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Prospective associations and population impact of sweet beverage intake and type 2 diabetes, and effects of substitutions with alternative beverages.


Type

Article

Change log

Authors

O'Connor, Laura 
Lentjes, Marleen AH 
Wareham, Nicholas J 

Abstract

AIMS/HYPOTHESIS: This study aimed to evaluate the association of types of sugar-sweetened beverages (SSB) (soft drinks, sweetened-milk beverages, sweetened tea/coffee), artificially sweetened beverages (ASB) and fruit juice with incident type 2 diabetes and determine the effects of substituting non-SSB for SSB and the population-attributable fraction of type 2 diabetes due to total sweet beverages. METHODS: Beverage consumption of 25,639 UK-resident adults without diabetes at baseline (1993-1997) in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk study was assessed using 7-day food diaries. During 10.8 years of follow-up 847 incident type 2 diabetes cases were verified. RESULTS: In adjusted Cox regression analyses there were positive associations (HR [95% CI] per serving/day]) for soft drinks 1.21 (1.05, 1.39), sweetened-milk beverages 1.22 (1.05, 1.43) and ASB 1.22 (1.11, 1.33), but not for sweetened tea/coffee 0.98 (0.94, 1.02) or fruit juice 1.01 (0.88, 1.15). Further adjustment for adiposity attenuated the association of ASB, HR 1.06 (0.93, 1.20). There was a positive dose-response relationship with total sweet beverages: HR per 5% energy 1.18 (1.11, 1.26). Substituting ASB for any SSB did not reduce the incidence in analyses accounting for energy intake and adiposity. Substituting one serving/day of water or unsweetened tea/coffee for soft drinks and for sweetened-milk beverages reduced the incidence by 14%-25%. If sweet beverage consumers reduced intake to below 2% energy, 15% of incident diabetes might be prevented. CONCLUSIONS/INTERPRETATION: The consumption of soft drinks, sweetened-milk beverages and energy from total sweet beverages was associated with higher type 2 diabetes risk independently of adiposity. Water or unsweetened tea/coffee appear to be suitable alternatives to SSB for diabetes prevention. These findings support the implementation of population-based interventions to reduce SSB consumption and increase the consumption of suitable alternatives.

Description

Keywords

Adiposity, Adult, Aged, Animals, Beverages, Coffee, Cohort Studies, Diabetes Mellitus, Type 2, Diet, Diet Records, Dose-Response Relationship, Drug, Female, Fruit, Humans, Male, Middle Aged, Milk, Population, Prospective Studies, Sweetening Agents, Tea, United Kingdom

Journal Title

Diabetologia

Conference Name

Journal ISSN

0012-186X
1432-0428

Volume Title

58

Publisher

Springer Verlag
Sponsorship
Medical Research Council (MC_UU_12015/5)
Medical Research Council (G1000143)
Medical Research Council (MC_UU_12015/1)
Medical Research Council (G0401527)
Medical Research Council (MC_U106179471)
This work was supported by programme grants from the Medical Research Council (MRC) UK and Cancer Research UK. We acknowledge support from the MRC Epidemiology Unit (grant number MC_UU_12015/5).