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Health Benefits of Reducing Sugar-Sweetened Beverage Intake in High Risk Populations of California: Results from the Cardiovascular Disease (CVD) Policy Model

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Tekeshe A Mekonnen
Tekeshe A Mekonnen
Tekeshe A Mekonnen
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Michelle C Odden
Michelle C Odden
Michelle C Odden
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Pamela Coxson at UCSF University of California, San Francisco
Pamela Coxson
David Guzmán at University of Chile
David Guzmán
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Abstract and Figures

Consumption of sugar-sweetened beverage (SSB) has risen over the past two decades, with over 10 million Californians drinking one or more SSB per day. High SSB intake is associated with risk of type 2 diabetes, obesity, hypertension, and coronary heart disease (CHD). Reduction of SSB intake and the potential impact on health outcomes in California and among racial, ethnic, and low-income sub-groups has not been quantified. We projected the impact of reduced SSB consumption on health outcomes among all Californians and California subpopulations from 2013 to 2022. We used the CVD Policy Model - CA, an established computer simulation of diabetes and heart disease adapted to California. We modeled a reduction in SSB intake by 10-20% as has been projected to result from proposed penny-per-ounce excise tax on SSB and modeled varying effects of this reduction on health parameters including body mass index, blood pressure, and diabetes risk. We projected avoided cases of diabetes and CHD, and associated health care cost savings in 2012 US dollars. Over the next decade, a 10-20% SSB consumption reduction is projected to result in a 1.8-3.4% decline in the new cases of diabetes and an additional drop of 0.5-1% in incident CHD cases and 0.5-0.9% in total myocardial infarctions. The greatest reductions are expected in African Americans, Mexican Americans, and those with limited income regardless of race and ethnicity. This reduction in SSB consumption is projected to yield $320-620 million in medical cost savings associated with diabetes cases averted and an additional savings of $14-27 million in diabetes-related CHD costs avoided. A reduction of SSB consumption could yield substantial population health benefits and cost savings for California. In particular, racial, ethnic, and low-income subgroups of California could reap the greatest health benefits.
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Health Benefits of Reducing Sugar-Sweetened Beverage Intake in High Risk Populations of California: Results from the Cardiovascular Disease (CVD) Policy Mod
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... The high co fast-absorbing carbohydrates in these drinks generates, in the long term, an inc insulin resistance, but also an addiction to consumption. Carbonated diet drinks g contain synthetic sweeteners that have proven to be quite toxic to the body, so carcinogenic potential in addition to hepatotoxicity [16][17][18][19][20][21][22]. Sweetened soft drinks and energy drinks are among the most unhealthy non-alcoholic drinks. ...
... The high content of fast-absorbing carbohydrates in these drinks generates, in the long term, an increase in insulin resistance, but also an addiction to consumption. Carbonated diet drinks generally contain synthetic sweeteners that have proven to be quite toxic to the body, some with carcinogenic potential in addition to hepatotoxicity [16][17][18][19][20][21][22]. ...
... The frequency of daily coffee consumption increases with age; thus, the very young respondents (age group [18][19][20][21][22][23][24][25] show the lowest consumption tendency, both regarding a single cup a day (OR = 0.220), as well as consumption of two to three cups a day (OR = 0.150). Respondents over 50 years of age show the highest trend related to the frequency and quantity of coffee consumed. ...
Evaluation of Non-Alcoholic Beverages and the Risk Related to Consumer Health among the Romanian Population
Article
Full-text available
  • Sep 2023
The range of non-alcoholic drinks is very varied both from a compositional point of view and from a caloric and nutritional point of view. The excessive consumption of sweetened non-alcoholic beverages represents an important risk factor for health, especially when it is accompanied by an unbalanced diet and a disordered lifestyle. In order to evaluate the consumption of non-alcoholic beverages correlated with the evaluation of the main lifestyle factors that can affect the state of health among Romanians, a cross-sectional observational study was carried out based on a questionnaire. The results of the study indicate that among the most consumed non-alcoholic drinks are coffee and sweetened carbonated and non-carbonated drinks, which are indicated as being responsible for the development of consumption addictions: 44% for coffee, 16.5% for sweetened or tonic carbonated drinks and 12% for sweetened non-carbonated drinks. Considering that the consumption of coffee is usually associated with sweeteners, there is a risk of excessive caffeine and caloric intake in a context where a lack of exercise predominates (59.98%) among respondents declaring that they do sports rarely or not at all, which can lead, in the long term, to the appearance of imbalances either of a psycho-emotional nature or of a metabolic nature. A significant link was found between sports activity and the environment in which they work (χ2 = 51.33, p = 0.05). Respondents with a daily activity that involves movement (working outdoors, working on a construction site) are also those who usually do sports, while 60.67% of the respondents who work a lot in front of the computer declared that they do sports very rarely or not at all. Reducing the excessive consumption of sweetened drinks can be achieved through an appropriate consumption of water and fruits and by intensifying physical activity as a way of counterbalancing the excess caloric intake.
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... Sin embargo, los modelos informáticos de simulación pueden ayudar con este problema. Desarrollado en la década de 1980 para ser utilizado inicialmente en EEUU,(2) este modelo ha sido ampliamente utilizado en el mundo para predecir la ocurrencia de eventos cardiovasculares y modelar distintas intervenciones (3)(4)(5)(6)(7). En Argentina, ha servido para modelar el impacto de estrategias poblacionales de reducción del consumo de sal (8,9), para analizar el impacto de la ley nacional de control de tabaco y potenciales aumentos en el precio de los cigarrillos (10), y para analizar la costo-efectividad de distintas estrategias poblacionales de utilización de estatinas (11). ...
... Argentina presenta uno de los consumos de gaseosas azucaradas más altos del mundo. Una disminución del mismo, con la consiguiente reducción de la ingesta de fructosa y calorías liquidas, se reflejaría en una mejoría de al menos 3 de los principales factores de riesgo cardiovascular: obesidad, diabetes mellitus e hipertensión arterial (4,(12)(13)(14)(15)(16)(17). Un estudio realizado en México utilizando el CVD Policy Model halló que una reducción del 10% en el consumo de gaseosas de los adultos prevendría el desarrollo de 189.300 casos de diabetes de tipo 2, así como 20.400 accidentes cerebrovasculares e infartos de miocardio y 18.900 muertes entre los años 2013 y 2022 (18). ...
... Investigadora visitante del Área Salud, Economía y Sociedad del CEDES.3 Socióloga, Universidad Nacional de La Plata, maestranda en Sociología Económica, Instituto de Altos estudios Sociales(IDAES-UNSAM), asistente de investigación del Área Salud, Economía y Sociedad del CEDES.4 Cuando hablamos de niños, nos referimos al genérico (niños y niñas).5 Propuesta metodológica de IDRC, SDC (2008): "The RM Knowledge Translation Toolkit: A Resource for Researchers".6 ...
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... Four studies reported a percentage reduction in CVD cases (see Figure 3). 28,31,44,52 Three studies were from the USA 31,44,52 and one from India. 28 Face validation was adequate for all the studies. ...
... Three studies modelled different interventions among the US population. 31,44,52 A smoke smoking-free policy demonstrated the largest percentage reduction in CVD cases (4%), 52 followed by a supplementary nutrition assistance programme (1.4%) 31 and a SSB tax (1.0%). 31 ...
The potential impact of policies and structural interventions in reducing cardiovascular disease and mortality: a systematic review of simulation-based studies
Article
Full-text available
  • Dec 2023
Background The aim of the study was to investigate the potential effect of different structural interventions for preventing cardiovascular disease. Methods Medline and EMBASE were searched for peer-reviewed simulation-based studies of structural interventions for prevention of cardiovascular disease. We performed a systematic narrative synthesis. Results A total of 54 studies met the inclusion criteria. Diet, nutrition, tobacco and alcohol control and other programmes are among the policy simulation models explored. Food tax and subsidies, healthy food and lifestyles policies, palm oil tax, processed meat tax, reduction in ultra-processed foods, supplementary nutrition assistance programmes, stricter food policy and subsidised community-supported agriculture were among the diet and nutrition initiatives. Initiatives to reduce tobacco and alcohol use included a smoking ban, a national tobacco control initiative and a tax on alcohol. Others included the NHS Health Check, WHO 25 × 25 and air quality management policy. Future work and limitations There is significant heterogeneity in simulation models, making comparisons of output data impossible. While policy interventions typically include a variety of strategies, none of the models considered possible interrelationships between multiple policies or potential interactions. Research that investigates dose–response interactions between numerous modifications as well as longer-term clinical outcomes can help us better understand the potential impact of policy-level interventions. Conclusions The reviewed studies underscore the potential of structural interventions in addressing cardiovascular diseases. Notably, interventions in areas such as diet, tobacco, and alcohol control demonstrate a prospective decrease in cardiovascular incidents. However, to realize the full potential of such interventions, there is a pressing need for models that consider the interplay and cumulative impacts of multiple policies. Rigorous research into holistic and interconnected interventions will pave the way for more effective policy strategies in the future. Study registration The study is registered as PROSPERO CRD42019154836. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/148/05.
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... This is similar to other research that has reported reductions in the prevalence of obesity as a result of drops in intakes of added sugars [29,30]. Modelling studies have shown both health and economic gains resulting from a reduced intake of added sugars [31][32][33][34], and as a result of the taxation of salt or foods high in salt [34][35][36][37][38]. Hence, the observed changes in overweight and obesity are likely to also generate improved health outcomes. ...
Modelling impacts of a salt and sugar tax on intra-category food substitutions, BMI and environmental footprints
Preprint
Full-text available
  • Feb 2024
Purpose Taxes on unhealthy foods can help improve population health in the United Kingdom (UK), but the health effects of food substitutions resulting from these taxes are often unclear. We investigated the potential impacts of a salt and sugar tax on hypothetical intra-category food substitutions, cost, body-mass index (BMI), and environmental footprints. Methods Purchase panel data from Kantar (2017) were used to determine the most popular foods high in salt or sugar within eight ‘salt-intensive’/‘sugar-intensive’ food categories. Within food categories, the most popular lower salt (≤1.5g salt/100g product) and lower sugar (≤22.5g sugar/100g product) substitutes were also identified. Hypothetical swaps between high salt/sugar foods and lower salt/sugar substitutes were explored, focusing on changes to cost, caloric intake and BMI, and environmental impacts. Results The suggested intra-category substitutions were largely like-for-like and did not accrue an added overall cost to consumers. The substitutions reduced calorie intake by about 200kcal/day and lowered the prevalence of overweight and obesity in the UK from approximately 60-65% to about 40-45%. The proposed food substitutions led to a total reduction of -2.7Mt of greenhouse gases, ~ -500.000ha of land, -0.5km³ of blue water, -12km³ of scarcity weighted water, ~ -12.000t of phosphorus, and nearly -14.000t of sulphur dioxide over one year for the UK population due to reductions in calorie intake. Conclusion Food substitutions following a tax on salt and sugar could lead to significant benefits for health and the environment, without necessarily resulting in major changes to people’s expenditure on familiar salty and sugary snacks.
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... 35 This is similar with other literatures. [36][37][38][39][40] SSB consumption is influenced by its price, therefore establishing taxes can be an effective means of reducing SSB consumption. 41,42 As shown in the included studies, the higher the tax price, the higher the impact on averting undesirable health outcomes. ...
Effectiveness of sugar sweetened beverages tax on health and healthcare costs: A systematic review
Article
Full-text available
  • Sep 2023
Background: Taxing sugar-sweetened beverages (SSB) is one of many other best strategies to reduce consumption of SSB among populations. It is known that SSB consumption is the main contributor which cause obesity and further lead to non-communicable diseases. This study aimed to gather the evidence on the effectiveness of sugar-sweetened beverages tax implementation, in terms of health outcome and healthcare cost benefit. Methodology: A systematic review was done related to literature that reported about effectiveness of sugar-sweetened beverages tax implementation, in terms of health outcome and healthcare cost benefit. Four databases were used to identify the literature, namely PubMed, Cochrane, Scopus and Ovid and Medline. PRISMA flow checklist was used as a guide to search for the eligible articles. Results: In total, there were sixteen eligible articles included in this systematic review. All studies are simulation studies. Results shows that both excise and ad valorem tax are effective to reduce healthcare costs and could avert diseases related to high sugar intake. Other than that, it is proven that implementing tax will gain favorable health outcome rather than do nothing. Better results seen when the tax is increased. Conclusion: As a conclusion, SSB tax is proven as an effective public health intervention in terms of giving benefit to the health outcome and healthcare cost. Keywords: sugar-sweetened beverages tax, effectiveness, health, healthcare costs
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... Reducing the consumption of SSBs reduces the risk of overweight and obesity and lowers the risk of obesity-related diseases such as cardiovascular and cerebrovascular disease, cancer, musculoskeletal disorders, asthma, depression, social isolation and dental caries, among others. [12][13][14] The evidence confirms the link between SSB consumption and weight gain in children and adolescents along with greater risk of insulin resistance, high blood pressure and dental caries, among others. 15 16 SSB consumption varies considerably according to sociodemographic characteristics, with consumption being higher in younger people, males and in LAC in relation to other regions. ...
Health and economic burden of disease of sugar-sweetened beverage consumption in four Latin American and Caribbean countries: a modelling study
Article
Full-text available
  • Feb 2023
Objective Overweight and obesity are important contributors to the non-communicable disease burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of type 2 diabetes mellitus (T2DM), cardiovascular disease, cancer and other conditions. The objective of this study was to estimate the burden of disease attributable to the consumption of SSBs and the costs to the healthcare systems in Argentina, Brazil, El Salvador, and Trinidad and Tobago. Design Following a systematic review of models, a comparative risk assessment framework was developed to estimate the health and economic impact associated with the consumption of SSBs. Setting Argentina, Brazil, El Salvador, and Trinidad and Tobago. Participants Overall population. Primary and secondary outcome measures The model estimated the effects of SSB consumption on health through two causal pathways: one mediated by body mass index (BMI) and health conditions associated with BMI and another that reflected the independent effects of SSB consumption on T2DM and cardiovascular diseases. Results The model results indicated that for all four countries, in 1 year, SSB consumption was associated with 18 000 deaths (3.2% of the total disease-related deaths), seven million disease events (3.3% of the total disease-related events), a half-million DALYs and US$2 billion in direct medical costs. This included 1.5 million cases of overweight and obesity in children/adolescents (12% of the excess weight cases) and 2.8 million cases in adults (2.8%); 2.2 million cases of type 2 diabetes (19%); 200 000 cases of heart disease (3.8%); 124 000 strokes (3.9%); 116 000 cases of musculoskeletal disease (0.2%); 102 000 cases of kidney disease (0.9%); and 45 000 episodes of asthma (0.4%). The Trinidad and Tobago population were the most affected by disease events. Conclusions The study results indicate that the consumption of SSBs is associated with a significant burden of disease and death in Latin America and the Caribbean.
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... Reducing the consumption of SSBs reduces the risk of overweight and obesity and lowers the risk of obesity-related diseases such as cardiovascular and cerebrovascular disease, cancer, musculoskeletal disorders, asthma, depression, social isolation and dental caries, among others. [12][13][14] The evidence confirms the link between SSB consumption and weight gain in children and adolescents along with greater risk of insulin resistance, high blood pressure and dental caries, among others. 15 16 SSB consumption varies considerably according to sociodemographic characteristics, with consumption being higher in younger people, males and in LAC in relation to other regions. ...
The Health and Economic Burden of Disease of Sugar Sweetened Beverage Consumption in 4 Latin-American and Caribbean Countries: A Modelling Study
Article
Full-text available
  • Jan 2022
Objective: Overweight and obesity are important contributors to the non-communicable disease burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of type 2 diabetes mellitus (T2DM), cardiovascular disease, cancer and other conditions. The objective of this study was to estimate the burden of disease attributable to the consumption of SSBs and the costs to the healthcare systems in Argentina, Brazil, El Salvador, and Trinidad and Tobago. Design: Following a systematic review of models, a comparative risk assessment framework was developed to estimate the health and economic impact associated with the consumption of SSBs. Setting: Argentina, Brazil, El Salvador, and Trinidad and Tobago. Participants: Overall population. Primary and secondary outcome measures: The model estimated the effects of SSB consumption on health through two causal pathways: one mediated by body mass index (BMI) and health conditions associated with BMI and another that reflected the independent effects of SSB consumption on T2DM and cardiovascular diseases. Results: The model results indicated that for all four countries, in 1 year, SSB consumption was associated with 18 000 deaths (3.2% of the total disease-related deaths), seven million disease events (3.3% of the total disease-related events), a half-million DALYs and US$2billion in direct medical costs. This included 1.5 million cases of overweight and obesity in children/adolescents(12% of the excess weight cases) and 2.8 million cases in adults (2.8%); 2.2 million cases of type 2 diabetes(19%); 200 000 cases of heart disease (3.8%); 124000 strokes (3.9%); 116 000 cases of musculoskeletal disease (0.2%); 102 000 cases of kidney disease (0.9%); and 45 000 episodes of asthma (0.4%). The Trinidad and Tobago population were the most affected by disease events. Conclusions: The study results indicate that the consumption of SSBs is associated with a significant burden of disease and death in Latin America and the Caribbean.
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... In the U.S., SSB consumption alone is projected to account for 1.8 million new cases of T2D over the next 10 years. The percentage of cases attributable to SSB is much higher in low-income populations and communities of color, and SSB consumption is a significant contributor to race/ethnicity-, education-, and incomerelated disparities in diabetes (84). ...
The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs for Population-Level Diabetes Prevention and Control: Recommendations From the National Clinical Care Commission
Article
  • Jan 2023
  • DIABETES CARE
The etiology of type 2 diabetes is rooted in a myriad of factors and exposures at individual, community, and societal levels, many of which also affect the control of type 1 and type 2 diabetes. Not only do such factors impact risk and treatment at the time of diagnosis but they also can accumulate biologically from preconception, in utero, and across the life course. These factors include inadequate nutritional quality, poor access to physical activity resources, chronic stress (e.g., adverse childhood experiences, racism, and poverty), and exposures to environmental toxins. The National Clinical Care Commission (NCCC) concluded that the diabetes epidemic cannot be treated solely as a biomedical problem but must also be treated as a societal problem that requires an all-of-government approach. The NCCC determined that it is critical to design, leverage, and coordinate federal policies and programs to foster social and environmental conditions that facilitate the prevention and treatment of diabetes. This article reviews the rationale, scientific evidence base, and content of the NCCC’s population-wide recommendations that address food systems; consumption of water over sugar-sweetened beverages; food and beverage labeling; marketing and advertising; workplace, ambient, and built environments; and research. Recommendations relate to specific federal policies, programs, agencies, and departments, including the U.S. Department of Agriculture, the Food and Drug Administration, the Federal Trade Commission, the Department of Housing and Urban Development, the Environmental Protection Agency, and others. These population-level recommendations are transformative. By recommending health-in-all-policies and an equity-based approach to governance, the NCCC Report to Congress has the potential to contribute to meaningful change across the diabetes continuum and beyond. Adopting these recommendations could significantly reduce diabetes incidence, complications, costs, and inequities. Substantial political resolve will be needed to translate recommendations into policy. Engagement by diverse members of the diabetes stakeholder community will be critical to such efforts.
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Association between sugar‐free beverage intake and childhood obesity among Chinese children and adolescents
Article
  • Jan 2024
Background The relationship between sugar‐free beverage (SFB) intake and childhood obesity among Chinese children is unknown. Objectives To describe the status of SFB consumption among children and adolescents in China and assess the association between SFB intake and different types of obesity. Methods The study was based on the baseline data of an ongoing cohort project named Evaluation and Monitoring on School‐based Nutrition and Growth in Shenzhen (EMSNGS). Food frequency questionnaires were used to collect information on SFB consumption in 3227 students aged 9–17. Physical and clinical examinations were conducted by trained investigators and clinicians. Multivariable binary logistic regression models were performed to assess the association between SFB intake and general obesity, overweight/obesity, abdominal obesity, metabolically unhealthy overweight (MUOW)/metabolically unhealthy obesity (MUO). Results The median age of the participants was 13.28 years. Among the participants, 55.2% were boys, and 66.1% were adolescents. The median SFB consumption was 16.67 mL/d. After adjusting for potential confounding factors, each 100 mL increase in daily SFB intake was associated with an increased risk of overweight/obesity (OR = 1.14; 95%CI: 1.06–1.23), abdominal obesity (OR = 1.12; 95%CI: 1.03–1.23), and MUOW/MUO (OR = 1.12; 95%CI: 1.02–1.21), respectively. Stratified analyses showed that family income may have an impact on the association between SFB intake and overweight/obesity ( P for interaction = 0.021) and abdominal obesity ( P for interaction = 0.031). Conclusion SFB intake was positively associated with childhood obesity in Chinese children, particularly among individuals with high‐income families.
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Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidemiologique aupres des femmes de la Mutuelle Generale de l'Education Nationale-European Prospective Investigation into Cancer and Nutrition cohort
Article
Full-text available
  • Jan 2013
  • AM J CLIN NUTR
Background: It has been extensively shown, mainly in US populations, that sugar-sweetened beverages (SSBs) are associated with increased risk of type 2 diabetes (T2D), but less is known about the effects of artificially sweetened beverages (ASBs). Objective: We evaluated the association between self-reported SSB, ASB, and 100% fruit juice consumption and T2D risk over 14 y of follow-up in the French prospective Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l'Education Nationale-European Prospective Investigation into Cancer and Nutrition cohort. Design: A total of 66,118 women were followed from 1993, and 1369 incident cases of T2D were diagnosed during the follow-up. Cox regression models were used to estimate HRs and 95% CIs for T2D risk. Results: The average consumption of sweetened beverages in consumers was 328 and 568 mL/wk for SSBs and ASBs, respectively. Compared with nonconsumers, women in the highest quartiles of SSB and ASB consumers were at increased risk of T2D with HRs (95% CIs) of 1.34 (1.05, 1.71) and 2.21 (1.56, 3.14) for women who consumed >359 and >603 mL/wk of SSBs and ASBs, respectively. Strong positive trends in T2D risk were also observed across quartiles of consumption for both types of beverage (P = 0.0088 and P < 0.0001, respectively). In sensitivity analyses, associations were partly mediated by BMI, although there was still a strong significant independent effect. No association was observed for 100% fruit juice consumption. Conclusions: Both SSB consumption and ASB consumption were associated with increased T2D risk. We cannot rule out that factors other than ASB consumption that we did not control for are responsible for the association with diabetes, and randomized trials are required to prove a causal link between ASB consumption and T2D.
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Personal responsibility and obesity: a constructive approach to a controversial issue
Article
  • Jan 2010
... Kelly D. Brownell is founding director of the Rudd Center for Obesity and Food Policy at Yale University. ... new “default” setting, he says, “and what we&apos;re doing is working with policymakers to change the defaults.” He&apos;s thus become a crusader for a penny-an-ounce soda tax . ...
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Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women
Article
  • Nov 2004
... 8. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar - sweetened drinks and childhood obesity : a prospective, observational analysis. Lancet. 2001;357:505-508.pmid:11229668. ...
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Obesity and diabetes: two growing epidemics in California
Article
  • Aug 2010
The prevalence of both diabetes and obesity has grown significantly in California. Six million adults are obese and an additional 9.3 million are overweight. Obesity is a significant risk factor for diabetes; more than two million adults have been diagnosed with diabetes in California. Obesity and diabetes disproportionately affect people of color, the poor and those with the least education in California. Policy and environmental changes that promote and encourage physical activity and healthy eating will likely prove most effective in combating obesity and related conditions
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Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct InterAct consortium Diabetologia 2013 56 7 1520 30 10.1007/s00125-013-2899-8
Article
  • Jul 2013
Aims/hypothesisConsumption of sugar-sweetened beverages has been shown, largely in American populations, to increase type 2 diabetes incidence. We aimed to evaluate the association of consumption of sweet beverages (juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks) with type 2 diabetes incidence in European adults.Methods We established a case–cohort study including 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants selected from eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. After exclusions, the final sample size included 11,684 incident cases and a subcohort of 15,374 participants. Cox proportional hazards regression models (modified for the case–cohort design) and random-effects meta-analyses were used to estimate the association between sweet beverage consumption (obtained from validated dietary questionnaires) and type 2 diabetes incidence.ResultsIn adjusted models, one 336 g (12 oz) daily increment in sugar-sweetened and artificially sweetened soft drink consumption was associated with HRs for type 2 diabetes of 1.22 (95% CI 1.09, 1.38) and 1.52 (95% CI 1.26, 1.83), respectively. After further adjustment for energy intake and BMI, the association of sugar-sweetened soft drinks with type 2 diabetes persisted (HR 1.18, 95% CI 1.06, 1.32), but the association of artificially sweetened soft drinks became statistically not significant (HR 1.11, 95% CI 0.95, 1.31). Juice and nectar consumption was not associated with type 2 diabetes incidence.Conclusions/interpretationThis study corroborates the association between increased incidence of type 2 diabetes and high consumption of sugar-sweetened soft drinks in European adults.
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Sugar-Sweetened Beverages and Genetic Risk of Obesity
Article
  • Mar 2013
Background: Temporal increases in the consumption of sugar-sweetened beverages have paralleled the rise in obesity prevalence, but whether the intake of such beverages interacts with the genetic predisposition to adiposity is unknown. Methods: We analyzed the interaction between genetic predisposition and the intake of sugar-sweetened beverages in relation to body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) and obesity risk in 6934 women from the Nurses' Health Study (NHS) and in 4423 men from the Health Professionals Follow-up Study (HPFS) and also in a replication cohort of 21,740 women from the Women's Genome Health Study (WGHS). The genetic-predisposition score was calculated on the basis of 32 BMI-associated loci. The intake of sugar-sweetened beverages was examined prospectively in relation to BMI. Results: In the NHS and HPFS cohorts, the genetic association with BMI was stronger among participants with higher intake of sugar-sweetened beverages than among those with lower intake. In the combined cohorts, the increases in BMI per increment of 10 risk alleles were 1.00 for an intake of less than one serving per month, 1.12 for one to four servings per month, 1.38 for two to six servings per week, and 1.78 for one or more servings per day (P<0.001 for interaction). For the same categories of intake, the relative risks of incident obesity per increment of 10 risk alleles were 1.19 (95% confidence interval [CI], 0.90 to 1.59), 1.67 (95% CI, 1.28 to 2.16), 1.58 (95% CI, 1.01 to 2.47), and 5.06 (95% CI, 1.66 to 15.5) (P=0.02 for interaction). In the WGHS cohort, the increases in BMI per increment of 10 risk alleles were 1.39, 1.64, 1.90, and 2.53 across the four categories of intake (P=0.001 for interaction); the relative risks for incident obesity were 1.40 (95% CI, 1.19 to 1.64), 1.50 (95% CI, 1.16 to 1.93), 1.54 (95% CI, 1.21 to 1.94), and 3.16 (95% CI, 2.03 to 4.92), respectively (P=0.007 for interaction). Conclusions: The genetic association with adiposity appeared to be more pronounced with greater intake of sugar-sweetened beverages. (Funded by the National Institutes of Health and others.).
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Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements
Article
  • Jul 2013
The negative impact of consuming sugar-sweetened beverages on weight and other health outcomes has been increasingly recognized; therefore, many people have turned to high-intensity sweeteners like aspartame, sucralose, and saccharin as a way to reduce the risk of these consequences. However, accumulating evidence suggests that frequent consumers of these sugar substitutes may also be at increased risk of excessive weight gain, metabolic syndrome, type 2 diabetes, and cardiovascular disease. This paper discusses these findings and considers the hypothesis that consuming sweet-tasting but noncaloric or reduced-calorie food and beverages interferes with learned responses that normally contribute to glucose and energy homeostasis. Because of this interference, frequent consumption of high-intensity sweeteners may have the counterintuitive effect of inducing metabolic derangements.
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