The number of people with type 2 diabetes is increasing worldwide. A total of 366 million people had diabetes in 2011 and the number will rise to 552 million by 2030 (1). Therefore, identification of the modifiable risk factors for diabetes is essential in order to prevent the disease.
Diet is known as an important and controllable risk factor for type 2 diabetes. In recent decades, the consumption of sugar and artificially sweetened beverages has increased around the world consistent with the increase in diabetes incidence. The researchers tried to confirm and quantify the linkage between sweet beverages and diabetes.
Sugar-sweetened soda is linked to increased type 2 diabetes risk
Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study were used to evaluate the association between intake of sweet beverages (juices and nectars, sugar-sweetened soft drinks, and artificially sweetened soft drinks) and the incidence of type 2 diabetes (4).
In the European population, one 12 oz daily increment in sugar-sweetened soft drink consumption was associated with a 22% increase in the risk of type 2 diabetes. One 12 oz daily increment in artificially sweetened soft drinks was associated with a 52% increase in risk. After the adjustment for BMI, the link between sugar-sweetened soft drinks consumption and diabetes persisted, but the link between artificially sweetened soft drinks and diabetes decreased and became statistically not significant. Juice and nectar consumption was not linked with type 2 diabetes incidence.
These results confirm the data from a meta-analysis of 11 studies conducted in North American populations. This meta-analysis reported in 2010 that consumption of just one or two sugar-sweetened beverages per day is associated with a 26% greater risk of developing type 2 diabetes (3).
Within the same context, a prospective study from France published in 2013 found that women who drink large amounts of diet soda are at increased risk of type 2 diabetes. The results also confirmed the previously documented association between high intake of sugar-sweetened beverages and diabetes. Adjustment for BMI did modify the results somewhat, although the associations remained significant for both sugar and artificially sweetened beverages (4).
More mechanism are involved in this association
Sugar-sweetened beverage consumption may lead to type 2 diabetes because of its effect on weight gain and BMI, as well as on an increase in blood glucose and insulin secretion. This could be related to some unique metabolic effects of fructose and other components of soft drinks.
In the case of artificially sweetened soft drinks, there are two possible explanations that are mentioned. The observed association could be driven by a reverse causality, given that the underlying health of people consuming artificially sweetened soft drinks may be compromised and their risk of type 2 diabetes increased. The association could be also mediated through increased BMI.
These studies confirm and quantify a roughly one fifth increased type 2 diabetes risk associated with sugar-sweetened soft drink consumption. The association between artificially sweetened soft drink consumption and type 2 diabetes is not consistent when the results are adjusted for BMI, and need further research. Given the increase in sweet beverage consumption worldwide, clear messages on its harmful effect on health should be given to the population: a simple choice to drink or to avoid a sweet beverage can change peoples’ lives.
1. IDF Diabetes Atlas, http://www.idf.org/diabetesatlas/5e/the-global-burden
2. D. Romaguera, “Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC”, Diabetologia, Springer-VerlagBerlin, Heidelberg11 March 2013
3. Vasanti S. Malik, Barry M. Popkin, George A. Bray, et. al., “Sugar Sweetened Beverages, Obesity, Type 2 Diabetes and Cardiovascular Disease risk”, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862465/
4. Guy Fagherazzi, Alice Vilier, Daniela Saes Sartorelli, et. al., “Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale–European Prospective Investigation into Cancer and Nutrition cohort”, 2013 American Society for Nutrition