Sugar-Sweetened Beverages and Health: Studies in Adults. Frank M. Sacks, M.D. Nutrition Department, Harvard School of Public Health

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1 Sugar-Sweetened Beverages and Health: Studies in Adults Frank M. Sacks, M.D. Nutrition Department, Harvard School of Public Health

2 Acknowledgments Cara Ebbeling: Children s Hospital, Boston Frank Hu: Harvard School of Public Health Miriam Vos: Emory University Walter Willett: Harvard School of Public Health

3 Sugar Sweetened Beverages Coronary Heart Disease Diabetes Obesity Triglycerides and HDL Fatty liver Sucrose vs High-Fructose Corn Syrup Fructose vs Glucose

4 Sweetened beverages & risk of CHD: 24-year follow-up in the Nurses Health Study Relative Risk of CHD P<0.001 <1/mo 1-4/mo 2-6/wk 1- <2/d 2+/d Sweetened Beverage Intake Adjusted for age, smoking, alcohol intake, parental history of CHD, physical activity, aspirin, postmenopausal hormones, hypertension, high cholesterol, and overall diet pattern. Fung TT et al. AJCN 2009;89:1037

5 Specific Sugar-Sweetened Sweetened Beverages and Risk of Coronary Heart Disease in US women: Multivariate RRs for 2-serving per day Beverage type RR (95% CI) P value All Colas Carbonate noncolas Fruit drinks/punch 1.28 (1.14, 1.44) < (1.15, 1.57) < (0.87, 1.86) (1.03, 1.71) 0.03 MV including diet (Fung TT et al. AJCN 2009;89:1037)

6 Sugar-Sweetened Soft Drinks and Type 2 Diabetes, Nurses Health Study R ela ti ive R isk P<0.001 for trend <1/mo 1-4/mo 2-6/wk >=1/d Sugar-sweetened soft drink consumption multivariate adjusted multivariate + BMI Schulze M et al. JAMA 2004;292:927

7 Sugar-Sweetened Soda and Type 2 Diabetes in the Black Women s Health Study Relati ive Risk P< <1/mo 1-7/mo 2-6/wk 1/day 2+/day Sugar-Sweetened Soft Drink Consumption Palmer JR et al. Arch Intern Med 2008;168:1487

8 Singapore Chinese Health Study: Soft Drinks and Type 2 Diabetes RR 1.2 Soft Drink, p< Fruit juice. P= None 1-3/mon 1/wk 2+/wk Odegaard AO et al. Am J Epidemiol 2010;171:epub

9 Gestational Diabetes: Sugar Sweetened Beverages Increase Risk in US Women (N= 13475, cases = 860) SSB consumption P for trend All Sugarsweetened beverages 0-3/mo 1-4/week 5/week 1 serving increment Case/person-years 323/185, /173, /185,757 RR1 (95% CI) (1.07, 1.45) RR2 (95% CI) (1.01, 1.37) RR3 (95% CI) (1.05, 1.43) 0.01 Sugar-sweetened cola Case/person-years 544/332, /113, /98,214 RR1 (95% CI) (1.16, 1.67) < RR2 (95% CI) (1.04, 1.51) 0.02 RR3 (95% CI) (1.07, 1.55) < Chen L et al. Diabetes Care 2009;32:2236

10 Sugar Sweetened Beverages and Mean Body Weight in 1991, 1995, and 1999: Nurses Health Study II 80 Weight (in kg) p=0.022 p=0.021 Regular soft drink intake '91 - '95 - '99 low-high-high low-high-low high-low-high high-low-low Year Schulze M et al. JAMA 2004

11 Singapore Chinese Health Study: Soft drinks predict subsequent weight gain Odegaard AO et al. Am J Epidemiol 2010;171:epub

12 Change in soft drink consumption and magnitude of weight gain: The Black Women s Health Study Intake Sugar-sweetened soft drinks N Mean weight gain* in kilograms (standard deviation) 1/week 1/day (0.28) 1/day 1/day 2, (0.19) 1/week 1/week 14, (0.07) 1/day 1/week 1, (0.22) All others 11, (0.08) Palmer et al. Arch Intern Medicine 2008

13 Added Sugar Intake Associated with Low HDL-C Levels Among US Adults NHANES a (referent) Mea an HDL-C (mg/dl) b b b <5% 5 -<10% 10 -<17.5% <25% >=25% Percent of total energy from added sugar a Error bars represent 95% confidence intervals; p-linear trend <0.001 b Adjusted mean is significantly lower than the referent, p<0.001 Source: Welsh JA, et al.. JAMA. 2010

14 Added Sugar Intake Associated with Higher Triglyceride Levels Among US Adults NHANES a 120 b c c Geometric mean iglycerides (mg/dl) tri (referent) <5% 5 -<10% 10 -<17.5% <25% >=25% Percent of total energy (kcals) from added sugar a Error bars represent 95% confidence intervals; p-linear trend =0.02 b Adjusted mean is significantly higher than the referent, p<0.01 c Adjusted mean is significantly higher than the referent, p<0.05 Source: Welsh JA, et al.. JAMA. 2010

15 High Fructose Corn Syrup vs Sucrose High Fructose Corn Syrup Fructose 55% Glucose 41% Sucrose (table sugar) a disaccaride 50% fructose and 50% glucose

16 Fructose Metabolism Elliot et al, 2002 Am J Clin Nut

17 In animal studies, chronic fructose feeding causes fatty liver (along with. Insulin resistance Hypertension Plasma hypertriglyceridemia Visceral obesity Oxidative stress Vos 2010

18 Fructose vs Glucose: Abdominal Fat Content (Sweetened beverages, 25% of energy requirements for 10 weeks) Stanhope et al. J Clin Invest 2009;119:1322

19 Glucose Intake Increases Blood Glucose Concentrations More Than Fructose Intake in Women FIG. 1. Plasma glucose concentrations during a 24-h period ( h) in 12 normal wt women consuming high glucose or high fructose beverages with each meal. Teff et al, J Clin Endo Metab 2004.

20 FIG. 2. Plasma insulin concentrations during a 24-h period ( h) in 12 women consuming HGl or HFr beverages with each meal Teff, K. L. et al. J Clin Endocrinol Metab 2004;89: Copyright 2004 T he Endocrine Society

21 Fructose Intake Increases Plasma Triglycerides More than - Glucose - Intake Teff, K. L. et al. J Clin Endocrinol Metab 2004;89: Copyright 2004 The Endocrine Society

22 Assessed associations with fructosecontaining sugar-sweetened beverages in 427 adults with biopsy proven nonalcoholic fatty liver disease Daily vs no intake was associated with 2.6 times the odds of having higher histologic grades of liver fibrosis (p=.004)

23 Brunt, Vos et al, 2010

24 Sugar-Sweetened Beverage Consumption Energy in liquid form Displacement of more satiating foods High glycemic load Fructose Alteration of taste preferences Sugar Incomplete calorie compensation Passive calorie overconsumption when drinking to satisfy thirst Increased hunger Insulin resistance Postprandial hyperglycemia & hyperinsulinemia B-cell dysfunction Increased intake of sugary foods; decreased intake of vegetables, fruits, etc Lower intake of fiber micronutrients, antioxidants and other phytochemicals Increased energy intake Metabolic Syndrome (low HDLC, high triglyceride, hypertension, hyperglycemia coagulopathy, chronic inflammation) Hyperuricemia Obesity Diabetes CHD Gout Dental caries

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