0.05; the minimum sample size of participants required for the study was 385 participants. The final sample size was adjusted to 964 participants, taking into account an acceptance rate of 80% and a cluster correction (k = 2). Regarding the analytic component, the minimum sample size required for the study was estimated using the sample size tables developed by Lemeshow et al. (1990) [ 44 ] for an unmatched case-control study. Taking into account a power of 90%, two-sided alpha of 5%, exposure prevalence among controls was set at 32.9% for soft drinks [ 45 ] and 66% for alcohol beverage [ 46 ], an anticipated odd ratio of 2, we had a minimum of 168 cases and 168 controls for soft drink exposure, and a minimum of 125 cases and 125 controls for alcoholic beverages. Considering a 1:2 ratio, the sample size gave 504 participants (168 cases and 336 controls) for soft drink exposure and 375 participants (125 cases and 250 controls) for alcohol drink exposure. We used a stratified random cluster sampling. Our strata were the 14 health areas of the Biyem-Assi Health District. For each health area, we calculated the number of households in proportion to the estimated size of the population in each health area ( Table I ). After defining the number of households per health area, a cluster sampling technique was used, where each cluster consisted of 10 households. In every household within a cluster, at least one adult was interviewed, resulting in a minimum of ten adult respondents per cluster, giving a total of 100 clusters. 2.4. Administrative, ethical, and research procedures After validation of the protocol by the co-directors and thesis director of the Faculty of Medicine and Pharmaceutical Sciences of the University of Dschang, obtaining ethical clearance from the “Centre Regional Ethics Committee for Human Health Research” (CRERSH-CE), approval of the Head of District as well as the respective chief of health area, a general meeting was organized where all the communication focal points were invited for a briefing and we pre-tested the questionnaire (see supplementary material). Communication of the various dates of field work was given, and a day prior to that of the data collection in each respective health area, a meeting was held where all the recruited staff (5 in total) were briefed on how to approach participants, and take measurements, as well as how to use the geo-localisation tool for tracking. On the day of data collection, our reference point was the health centre in each health area, and dispatchment into the community for data collection was done using a ballpoint pen, where the pointer of the ballpoint pen indicated the direction to go. 2.5. Variables of interest Anthropometric measures (height, weight, waist circumference) Type of beverages consumed (SSBs, natural juice, energy drinks, local beer, industrial beer, industrial liquor, etc.) Overweight/Obesity status (Dependent variable): It was measured as a binary variable (overweight/obese; non-overweight/non-obese) or a continuous variable (body mass index, BMI) using an electronic balance to measure the weight and a stadiometer for the height. The WHO’s scale for weight status was used to rate the participants into either overweight/obese or not. Soft and alcoholic drinks consumption (Independent variable): It was measured as the frequency (never, monthly or less than, 2–4 times a month, 2–3 times per week, > 4 times per week), or the quantity of beverages consumption (1–2 units, 3–4 units, 5–6 units, 7–9 units, > 10 units). Potential confounders: This was done through socio-demographic characteristics (age, sex, education, socioeconomic status, i.e. , income level), lifestyle factors (physical activity, dietary habits). 2.4. Administrative, ethical, and research procedures After validation of the protocol by the co-directors and thesis director of the Faculty of Medicine and Pharmaceutical Sciences of the University of Dschang, obtaining ethical clearance from the “Centre Regional Ethics Committee for Human Health Research” (CRERSH-CE), approval of the Head of District as well as the respective chief of health area, a general meeting was organized where all the communication focal points were invited for a briefing and we pre-tested the questionnaire (see supplementary material). Communication of the various dates of field work was given, and a day prior to that of the data collection in each respective health area, a meeting was held where all the recruited staff (5 in total) were briefed on how to approach participants, and take measurements, as well as how to use the geo-localisation tool for tracking. On the day of data collection, our reference point was the health centre in each health area, and dispatchment into the community for data collection was done using a ballpoint pen, where the pointer of the ballpoint pen indicated the direction to go. 2.5. Variables of interest Anthropometric measures (height, weight, waist circumference) Type of beverages consumed (SSBs, natural juice, energy drinks, local beer, industrial beer, industrial liquor, etc.) Overweight/Obesity status (Dependent variable): It was measured as a binary variable (overweight/obese; non-overweight/non-obese) or a continuous variable (body mass index, BMI) using an electronic balance to measure the weight and a stadiometer for the height. The WHO’s scale for weight status was used to rate the participants into either overweight/obese or not. Soft and alcoholic drinks consumption (Independent variable): It was measured as the frequency (never, monthly or less than, 2–4 times a month, 2–3 times per week, > 4 times per week), or the quantity of beverages consumption (1–2 units, 3–4 units, 5–6 units, 7–9 units, > 10 units). Potential confounders: This was done through socio-demographic characteristics (age, sex, education, socioeconomic status, i.e. , income level), lifestyle factors (physical activity, dietary habits). 2.6. Definition of key and operational terms Prevalence : It refers to the proportion of the adult population of the Health District of Biyem-Assi at the time of study. Overweight/obese status : This was the primary outcome variable. Any adult who has a BMI ≥ 30 kg/m² is overweight, as a BMI between 25.0 and 29.9 kg/m². Alcohol : Any kind of beverage obtained by distillation of wine, cider, fermented juice or any fermented liquor derived from sugary or starchy substances or containing ethanol. Sugary drink : Beverages that contain a high number of calories from sugar, whether natural, as in fruit juices and smoothies or added as in sodas or sparkling drinks. Alcohol/soft drink consumer : Anyone who has had to consume alcoholic/sugary drinks in the last twelve months, and the tool used will be the Alcohol Use Disorders and Identification Test-Consumption ( Audit-C). A score of 0 indicates non-drinkers, 1–3 indicates drinkers (females), and 1–4 indicates drinkers (males), and a score of ≥ 4 indicates higher risk drinking (females), while a score of ≥ 5 indicates higher risk drinking (males). Sociodemographic and economic characteristics : This included Sex: Measured as a binary variable (male/female). Educational Level: Measured as a categorical variable (no formal education, primary, secondary, tertiary) and further categorized into low (no formal education and primary), medium (secondary), and high (tertiary). Income level: Measured based on monthly income and further categorised into low for people who earned less than 50,000 FCFA per month; medium for people who earned between 50,000-250,000 FCFA per month, and high for those who earned > 250,000 FCFA per month. 2.7. Data analysis This involved data entry in CSPRO®, reviewing and cleaning the collected data to ensure accuracy. Data collected was analysed using SPSS version 23 software. Quantitative variables were described by means (± standard deviation) or by medians (interquartile ranges). Qualitative variables were described as numbers (percentages). The Chi-square test and Fisher's exact test were used to compare categorical variables in the bivariate analysis. Differences were considered statistically significant for p ˂ 0.05. The analysis equally took into account the main confounding factors during multivariate analysis (age, sex, income, education, physical activity, dietary habits) after their p-value was significant in the bivariate analysis, i.e. , p ≤ 5%. 2.8. Ethical considerations Approval from the appropriate ethical review board before any involvement in the study was required. In line with the ethical clearance obtained from the CRERSH-CE, this work was done in strict compliance with the fundamental principle of medical research. Ethical clearance CE N ͦ 001159/CRERSHC/2025 was granted by the Centre Regional Ethics Committee for Human Health Research. III. Results In this study, a total of 1260 households (90 participants per Health Area) were recruited, thereby recruiting 1260 participants. Of these 1260 participants, 77% were included in the analysis, while the 290 remaining (23%) were excluded due to incompleteness of data records and overweight/obesity-related health diseases. Figure 1 shows the enrolment procedure of participants. 3.1. General characteristics of the study population The age distribution among the participants in this study revealed a mean age of 35.49 years, with females (54.9%) being mostly represented. Nearly half of the respondents had completed secondary education (49.5%). The marital status distribution showed that just over half of the participants were single (52.8%), while 42.1% were married. A smaller proportion were widowed (3.1%) or divorced (2.1%). Employment in the formal sector was the most common employment status (37.7%), though half of the study population (50.6%) reported earning less than 50,000 FCFA. Participants' characteristics are detailed in Table II . 3.2. Soft drink and alcoholic beverage consumption 3.2.1. Distribution of the frequency of soft drink and alcoholic beverage consumption according to sex, age, and type of beverage Overall, younger individuals (< 40 years) consumed more soft and alcoholic drinks, with males consuming more units per sitting than females, especially at high quantities. Regarding the patterns, different patterns were observed for the types of beverages consumed, with sugar-sweetened beverages being the most consumed for soft drinks and industrial beer being the most consumed for alcoholic beverages, irrespective of the frequency of consumption. 3.2.2. Distribution of the average number of drinks per sitting according to sex, age Tables III and IV represent the average number of drinks per sitting for soft drinks and alcoholic beverages, respectively, according to sex and age. Regarding soft drinks consumption (n = 821), the majority consumed 1–2 units per sitting, especially among < 40 years (n = 506) and females (n = 381). However, higher consumption levels (5–9 units) are more common in males and 5 units) was more prevalent among males and those > 40 years, suggesting a possible binge tendency in older males. 3.3 Anthropometric status Table V presents descriptive statistics of the study population’s anthropometric measurements, including height, weight, waist circumference, and body mass index (BMI). The mean height, weight, waist circumference, and BMI were respectively 1.66 ± 0.11 m, 75.71 ± 15.63 kg, 87.85 ± 15.84 cm, and 27.53 ± 6.15 kg/m². 3.3.1. Prevalence of overweight/obesity Figure 2 presents the distribution of the study population according to body mass index (BMI) categories, highlighting the prevalence of underweight, normal weight, overweight, and obesity. Of the 970 participants included, a significant proportion of the population was found to be overweight (BMI 25–29.9 Kg/m 2 ), representing 31.9% of respondents, while 29.4% were classified as obese (BMI ≥ 30 Kg/m 2 ). The overall percentage of overweight/obese individuals is 61.4%. 3.3.2. Distribution of overweight/obesity across participants’ characteristics Table VI below presents the prevalence of overweight/obesity across the study population. Out of 970 participants, 61.4% were classified as overweight or obese. The prevalence of obesity was higher in females (70.9%) than in males, and this was statistically significant ( p < 0.001), as well as in those who were above 40 years (76.7%). On the other hand, higher income levels and education levels were significantly associated with increased overweight/obesity. Combining high-calorie meals with drinks, be it soft drinks or alcohol, showed a statistically strong association (66%) ( p < 0.001) in developing overweight/obesity. 3.4. Association between overweight/obesity and soft drink and alcohol beverage consumption Table VII presents the association between overweight/obesity and soft drink alcoholic beverages regarding both the consumption and frequency of consumption after adjusting for confounders such as sex, age, education level, income, dietary habits, and active transportation. We note that, for the consumption of soft drinks, after adjusting for sociodemographic and behavioural factors, soft drink consumption was significantly associated with increased odds of overweight/obesity. Individuals who reported consuming soft drinks had twice the odds of being overweight or obese compared to non-consumers (aOR = 2.00; [95% CI: 1.09–3.66]; p = 0.024). Also, alcohol drinkers were significantly more likely to be overweight/obese than non-drinkers (aOR = 2.34; [95% CI: 1.21–4.53]; p = 0.012), suggesting a positive association between alcohol intake and excess body weight. In addition to that, being classified as an “at-risk” drinker was independently and strongly associated with overweight/obesity (aOR = 5.77; [95% CI: 2.64–12.59]; p < 0.001), compared to non-drinkers. Considering the frequency, we note that frequent alcohol drinkers had significantly increased odds of being overweight/obese than rare drinkers (aOR = 6.63; [95% CI: 3.28–13.39]; p < 0.001), while moderate drinkers also showed a statistically significant association (aOR = 2.66; [95% CI: 1.11–6.35]; p = 0.028). IV. Discussion This study investigated the contribution of soft drink and alcoholic beverage consumption to overweight and obesity among adults in the Biyem-Assi Health District. The prevalence of overweight and obesity was alarmingly high (61.4%), comprising 31.9% overweight and 29.4% obese. This figure is notably higher than previous national and subnational estimates, such as the pooled national prevalence reported by Nansseu et al. (50.1%) [ 38 ] and the lower prevalence rates reported by Choukem et al. , in urban Cameroonian children and university students [ 39 , 40 ]. The significant increase observed here may reflect intensifying urban dietary transitions, increased sedentary lifestyles, and increased access to ultra-processed foods [ 43 ]. Consistent with studies by Choukem and colleagues, this trend underscores the mounting burden of adiposity-related health risks in both youth and adult populations [ 39 – 42 ]. Our findings are particularly worrisome as they reflect a more advanced stage of the nutrition transition in urban Cameroon, where energy-dense diets and limited physical activity converge to drive weight gain. The observed high frequency and quantity of soft drink and alcohol consumption, particularly among younger adults (< 40 years) and males, mirrors patterns reported both globally and regionally. This trend is consistent with extensive research showing that adolescents and young adults are the main consumers of sugar-sweetened beverages (SSBs) and alcoholic drinks [ 1 , 6 , 21 ]. Several factors contribute to this phenomenon, including aggressive marketing strategies targeting youth, strong peer influence, and the increasing autonomy young adults have in making dietary choices [ 3 , 5 – 6 , 36 ]. The gender disparity in consumption, with males reporting higher average intake per occasion, reflects entrenched gender norms and behavioural patterns related to alcohol and beverage use [ 23 ]. Males often experience social and cultural pressures to consume more alcohol and SSBs, which may be seen as markers of masculinity or social bonding [ 25 ]. This aligns with findings from Cameroonian studies showing men generally have higher rates of substance use, including alcohol [ 18 ]. Taste preference and peer influence are significant drivers for frequent SSB consumption among younger populations, compounded by a widespread lack of awareness about the nutritional implications of these beverages [ 5 , 26 ]. This is concerning given the well-established links between excessive SSB intake and increased risk of overweight, obesity, and metabolic disorders [ 19 , 20 , 21 ]. Interestingly, the preference for alcohol among older males likely reflects deeper cultural and social norms [ 25 ], as well as practical factors such as increased disposable income and beverage accessibility [ 17 , 23 ]. Overall, this pattern of consumption contributes substantially to the rising burden of obesity and non-communicable diseases observed globally and within Cameroon [ 7 , 10 , 11 ]. Women had significantly higher odds (2.56) of being overweight or obese, consistent with prior findings in Cameroon and Sub-Saharan Africa [ 10 – 11 , 16 , 28 ]. This gender disparity is often explained by socio-cultural factors, where increased body weight is traditionally associated with beauty, social status, wealth, and fertility [ 10 , 25 ]. Such cultural perceptions contribute to the acceptance and even desirability of overweight among women in many African contexts, complicating public health efforts to reduce obesity. Increasing age also demonstrated a strong positive trend with overweight/obesity, with participants aged > 50 years having over 9 times the odds compared to the youngest group. This age-related weight gain could be explained via biological mechanisms such as metabolic slowdown, hormonal changes, and reduced physical activity, with advancing age playing crucial roles [ 7 , 13 ]. Furthermore, cumulative lifestyle exposures over time, such as prolonged sedentary behaviour and unhealthy diets, further exacerbate weight gain among older adults. Middle-level education was associated with a higher risk, which diverges from high-income countries, where lower education is often a risk factor [ 30 ]. This may reflect the nutrition transition in Cameroon, where higher education levels often come with greater access to energy-dense foods and sedentary employment [ 8 , 10 , 43 ]. These findings align with local [ 16 , 28 ] and global patterns [ 7 , 15 ], though potential residual confounding cannot be excluded, especially regarding unmeasured lifestyle factors. Regarding income levels, contrary to the assumption in your initial hypothesis, participants with low income had significantly lower odds (72% reduced chances) of being overweight or obese compared to those with high income. This suggests a protective effect of low income against excess weight. This result aligns with findings from several studies in low- and middle-income countries (LMICs), where obesity is often a disease of affluence. In such contexts, individuals with higher income may have greater access to processed, energy-dense foods, sedentary lifestyles, and reduced physical labour, which collectively increase the risk of weight gain [ 10 , 30 , 34 ]. While in high-income countries, low income is often linked with obesity due to poor access to healthy foods, in LMICs like Cameroon, economic transition is still shaping the food environment and the “obesogenic shift” tends to begin in higher socioeconomic strata [ 10 , 30 ]. Moreover, higher income groups may consume more convenience foods, dine out more frequently, and have less time for physical activity due to work demands. They may also perceive excess body weight as a marker of prosperity or health, a persistent cultural belief in many African contexts [ 16 , 30 ]. Alcohol drinkers had significantly greater odds of overweight/obesity (2.4 times higher chances), especially among at-risk drinkers (almost 6 times the odds) and frequent drinkers (almost 7 times the odds). These results are consistent with several studies showing alcohol’s role in positive energy balance, increased appetite, and fat accumulation, particularly central adiposity [ 1 , 20 , 34 ]. Alcohol contains 7 kcal/g and is often consumed in addition to meals. It can inhibit lipid oxidation and impair metabolic regulation, promoting visceral fat accumulation [ 20 , 31 ]. Heavy drinking may also be associated with late-night eating or lower physical activity [ 29 ]. Similar associations were noted in Ireland [ 1 ] and Cameroon [ 16 , 35 ], supporting the generalizability of our findings. However, the strength of the association in our study was higher than that in some Western studies, potentially due to variations in alcohol type (e.g., high-proof homemade alcohols), drinking patterns, and combined meal types [ 34 ]. Also, self-reported alcohol use may be prone to underreporting. Results revealed a positive and statistically significant association between soft drink consumption and overweight/obesity. Adults who consumed soft drinks had an adjusted odds ratio of 2.00, indicating a doubling of obesity risk compared to non-consumers. This finding aligns with a wide body of global literature that identifies sugar-sweetened beverages (SSBs) as major contributors to excess energy intake and adiposity. A meta-analysis by Ardeshirlarijani et al. (2021) [ 32 ] and another by Vartanian et al. (2007) [ 18 ] both concluded that soft drink intake is associated with increased weight gain and obesity. The liquid calories in soft drinks have low satiety value, leading to passive overconsumption of energy [ 24 , 30 , 33 ]. Studies from Spain [ 24 ], Mexico [ 34 ], and 75-country global analyses [ 27 ] consistently support this relationship. In Cameroon, similar trends have been documented in both urban and rural settings, where the nutrition transition has led to increased intake of processed and sugary foods and beverages [ 16 , 28 ]. Indeed, soft drinks contribute to obesity via several mechanisms: They are energy-dense yet fail to induce satiety, they stimulate glycaemic and insulin spikes, increasing fat storage, and frequent consumption may be accompanied by other poor dietary patterns, including processed foods and snacking [ 24 , 33 ]. Participants who combined high-calorie meals with either soft drinks or alcohol had significantly higher odds of overweight/obesity (p < 0.001). This synergistic interaction is biologically plausible, as combined high-calorie meals and sugar or alcohol rapidly raise postprandial glucose and insulin, promoting lipogenesis [ 34 , 37 ], thus leading to weight gain. Strengths and limitations Strengths of this study included its relatively large sample size and analytic rigor, with adjusted models accounting for key sociodemographic confounders as well as dietary habits, active transportation, and combination with high-calorie meals or not. However, several limitations were as follows: Self-reported consumption data may be subject to recall and social desirability bias. The study did not measure total caloric intake, physical activity levels in detail, or other dietary habits. V. Conclusion In a community-based cross-sectional study including 970 participants, conducted in the Biyem-Assi Health District of Yaoundé (Cameroon), a high prevalence of overweight and obesity among adults was found. Frequent soft drink consumption was predominantly observed among males aged 21–30 years and individuals with lower income levels. Compared to men, women had 2.5 times the odds of being overweight/obese. Six adults out of ten were found to be either overweight or obese. Being a female, having a medium education level, and increasing age were risk factors for the onset of overweight/obesity, while low income was a protective factor. Also, adults under 40 years of age and those who earned low income consumed more SSBs than older adults. Regarding alcohol consumption, high-income individuals were those who consumed more alcoholic drinks. Participants who drank soft drinks or alcohol frequently or at risky levels had significantly 2 times the odds, 2.34 times the odds, and 5.77 times the odds of being overweight or obese, respectively. Abbreviations cOR : Crude Odd Ratio aOR : Adjusted Odd Ratio BAHD : Biyem-Assi Health District BMI : Body Mass Index BMR : Body Metabolic Rate FAO : Food and Agricultural Organization GL : Glycaemic Load GNR : Global Nutrition Report HFCS : High Fructose Corn Syrup LMICs : Low-Medium Income Countries MASLD : Metabolic dysfunction Associated Steatotic Liver Disease NCDs : Non-Communicable Diseases OR : Odd Ratio RRR : Relative Risk Ratio SABC : Cameroon Brewery Corporation SSBs : Sugar-Sweetened Beverages T2DM : Type 2 Diabetes Mellitus WHO : World Health Organization Declarations Ethics approval and consent to participate: We have obtained ethical clearance CE N ͦ 001159/CRERSHC/2025 from the Centre Regional Ethics Committee, Cameroon, and obtained research authorization from the Biyem-Assi Health District. We conducted this study in strict compliance with the fundamental principles of scientific research in medicine (Helsinki declaration). Participants were free to participate in the study without external constraints. We obtained an informed and signed consent form from each participant. Consent to publish: Not applicable Availability of data and materials : The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Competing interests : The authors declare that they have no competing interests. Funding : No funding was received for this study. Authors’ contribution : MDDT, SRSN, JA, FZN designed the study. Data collection: MDDT, KNF, SRSN, DMDT, AZ, HMM, SUPD, BGK, BWM collected data. MDDT, SON, EMFK and SRSN analyzed the data. MDDT, SRSN drafted the paper. KNN, AZ, HMM, SUPD, BGK, EMFK, FKL, CNO, SON, CMT, FZN and JA reviewed the paper. All the authors read and approved the final draft for publication. Acknowledgement : We thank all the participants in this study and the head of the Biyem-Assi Health District Clinical trial number: not applicable. Supplementary material: The questionnaire used to collect this data has been uploaded as supplementary material. References AlKalbani SR, Murrin C. The association between alcohol intake and obesity in a sample of the Irish adult population: a cross-sectional study. BMC Public Health. 2023;23(1):2075. Review WP. Obesity Rates by Country 2022: World Population Review. 2021. Pinho M, Mackenbach J, Charreire H, Oppert J, Bárdos H. Exploring the relationship between perceived barriers to healthy eating and dietary behaviors in European adults. Eur J Nutr. 2017;57:1761–70. Rajan T, Menon V. Psychiatric disorders and obesity: A review of association studies. J Postgrad Med. 2017;63(3):182–90. Zahran SM. Association of Beverage Consumption with Obesity in Healthy Adults. Arab J Nutr Exerc. 2017;1(1):37. Chan T. Sugar-Sweetened Beverage Consumption Frequency vs, in BMI, National Health and Nutrition Examination Survey 2003–2004.Thesis, Georgia State University, 2011. World Health Organization (WHO). Obesity and Overweight. Media Centre. 2022. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight . Accessed 11 Nov 2024. Global Nutrition Report (GNR). The burden of malnutrition at a glance. 2024. https://globalnutritionreport.org/resources/nutrition-profiles/africa/middle-africa/cameroon/ . Accessed 10 Nov 2024. Food and Agriculture Organization (FAO) of the United Nations. FAOSTAT. 2016. http://www.fao.org/faostat/en/#country/32 . Accessed 11 Nov 2024. Bisseck. Prevalence and determinants of obesity in urban Cameroon. J BMC Public Health. 2016. Simo L, Agbor V, Temgoua F, Fozeu L, Bonghaseh D, Mbonda A, et al. Prevalence and factors associated with overweight and obesity in selected health areas in a rural health district in Cameroon: a cross-sectional analysis. BMC Public Health. 2021;21(1):475. Ministry of Health, Cameroon. National Health Development Plan 2016–2020. 2016. http://www.minsante.cm/site/sites/default/files/National20Health20Development20Plan\202016-2020.Cameroon.pdf . Accessed 8 Nov 2024. Leal, Luana G, Magno A, Miguel L, Batista Jr. Physical exercise induced myokines and muscle-adipose tissue crosstalk: a review of current knowledge and the implications for health and metabolic diseases. Front Physiol. 2018;9:1307. Liu J, Yi S, Russo R, Mayer V, Wen M, Li Y. Trends and disparities in diabetes and prediabetes among adults in the United States, 1999–2018. Public Health. 2023;214:163–70. Ul-Haq Z, Mackay D, Fenwick E, Pell J. Meta-analysis of the association between body mass index and health-related quality of life among adults, assessed by the SF-36. Obes. 2013;21:322–27. Di Angelantonio E, Bhupathiraju S, Wormser D. 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Relationship of soft drink consumption to global overweight, obesity, and diabetes: a cross-national analysis of 75 countries. Am J Public Health. 2013;103(11):2071–7. Golzarand M, Salari-Moghaddam A, Mirmiran P. Association between alcohol intake and overweight and obesity: a systematic review and dose-response meta-analysis of 127 observational studies. Crit Rev Food Sci Nutr. 2022. Wannamethee SG, Alcohol. Overweight and Obesity. In: Watson RR, Preedy VR, Zibadi S, editors. Alcohol, Nutrition, and Health Consequences. Totowa, NJ: Humana; 2013. pp. 371–81. Cameroon. - Global Obesity Observatory. FOSSUNG N. The Socio-Language Effects of Alcohol Consumption in the Buea Municipality. Int J Res Innov Soc Sci. 2023;7(4):324–34. González-Morales R, Canto-Osorio F, Stern D, Sánchez-Romero, Torres-Ibarra L, Hernández-López R, et al. Soft drink intake is associated with weight gain, regardless of physical activity levels: the health workers cohort study. Int Int J Behav Nutr Phys Act. 2020;17:60. Arif AA, Rohrer JE. Patterns of alcohol drinking and its association with obesity: data from the Third National Health and Nutrition Examination Survey, 1988–1994. BMC Public Health. 2005;5:126. Arhakis A, Mavrogiannidou Z, Boka V. An Overview of the Types of Soft Drinks and Their Impact on Oral Health: Review of Literature. World J Dentistry. 2023;14(7):648–54. Betancur MI, Motoki K, Spence C, Velasco C. Factors influencing the choice of beer: A review. Food Res Int. 2020;137:109367. Capoccia D, Milani I, Colangeli L, Parrotta ME, Leonetti F, Guglielmi V. Social, cultural and ethnic determinants of obesity: From pathogenesis to treatment. Nutr Metab Cardiovasc Dis. 2025;35(6):103901. Castro A, Gili M, Visser M, Penninx BWJH, Brouwer IA, Montaño JJ, et al. Soft Drinks and Symptoms of Depression and Anxiety in Overweight Subjects: A Longitudinal Analysis of an European Cohort. Nutrients. 2023;15(18):3865. Crouch E, Abshire DA, Wirth MD, Hung P, Benavidez GA. Rural–Urban Differences in Overweight and Obesity, Physical Activity, and Food Security Among Children and Adolescents. Prev Chronic Dis. 2023;20:E92. Elmaleh-Sachs A, Schwartz JL, Bramante CT, Nicklas JM, Gudzune KA, Jay M. Obesity Management in Adults: A Review. JAMA. 2023;330(20):2000–15. Fazzino TL, Fleming K, Sher KJ, Sullivan DK, Befort C. Heavy Drinking in Young Adulthood Increases Risk of Transitioning to Obesity. Am J Prev Med. 2017;53(2):169–75. Ferretti F, Mariani M. Sugar-sweetened beverage affordability and the prevalence of overweight and obesity in a cross section of countries. Glob Health. 2019;18(1):30. Hanifah LN. Literature Review: Factors Affecting Alcohol Consumption and the Impact of Alcohol on Health Based on Behavioral Theory. Media Gizi Kesmas. 2023;12(1):453–62. Hodge AM, Bassett JK, Milne RL, English DR, Giles GG. Consumption of sugar-sweetened and artificially sweetened soft drinks and risk of obesity-related cancers. Public Health Nutr. 2018;21(9):1618–26. Nansseu J, Noubiap J, Bigna J. Epidemiology of Overweight and Obesity in Adults Living in Cameroon: A Systematic Review and Meta-Analysis. Obes. 2019;27(10):1682–92. Choukem SP, Tochie JN, Nguefack-Tsague G, Sibetcheu AT, Tchouaket Moifo B, Nansseu JR. Overweight and obesity in children aged 3–13 years in urban Cameroon: a cross-sectional study of prevalence and association with socioeconomic status. BMC Obes. 2017;4:7. Ngatchou W, Lemogoum D, Ndobo P, Lamlenn S, Ngogang J, Choukem SP. Cardiometabolic profile of obese children in a sub-Saharan African setting: a cross-sectional study. Ann Trop Paediatr. 2011;31(1):39–44. Choukem SP, Nansseu JR, Tiogouo Tchamba F, Katte JC, Fouejeu Kamdje AH. Overweight/obesity and associated cardiovascular risk factors in sub-Saharan African children and adolescents: a scoping review. Int J Pediatr Endocrinol. 2020;2020(1):9. Noubissi EC, Ama Moor VJ, Agba MC, Nchinjoh S, Tchokfe Ndé F, Toukam T, et al. Noncommunicable diseases behavioural risk factors among secondary school adolescents in urban Cameroon: a cross-sectional study. BMC Public Health. 2024;24:1086. Mbanya VN, Kufe CN, Noubiap JJ, Fetse GT, Choukem SP. Prevalence and determinants of selected cardio-metabolic risk factors among people living with HIV/AIDS on antiretroviral therapy in Southwest Cameroon. BMC Public Health. 2018;18(1):486. Lemeshow S, Hosmer DW Jr, Klar J, Lwanga SK. Adequacy of sample size in health studies. Chichester: John Wiley & Sons for the World Health Organization; 1990. Braig S, Weber A, Strobl R, Linkohr B, Leitzmann MF, Peters A, Thorand B. Soft drink consumption and overweight/obesity among adolescents in 107 countries: Global School-based Student Health Survey (GSHS) analysis. Nutrients. 2023;15(14):3195. Traversy G, Chaput JP. Alcohol consumption and obesity: an update. Curr Obes Rep. 2015;4(1):122–30. Tables Table I : Sampling frame Health Area Population Population percentage Minimum sample size Number of clusters of 10 households per health area Akok-ndoe 26,617 6 58 6 Biscuiterie 31,699 8 77 8 Biyem Assi 1 35,782 9 87 9 Biyem Assi 2 29,935 7 67 7 Elig Effa 36,517 9 87 9 Etoug Ebe 1 33,941 8 77 8 Etoug Ebe 2 18,398 5 48 5 Melen 31,910 8 77 8 Mendong 37,606 9 87 9 Mvog betsi 1 30,547 7 67 7 Mvog betsi 2 21,126 5 48 5 Nkolbikok 24,978 6 58 6 Simbok 1 27,663 7 67 7 Simbok 2 25,686 6 58 6 TOTAL BIYEM-ASSI 412,406 100 964 100 Table I I : Sociodemographic characteristics of the study population, 2025 Variables Modalities Frequency (n) Percentage (%) Age range in years 21-30 432 44.5 31-40 271 27.9 41-50 141 14.9 >50 125 12.9 Gender Male 437 45.1 Female 533 54.9 Single 512 52.8 Matrimonial status Married 408 42.1 Widow 30 3.1 Divorced 20 2.1 Education level None 20 2.1 Primary 111 11.4 Secondary 480 49.5 Higher education 359 37 Professional status Employed 366 37.7 Self employed 246 25.4 Unemployed 212 21.9 Student 146 15.1 Monthly income 250,000 FCFA 59 6.1 Table III : Distribution of the average number of drinks per sitting for soft drink consumption according to sex, age Variables Modalities Number of soft drink unit 1-2 UNITS 3-4 UNITS 5-6 UNITS 7-9 UNITS +10 UNITS Age in years 40 155(23.4) 26 (23.6) 5 (25.0) 9(45) 2(20) Sex Male 280 (42.4) 57 (51.8) 10(50.0) 13(65) 7(70) Female 381(57.6) 53(48.2) 10(50.0) 7(35) 3(30) Table IV : Distribution of the average number of drinks per sitting for alcohol drink consumption according to sex, age Variables Modalities Number of alcohol drink units 1-2 UNITS 3-4 UNITS 5-6 UNITS 7-9 UNITS +10 UNITS Age in years 40 68(23.4) 59(29.1) 25(30.9) 16(32.0) 37(45.7) Sex Male 112(38.6) 97(47.8) 46(56.8) 33(66.0) 52(64.2) Female 178 (61.4) 106(52.2) 35(43.2) 17(34.0) 29(35.8) Table V : Distribution of the population regarding anthropometric measures Variables Min – Max Mean ± SD Median Height (in m) 1.04-1.96 1.66±0.11 1.67 Weight (in Kg) 41.65-164 75.71±15.63 74.72 Body to mass index (Kg/m 2 ) 15.8-66.2 27.53±6.15 26.32 Table VI : Prevalence of overweight/obesity across participants’ characteristics Variable Category Prevalence p-value Normal weight (n=374) Overweight/Obese (n=596) Sex Male 219 (50.1) 218 (49.9) <0.001 Female 155 (29.1) 378 (70.9) Age <40 years 312 (44.3) 392 (55.7) 40 years 62 (23.3) 204 (76.7) Education None 12 (60) 8 (40) 0.001 Primary 35 (31.5) 76 (68.5) Secondary 164 (34.2) 316 (65.8) Tertiary 163 (45.4) 196 (54.6) Income Low 208 (42.4) 283 (57.6) 0.001 Middle 155 (36.9) 265 (63.1) High 11 (18.6) 48 (81.4) Active transport Yes 241 (40.8) 349 (59.2) 0.068 No 133 (35) 247 (65) High-calorie meal combined with either soft drink or alcohol Yes 220 (34) 457 (66) <0.001 No 155 (47.7) 169 (52.3) Table VII : Association between overweight/obesity and soft drink, alcohol beverage consumption Bivariate model Multivariate model Variable Modalities p-value cOR p-value aOR Soft drink Exposed 0.002 2.25 [1.36, 3.72] 0.024 2 [1.09, 3.66] Alcohol beverage Exposed 0.001 2.5 [1.47, 4.32] 0.012 2.34 [1.21, 4.53] Alcohol beverage status Drinkers 0.86 1.06 [0.56, 2] 0.8 1.1 [0.52, 2.33] At risk drinkers <0.001 5.99 [3.24, 11.07] <0.001 5.77 [2.64, 12.59] Alcohol frequency Moderate 0.047 2.07 [1.01, 4.23] 0.028 2.66 [1.11, 6.35] Frequent <0.001 6.48 [3.75, 11.19] <0.001 6.63 [3.28, 13.39] cOR: crude Odd Ratio aOR: adjusted Odd Ratio Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile.questionnaire.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 08 Apr, 2026 Reviewers agreed at journal 04 Apr, 2026 Reviewers invited by journal 03 Apr, 2026 Editor invited by journal 01 Apr, 2026 Editor assigned by journal 01 Apr, 2026 Submission checks completed at journal 01 Apr, 2026 First submitted to journal 31 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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overweight/obesity\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9276547/v1/37c54ddcb334b463037e8f5b.png"},{"id":106725016,"identity":"cc91c64d-a1d4-4809-a1d3-d0fb26cea020","added_by":"auto","created_at":"2026-04-12 18:31:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1945450,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9276547/v1/bc9559ee-92e9-42c1-ba5f-9bf19115cd3a.pdf"},{"id":106544678,"identity":"13020a9c-57f1-4a90-9876-3fce11b5e03e","added_by":"auto","created_at":"2026-04-09 16:41:48","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":27699,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile.questionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-9276547/v1/17c6bdf837638c6d833f03c0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Contribution of the intake of soft drinks and alcoholic beverages on overweight and obesity among adults in the Health District of Biyem-Assi: a cross-sectional study","fulltext":[{"header":"I. Introduction","content":"\u003cp\u003eObesity refers to an abnormal or excessive accumulation of body fat that surpasses the physiological requirements of the body and adversely affects overall health [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]. Recognized as a chronic and often difficult-to-control condition, obesity poses significant management challenges. Many individuals affected by it struggle to adopt and maintain healthier eating patterns, often hindered by low motivation and the pervasive availability of energy-dense, nutrient-poor foods and beverages [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. Obesity is commonly classified into two major forms: gynoid (characterized by fat accumulation around the hips and thighs) and central (marked by fat distribution around the abdominal area). The development of obesity typically results from a persistent energy imbalance where caloric intake exceeds energy expenditure, which not only drives weight gain but also contributes to the onset of several psychological and metabolic disorders as a critical public health concern in modern society [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSugar-sweetened beverages (SSBs), particularly carbonated soft drinks, are defined as drinks containing at least two grams of added sugars or high-fructose corn syrup per 240 mL serving [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]. The growing intake of such beverages has become a significant contributor to increased dietary energy consumption. In a study by Chan [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e], high SSB intake was linked to elevated body mass index (BMI), with further associations identified between frequent consumption and the risk of obesity, type 2 diabetes mellitus (T2DM), and dental decay. These beverages are thought to promote weight gain not only due to their high sugar content but also because they provide low satiety and poor caloric compensation [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. Furthermore, there is a robust positive relationship between soft drink consumption and the overall prevalence of overweight and obesity [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlcoholic beverages, commonly categorized as beer, wine, and spirits, have also been studied for their potential contribution to obesity. However, the evidence remains mixed, likely due to the interplay of various individual and behavioral factors [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. Despite this complexity, numerous studies suggest that excessive alcohol consumption is positively associated with increased likelihood of being overweight, obese, or exhibiting central obesity [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e], irrespective of the type of alcohol consumed or whether it is consumed with meals [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prevalence of overweight/obesity is escalating rapidly across Sub-Saharan Africa, including Cameroon, largely fueled by accelerating urbanization, lifestyle transitions, and evolving dietary patterns. In Cameroon, recent data reveal that adult obesity rates have nearly doubled, rising from 4.9% in 2000 to 9.5% in 2016 [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e] and 50.1% in 2022 [\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e]. A major driving force behind this surge is the increased intake of energy-dense foods and beverages, often coupled with a decline in physical activity levels [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. To formulate effective public health responses, it is essential to identify and address specific risk factors, particularly the consumption of sugar-sweetened and alcoholic beverages.\u003c/p\u003e \u003cp\u003eOverweight/obesity also serves as a key modifiable risk factor for numerous non-communicable diseases (NCDs), including type 2 diabetes, cardiovascular disorders, and various forms of cancer [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. With the burden of NCDs steadily increasing in Cameroon, the need for focused research to inform preventive strategies is more urgent than ever. While some investigations have explored obesity within specific Cameroonian subpopulations, there remains a dearth of data from certain geographic contexts, especially semiurban zones such as Biyem-Assi [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. Generating localized evidence from these underrepresented areas is critical for crafting tailored and impactful public health policies. To formulate effective public health responses, it is essential to identify and address specific risk factors, particularly the consumption of sugar-sweetened and alcoholic beverages.\u003c/p\u003e \u003cp\u003eMoreover, despite the growing incidence of overweight/obesity, Cameroon’s National Health Development Plan has yet to adequately incorporate overweight/obesity prevention measures aimed at semiurban populations [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. Gaining a deeper understanding of the prevalence and drivers of overweight/obesity in these settings is thus vital for informing evidence-based policymaking, designing community-specific interventions, and ensuring effective disease control efforts.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"II. Methods","content":"\u003ch2\u003e2.1. Study design\u003c/h2\u003e\n\u003cp\u003eA community-based cross-sectional study was conducted in the Biyem-Assi Health District (BAHD), where adults were selected via a cluster random stratified sampling. This study combined two components: a descriptive component aiming to determine the prevalence of obesity and overweight, and an analytical nested case-control study. The cases were individuals with a Body Mass Index (BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u0026sup2;), and the controls were healthy weight individuals (BMI 18.5\u0026ndash;24.9 kg/m\u0026sup2;). The study was carried out from August 2024 to June 2025, with a period of recruitment of 3 weeks and 2 days, \u003cem\u003ei.e.\u003c/em\u003e, from March 25 to April 17.\u003c/p\u003e\n\u003ch2\u003e2.2. Study site\u003c/h2\u003e\n\u003cp\u003eThe study was conducted in the Biyem-Assi Health District in Yaound\u0026eacute;, in the Centre Region of Cameroon. The Health District of Biyem-Assi is cosmopolitan with a diverse cultural influence. As such, results obtained would be inferred to the general population as a whole. The Biyem-Assi health district covers an estimated population for the ongoing year of 434,550 inhabitants (both sexes). Being in a semi-urban area, the Biyem-Assi health district is of a lesser cultural influence. Also, the high population density has maximized the rate of participant inclusion. The Health District comprises fourteen Health Areas covering an area of 72 km\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n\u003ch2\u003e2.3. Population study and selection criteria\u003c/h2\u003e\n\u003cp\u003eThe targeted population was adults aged 21 years and older residing in the Health District of Biyem-Assi for at least 1 year. The population source was the population of the Health District of Biyem-Assi.\u003c/p\u003e\n\u003ch2\u003e2.3.1. Selection criteria\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdults aged 21 years and older residing in the Health District of Biyem-Assi.\u003c/p\u003e\n\u003cp\u003eFor the descriptive part of the study, we included those who gave their free consent, adults residing in the Health District of Biyem-Assi in 2025. We excluded all those above 21 years who presented a medical condition like diabetes, thyroid conditions, hypophyseal, or adrenal diseases, pregnant or nursing, ongoing weight loss or gain programs, incompletely filled data or who withdrew their consent.\u003c/p\u003e\n\u003cp\u003eFor the analytical part, we included adults who were willing to participate and provide informed consent for both cases and controls. Also, we included as cases, adults who had a confirmed diagnosis of overweight/obesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u0026sup2;) and as controls healthy weight individuals (BMI 18.5\u0026ndash;24.9 kg/m\u0026sup2;). We excluded from our inclusion of cases individuals with chronic illnesses affecting weight, individuals on weight-loss medication, and excluded from our inclusion of controls individuals with a history of eating disorders, and individuals with chronic illnesses that may affect dietary habits.\u003c/p\u003e\n\u003ch2\u003e2.3.2. Sample size estimate\u003c/h2\u003e\n\u003cp\u003eThe sample size was calculated using Cochrane\u0026rsquo;s formula. According to a study done by Nansseu \u003cem\u003eet al.\u003c/em\u003e (2022) [\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e], the prevalence of overweight and obesity among adults in Cameroon is 50.1% with a precision of 5%, and a significance level of 0.05; the minimum sample size of participants required for the study was 385 participants. The final sample size was adjusted to 964 participants, taking into account an acceptance rate of 80% and a cluster correction (k\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e\n\u003cp\u003eRegarding the analytic component, the minimum sample size required for the study was estimated using the sample size tables developed by Lemeshow \u003cem\u003eet al.\u003c/em\u003e (1990) [\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e] for an unmatched case-control study. Taking into account a power of 90%, two-sided alpha of 5%, exposure prevalence among controls was set at 32.9% for soft drinks [\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e] and 66% for alcohol beverage [\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e], an anticipated odd ratio of 2, we had a minimum of 168 cases and 168 controls for soft drink exposure, and a minimum of 125 cases and 125 controls for alcoholic beverages. Considering a 1:2 ratio, the sample size gave 504 participants (168 cases and 336 controls) for soft drink exposure and 375 participants (125 cases and 250 controls) for alcohol drink exposure.\u003c/p\u003e\n\u003cp\u003eWe used a stratified random cluster sampling. Our strata were the 14 health areas of the Biyem-Assi Health District. For each health area, we calculated the number of households in proportion to the estimated size of the population in each health area (\u003cstrong\u003eTable I\u003c/strong\u003e). After defining the number of households per health area, a cluster sampling technique was used, where each cluster consisted of 10 households. In every household within a cluster, at least one adult was interviewed, resulting in a minimum of ten adult respondents per cluster, giving a total of 100 clusters.\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003e2.4. Administrative, ethical, and research procedures\u003c/h2\u003e\n\u003cp\u003eAfter validation of the protocol by the co-directors and thesis director of the Faculty of Medicine and Pharmaceutical Sciences of the University of Dschang, obtaining ethical clearance from the \u0026ldquo;Centre Regional Ethics Committee for Human Health Research\u0026rdquo; (CRERSH-CE), approval of the Head of District as well as the respective chief of health area, a general meeting was organized where all the communication focal points were invited for a briefing and we pre-tested the questionnaire (see supplementary material). Communication of the various dates of field work was given, and a day prior to that of the data collection in each respective health area, a meeting was held where all the recruited staff (5 in total) were briefed on how to approach participants, and take measurements, as well as how to use the geo-localisation tool for tracking. On the day of data collection, our reference point was the health centre in each health area, and dispatchment into the community for data collection was done using a ballpoint pen, where the pointer of the ballpoint pen indicated the direction to go.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5. Variables of interest\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eAnthropometric measures (height, weight, waist circumference)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eType of beverages consumed (SSBs, natural juice, energy drinks, local beer, industrial beer, industrial liquor, etc.)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eOverweight/Obesity status (Dependent variable): It was measured as a binary variable (overweight/obese; non-overweight/non-obese) or a continuous variable (body mass index, BMI) using an electronic balance to measure the weight and a stadiometer for the height. The WHO\u0026rsquo;s scale for weight status was used to rate the participants into either overweight/obese or not.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSoft and alcoholic drinks consumption (Independent variable): It was measured as the frequency (never, monthly or less than, 2\u0026ndash;4 times a month, 2\u0026ndash;3 times per week, \u0026gt;\u0026thinsp;4 times per week), or the quantity of beverages consumption (1\u0026ndash;2 units, 3\u0026ndash;4 units, 5\u0026ndash;6 units, 7\u0026ndash;9 units, \u0026gt; 10 units).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePotential confounders: This was done through socio-demographic characteristics (age, sex, education, socioeconomic status, \u003cem\u003ei.e.\u003c/em\u003e, income level), lifestyle factors (physical activity, dietary habits).\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003ch2\u003e2.4. Administrative, ethical, and research procedures\u003c/h2\u003e\n\u003cp\u003eAfter validation of the protocol by the co-directors and thesis director of the Faculty of Medicine and Pharmaceutical Sciences of the University of Dschang, obtaining ethical clearance from the \u0026ldquo;Centre Regional Ethics Committee for Human Health Research\u0026rdquo; (CRERSH-CE), approval of the Head of District as well as the respective chief of health area, a general meeting was organized where all the communication focal points were invited for a briefing and we pre-tested the questionnaire (see supplementary material). Communication of the various dates of field work was given, and a day prior to that of the data collection in each respective health area, a meeting was held where all the recruited staff (5 in total) were briefed on how to approach participants, and take measurements, as well as how to use the geo-localisation tool for tracking. On the day of data collection, our reference point was the health centre in each health area, and dispatchment into the community for data collection was done using a ballpoint pen, where the pointer of the ballpoint pen indicated the direction to go.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5. Variables of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eAnthropometric measures (height, weight, waist circumference)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eType of beverages consumed (SSBs, natural juice, energy drinks, local beer, industrial beer, industrial liquor, etc.)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eOverweight/Obesity status (Dependent variable): It was measured as a binary variable (overweight/obese; non-overweight/non-obese) or a continuous variable (body mass index, BMI) using an electronic balance to measure the weight and a stadiometer for the height. The WHO\u0026rsquo;s scale for weight status was used to rate the participants into either overweight/obese or not.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSoft and alcoholic drinks consumption (Independent variable): It was measured as the frequency (never, monthly or less than, 2\u0026ndash;4 times a month, 2\u0026ndash;3 times per week, \u0026gt;\u0026thinsp;4 times per week), or the quantity of beverages consumption (1\u0026ndash;2 units, 3\u0026ndash;4 units, 5\u0026ndash;6 units, 7\u0026ndash;9 units, \u0026gt; 10 units).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePotential confounders: This was done through socio-demographic characteristics (age, sex, education, socioeconomic status, \u003cem\u003ei.e.\u003c/em\u003e, income level), lifestyle factors (physical activity, dietary habits).\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2\u003e2.6. Definition of key and operational terms\u0026nbsp;\u003c/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence\u003c/strong\u003e: It refers to the proportion of the adult population of the Health District of Biyem-Assi at the time of study.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eOverweight/obese status\u003c/strong\u003e: This was the primary outcome variable. Any adult who has a BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u0026sup2; is overweight, as a BMI between 25.0 and 29.9 kg/m\u0026sup2;.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eAlcohol\u003c/strong\u003e: Any kind of beverage obtained by distillation of wine, cider, fermented juice or any fermented liquor derived from sugary or starchy substances or containing ethanol.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eSugary drink\u003c/strong\u003e: Beverages that contain a high number of calories from sugar, whether natural, as in fruit juices and smoothies or added as in sodas or sparkling drinks.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eAlcohol/soft drink consumer\u003c/strong\u003e: Anyone who has had to consume alcoholic/sugary drinks in the last twelve months, and the tool used will be the \u003cem\u003eAlcohol Use Disorders and Identification Test-Consumption (\u003c/em\u003eAudit-C). A score of 0 indicates non-drinkers, 1\u0026ndash;3 indicates drinkers (females), and 1\u0026ndash;4 indicates drinkers (males), and a score of \u0026ge;\u0026thinsp;4 indicates higher risk drinking (females), while a score of \u0026ge;\u0026thinsp;5 indicates higher risk drinking (males).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic and economic characteristics\u003c/strong\u003e: This included\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSex: Measured as a binary variable (male/female).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eEducational Level: Measured as a categorical variable (no formal education, primary, secondary, tertiary) and further categorized into low (no formal education and primary), medium (secondary), and high (tertiary).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eIncome level: Measured based on monthly income and further categorised into low for people who earned less than 50,000 FCFA per month; medium for people who earned between 50,000-250,000 FCFA per month, and high for those who earned\u0026thinsp;\u0026gt;\u0026thinsp;250,000 FCFA per month.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2\u003e2.7. Data analysis\u003c/h2\u003e\n\u003cp\u003eThis involved data entry in CSPRO\u0026reg;, reviewing and cleaning the collected data to ensure accuracy. Data collected was analysed using SPSS version 23 software. Quantitative variables were described by means (\u0026plusmn;\u0026thinsp;standard deviation) or by medians (interquartile ranges). Qualitative variables were described as numbers (percentages). The Chi-square test and Fisher's exact test were used to compare categorical variables in the bivariate analysis. Differences were considered statistically significant for p ˂ 0.05. The analysis equally took into account the main confounding factors during multivariate analysis (age, sex, income, education, physical activity, dietary habits) after their p-value was significant in the bivariate analysis, \u003cem\u003ei.e.\u003c/em\u003e, p\u0026thinsp;\u0026le;\u0026thinsp;5%.\u003c/p\u003e\n\u003ch2\u003e2.8. Ethical considerations\u003c/h2\u003e\n\u003cp\u003eApproval from the appropriate ethical review board before any involvement in the study was required. In line with the ethical clearance obtained from the CRERSH-CE, this work was done in strict compliance with the fundamental principle of medical research. Ethical clearance \u003cstrong\u003eCE N ͦ 001159/CRERSHC/2025\u003c/strong\u003e was granted by the Centre Regional Ethics Committee for Human Health Research.\u003c/p\u003e"},{"header":"III. Results","content":"\u003cp\u003eIn this study, a total of 1260 households (90 participants per Health Area) were recruited, thereby recruiting 1260 participants. Of these 1260 participants, 77% were included in the analysis, while the 290 remaining (23%) were excluded due to incompleteness of data records and overweight/obesity-related health diseases. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the enrolment procedure of participants.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.1. General characteristics of the study population\u003c/h2\u003e \u003cp\u003eThe age distribution among the participants in this study revealed a mean age of 35.49 years, with females (54.9%) being mostly represented. Nearly half of the respondents had completed secondary education (49.5%). The marital status distribution showed that just over half of the participants were single (52.8%), while 42.1% were married. A smaller proportion were widowed (3.1%) or divorced (2.1%). Employment in the formal sector was the most common employment status (37.7%), though half of the study population (50.6%) reported earning less than 50,000 FCFA. Participants' characteristics are detailed in \u003cb\u003eTable II\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Soft drink and alcoholic beverage consumption\u003c/h2\u003e \u003cp\u003e \u003cb\u003e3.2.1. Distribution of the frequency of soft drink and alcoholic beverage consumption according to sex, age, and type of beverage\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOverall, younger individuals (\u0026lt;\u0026thinsp;40 years) consumed more soft and alcoholic drinks, with males consuming more units per sitting than females, especially at high quantities. Regarding the patterns, different patterns were observed for the types of beverages consumed, with sugar-sweetened beverages being the most consumed for soft drinks and industrial beer being the most consumed for alcoholic beverages, irrespective of the frequency of consumption.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2. Distribution of the average number of drinks per sitting according to sex, age\u003c/h2\u003e \u003cp\u003e \u003cb\u003eTables III\u003c/b\u003e and \u003cb\u003eIV\u003c/b\u003e represent the average number of drinks per sitting for soft drinks and alcoholic beverages, respectively, according to sex and age. Regarding soft drinks consumption (n\u0026thinsp;=\u0026thinsp;821), the majority consumed 1\u0026ndash;2 units per sitting, especially among \u0026lt;\u0026thinsp;40 years (n\u0026thinsp;=\u0026thinsp;506) and females (n\u0026thinsp;=\u0026thinsp;381). However, higher consumption levels (5\u0026ndash;9 units) are more common in males and \u0026lt;\u0026thinsp;40 years. For alcohol beverage consumption (n\u0026thinsp;=\u0026thinsp;705), higher unit consumption (\u0026gt;\u0026thinsp;5 units) was more prevalent among males and those\u0026thinsp;\u0026gt;\u0026thinsp;40 years, suggesting a possible binge tendency in older males.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Anthropometric status\u003c/h2\u003e \u003cp\u003eTable V presents descriptive statistics of the study population\u0026rsquo;s anthropometric measurements, including height, weight, waist circumference, and body mass index (BMI). The mean height, weight, waist circumference, and BMI were respectively 1.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11 m, 75.71\u0026thinsp;\u0026plusmn;\u0026thinsp;15.63 kg, 87.85\u0026thinsp;\u0026plusmn;\u0026thinsp;15.84 cm, and 27.53\u0026thinsp;\u0026plusmn;\u0026thinsp;6.15 kg/m\u0026sup2;.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1. Prevalence of overweight/obesity\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the distribution of the study population according to body mass index (BMI) categories, highlighting the prevalence of underweight, normal weight, overweight, and obesity. Of the 970 participants included, a significant proportion of the population was found to be overweight (BMI 25\u0026ndash;29.9 Kg/m\u003csup\u003e2\u003c/sup\u003e), representing 31.9% of respondents, while 29.4% were classified as obese (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 Kg/m\u003csup\u003e2\u003c/sup\u003e). The overall percentage of overweight/obese individuals is 61.4%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2. Distribution of overweight/obesity across participants\u0026rsquo; characteristics\u003c/h2\u003e \u003cp\u003e \u003cb\u003eTable VI\u003c/b\u003e below presents the prevalence of overweight/obesity across the study population. Out of 970 participants, 61.4% were classified as overweight or obese. The prevalence of obesity was higher in females (70.9%) than in males, and this was statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as well as in those who were above 40 years (76.7%). On the other hand, higher income levels and education levels were significantly associated with increased overweight/obesity. Combining high-calorie meals with drinks, be it soft drinks or alcohol, showed a statistically strong association (66%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in developing overweight/obesity.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Association between overweight/obesity and soft drink and alcohol beverage consumption\u003c/h2\u003e \u003cp\u003e \u003cb\u003eTable VII\u003c/b\u003e presents the association between overweight/obesity and soft drink alcoholic beverages regarding both the consumption and frequency of consumption after adjusting for confounders such as sex, age, education level, income, dietary habits, and active transportation. We note that, for the consumption of soft drinks, after adjusting for sociodemographic and behavioural factors, soft drink consumption was significantly associated with increased odds of overweight/obesity. Individuals who reported consuming soft drinks had twice the odds of being overweight or obese compared to non-consumers (aOR\u0026thinsp;=\u0026thinsp;2.00; [95% CI: 1.09\u0026ndash;3.66]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024). Also, alcohol drinkers were significantly more likely to be overweight/obese than non-drinkers (aOR\u0026thinsp;=\u0026thinsp;2.34; [95% CI: 1.21\u0026ndash;4.53]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012), suggesting a positive association between alcohol intake and excess body weight.\u003c/p\u003e \u003cp\u003eIn addition to that, being classified as an \u0026ldquo;at-risk\u0026rdquo; drinker was independently and strongly associated with overweight/obesity (aOR\u0026thinsp;=\u0026thinsp;5.77; [95% CI: 2.64\u0026ndash;12.59]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), compared to non-drinkers. Considering the frequency, we note that frequent alcohol drinkers had significantly increased odds of being overweight/obese than rare drinkers (aOR\u0026thinsp;=\u0026thinsp;6.63; [95% CI: 3.28\u0026ndash;13.39]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while moderate drinkers also showed a statistically significant association (aOR\u0026thinsp;=\u0026thinsp;2.66; [95% CI: 1.11\u0026ndash;6.35]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.028).\u003c/p\u003e \u003c/div\u003e"},{"header":"IV. Discussion","content":"\u003cp\u003eThis study investigated the contribution of soft drink and alcoholic beverage consumption to overweight and obesity among adults in the Biyem-Assi Health District. The prevalence of overweight and obesity was alarmingly high (61.4%), comprising 31.9% overweight and 29.4% obese. This figure is notably higher than previous national and subnational estimates, such as the pooled national prevalence reported by Nansseu \u003cem\u003eet al.\u003c/em\u003e (50.1%) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] and the lower prevalence rates reported by Choukem \u003cem\u003eet al.\u003c/em\u003e, in urban Cameroonian children and university students [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The significant increase observed here may reflect intensifying urban dietary transitions, increased sedentary lifestyles, and increased access to ultra-processed foods [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Consistent with studies by Choukem and colleagues, this trend underscores the mounting burden of adiposity-related health risks in both youth and adult populations [\u003cspan additionalcitationids=\"CR40 CR41\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Our findings are particularly worrisome as they reflect a more advanced stage of the nutrition transition in urban Cameroon, where energy-dense diets and limited physical activity converge to drive weight gain.\u003c/p\u003e \u003cp\u003eThe observed high frequency and quantity of soft drink and alcohol consumption, particularly among younger adults (\u0026lt;\u0026thinsp;40 years) and males, mirrors patterns reported both globally and regionally. This trend is consistent with extensive research showing that adolescents and young adults are the main consumers of sugar-sweetened beverages (SSBs) and alcoholic drinks [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Several factors contribute to this phenomenon, including aggressive marketing strategies targeting youth, strong peer influence, and the increasing autonomy young adults have in making dietary choices [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The gender disparity in consumption, with males reporting higher average intake per occasion, reflects entrenched gender norms and behavioural patterns related to alcohol and beverage use [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Males often experience social and cultural pressures to consume more alcohol and SSBs, which may be seen as markers of masculinity or social bonding [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This aligns with findings from Cameroonian studies showing men generally have higher rates of substance use, including alcohol [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTaste preference and peer influence are significant drivers for frequent SSB consumption among younger populations, compounded by a widespread lack of awareness about the nutritional implications of these beverages [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This is concerning given the well-established links between excessive SSB intake and increased risk of overweight, obesity, and metabolic disorders [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Interestingly, the preference for alcohol among older males likely reflects deeper cultural and social norms [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], as well as practical factors such as increased disposable income and beverage accessibility [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Overall, this pattern of consumption contributes substantially to the rising burden of obesity and non-communicable diseases observed globally and within Cameroon [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWomen had significantly higher odds (2.56) of being overweight or obese, consistent with prior findings in Cameroon and Sub-Saharan Africa [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This gender disparity is often explained by socio-cultural factors, where increased body weight is traditionally associated with beauty, social status, wealth, and fertility [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Such cultural perceptions contribute to the acceptance and even desirability of overweight among women in many African contexts, complicating public health efforts to reduce obesity.\u003c/p\u003e \u003cp\u003eIncreasing age also demonstrated a strong positive trend with overweight/obesity, with participants aged\u0026thinsp;\u0026gt;\u0026thinsp;50 years having over 9 times the odds compared to the youngest group. This age-related weight gain could be explained via biological mechanisms such as metabolic slowdown, hormonal changes, and reduced physical activity, with advancing age playing crucial roles [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, cumulative lifestyle exposures over time, such as prolonged sedentary behaviour and unhealthy diets, further exacerbate weight gain among older adults.\u003c/p\u003e \u003cp\u003eMiddle-level education was associated with a higher risk, which diverges from high-income countries, where lower education is often a risk factor [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This may reflect the nutrition transition in Cameroon, where higher education levels often come with greater access to energy-dense foods and sedentary employment [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. These findings align with local [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and global patterns [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], though potential residual confounding cannot be excluded, especially regarding unmeasured lifestyle factors.\u003c/p\u003e \u003cp\u003eRegarding income levels, contrary to the assumption in your initial hypothesis, participants with low income had significantly lower odds (72% reduced chances) of being overweight or obese compared to those with high income. This suggests a protective effect of low income against excess weight. This result aligns with findings from several studies in low- and middle-income countries (LMICs), where obesity is often a disease of affluence. In such contexts, individuals with higher income may have greater access to processed, energy-dense foods, sedentary lifestyles, and reduced physical labour, which collectively increase the risk of weight gain [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. While in high-income countries, low income is often linked with obesity due to poor access to healthy foods, in LMICs like Cameroon, economic transition is still shaping the food environment and the \u0026ldquo;obesogenic shift\u0026rdquo; tends to begin in higher socioeconomic strata [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Moreover, higher income groups may consume more convenience foods, dine out more frequently, and have less time for physical activity due to work demands. They may also perceive excess body weight as a marker of prosperity or health, a persistent cultural belief in many African contexts [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlcohol drinkers had significantly greater odds of overweight/obesity (2.4 times higher chances), especially among at-risk drinkers (almost 6 times the odds) and frequent drinkers (almost 7 times the odds). These results are consistent with several studies showing alcohol\u0026rsquo;s role in positive energy balance, increased appetite, and fat accumulation, particularly central adiposity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlcohol contains 7 kcal/g and is often consumed in addition to meals. It can inhibit lipid oxidation and impair metabolic regulation, promoting visceral fat accumulation [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Heavy drinking may also be associated with late-night eating or lower physical activity [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Similar associations were noted in Ireland [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and Cameroon [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], supporting the generalizability of our findings. However, the strength of the association in our study was higher than that in some Western studies, potentially due to variations in alcohol type (e.g., high-proof homemade alcohols), drinking patterns, and combined meal types [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Also, self-reported alcohol use may be prone to underreporting.\u003c/p\u003e \u003cp\u003eResults revealed a positive and statistically significant association between soft drink consumption and overweight/obesity. Adults who consumed soft drinks had an adjusted odds ratio of 2.00, indicating a doubling of obesity risk compared to non-consumers. This finding aligns with a wide body of global literature that identifies sugar-sweetened beverages (SSBs) as major contributors to excess energy intake and adiposity. A meta-analysis by Ardeshirlarijani \u003cem\u003eet al.\u003c/em\u003e (2021) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and another by Vartanian \u003cem\u003eet al.\u003c/em\u003e (2007) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] both concluded that soft drink intake is associated with increased weight gain and obesity. The liquid calories in soft drinks have low satiety value, leading to passive overconsumption of energy [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Studies from Spain [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], Mexico [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and 75-country global analyses [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] consistently support this relationship. In Cameroon, similar trends have been documented in both urban and rural settings, where the nutrition transition has led to increased intake of processed and sugary foods and beverages [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Indeed, soft drinks contribute to obesity via several mechanisms: They are energy-dense yet fail to induce satiety, they stimulate glycaemic and insulin spikes, increasing fat storage, and frequent consumption may be accompanied by other poor dietary patterns, including processed foods and snacking [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Participants who combined high-calorie meals with either soft drinks or alcohol had significantly higher odds of overweight/obesity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This synergistic interaction is biologically plausible, as combined high-calorie meals and sugar or alcohol rapidly raise postprandial glucose and insulin, promoting lipogenesis [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], thus leading to weight gain.\u003c/p\u003e\n\u003ch3\u003eStrengths and limitations\u003c/h3\u003e\n\u003cp\u003eStrengths of this study included its relatively large sample size and analytic rigor, with adjusted models accounting for key sociodemographic confounders as well as dietary habits, active transportation, and combination with high-calorie meals or not. However, several limitations were as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSelf-reported consumption data may be subject to recall and social desirability bias.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe study did not measure total caloric intake, physical activity levels in detail, or other dietary habits.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"V. Conclusion","content":"\u003cp\u003eIn a community-based cross-sectional study including 970 participants, conducted in the Biyem-Assi Health District of Yaound\u0026eacute; (Cameroon), a high prevalence of overweight and obesity among adults was found. Frequent soft drink consumption was predominantly observed among males aged 21\u0026ndash;30 years and individuals with lower income levels. Compared to men, women had 2.5 times the odds of being overweight/obese. Six adults out of ten were found to be either overweight or obese. Being a female, having a medium education level, and increasing age were risk factors for the onset of overweight/obesity, while low income was a protective factor. Also, adults under 40 years of age and those who earned low income consumed more SSBs than older adults. Regarding alcohol consumption, high-income individuals were those who consumed more alcoholic drinks. Participants who drank soft drinks or alcohol frequently or at risky levels had significantly 2 times the odds, 2.34 times the odds, and 5.77 times the odds of being overweight or obese, respectively.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ecOR\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCrude Odd Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eaOR\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odd Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBAHD\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBiyem-Assi Health District\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBMR\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Metabolic Rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFAO\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFood and Agricultural Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGL\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlycaemic Load\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGNR\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlobal Nutrition Report\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHFCS\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHigh Fructose Corn Syrup\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLMICs\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-Medium Income Countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMASLD\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMetabolic dysfunction Associated Steatotic Liver Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNCDs\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon-Communicable Diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOR\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdd Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eRRR\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRelative Risk Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSABC\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCameroon Brewery Corporation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSSBs\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSugar-Sweetened Beverages\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eT2DM\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eType 2 Diabetes Mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eWHO\u003c/b\u003e:\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e We have obtained ethical clearance\u0026nbsp;\u003cstrong\u003eCE N ͦ 001159/CRERSHC/2025\u0026nbsp;\u003c/strong\u003efrom the Centre Regional Ethics Committee, Cameroon, and obtained research authorization from the Biyem-Assi Health District. We conducted this study in strict compliance with the fundamental principles of scientific research in medicine (Helsinki declaration). Participants were free to participate in the study without external constraints. We obtained an informed and signed consent form from each participant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish:\u0026nbsp;\u003c/strong\u003eNot applicable \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e:\u0026nbsp;The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contribution\u003c/strong\u003e: MDDT, SRSN, JA, FZN designed the study.\u0026nbsp;Data collection:\u0026nbsp;MDDT,\u0026nbsp;KNF, SRSN, DMDT, AZ, HMM, SUPD, BGK, BWM\u0026nbsp;collected data. \u0026nbsp;MDDT, SON, EMFK and SRSN analyzed the data. MDDT, SRSN drafted the paper. KNN, AZ, HMM, SUPD, BGK, EMFK, FKL, CNO, SON, CMT, FZN and JA reviewed the paper. All the authors read and approved the final draft for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e:\u0026nbsp;We thank all the participants in this study and the head of the Biyem-Assi Health District\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003enot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary material:\u003c/strong\u003e The questionnaire used to collect this data has been uploaded as supplementary material.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlKalbani SR, Murrin C. The association between alcohol intake and obesity in a sample of the Irish adult population: a cross-sectional study. BMC Public Health. 2023;23(1):2075.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReview WP. 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Am J Public Health. 2007;97(4):667\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFuntikova A, Subirana I, Gomez S, Fit\u0026oacute; M, Elosua R, Ben\u0026iacute;tez-Arciniega A, et al. Soft Drink Consumption Is Positively Associated with Increased Waist Circumference and 10-Year Incidence of Abdominal Obesity in Spanish Adults. J Nutr. 2014;145(2):328\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasu S, McKee M, Galea G, Stuckler D. Relationship of soft drink consumption to global overweight, obesity, and diabetes: a cross-national analysis of 75 countries. Am J Public Health. 2013;103(11):2071\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGolzarand M, Salari-Moghaddam A, Mirmiran P. Association between alcohol intake and overweight and obesity: a systematic review and dose-response meta-analysis of 127 observational studies. Crit Rev Food Sci Nutr. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWannamethee SG, Alcohol. Overweight and Obesity. In: Watson RR, Preedy VR, Zibadi S, editors. Alcohol, Nutrition, and Health Consequences. Totowa, NJ: Humana; 2013. pp. 371\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCameroon. - Global Obesity Observatory.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFOSSUNG N. The Socio-Language Effects of Alcohol Consumption in the Buea Municipality. Int J Res Innov Soc Sci. 2023;7(4):324\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonz\u0026aacute;lez-Morales R, Canto-Osorio F, Stern D, S\u0026aacute;nchez-Romero, Torres-Ibarra L, Hern\u0026aacute;ndez-L\u0026oacute;pez R, et al. Soft drink intake is associated with weight gain, regardless of physical activity levels: the health workers cohort study. Int Int J Behav Nutr Phys Act. 2020;17:60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArif AA, Rohrer JE. Patterns of alcohol drinking and its association with obesity: data from the Third National Health and Nutrition Examination Survey, 1988\u0026ndash;1994. BMC Public Health. 2005;5:126.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArhakis A, Mavrogiannidou Z, Boka V. An Overview of the Types of Soft Drinks and Their Impact on Oral Health: Review of Literature. World J Dentistry. 2023;14(7):648\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBetancur MI, Motoki K, Spence C, Velasco C. Factors influencing the choice of beer: A review. Food Res Int. 2020;137:109367.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCapoccia D, Milani I, Colangeli L, Parrotta ME, Leonetti F, Guglielmi V. Social, cultural and ethnic determinants of obesity: From pathogenesis to treatment. Nutr Metab Cardiovasc Dis. 2025;35(6):103901.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastro A, Gili M, Visser M, Penninx BWJH, Brouwer IA, Monta\u0026ntilde;o JJ, et al. Soft Drinks and Symptoms of Depression and Anxiety in Overweight Subjects: A Longitudinal Analysis of an European Cohort. Nutrients. 2023;15(18):3865.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrouch E, Abshire DA, Wirth MD, Hung P, Benavidez GA. Rural\u0026ndash;Urban Differences in Overweight and Obesity, Physical Activity, and Food Security Among Children and Adolescents. Prev Chronic Dis. 2023;20:E92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElmaleh-Sachs A, Schwartz JL, Bramante CT, Nicklas JM, Gudzune KA, Jay M. Obesity Management in Adults: A Review. JAMA. 2023;330(20):2000\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFazzino TL, Fleming K, Sher KJ, Sullivan DK, Befort C. Heavy Drinking in Young Adulthood Increases Risk of Transitioning to Obesity. Am J Prev Med. 2017;53(2):169\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerretti F, Mariani M. Sugar-sweetened beverage affordability and the prevalence of overweight and obesity in a cross section of countries. Glob Health. 2019;18(1):30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanifah LN. Literature Review: Factors Affecting Alcohol Consumption and the Impact of Alcohol on Health Based on Behavioral Theory. Media Gizi Kesmas. 2023;12(1):453\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHodge AM, Bassett JK, Milne RL, English DR, Giles GG. Consumption of sugar-sweetened and artificially sweetened soft drinks and risk of obesity-related cancers. Public Health Nutr. 2018;21(9):1618\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNansseu J, Noubiap J, Bigna J. 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Overweight/obesity and associated cardiovascular risk factors in sub-Saharan African children and adolescents: a scoping review. Int J Pediatr Endocrinol. 2020;2020(1):9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoubissi EC, Ama Moor VJ, Agba MC, Nchinjoh S, Tchokfe Nd\u0026eacute; F, Toukam T, et al. Noncommunicable diseases behavioural risk factors among secondary school adolescents in urban Cameroon: a cross-sectional study. BMC Public Health. 2024;24:1086.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMbanya VN, Kufe CN, Noubiap JJ, Fetse GT, Choukem SP. Prevalence and determinants of selected cardio-metabolic risk factors among people living with HIV/AIDS on antiretroviral therapy in Southwest Cameroon. BMC Public Health. 2018;18(1):486.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLemeshow S, Hosmer DW Jr, Klar J, Lwanga SK. Adequacy of sample size in health studies. Chichester: John Wiley \u0026amp; Sons for the World Health Organization; 1990.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraig S, Weber A, Strobl R, Linkohr B, Leitzmann MF, Peters A, Thorand B. Soft drink consumption and overweight/obesity among adolescents in 107 countries: Global School-based Student Health Survey (GSHS) analysis. Nutrients. 2023;15(14):3195.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTraversy G, Chaput JP. Alcohol consumption and obesity: an update. Curr Obes Rep. 2015;4(1):122\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eSampling frame\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth Area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePopulation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePopulation percentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinimum sample size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of clusters of 10 households per health area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eAkok-ndoe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e26,617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eBiscuiterie\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e31,699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eBiyem Assi 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e35,782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eBiyem Assi 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e29,935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eElig Effa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e36,517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eEtoug Ebe 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e33,941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eEtoug Ebe 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e18,398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eMelen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e31,910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eMendong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e37,606\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eMvog betsi 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e30,547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eMvog betsi 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e21,126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNkolbikok\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e24,978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eSimbok 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e27,663\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003eSimbok 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e25,686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL BIYEM-ASSI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e412,406\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e964\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eSociodemographic characteristics of the study population, 2025\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge range in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 157px;\"\u003e\n \u003cp\u003e21-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e432\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e44.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 157px;\"\u003e\n \u003cp\u003e31-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e27.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 157px;\"\u003e\n \u003cp\u003e41-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026gt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e12.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 157px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 157px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e54.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 157px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMatrimonial status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 157px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 157px;\"\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 157px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 154px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003eHigher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e37.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003eSelf employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e25.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e15.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly income\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026lt;50,000 FCFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e50.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003e50,000\u0026ndash;100,000 FCFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003e100,000\u0026ndash;250,000 FCFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026gt; 250,000 FCFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp id=\"_Toc202964885\"\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eIII\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eDistribution of the average number of drinks per sitting for soft drink consumption according to sex, age\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 474px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of soft drink unit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1-2 UNITS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e3-4 UNITS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e5-6 UNITS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e7-9 UNITS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e+10 UNITS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026lt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e506(76.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e84(76.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e15(75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e11(55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e8(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026gt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e155(23.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e26 (23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e5 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e9(45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e280 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e57 (51.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e10(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e13(65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e7(70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e381(57.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e53(48.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e10(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e7(35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e3(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc202964886\"\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable IV\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Distribution of the average number of drinks per sitting for alcohol drink consumption according to sex, age\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 473px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of alcohol drink units\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1-2 UNITS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3-4 UNITS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e5-6 UNITS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e7-9 UNITS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e+10 UNITS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026lt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e222 (76.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e144(70.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e56(69.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e34(68.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e44(54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026gt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e68(23.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e59(29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e25(30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e16(32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37(45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e112(38.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e97(47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e46(56.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e33(66.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e52(64.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e178 (61.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e106(52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e35(43.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e17(34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e29(35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc202964887\"\u003e\u003cstrong\u003eTable V\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eDistribution of the population regarding anthropometric measures\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin \u0026ndash; Max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eHeight (in m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e1.04-1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e1.66\u0026plusmn;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e1.67\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eWeight (in Kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e41.65-164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e75.71\u0026plusmn;15.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e74.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eBody to mass index (Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e15.8-66.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e27.53\u0026plusmn;6.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e26.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc202964888\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable VI\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Prevalence of overweight/obesity across participants\u0026rsquo; characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp id=\"_Toc202964895\"\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal weight (n=374)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverweight/Obese (n=596)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e219 (50.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e218 (49.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e155 (29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e378 (70.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026lt;40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e312 (44.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e392 (55.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026gt;40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e62 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e204 (76.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e12 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e8 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e35 (31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e76 (68.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e164 (34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e316 (65.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e163 (45.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e196 (54.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e208 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e283 (57.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e155 (36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e265 (63.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e11 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e48 (81.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive transport\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e241 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e349 (59.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e133 (35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e247 (65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh-calorie meal combined with either soft drink or alcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e220 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e457 (66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e155 (47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e169 (52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eVII\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Association between overweight/obesity and soft drink, alcohol beverage consumption\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 168px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 256px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBivariate model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 256px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSoft drink\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eExposed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e2.25 [1.36, 3.72]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e2 [1.09, 3.66]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol beverage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eExposed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e2.5 [1.47, 4.32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e2.34 [1.21, 4.53]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol beverage status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eDrinkers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e1.06 [0.56, 2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e1.1 [0.52, 2.33]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eAt risk drinkers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e5.99 [3.24, 11.07]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e5.77 [2.64, 12.59]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e2.07 [1.01, 4.23]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e2.66 [1.11, 6.35]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e6.48 [3.75, 11.19]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 162px;\"\u003e\n \u003cp\u003e6.63 [3.28, 13.39]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ecOR:\u0026nbsp;\u003c/strong\u003ecrude Odd Ratio\u003cstrong\u003e\u0026nbsp;aOR:\u0026nbsp;\u003c/strong\u003eadjusted Odd Ratio\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Soft drink, Alcohol beverage, Overweight, Obesity, Sociodemographic factors","lastPublishedDoi":"10.21203/rs.3.rs-9276547/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9276547/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe global rise in overweight and obesity represents a major public health concern. Consumption of soft drinks and alcoholic beverages has been investigated as potential factors, though evidence remains limited and sometimes contradictory. This study aimed to assess the role of soft drinks and alcoholic beverage consumption in the occurrence of overweight and obesity.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional, community-based survey was conducted in the Biyem-Assi Health District (Yaound\u0026eacute;, Cameroon) using a two-stage stratified cluster sampling method. Data were collected using standardized questionnaires. The body mass index classification established was used to define overweight and obesity. Logistic regression was performed to assess the relationships between beverage intake and weight status.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 970 participants, the age distribution revealed a mean age of 35.49 years, with females (59.9%) being mostly represented. Frequent soft drink and alcohol intake consumption was predominantly reported by males (78.5%) and individuals with lower income levels (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with SSB and industrial beer being the most consumed soft drink and alcoholic beverage, respectively. Five hundred and ninety-six participants were either overweight or obese, yielding a prevalence of 61.4% [95% CI: 0.58\u0026ndash;0.64], with a notably higher rate among women (70.9%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to men. Higher odds of overweight and obesity were significantly associated with females (aOR\u0026thinsp;=\u0026thinsp;2.56; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), older age, \u003cem\u003ei.e.\u003c/em\u003e, \u0026gt;\u0026thinsp;50 years (aOR\u0026thinsp;=\u0026thinsp;9.13; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and higher income. Soft drink consumption significantly increased the odds of overweight/obesity (aOR\u0026thinsp;=\u0026thinsp;2.00; [95% CI: 1.09\u0026ndash;3.66]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024), as did alcohol use (aOR\u0026thinsp;=\u0026thinsp;2.34; [95% CI: 1.21\u0026ndash;4.53]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe consumption of SSBs and industrial beer was widespread, particularly among younger adults and males. After adjusting for sociodemographic variables, these consumption patterns were significantly associated with overweight or obesity. Factors such as sex, age, education level, and income were identified as key determinants of excess weight.\u003c/p\u003e","manuscriptTitle":"Contribution of the intake of soft drinks and alcoholic beverages on overweight and obesity among adults in the Health District of Biyem-Assi: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 16:41:28","doi":"10.21203/rs.3.rs-9276547/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"236000757317199182795434513978910239239","date":"2026-04-08T19:56:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"150888995516508249722735050639551668659","date":"2026-04-04T07:57:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-03T13:05:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-01T12:20:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-01T07:24:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-01T07:24:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nutrition","date":"2026-03-31T07:57:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9212bfca-588d-4fae-89f1-6e56205ee1a1","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-09T16:41:28+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 16:41:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9276547","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9276547","identity":"rs-9276547","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}