Sweeteners and Risk of Obesity and Type 2 Diabetes: The Role of Sugar-Sweetened Beverages
Temporal patterns over the past three to four decades have shown a close parallel between the rise in added sugar intake and the global obesity and type 2 diabetes (T2D) epidemics. Sugar-sweetened beverages (SSBs), which include the full spectrum of soft drinks, fruit drinks, energy and vitamin water drinks, are composed of naturally derived caloric sweeteners such as sucrose, high fructose corn syrup, or fruit juice concentrates. Collectively they are the largest contributor to added sugar intake in the US diet. Over the past 10 years a number of large observational studies have found positive associations between SSB consumption and long-term weight gain and development of T2D and related metabolic conditions. Experimental studies provide insight into potential biological mechanisms and illustrate that intake of SSBs increases T2D and cardiovascular risk factors. SSBs promote weight gain by incomplete compensation of liquid calories and contribute to increased risk of T2D not only through weight gain, but also independently through glycemic effects of consuming large amounts of rapidly absorbable sugars and metabolic effects of fructose.
KeywordsSugar-sweetened beverages Added sugar Obesity Type 2 diabetes Cardiovascular risk
Clinical Trial Acronyms
Coronary Artery Risk Development in Young Adults
Health Professionals Follow-up Study
Nurses’ Health Study
- NHS II
Nurses’ Health Study II.
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- 2.International Diabetes Federation. IDF diabetes atlas. 4th ed. Brussels: International Diabetes Federation; 2009.Google Scholar
- 4.• Johnson RK, Appel LJ, Brands M, et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2009;120(11):1011–20. This paper has an important impact because it provided evidence-based recommendations for reductions in intake of added sugar to improve cardiovascular health of Americans, guidelines for consumption of added sugar, and identified SSBs as the greatest contributor of added sugar in the US diet. PubMedCrossRefGoogle Scholar
- 6.•• Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care. 2010;33(11):2477–83. This paper is of particular importance because it quantified the association between SSB beverage consumption and risk of T2D and metabolic syndrome, thus providing empirical evidence that intake of SSBs should be limited to reduce obesity-related risk of chronic metabolic diseases. PubMedCrossRefGoogle Scholar
- 16.Odegaard AO, Koh WP, Arakawa K, Yu MC, Pereira MA. Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes: the Singapore Chinese Health Study. Am J Epidemiol. 171(6):701–8.Google Scholar
- 17.• Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364(25):2392–404. This study is important because it identified SSBs as one of the top three dietary predictors of long-term weight gain in three large cohorts of US adults. These findings suggest that targeted strategies to reduce intake of sugary beverages may be an effective approach for obesity prevention on the individual and population level. PubMedCrossRefGoogle Scholar
- 25.Raben A, Moller BK, Flint A, et al. Increased postprandial glycaemia, insulinemia, and lipidemia after 10 weeks’ sucrose-rich diet compared to an artificially sweetened diet: a randomised controlled trial. Food Nutr Res. 2011;55.Google Scholar
- 32.Pan A, Hu FB. Effects of carbohydrates on satiety: differences between liquid and solid food. Curr Opin Clin Nutr Metab Care. 14(4):385–90.Google Scholar
- 45.Teff KL, Grudziak J, Townsend RR, et al. Endocrine and metabolic effects of consuming fructose- and glucose-sweetened beverages with meals in obese men and women: influence of insulin resistance on plasma triglyceride responses. J Clin Endocrinol Metab. 2009;94(5):1562–9.PubMedCrossRefGoogle Scholar
- 62.Yale Rudd Center. Sugar-Sweetened Beverage Taxes and Sugar Intake: Policy Statements, Endorsements and Recommendations. http://www.yaleruddcenter.org/resources/upload/docs/what/policy/SSBtaxes/SSBTaxStatements.pdf In.
- 76.Ganmaa D, Cui X, Feskanich D, Hankinson SE, Willett WC. Milk, dairy intake and risk of endometrial cancer: A 26-year follow-up. Int J Cancer. 2011.Google Scholar