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Title: Sugar-sweetened beverages and prevalence of the metabolically abnormal phenotype in the Framingham Heart Study

Author
item Green, Angela - Tufts University
item Jacques, Paul - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item Rogers, Gail - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item Fox, Caroline - Framingham Heart Study
item Meigs, James - Massachusetts General Hospital
item Mckeown, Nicola - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/14/2014
Publication Date: 5/1/2014
Citation: Green, A.K., Jacques, P.F., Rogers, G., Fox, C.S., Meigs, J.B., Mckeown, N.M. 2014. Sugar-sweetened beverages and prevalence of the metabolically abnormal phenotype in the Framingham Heart Study. Obesity. 22(5):E157-163. DOI:10.1002/oby.20724.

Interpretive Summary: “Metabolic syndrome” refers to a group of metabolic abnormalities that raise the risk for heart disease and other negative health outcomes such as diabetes. Obesity continues to be a major public health concern in the US, and many obese adults display metabolic abnormalities. These abnormalities include high triglyceride levels, low HDL cholesterol (i.e., low amounts of “good” cholesterol), high blood pressure, and high blood sugar which can be a precursor to diabetes. Interestingly, some obese individuals appear to be protected from developing metabolic abnormalities associated with obesity and may be at lower risk of developing chronic diseases. These individuals are known as the “metabolically healthy obese (MHO).” In contrast, some normal weight individuals appear to have metabolic abnormalities and, thus, are at risk for cardiovascular disease despite the fact that they are not obese. These individuals are known as “metabolically obese normal weight (MONW)” individuals. Little is known about why MHO individuals appear to be protected from developing metabolic abnormalities associated with obesity or why MONW individuals are at greater metabolic risk despite their normal body weight. To date, only a few studies have examined the role of diet in determining MHO and MONW individuals. Several large research studies have linked sugar-sweetened beverage (SSB) intake with a 20-30% higher incidence of type 2 diabetes and cardiovascular diseases. In addition, a recent population-based study of 8,157 adults followed for six years observed that an increase in SSB consumption was associated with a greater risk of developing metabolic syndrome. Thus, this study aimed to specifically examine the relationship between SSB consumption and metabolic health. We used data from the Framingham Heart Study to examine metabolic health among obese, overweight, and normal individuals across different levels of SSB consumption (high SSB consumers to non-consumers). Our findings suggest that individuals who frequently consume SSB are more likely to display metabolic abnormalities than individuals who do not consume SSB, regardless of whether they are obese or normal weight. Thus, our findings suggest that decreasing consumption of SSB is associated with better metabolic health.

Technical Abstract: The purpose of this study was to examine the relationship between usual sugar-sweetened beverage (SSB) consumption and prevalence of abnormal metabolic health across body mass index (BMI) categories. The metabolic health of 6,842 non-diabetic adults was classified using cross-sectional data from the Framingham Heart Study Offspring (1998-2001) and Third Generation (2002-2005) cohorts. Adults were classified as normal weight, overweight or obese and, within these categories, metabolic health was defined based on five criteria—hypertension, elevated fasting glucose, elevated triglycerides, low HDL cholesterol, and insulin resistance. Individuals without metabolic abnormalities were considered metabolically healthy. Logistic regression was used to examine the associations between categories of SSB consumption and risk of metabolic health after stratification by BMI. Comparing the highest category of SSB consumers (median of 7 SSB per week) to the lowest category (non-consumers), odds ratios (95% confidence intervals) for metabolically abnormal phenotypes, compared to the metabolically normal, were 1.9 (1.1-3.4) among the obese, 2.0 (1.4-2.9) among the overweight, and 1.9 (1.4-2.6) among the normal weight individuals. In this cross-sectional analysis, it is observed that, irrespective of weight status, consumers of SSB were more likely to display metabolic abnormalities compared to non-consumers in a dose-dependent manner.