Drinking More Sweet Beverages, Even Juice, Tied to Type 2 Diabetes

Miriam E. Tucker

October 07, 2019

People who increase their consumption of sugar-sweetened beverages — whether they contain added or naturally occurring sugar in the form of fruit juice — face a moderately higher risk of type 2 diabetes, while replacing one of those drinks per day with water, coffee, or tea reduces the risk.

This latest research, which adds to the evidence base on the topic, also found that drinking more artificially sweetened beverages, or diet drinks, in place of sugary ones did not appear to lessen diabetes risk.

Charting 22-26 years' worth of data from nearly 200,000 participants in three prospective cohort studies, the work represents a first look at whether long-term changes in soda, diet soda, fruit juice, and other beverage consumption are linked with type 2 diabetes risk, say the researchers, led by Jean-Philippe Drouin-Chartier, PhD, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

The results were published online October 3 in Diabetes Care

"The concordance of our observations with previous studies further underscores the importance of limiting [sugar-sweetened beverage] consumption and replacing these beverages with healthy alternatives," Drouin-Chartier and colleagues write.

The relationship between 100% fruit juice consumption and increased diabetes risk is notable, they say, as those beverages are considered healthful alternatives to sugary sodas.

"Our study, along with previous ones, suggests that the relationship between 100% fruit juice consumption and diabetes risk shares more similarities with the association between [sugar-sweetened beverage] consumption and diabetes, in contrast to the inverse association between whole fruit consumption and diabetes," state the authors.

Changes in Intake of Different Beverages and Subsequent Diabetes Risk

The research included pooled data for 76,531 women in the Nurses' Health Study (1986–2012), 81,597 women in the Nurses' Health Study II (1991–2013), and 34,224 men in the Health Professionals' Follow-up Study (1986–2012). All participants filled out food frequency questionnaires every 4 years, including beverage consumption as 8-ounce per day servings.

Over 2,783,210 person-years of follow-up, there were 11,906 incident cases of type 2 diabetes across the three study populations.

After adjustment for numerous factors including initial age, race, family history of diabetes, menopausal status, hormone use, physical activity level, body mass index, and initial beverage consumption, individuals who decreased their total sugary beverage consumption — including 100% fruit juice — by more than 0.50 servings per day had a similar risk for diabetes in the subsequent 4 years as did those whose intake didn't change.

In contrast, increasing total sugary beverage intake by more than 0.50 servings/day was associated with a 16% greater risk for type 2 diabetes compared to those who maintained steady consumption.

Half-serving increases of just sugar-sweetened beverages resulted in a 9% increased risk, while increased fruit juice consumption raised the risk by 15%. Both findings were statistically significant.

Decreased consumption of artificially sweetened beverages didn't change the diabetes risk compared to steady intake, while an increase in artificially sweetened beverage consumption by more than 0.50 servings per day was associated with a significant 18% greater risk in the subsequent 4 years.   

But this latter increase may be because of reverse causation (the fact that people who know they are at increased risk might choose diet drinks over sugar-sweetened ones) and surveillance bias (high-risk individuals are more likely to be screened for diabetes and thus diagnosed more rapidly), the authors note.

In sensitivity analyses, the results didn't change after further adjustment for concurrent changes in calorie intake or body weight.

Replace Sugary Drinks With Tea, Coffee, Water, or Low-Fat Milk

Weight change explained 27.9% of the trend between changes in total sugary beverage consumption and diabetes risk, the authors say.

Based on the data, they estimated that replacing one daily serving of a sugary beverage with one daily serving of an artificially sweetened beverage was not associated with diabetes risk in the subsequent 4 years.

However, replacing a sugary beverage with water, coffee, tea, or reduced-fat milk (0–2% fat) was associated with a 2–10% lower diabetes risk.

"The study results are in-line with current recommendations to replace sugary beverages with noncaloric beverages free of artificial sweeteners," said senior author Frank Hu, MD, PhD, Fredrick J. Stare professor of nutrition and epidemiology, also of the Harvard T.H. Chan School of Public Health.

"Although fruit juices contain some nutrients, their consumption should be moderated," he said in a statement from his institution.

Drouin-Chartier has received speaker and consulting honoraria from the Dairy Farmers of Canada in 2016 and 2018.

Diabetes Care. Published online October 3, 2019. Abstract

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