Sugar sweetened drinks may give rise to nearly 2 million diabetes cases over 10 years in the US and 80,000 in the UK, estimates study published in the BMJ
Summary evidence indicates that regular consumption of sugar sweetened drinks is positively associated with type 2 diabetes independent of obesity status. Artificially sweetened drinks and fruit juice also showed a positive association with type 2 diabetes, but the quality of evidence was limited. Nonetheless, the authors warn that neither artificially sweetened drinks nor fruit juice are suitable alternatives to sugar sweetened drinks for the prevention of type 2 diabetes.
Artificially sweetened beverages have been seen as possible alternatives to sugar sweetened beverages to reduce intake of sugars and energy, and fruit juice has been considered a healthier alternative. However, evidence was not available to clarify whether or not consumption of each of sugar sweetened beverages, artificially sweetened beverages, and fruit juice is associated with risk of diabetes after taking account of obesity status.
To address this question, an international team of researchers led by the MRC Epidemiology Unit at the University of Cambridge set out to assess whether or not habitual consumption of sugar sweetened drinks, artificially sweetened drinks, or fruit juice was associated with the incidence of type 2 diabetes – and to estimate the 10-year risk attributable to sugar sweetened drinks in the USA and UK. They analysed the results of 17 observational studies. Design and quality were taken into account to minimise bias. None of these was funded by industry.
They found that habitual consumption of sugar sweetened drinks was positively associated with incidence of type 2 diabetes, independently of obesity status.
The association between artificially sweetened drinks or fruit juice and incident type 2 diabetes was less evident. Yet, the researchers found little evidence for benefits of these beverages, and therefore concluded these drinks are unlikely to be healthy alternatives to sugar sweetened drinks for preventing type 2 diabetes.
They point out that the studies analysed were observational, so no definitive conclusions can be drawn about cause and effect.
However, assuming a causal association, they estimate that two million new-onset type 2 diabetes events in the USA and 80,000 in the UK from 2010 to 2020 would be related to consumption of sugar sweetened beverages.
Dr Fumiaki Imamura, lead author of the study at the MRC Epidemiology Unit said:
This latest review and synthesis of the evidence builds on our ongoing research into the health impact of sugar sweetened drinks, including recent findings from the EPIC-InterAct study in 8 European countries as well as our work in the EPIC-Norfolk study in the UK where we found that drinking water or unsweetened tea or coffee in place of one sugary drink per day can help to reduce the risk of type 2 diabetes.
These findings together indicate that substituting sugar sweetened drinks with artificially sweetened drinks or fruit juice is unlikely to be the best strategy in reducing the risk of developing type 2 diabetes: water or other unsweetened beverages are better options.”
Dr Nita Forouhi, senior author of the study at the MRC Epidemiology Unit said:
Our new findings provide further evidence to support the recent UK Scientific Advisory Committee on Nutrition (SACN) recommendation that minimising the consumption of sugary drinks presents a clear opportunity towards the goal of free sugars contributing to no more than 5% of daily energy intake and to improve health.”
Adapted from a press release from The BMJ.
Imamura, F et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. The BMJ 21 July 2015. www.bmj.com/cgi/doi/10.1136/bmj.h3576