O’Connor,L., Imamura,F., Lentjes,M.A., Khaw,K.T., Wareham,N.J. and Forouhi,N.G., (2015) Diabetologia 58:1474-1483 10.1007/s00125-015-3572-1
OBJECTIVE: To examine (1) the associations of different types of SSB with incident type 2 diabetes, (2) whether the contribution of sweet beverages to total energy intake (TEI) affects the risk of type 2 diabetes, and (3) the potential effects on type 2 diabetes incidence of substituting alternative beverages for SSB in order to determine appropriate replacement beverages.
DESIGN: Data were from the EPIC Norfolk study, a UK population–based cohort of 25,639 participants. Participants who did not return a food diary, those at extremes of TEI (1% upper and lower values), those with prevalent or unconfirmed diabetes, or missing particular covariates were excluded. Incident type 2 diabetes cases occurring until 31 July 2006 were ascertained. Dietary intake data were collected using 7-day food diaries at baseline. Self-administered questionnaires were used to collect baseline demographic, socioeconomic, lifestyle, physical activity and health characteristics. Height, weight and waist circumference were measured. SETTING: UK.
PARTICIPANTS: N = 24,653 men and women aged 40-79 years at baseline in 1993-97.
MAIN OUTCOME MEASURES: Associations for intake of sweetened beverages (soft drinks, sweetened,-milk beverages, sweetened tea/coffee, artificially sweetened beverages (ASBs), and fruit juice) with incident type 2 diabetes, the effect of substituting non-SB for SSB, and the population impact of sweet beverage consumption in lowering type 2 diabetes incidence.
RESULTS: During follow-up 847 cases of type 2 diabetes were identified. After adjusting for potential confounders, TEI, BMI and waist circumference, and based on continuous estimates, there was a significant association for type 2 diabetes per serving of soft drinks (HR 1.14; 95% CI 1.01, 1.32) and per serving of sweetened milk beverages (1.27; 1.09, 1.48). Based on estimates using categorical measures, the association per serving of soft drinks was attenuated and became non-significant after adjustment for adiposity (1.13; 0.94, 1.36, p linear trend 0.306). Per serving intake of sweetened tea or coffee, or fruit juice was not significantly associated with type 2 diabetes incidence using either continuous or categorical estimates. There was no association with drinking water per serving, and a negative association with unsweetened tea or coffee per serving (0.92; 0.89, 0.96).
There was a positive linear association between total sweet beverage intake (%TEI) and incident type 2 diabetes, which was significant at intake above 1% TEI. Each 5% higher intake was associated with 18% (95% CI 11%, 26%) higher incidence of type 2 diabetes. Substituting artificially sweetened beverages for soft drinks or sweetened milk beverages was not significantly associated with type 2 diabetes incidence. Substituting a serving of drinking water or unsweetened tea or coffee for a serving of soft drinks (0.86; 0.74, 0.99; 0.86; 0.73, 0.99, respectively) or sweetened-milk beverages (0.80; 0.67, 0.94; 0.75; 0.63, 0.86, respectively) were both estimated to reduce significantly the incidence of type 2 diabetes, though for soft drinks the upper limit of the 95% CI was 0.99 in both cases).
ASB consumers were younger, more likely to be women, obese and to have a reported family history of diabetes, they reported being the most physically active and had the lowest TEIs. After adjusting for potential confounders and TEI a higher type 2 diabetes incidence was observed per serving of ASB (1.22; 1.11, 1.33), but this was attenuated after adjustment for BMI and waist circumference (1.06; 0.93, 1.20).
CONCLUSIONS: Consumption of soft drinks and sweetened-milk beverages, and the energy from total sweetened beverages, were associated with higher type 2 diabetes risk independently of adiposity and socio-demographic, lifestyle and dietary factors. The authors concluded that reducing consumption of soft drinks and sweetened milk beverages and promoting water and unsweetened tea or coffee as alternatives may be beneficial for diabetes prevention.
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