Sweeteners and Risk of Obesity and Type 2 Diabetes: The Role of Sugar-Sweetened Beverages

Abstract

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.

This is a preview of subscription content, log in to check access.

Fig. 1

Abbreviations

CARDIA:

Coronary Artery Risk Development in Young Adults

HPFS:

Health Professionals Follow-up Study

NHS:

Nurses’ Health Study

NHS II:

Nurses’ Health Study II.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Naser KA, Gruber A, Thomson GA. The emerging pandemic of obesity and diabetes: are we doing enough to prevent a disaster? Int J Clin Pract. 2006;60(9):1093–7.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    International Diabetes Federation. IDF diabetes atlas. 4th ed. Brussels: International Diabetes Federation; 2009.

    Google Scholar 

  3. 3.

    Huang ES, Basu A, O’Grady M, Capretta JC. Projecting the future diabetes population size and related costs for the U.S. Diabetes Care. 2009;32(12):2225–9.

    PubMed  Article  Google Scholar 

  4. 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.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Malik VS, Popkin BM, Bray GA, Despres JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010;121(11):1356–64.

    PubMed  Article  Google Scholar 

  6. 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.

    PubMed  Article  Google Scholar 

  7. 7.

    Malik VS, Willett WC, Hu FB. Sugar-sweetened beverages and BMI in children and adolescents: reanalyses of a meta-analysis. Am J Clin Nutr. 2009;89(1):438–9. author reply 439–440.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97(4):667–75.

    PubMed  Article  Google Scholar 

  9. 9.

    Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr. 2004;79(4):537–43.

    PubMed  CAS  Google Scholar 

  10. 10.

    Block G. Foods contributing to energy intake in the US: data from NHANES III and NHANES 1999–2000. J Food Compos Anal. 2004;17:439–47.

    Article  Google Scholar 

  11. 11.

    Popkin BM. Patterns of beverage use across the lifecycle. Physiol Behav. 2010;100(1):4–9.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Hu FB, Malik VS. Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence. Physiol Behav. 2010;100(1):47–54.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84(2):274–88.

    PubMed  CAS  Google Scholar 

  14. 14.

    Schulze MB, Manson JE, Ludwig DS, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004;292(8):927–34.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L. Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med. 2008;168(14):1487–92.

    PubMed  Article  Google Scholar 

  16. 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.

  17. 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.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Raben A, Vasilaras TH, Moller AC, Astrup A. Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. Am J Clin Nutr. 2002;76(4):721–9.

    PubMed  CAS  Google Scholar 

  19. 19.

    Tordoff MG, Alleva AM. Effect of drinking soda sweetened with aspartame or high-fructose corn syrup on food intake and body weight. Am J Clin Nutr. 1990;51(6):963–9.

    PubMed  CAS  Google Scholar 

  20. 20.

    de Koning L, Malik VS, Rimm EB, Willett WC, Hu FB. Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am J Clin Nutr. 2011;93(6):1321–7.

    PubMed  Article  Google Scholar 

  21. 21.

    Dhingra R, Sullivan L, Jacques PF, et al. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation. 2007;116(5):480–8.

    PubMed  Article  Google Scholar 

  22. 22.

    Nettleton JA, Lutsey PL, Wang Y, et al. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2009;32(4):688–94.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Winkelmayer WC, Stampfer MJ, Willett WC, Curhan GC. Habitual caffeine intake and the risk of hypertension in women. JAMA. 2005;294(18):2330–5.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Duffey KJ, Gordon-Larsen P, Steffen LM, Jacobs Jr DR, Popkin BM. Drinking caloric beverages increases the risk of adverse cardiometabolic outcomes in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr. 2010;92(4):954–9.

    PubMed  Article  CAS  Google Scholar 

  25. 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.

  26. 26.

    Aeberli I, Gerber PA, Hochuli M, et al. Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial. Am J Clin Nutr. 2011;94(2):479–85.

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Sorensen LB, Raben A, Stender S, Astrup A. Effect of sucrose on inflammatory markers in overweight humans. Am J Clin Nutr. 2005;82(2):421–7.

    PubMed  CAS  Google Scholar 

  28. 28.

    Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr. 2009;89(4):1037–42.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Hall KD, Sacks G, Chandramohan D, et al. Quantification of the effect of energy imbalance on bodyweight. Lancet. 2011;378(9793):826–37.

    PubMed  Article  Google Scholar 

  30. 30.

    DellaValle DM, Roe LS, Rolls BJ. Does the consumption of caloric and non-caloric beverages with a meal affect energy intake? Appetite. 2005;44(2):187–93.

    PubMed  Article  Google Scholar 

  31. 31.

    Reid M, Hammersley R, Hill AJ, Skidmore P. Long-term dietary compensation for added sugar: effects of supplementary sucrose drinks over a 4-week period. Br J Nutr. 2007;97(1):193–203.

    PubMed  Article  CAS  Google Scholar 

  32. 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.

  33. 33.

    DiMeglio DP, Mattes RD. Liquid versus solid carbohydrate: effects on food intake and body weight. Int J Obes Relat Metab Disord. 2000;24(6):794–800.

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Popkin BM, Armstrong LE, Bray GM, Caballero B, Frei B, Willett WC. A new proposed guidance system for beverage consumption in the United States. Am J Clin Nutr. 2006;83(3):529–42.

    PubMed  CAS  Google Scholar 

  35. 35.

    Janssens JP, Shapira N, Debeuf P, et al. Effects of soft drink and table beer consumption on insulin response in normal teenagers and carbohydrate drink in youngsters. Eur J Canc Prev. 1999;8(4):289–95.

    Article  CAS  Google Scholar 

  36. 36.

    Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA. 2002;287(18):2414–23.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Radulian G, Rusu E, Dragomir A, Posea M. Metabolic effects of low glycaemic index diets. Nutr J. 2009;8:5.

    PubMed  Article  Google Scholar 

  38. 38.

    Liu S, Willett WC, Stampfer MJ, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr. 2000;71(6):1455–61.

    PubMed  CAS  Google Scholar 

  39. 39.

    Hofmann SM, Dong HJ, Li Z, et al. Improved insulin sensitivity is associated with restricted intake of dietary glycoxidation products in the db/db mouse. Diabetes. 2002;51(7):2082–9.

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Vlassara H, Cai W, Crandall J, et al. Inflammatory mediators are induced by dietary glycotoxins, a major risk factor for diabetic angiopathy. Proc Natl Acad Sci U S A. 2002;99(24):15596–601.

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Stanhope KL, Griffen SC, Bremer AA, et al. Metabolic responses to prolonged consumption of glucose- and fructose-sweetened beverages are not associated with postprandial or 24-h glucose and insulin excursions. Am J Clin Nutr. 2011;94(1):112–9.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Bray GA. How bad is fructose? Am J Clin Nutr. 2007;86(4):895–6.

    PubMed  CAS  Google Scholar 

  43. 43.

    Stanhope KL, Schwarz JM, Keim NL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009;119(5):1322–34.

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Stanhope KL, Bremer AA, Medici V, et al. Consumption of fructose and high fructose corn syrup increase postprandial triglycerides, LDL-cholesterol, and apolipoprotein-b in young men and women. J Clin Endocrinol Metab. 2011;96(10):E1596–605.

    PubMed  Article  CAS  Google Scholar 

  45. 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.

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Stanhope KL, Griffen SC, Bair BR, Swarbrick MM, Keim NL, Havel PJ. Twenty-four-hour endocrine and metabolic profiles following consumption of high-fructose corn syrup-, sucrose-, fructose-, and glucose-sweetened beverages with meals. Am J Clin Nutr. 2008;87(5):1194–203.

    PubMed  CAS  Google Scholar 

  47. 47.

    Stanhope KL, Havel PJ. Endocrine and metabolic effects of consuming beverages sweetened with fructose, glucose, sucrose, or high-fructose corn syrup. Am J Clin Nutr. 2008;88(6):1733S–7S.

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    Rodin J. Comparative effects of fructose, aspartame, glucose, and water preloads on calorie and macronutrient intake. Am J Clin Nutr. 1990;51(3):428–35.

    PubMed  CAS  Google Scholar 

  49. 49.

    Ghanim H, Mohanty P, Pathak R, Chaudhuri A, Sia CL, Dandona P. Orange juice or fructose intake does not induce oxidative and inflammatory response. Diabetes Care. 2007;30(6):1406–11.

    PubMed  Article  CAS  Google Scholar 

  50. 50.

    Johnson RJ, Segal MS, Sautin Y, et al. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am J Clin Nutr. 2007;86(4):899–906.

    PubMed  CAS  Google Scholar 

  51. 51.

    Nakagawa T, Hu H, Zharikov S, et al. A causal role for uric acid in fructose-induced metabolic syndrome. Am J Physiol Ren Physiol. 2006;290(3):F625–31.

    Article  CAS  Google Scholar 

  52. 52.

    Richette P, Bardin T. Gout. Lancet. 2010;375(9711):318–28.

    PubMed  Article  CAS  Google Scholar 

  53. 53.

    Gao X, Qi L, Qiao N, et al. Intake of added sugar and sugar-sweetened drink and serum uric acid concentration in US men and women. Hypertension. 2007;50(2):306–12.

    PubMed  Article  CAS  Google Scholar 

  54. 54.

    Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA. 2010;304(20):2270–8.

    PubMed  Article  CAS  Google Scholar 

  55. 55.

    Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008;336(7639):309–12.

    PubMed  Article  Google Scholar 

  56. 56.

    Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr. 2009;89(1):1–14.

    PubMed  Article  CAS  Google Scholar 

  57. 57.

    Lutsey PL, Steffen LM, Stevens J. Dietary intake and the development of the metabolic syndrome: the atherosclerosis risk in communities study. Circulation. 2008;117(6):754–61.

    PubMed  Article  Google Scholar 

  58. 58.

    Mackenzie T, Brooks B, O’Connor G. Beverage intake, diabetes, and glucose control of adults in America. Ann Epidemiol. 2006;16(9):688–91.

    PubMed  Article  Google Scholar 

  59. 59.

    Brown RJ, de Banate MA, Rother KI. Artificial sweeteners: a systematic review of metabolic effects in youth. Int J Pediatr Obes. 2010;5(4):305–12.

    PubMed  Article  Google Scholar 

  60. 60.

    Fowler SP, Williams K, Resendez RG, Hunt KJ, Hazuda HP, Stern MP. Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain. Obesity (Silver Spring). 2008;16(8):1894–900.

    Article  Google Scholar 

  61. 61.

    Hill A. Proc R Soc Med. 1965;58:295–300.

    PubMed  CAS  Google Scholar 

  62. 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.

  63. 63.

    Brownell KD, Farley T, Willett WC, et al. The public health and economic benefits of taxing sugar-sweetened beverages. N Engl J Med. 2009;361(16):1599–605.

    PubMed  Article  CAS  Google Scholar 

  64. 64.

    Forshee RA, Storey ML. Evaluation of the association of demographics and beverage consumption with dental caries. Food Chem Toxicol. 2004;42(11):1805–16.

    PubMed  Article  CAS  Google Scholar 

  65. 65.

    Wyshak G. Teenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med. 2000;154(6):610–3.

    PubMed  CAS  Google Scholar 

  66. 66.

    Stookey JD, Constant F, Gardner CD, Popkin BM. Replacing sweetened caloric beverages with drinking water is associated with lower energy intake. Obesity (Silver Spring). 2007;15(12):3013–22.

    Article  CAS  Google Scholar 

  67. 67.

    Dennis EA, Dengo AL, Comber DL, et al. Water consumption increases weight loss during a hypocaloric diet intervention in middle-aged and older adults. Obesity (Silver Spring). 2010;18(2):300–7.

    Article  Google Scholar 

  68. 68.

    Popkin BM, Barclay DV, Nielsen SJ. Water and food consumption patterns of U.S. adults from 1999 to 2001. Obes Res. 2005;13(12):2146–52.

    PubMed  Article  Google Scholar 

  69. 69.

    Bazzano LA, Li TY, Joshipura KJ, Hu FB. Intake of fruit, vegetables, and fruit juices and risk of diabetes in women. Diabetes Care. 2008;31(7):1311–7.

    PubMed  Article  CAS  Google Scholar 

  70. 70.

    van Dieren S, Uiterwaal CS, van der Schouw YT, et al. Coffee and tea consumption and risk of type 2 diabetes. Diabetologia. 2009;52(12):2561–9.

    PubMed  Article  Google Scholar 

  71. 71.

    van Dam RM. Coffee consumption and risk of type 2 diabetes, cardiovascular diseases, and cancer. Appl Physiol Nutr Metab. 2008;33(6):1269–83.

    PubMed  Article  Google Scholar 

  72. 72.

    Malik VS, Sun Q, van Dam RM, et al. Adolescent dairy product consumption and risk of type 2 diabetes in middle-aged women. Am J Clin Nutr. 2011;94(3):854–61.

    PubMed  Article  CAS  Google Scholar 

  73. 73.

    Choi HK, Willett WC, Stampfer MJ, Rimm E, Hu FB. Dairy consumption and risk of type 2 diabetes mellitus in men: a prospective study. Arch Intern Med. 2005;165(9):997–1003.

    PubMed  Article  Google Scholar 

  74. 74.

    Wang L, Manson JE, Buring JE, Lee IM, Sesso HD. Dietary intake of dairy products, calcium, and vitamin D and the risk of hypertension in middle-aged and older women. Hypertension. 2008;51(4):1073–9.

    PubMed  Article  CAS  Google Scholar 

  75. 75.

    Soedamah-Muthu SS, Ding EL, Al-Delaimy WK, et al. Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose–response meta-analysis of prospective cohort studies. Am J Clin Nutr. 2011;93(1):158–71.

    PubMed  Article  CAS  Google Scholar 

  76. 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.

  77. 77.

    Shin MH, Holmes MD, Hankinson SE, Wu K, Colditz GA, Willett WC. Intake of dairy products, calcium, and vitamin d and risk of breast cancer. J Natl Canc Inst. 2002;94(17):1301–11.

    Article  CAS  Google Scholar 

  78. 78.

    Chan JM, Giovannucci EL. Dairy products, calcium, and vitamin D and risk of prostate cancer. Epidemiol Rev. 2001;23(1):87–92.

    PubMed  Article  CAS  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Frank B. Hu.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Malik, V.S., Hu, F.B. Sweeteners and Risk of Obesity and Type 2 Diabetes: The Role of Sugar-Sweetened Beverages. Curr Diab Rep 12, 195–203 (2012). https://doi.org/10.1007/s11892-012-0259-6

Download citation

Keywords

  • Sugar-sweetened beverages
  • Added sugar
  • Obesity
  • Type 2 diabetes
  • Cardiovascular risk