Sugar-sweetened beverage but not diet soda consumption is positively associated with progression of insulin resistance and prediabetes

Authors: MA, JIANTAO - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; MEIGS, JAMES - Harvard University; FOX, CAROLINE - National Heart, Lung And Blood Institute(NHLBI, NIH); ROGERS, GAIL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; SMITH, CAREN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; HURBY, ADELA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; SALTZMAN, EDWARD - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; MCKEOWN, NICOLA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/11/2016
Publication Date: 11/9/2016
Citation: Ma, J., Jacques, P.F., Meigs, J.B., Fox, C.S., Rogers, G., Smith, C.E., Hurby, A., Saltzman, E., Mckeown, N. 2016. Sugar-sweetened beverage but not diet soda consumption is positively associated with progression of insulin resistance and prediabetes. Journal of Nutrition. doi: 10.3945/jn.116.234047.

Interpretive Summary: Many studies suggest that regular sugar-sweetened beverage intake may promote type 2 diabetes. However, it is unknown whether regular sugar-sweetened beverage intake is associated with insulin resistance, the major cause of type 2 diabetes. It is also unknown whether sugar-sweetened beverages elevate the risk of developing prediabetes, which is likely to become type 2 diabetes in a couple of years. In this study, we analyzed data collected from ~2,000 participants who attended the Framingham Heart Study. We calculated the change in insulin resistance over approximately 7 years and the odds of developing prediabetes over approximately 14 years in non-consumers and in three levels of sugar-sweetened beverage consumers. After accounting for multiple potential confounders in the analysis, we found a positive correlation between sugar-sweetened beverage consumption and insulin resistance. For instance, participants who consumed higher amounts of sugar-sweetened beverages had greater levels of insulin resistance. Compared with non-consumers, the highest sugar-sweetened beverage consumers (1 drink per day on average) had a 9% increase in insulin resistance. Also, compared with non-consumers, the highest sugar-sweetened beverage consumers had 46% higher risk of developing prediabetes. Our data suggest that the long-term consumption of sugar-sweetened beverages predicts increased insulin resistance and provides further evidence to support the relationship between sugar-sweetened beverage intake and type 2 diabetes.

Technical Abstract: Background: Previous studies have shown an inconsistent relationship between habitual beverage consumption and insulin resistance and prediabetes. Objective: The objective of the present study was to test the hypothesis that the consumption of sugar-sweetened beverages (SSBs), rather than diet soda, is associated with long-term progression of insulin resistance and the development of prediabetes. Methods: We analyzed the prospective association between cumulative mean consumption of SSBs or diet soda and incident prediabetes (n = 1685) identified across a median of 14 y of follow-up in participants [aged 51.9 +/- 9.2 y; 59.6% women; body mass index (BMI; kg/m2): 26.3 +/- 4.4] of the Framingham Offspring cohort. The prospective association between beverage consumption and change in homeostasis model assessment of insulin resistance (HOMA-IR; n = 2076) over approximately 7 y was also analyzed. The cumulative mean consumption of SSBs and diet soda was estimated by using food frequency questionnaires. Multivariable Cox proportional hazards models and linear regression models were implemented to estimate the HRs of incident prediabetes and change in HOMA-IR, respectively. Results: After adjustment for multiple potential confounders, including baseline BMI, we observed that SSB intake was positively associated with incident prediabetes (P-trend < 0.001); the highest SSB consumers (>3 servings/wk; median: 6 servings/wk) had a 46% higher risk of developing prediabetes than did the SSB nonconsumers (HR: 1.46; 95% CI: 1.16, 1.83). Higher SSB intake was also associated with a greater increase in HOMA-IR (P-trend = 0.006). No prospective associations were observed between diet soda intake and risk of prediabetes (P-trend = 0.24) or changes in HOMA-IR (P-trend= 0.25). These associations were similar after additional adjustment for change in BMI. Conclusion: Regular SSB intake, but not diet soda intake, is associated with a greater increase in insulin resistance and a higher risk of developing prediabetes in a group of middle-aged adults.