Home Forums Other Specialities Endocrinology Replacing sugary drinks with water may reduce diabetes risk

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    The study was carried out by researchers from the University of Cambridge, and was funded by The Medical Research Council UK and Cancer Research UK.
    It was published in the peer-reviewed medical journal Diabetologia.

    The major UK study, involved around 25,000 adults, looking at the association between drink choices and the risk of type 2 diabetes. It found that those who consumed more of their calories through sugary drinks, and those who drank more soft drinks or sweetened milk drinks, were more likely to develop type 2 diabetes. The current analysis looked at whether the amount of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs) and fruit juice a person drank was linked to their risk of developing type 2 diabetes. The researchers also wanted to estimate what impact swapping non-sweetened beverages for these sweet beverages would have.

    The adults recruited did not have diabetes or have a family history of diabetes and had them record their food and drink consumption over a week. They then followed them up over almost 11 years to see who developed type 2 diabetes, and analysed whether people who drank more sweet beverages were at increased risk. Using their results, they then calculated what impact it would have if people swapped non-sweetened drinks, such as water, for these sweet beverages.

    The 25,639 participants in the study were recruited in the 1990s, when they were aged 40 to 79 years old. They filled out a food diary for a week, and the researchers used these to determine how much of the following they drank:

    – soft drinks – squashes and juice-based drinks sweetened with sugar
    – sweetened tea or coffee
    – sweetened milk beverages – such as milkshakes, flavoured milks, and hot chocolate
    – artificially sweetened drinks (ASBs) – such as diet sodas
    – fruit juice

    During the study, they had health checks and filled in follow-up health and lifestyle questionnaires. The researchers followed participants up until 2006, and identified anyone who developed type 2 diabetes through the health checks, questionnaires, and confirmed by medical records. These analyses took into account a range of factors that could influence the results (potential confounders), such as:

    – age
    – gender
    – socioeconomic status
    – physical activity
    – smoking
    – intake of other sweet beverages
    – total calorie intake
    – body mass index (BMI)
    – waist circumference

    The researchers used standard methods to estimate what impact it would have if people stopped consuming SSBs, based on their findings. They also calculated the potential impact of swapping water or ASBs for SSBs.

    During the study, 847 participants (3.4%) developed type 2 diabetes.
    After adjustment for all of the potential confounders, including total energy intake and BMI:
    each additional serving of soft drinks was associated with a 14% increase in the risk of developing diabetes (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.01 to 1.32)
    each additional serving of sweetened milk drinks was associated with a 27% increase in the risk of developing diabetes (HR 1.27, 95% CI 1.09 to 1.48)

    sugar-sweetened tea and coffee, ASBs, fruit juice and water were not associated with type 2 diabetes risk

    Overall, consuming more sweet drinks (measured as what percentage of a person’s calorie intake came from these drinks) was associated with increased type 2 diabetes risk. Substituting one serving a day of water or unsweetened tea or coffee for soft drinks or sweetened milk drinks was estimated to have the potential to reduce the number of new cases of type 2 diabetes by 14-25%. Substituting ASBs for SSBs was not estimated to have a significant effect.

    If people who drank sweet beverages reduced their intake of these drinks so they accounted for less than 2% of their total calorie intake, this was estimated to have the potential to prevent 15% of new diabetes cases.

    They suggest that, “Water or unsweetened tea/coffee appear to be suitable alternatives to SSBs for diabetes prevention”.


    The researchers concluded that, “The consumption of soft drinks, sweetened milk beverages and energy from total sweet beverages was associated with higher type 2 diabetes risk independently of adiposity [BMI and waist circumference]”. The study has a number of strengths, including its large size and use of multiple approaches to identify people who developed diabetes. But its main limitation is that other factors may be contributing to the effect seen, even though the researchers did try to reduce this as much as possible.
    This cohort study has found an association between sugar-sweetened drink consumption and the risk of type 2 diabetes. It estimated that swapping water or unsweetened tea or coffee for these beverages could have the potential to reduce the number of new diabetes cases by up to 25%.

    As with all studies of this type, the main limitation is that it is difficult to single out the impact of one factor and be sure that no others are contributing to the link seen.
    The researchers did take into account a range of factors, such as diet and physical activity in their analyses, to reduce this as much as they could, but it could still be having some effect. Another limitation is that the researchers only assessed drink intake once, at the start of the study, and this may have changed over time.

    Overall, we know that being overweight or obese is a major risk factor for type 2 diabetes. Maintaining a healthy weight will help to reduce this risk. Reducing your calorie intake by swapping sugar-sweetened drinks for unsweetened drinks could work towards this goal.

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