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

20 / 06 / 15

There were three aims to this research paper: (1) to examine the association of different types of sugar sweetened beverages (SSB), such as soft drinks, sweetened milk beverages and drinks sweetened with sugar post-purchase, artificially sweetened beverages (ASB) and fruit juice with 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.

Baseline nutritional information from seven day food diaries and incidence of type 2 diabetes was obtained from the EPIC-Norfolk study cohort of 24,653 UK men and women aged between 40 and 79 years old in 1993-1997. This was used to assess intake (g/day) of (1) soft drinks (soft drinks, squashes (cordial) and juice-based drinks sweetened with sugar), (2)sweetened tea or coffee, (3) sweetened-milk beverages (milkshakes, flavoured milks, hot chocolate), (4) ASB and (5) fruit juice. Note (1), (2) and (3) were collectively defined as SSB in this study. TEI (kJ/day) from these sweet beverages were also estimated.

Positive associations were observed between soft drinks, sweetened milk beverages and ASB, but not for sweetened tea/coffee or fruit juice. Adjustments for adiposity attenuated the association of ASB suggesting reverse causality. There was a positive dose-response relationship with total sweet beverages. Substituting ASB for any SSB did not reduce the incidence of type 2 diabetes 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 of type 2 diabetes by 14-25%.

The consumption of soft drinks, sweetened milk beverages and energy from total sweet beverages was associated with higher type 2 diabetes risk independent of adiposity. Water or unsweetened tea/coffee appear to be better alternatives.

Limitations of this study include dietary intake was only assessed at baseline and not over time. The study also looks at the UK population intake between the years of 1993 and1997.