Frequent Consumption of Sugar- and Artificially Sweetened Beverages and Natural and Bottled Fruit Juices Is Associated with an Increased Risk of Metabolic Syndrome in a Mediterranean Population at High Cardiovascular Disease Risk

J Nutr. 2016 Aug;146(8):1528-36. doi: 10.3945/jn.116.230367. Epub 2016 Jun 29.


Background: The relation between the consumption of sweetened beverages and metabolic syndrome (MetS) is controversial.

Objective: This analysis evaluated the associations between intakes of sugar-sweetened beverages (SSBs), artificially sweetened beverages, and natural and bottled fruit juices and the incidence of MetS in elderly individuals at high risk of cardiovascular disease (CVD) and without MetS at baseline.

Methods: We prospectively examined 1868 participants free of MetS at baseline from the PREDIMED (PREvención con DIeta MEDiterránea) study. MetS was defined by using the updated harmonized criteria of the International Diabetes Federation, the American Heart Association, and National Heart, Lung, and Blood Institute. Energy and nutrient intakes were evaluated at baseline and then yearly by using a validated 137-item food-frequency questionnaire. Multivariable-adjusted HRs for MetS and its components were estimated from mean intakes during follow-up. We compared the 2 highest consumption categories (1-5 and >5 servings/wk) with the lowest category (<1 serving/wk).

Results: A total of 930 incident cases of MetS were documented during a median follow-up of 3.24 y. When we compared consumption of >5 servings/wk with consumption of <1 serving/wk, multivariable HRs (95% CIs) for MetS incidence were 1.43 (1.00, 2.15), 1.74 (1.26, 2.41), 1.30 (1.00, 1.69), and 1.14 (1.04, 1.65) for SSBs, artificially sweetened beverages, natural fruit juices, and bottled fruit juices, respectively.

Conclusions: The occasional consumption of SSBs and artificially sweetened beverages (1-5 servings/wk) was not associated with the incidence of MetS in middle-aged and elderly individuals at high risk of CVD. The consumption of >5 servings/wk of all of the types of beverages analyzed was associated with an increased risk of MetS and some of its components. However, for SSBs and bottled fruit juices these associations must be interpreted with caution because of the low frequency of consumption in this population. This trial was registered at as ISRCTN35739639.

Keywords: PREDIMED study; artificially sweetened beverages; fruit juices; metabolic syndrome; metabolic syndrome components; sugar-sweetened beverages.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Beverages
  • Cardiovascular Diseases / etiology*
  • Diet Surveys
  • Diet*
  • Dietary Sucrose / administration & dosage
  • Dietary Sucrose / adverse effects*
  • Feeding Behavior*
  • Female
  • Fruit and Vegetable Juices*
  • Humans
  • Incidence
  • Male
  • Mediterranean Region
  • Metabolic Syndrome / epidemiology
  • Metabolic Syndrome / etiology*
  • Middle Aged
  • Non-Nutritive Sweeteners / administration & dosage
  • Non-Nutritive Sweeteners / adverse effects*
  • Prospective Studies
  • Risk Factors
  • Sweetening Agents / adverse effects


  • Dietary Sucrose
  • Non-Nutritive Sweeteners
  • Sweetening Agents

Associated data

  • ISRCTN/ISRCTN35739639