(12-06-11) Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men1,2,3

1. Lawrence de Koning,
2. Vasanti S Malik,
3. Eric B Rimm,
4. Walter C Willett, and
5. Frank B Hu
+ Author Affiliations
1. 1From the Departments of Nutrition (LdK, VSM, EBR, WCW, and FBH) and Epidemiology (EBR, WCW, and FBH), Harvard School of Public Health, Boston, MA; the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (EBR, WCW, and FBH); and the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (EBR, WCW, and FBH).
+ Author Notes
? ↵2 Supported by postdoctoral fellowships from the Canadian Institutes of Health Research and the Canadian Diabetes Association (to LdK). The Health Professionals Follow-Up Study is supported by grants CA55075, HL35464, and DK58845 from the National Institutes of Health.
? ↵3 Address correspondence to FB Hu, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02115. E-mail: [email protected].
Abstract
Background: Sugar-sweetened beverages are risk factors for type 2 diabetes; however, the role of artificially sweetened beverages is unclear.
Objective: The objective was to examine the associations of sugar- and artificially sweetened beverages with incident type 2 diabetes.
Design: An analysis of healthy men (n = 40,389) from the Health Professionals Follow-Up Study, a prospective cohort study, was performed. Cumulatively averaged intakes of sugar-sweetened (sodas, fruit punches, lemonades, fruit drinks) and artificially sweetened (diet sodas, diet drinks) beverages from food-frequency questionnaires were tested for associations with type 2 diabetes by using Cox regression.
Results: There were 2680 cases over 20 y of follow-up. After age adjustment, the hazard ratio (HR) for the comparison of the top with the bottom quartile of sugar-sweetened beverage intake was 1.25 (95% CI: 1.11, 1.39; P for trend < 0.01). After adjustment for confounders, including multivitamins, family history, high triglycerides at baseline, high blood pressure, diuretics, pre-enrollment weight change, dieting, total energy, and body mass index, the HR was 1.24 (95% CI: 1.09, 1.40; P for trend < 0.01). Intake of artificially sweetened beverages was significantly associated with type 2 diabetes in the age-adjusted analysis (HR: 1.91; 95% CI: 1.72, 2.11; P for trend < 0.01) but not in the multivariate-adjusted analysis (HR: 1.09; 95% CI: 0.98, 1.21; P for trend = 0.13). The replacement of one serving of sugar-sweetened beverage with 1 cup (≈237 mL) of coffee was associated with a risk reduction of 17%.
Conclusion: Sugar-sweetened beverage consumption is associated with a significantly elevated risk of type 2 diabetes, whereas the association between artificially sweetened beverages and type 2 diabetes was largely explained by health status, pre-enrollment weight change, dieting, and body mass index.

1. Source: Am J Clin Nutr June 2011 vol. 93 no. 6 1321-1327

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