Regular Sugary Beverages Worsen Long-Term Visceral Adiposity

Deborah Brauser

January 15, 2016

FRAMINGHAM, MA — More research is suggesting that sugary drinks are more sour than sweet when it comes to adverse health outcomes. New findings from the Framingham Heart Study showed that regular consumption of sugar-sweetened beverages (SSB) changed both quality and quantity of visceral adipose tissue in middle-aged adults[1].

In the analysis of 1003 participants in Framingham's third-generation cohort, those who had the highest intake of SSB, drinking at least one serving daily, had a significantly greater increase in volume of adipose tissue than those who did not drink these beverages at all (P<0.001). They also had a greater decrease in visceral adipose tissue attenuation at computed tomography (CT) imaging (P=0.007). There were no significant differences in abdominal adipose tissue changes between those who did and did not drink diet sodas.

"The present study supports current dietary recommendations that limiting SSB consumption may be helpful to prevent cardiometabolic diseases," write Dr Jiantao Ma (National Heart, Lung, and Blood Institute, Framingham, MA) and colleagues.

The findings were published online January 11, 2015 in Circulation, along with an accompanying editorial[2] by Dr Rachel Johnson (University of Vermont, Burlington).

Johnson told heartwire from Medscape that this is one of the first large cohort studies to link SSB consumption "to harmful changes in what is essentially belly fat. And we know that high amounts of adipose tissue in the abdominal area increase the risk of cardiovascular disease and type 2 diabetes."

The current findings, along with other recent research on the harms of sugary drinks, have led to a "tipping point," said Johnson. "To my view it is settled science that these drinks are associated with numerous adverse health consequences. So it's time to go forward with a number of policy initiatives to move the needle in terms of reducing consumption."

Third-Generation Cohort

All participants underwent abdominal CT scanning at baseline and at follow-up about 6 years later; adipose tissue "quality" was assessed by changes in attenuation Hounsfield units (HU).

Also at baseline, the participants filled out the 126-item Harvard food frequency questionnaire, which asked about sugar-sweetened beverages and diet soda. The four consumption subgroups consisted of those who drank:

  • Zero to less than one serving per month (nonconsumers).

  • One serving/month to less than one serving/week (occasional).

  • One serving/week to less than one serving/day (frequent).

  • One or more servings/day (daily).

Sugar-sweetened beverages included nondiet sodas, other carbonated beverages, fruit punches or drinks, and lemonade. These beverages, along with diet sodas, were consumed daily by 1% of the participants. Nonconsumers of either type of drink made up 14% of the study population.

When examining SSB intake only, 13% were daily consumers, 35% were frequent consumers, 20% were occasional consumers, and 32% were nonconsumers. "SSB consumers were more likely to be men, younger subjects, [and] current smokers [and] engaged in slightly more physical activity and less likely to have diabetes," write the investigators.

The diet-soda intake percentages were 15%, 22%, 13%, and 50%, respectively. Consumers of this type of beverage "were less likely to be engaged in physical activity, had higher BMI, and had higher prevalence of diabetes."

New Research "Vitally Important"

Adjusted visceral adipose tissue volume changed from baseline to follow-up by 852 cm3 in daily consumers of SSB vs 658 cm3 in nonconsumers ( P<0.001).

Between these two groups, adjusted visceral adipose tissue attenuation/quality change was also significantly different (-0.8 HU vs 0.4 HU, respectively; P =0.007). However, "the association became nonsignificant after additional adjustment for visceral adipose tissue volume change," report the researchers.

There were no significant associations between SSB intake and change in body weight or in subcutaneous adipose tissue volume or attenuation. The adjusted association was significant, however, between SSB consumption and change in the ratio of visceral to subcutaneous tissue volume (P for trend=0.004).

"Taken together, these findings suggest that habitual SSB intake was associated with a long-term adverse change in visceral adiposity . . . independent of weight gain," write the investigators.

Johnson noted in her editorial that "it is vitally important" now for new research to determine what approaches may be most effective in reducing SSB consumption, including increasing public-education campaigns—but also possibly enacting taxes on the products, replacing their sugar with low-calorie sweeteners, or even restricting access.

"It's not going to be a single intervention that's going to lead to lower sugary-drink consumption," Johnson said to heartwire . "It's going to take a lot of tools to reduce consumption across the country."

The study was funded by the National Heart, Lung, and Blood Institute. Ma and the coauthors, as well as Johnson, report no relevant financial relationships.


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