Water Insecurity Is Associated with Sugar-Sweetened Beverage Consumption in a Small-Scale Population in Lowland Bolivia Experiencing Lifestyle Changes

Background: Emerging evidence indicates water insecurity (WI) is detrimental to nutritional outcomes and dietary choices. Objective: WI experiences were measured alongside market and traditional sugar-sweetened beverage (SSB) consumption in a small-scale society experiencing the early stages of a nutrition transition (ie, lifestyle and dietary changes away from traditional foods) to test how they are associated. Design: The 12-item Household Water Insecurity Experiences (HWISE) scale was implemented along with a cross-sectional retrospective survey of beverage intake and sociodemographic characteristics across 5 communities at varying distances from a market town. Participants/setting: Participants were Tsimané forager-horticulturalist adults aged 16 years and older (n = 455; 47% were women) in lowland Bolivia from April through May 2019. Main outcome measure: Sugar-sweetened beverage consumption and traditional beverage consumption were measured. Statistical analyses performed: Multivariate logistic and Poisson regressions were performed, adjusting for possible confounding variables, including age, gender, income, household water needs, and community residence. Results: Using logistic regressions, each point higher WI (HWISE) score was associated with 23% (95% CI 1.01 to 1.50; P = .035) and 27% (95% CI 1.06 to 1.52; P = .008) higher odds of consuming an SSB in the past week for men and women, respectively. For men, each point higher HWISE score was associated with 13% (95% CI 1.10 to 1.16; P < .001) higher odds of drinking chicha fuerte (ie, a traditional, homemade fermented beverage with antibacterial properties) and 16% (95% CI 1.02 to 1.32; P = .022) higher odds of consuming liquor. SSB consumption was highest in the closest communities to the market town and declined significantly with distance; and traditional beverages, such as chicha dulce (a sugar-sweetened, unfermented homemade chicha), were lowest in the close communities and increased with distance to the market town. Conclusions: Among Tsimané adults living in the Bolivian Amazon experiencing the nutrition transition, WI was associated with greater SSB intake. Distance to the main market town shaped access and preferences, as it was associated with SSB and traditional beverage consumption.