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Sugar and artificially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose–response meta-analysis of prospective cohort studies

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Abstract

Although consumption of sugar-sweetened beverages (SSBs) and artificially sweetened beverages (ASBs) has increasingly been linked with obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality, evidence remains conflicted and dose–response meta-analyses of the associations are lacking. We conducted an updated meta-analysis to synthesize the knowledge about their associations and to explore their dose–response relations. We comprehensively searched PubMed, EMBASE, Web of Science, and Open Grey up to September 2019 for prospective cohort studies investigating the associations in adults. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated for the dose–response association. Restricted cubic splines were used to evaluate linear/non-linear relations. We included 39 articles in the meta-analysis. For each 250-mL/d increase in SSB and ASB intake, the risk increased by 12% (RR = 1.12, 95% CI 1.05–1.19, I2 = 67.7%) and 21% (RR = 1.21, 95% CI 1.09–1.35, I2 = 47.2%) for obesity, 19% (RR = 1.19, 95% CI 1.13–1.25, I2 = 82.4%) and 15% (RR = 1.15, 95% CI 1.05–1.26, I2 = 92.6%) for T2DM, 10% (RR = 1.10, 95% CI 1.06–1.14, I2 = 58.4%) and 8% (RR = 1.08, 95% CI 1.06–1.10, I2 = 24.3%) for hypertension, and 4% (RR = 1.04, 95% CI 1.01–1.07, I2 = 58.0%) and 6% (RR = 1.06, 95% CI 1.02–1.10, I2 = 80.8%) for all-cause mortality. For SSBs, restricted cubic splines showed linear associations with risk of obesity (Pnon-linearity = 0.359), T2DM (Pnon-linearity = 0.706), hypertension (Pnon-linearity = 0.510) and all-cause mortality (Pnon-linearity = 0.259). For ASBs, we found linear associations with risk of obesity (Pnon-linearity = 0.299) and T2DM (Pnon-linearity = 0.847) and non-linear associations with hypertension (Pnon-linearity = 0.019) and all-cause mortality (Pnon-linearity = 0.048). Increased consumption of SSBs and ASBs is associated with risk of obesity, T2DM, hypertension, and all-cause mortality. However, the results should be interpreted cautiously because the present analyses were based on only cohort but not intervention studies.

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Acknowledgements

We thank Laura Smales (BioMedEditing) for proofreading of the manuscript.

Funding

This meta-analysis was supported by the National Natural Science Foundation of China (Grant Nos. 81373074, 81402752 and 81673260); the Natural Science Foundation of Guangdong Province (Grant No. 2017A030313452); the Medical Research Foundation of Guangdong Province (Grant No. A2017181); and the Science and Technology Development Foundation of Shenzhen (Grant Nos. CYJ20140418091413562, JCYJ20160307155707264, JCYJ20170412110537191, and JCYJ20170302143855721).

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Author notes

  1. Pei Qin, Quanman Li and Yang Zhao contributed equally to this work.

Authors and Affiliations

  1. Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No. 1066 Xueyuan Avenue, Nanshan District, Shenzhen, 518060, Guangdong, People’s Republic of China

    Pei Qin, Quanman Li, Qionggui Zhou, Yang Li, Fulan Hu, Dongsheng Hu & Ming Zhang

  2. The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People’s Republic of China

    Quanman Li, Xizhuo Sun, Yu Liu, Honghui Li, Chunmei Guo, Dongdong Zhang, Gang Tian, Dechen Liu, Ranran Qie, Yifei Feng, Xingjin Yang, Fulan Hu & Dongsheng Hu

  3. Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People’s Republic of China

    Yang Zhao & Dongsheng Hu

  4. Department of Mental Health, Bao’an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, People’s Republic of China

    Qing Chen, Minghui Han, Shengbing Huang & Xiaoyan Wu

  5. Key Lab of Epidemiology, Department of Infectious Disease Control and Prevention, Shenzhen Guangming District Center for Disease Control and Prevention, Shenzhen, Guangdong, People’s Republic of China

    Tieqiang Wang & Xiaoliang Chen

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  1. Pei Qin
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Contributions

PQ, QL and MZ designed research; PQ, QL and YZ conducted the meta-analysis and drafted the manuscript; PQ, QL, YZ, QZ, CG, DZ, GT, and DL analyzed the data; RQ, MH, SH, XW, YL, YF, YZ, XY, FH, DH, MZ revised the manuscript. MZ had primary responsibility for final content. All authors read and approved the final manuscript.

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Correspondence to Ming Zhang.

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Qin, P., Li, Q., Zhao, Y. et al. Sugar and artificially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose–response meta-analysis of prospective cohort studies. Eur J Epidemiol 35, 655–671 (2020). https://doi.org/10.1007/s10654-020-00655-y

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