According to background information in the article, type 2 diabetes mellitus affects about 17 million U.S. individuals. The prevalence of diabetes and obesity has increased rapidly during the last decades, coinciding with an increase in soft drink consumption in the United States by 61 percent in adults from 1977 to 1997, and a more than doubling of soft drink consumption in children and adolescents from 1977-1978 to 1994-1998. Soft drinks are the leading source of added sugars in the U.S. diet, and may increase the risk of diabetes because they contain large amounts of high-fructose corn syrup, which raises blood glucose similarly to sucrose. Evidence has been limited on the link between sugar-sweetened soft drinks and risk of type 2 diabetes and obesity in adults.
Matthias B. Schulze, Dr.P.H., formerly of the Harvard School of Public Health, Boston, and colleagues examined the relationships between sugar-sweetened beverage consumption and weight gain and diabetes risk. The diabetes analysis included 91,249 women free of diabetes and other major chronic diseases at baseline in 1991. The weight change analysis included 51,603 women for whom complete dietary information and body weight were ascertained in 1991, 1995, and 1999. The women were part of the Nurses’ Health Study II. The researchers identified 741 cases of type 2 diabetes during the follow-up.
The researchers found that women with stable consumption patterns had no difference in weight gain, but weight gain over a 4-year period was highest among women who increased their sugar-sweetened soft drink consumption from 1 or fewer drinks per week to 1 or more drinks per day (average weight gain, 10.3 pounds for 1991 to 1995 and 9.3 pounds for 1995 to 1999) and was smallest among women who decreased their intake (2.9 pounds and .3 pounds for the two periods, respectively) after adjusting for lifestyle and dietary factors. Increased consumption of fruit punch was also associated with greater weight gain compared with decreased consumption. After adjustment for potential confounders, women consuming 1 or more sugar-sweetened soft drinks per day had a 83 percent increased risk for type 2 diabetes compared with those who consumed less than 1 of these beverages per month. Similarly, consuming one drink or more per day of fruit punch was associated with twice the risk for di!
abetes compared with consuming less than one drink of fruit punch per month.
“In conclusion, our findings suggest that frequent consumption of sugar-sweetened beverages may be associated with larger weight gain and increased risk of type 2 diabetes, possibly by providing excessive calories and large amounts of rapidly absorbable sugars. Public health strategies to prevent obesity and type 2 diabetes should focus on reducing sugar-sweetened beverage consumption,” the authors write. (JAMA. 2004; 292:927-934. Available post-embargo at JAMA.com)
Editor’s Note: This study was funded by a research grant from the National Institutes of Health. Dr. Schulze, now with the German Institute of Human Nutrition, Nuthetal, Germany, was also supported by a European Association for the Study of Diabetes/American Diabetes Association Trans-Atlantic fellowship and a fellowship of the German Academic Exchange Service (DAAD). Co-author Dr. Frank B. Hu is the recipient of an American Heart Association Established Investigator Award.
Editorial: Sugar-Sweetened Soft Drinks, Obesity, and Type 2 Diabetes
In an accompanying editorial, Caroline M. Apovian, M.D., of Boston Medical Center and Boston University School of Medicine, Boston, writes that the data in the study by Schulze et al reveal that women with a higher intake of sugar-sweetened soft drinks tended to be less physically active, smoke more, have higher intake of total calories and lower intake of protein, alcohol, magnesium, and cereal fiber.
“In addition, intake of total carbohydrates, sucrose, and fructose, as well as overall glycemic index, was higher in these women. In essence, these women have dietary patterns and lifestyle habits that lead to increased risk of several disease states, including obesity, type 2 diabetes, and cardiovascular disease. Perhaps the take-home message is that a simple question about sugar-sweetened beverage consumption can alert the primary care clinician to patients’ unhealthy eating and lifestyle habits. Sugar-sweetened beverage consumption as a marker of an unhealthy lifestyle has the potential of being a quick screening test for increased risk of obesity and type 2 diabetes, but it requires validation,” Dr. Apovian writes.
“From a public policy perspective, this study should help to convince the U.S. Department of Agriculture to redefine guidelines for sugar consumption, especially in soft drinks. In addition, the government should support local efforts to banish soda machines from schools or replace soft drinks with healthier options (e.g., not sugar-sweetened fruit drinks). School-based programs can play an important role in preventing obesity,” the author writes. “Because of the large amount of calories in sugar-sweetened soft drinks and the relationship between consumption of these drinks and weight gain, reducing sugar-sweetened beverage consumption may be the best single opportunity to curb the obesity epidemic. However, convincing individuals to alter their behavior will require major educational and public health efforts that have not been forthcoming.”
(JAMA. 2004; 292:978-979. Available post-embargo at JAMA.com) Editor’s Note: Dr. Apovian has received honoraria or grants from Abbott, GlaxoSmithKline, Pfizer, Takeda, and the National Institutes of Health.
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