Type 2 diabetes risk rises with more fruit juice, artificially sweetened beverage consumption
Adults who consume larger quantities of sweetened beverages, including fruit juices and those made with artificial sweeteners, are more likely to develop type 2 diabetes than those who drink smaller quantities, according to findings published in Diabetes Care.
“The relationship between the consumption of sugar-sweetened beverages (ie, soft drinks, punches, fruit drinks, sugared iced tea and sports drinks) and type 2 diabetes is supported by substantial epidemiologic evidence,” Jean-Philippe Drouin-Chartier, PhD, a postdoctoral fellow in the department of nutrition at the Harvard T.H. Chan School of Public Health, told Endocrine Today. “Even though consumption of 100% fruit juices has been considered a healthy alternative to sugar-sweetened beverages because of the vitamins and minerals in fruit juices, they typically contain similar amounts of sugar and calories as sugar-sweetened beverages, and epidemiologic evidence suggests that 100% fruit juices are also positively associated with risk of diabetes. This raises concerns for the negative health effects of sugary beverages, regardless of whether the sugar is added or naturally occurring.”
Drouin-Chartier and colleagues assessed sweetened beverage intake among participants in the Nurses’ Health Study (n = 121,701 women), the Nurses’ Health Study II (n = 116,430 women) and the Health Professional’ Follow-up Study (n = 51,529 men). Participants self-reported their intake at 4-year intervals using food frequency questionnaires, with serving sizes of 8 oz used for analysis. Diabetes status was self-reported and confirmed by the researchers at 2-year intervals. These data allowed the researchers to calculate diabetes risk.
Diabetes risk was greater for those who increased their intake of any sugary beverage by more than 0.5 servings per day vs. those who did not have a substantial change (HR = 1.16; 95% CI, 1.01-1.34). Diabetes risk also was greater for those who increased their intake of sugar-sweetened beverages (HR = 1.09; 95% CI, 1.03-1.17), 100% fruit juices (HR = 1.15; 95% CI, 1.07-1.23) and artificially sweetened beverages (HR = 1.18; 95% CI, 1.02-1.36) by more than 0.5 servings per day vs. those who did not have a substantial change.
When examining habitual changes over 4 years, the researchers found that diabetes risk was higher if a participant went from less than one weekly serving of a sugary beverage to one or more daily servings vs. those who maintained weekly servings of less than one (HR = 1.15; 95% CI, 0.98-1.35). Similarly, diabetes risk was 23% greater for those who consistently drank at least one serving per day (95% CI, 15-33) and 9% greater for those who went from drinking one or more daily servings to less than one weekly serving (95% CI, –5 to 25).
The researchers also wrote that “for artificially sweetened beverages, any increase in consumption was associated with a higher risk,” but noted that these findings were less clear cut.
“The findings regarding artificially sweetened beverages should be interpreted with caution due to the possibility of reverse causation — individuals already at high risk for diabetes may switch from sugary beverages to diet drinks — and surveillance bias — high-risk individuals are more likely to be screened for diabetes and thus diagnosed more rapidly,” Drouin-Chartier said.
The researchers furthered stated that diabetes risk was reduced if a participant drank one daily serving of coffee instead of a sugary drink (HR = 0.9; 95% CI, 0.88-0.92) or instead of an artificially sweetened beverage (HR = 0.91; 95% CI, 0.88-0.93). In addition, diabetes risk was reduced if participants drank one daily serving of tea instead of a sugary drink (HR = 0.93; 95% CI, 0.9-0.95) or instead of an artificially sweetened beverage (HR = 0.94; 95% CI, 0.91-0.96). Similarly, diabetes risk was reduced if participants drank one daily serving of 0% to 2% milk instead of a sugary drink (HR = 0.94; 95% CI, 0.91-0.97) or instead of an artificially sweetened beverage (HR = 0.94; 95% CI, 0.91-0.97). Lastly, diabetes risk was reduced if participants drank one daily serving of water instead of a sugary drink (HR = 0.98; 95% CI, 0.95-1) or instead of an artificially sweetened beverage (HR = 0.99; 95% CI, 0.97-1.01).
“The study provides further evidence demonstrating the health benefits associated with decreasing sugary beverage consumption and replacing these drinks with healthier alternatives like water, coffee or tea. The study results are in line with current recommendations to replace sugary beverages with noncaloric beverages free of artificial sweeteners,” Drouin-Chartier said. – by Phil Neuffer
Disclosures: Drouin-Chartier reports he has received speaker and consultant honoraria from Dairy Farmers of Canada. The other authors report no relevant financial disclosures.