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. 2016 Dec;146(12):2544-2550.
doi: 10.3945/jn.116.234047. Epub 2016 Nov 9.

Sugar-Sweetened Beverage but Not Diet Soda Consumption Is Positively Associated With Progression of Insulin Resistance and Prediabetes

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Free PMC article

Sugar-Sweetened Beverage but Not Diet Soda Consumption Is Positively Associated With Progression of Insulin Resistance and Prediabetes

Jiantao Ma et al. J Nutr. .
Free PMC article

Abstract

Background: Previous studies have shown an inconsistent relation 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 [mean ± SD age: 51.9 ± 9.2 y; 59.6% women; mean ± SD 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 ∼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.

Keywords: HOMA-IR; diet soda; insulin resistance; prediabetes; sugar-sweetened beverages.

Conflict of interest statement

2 Author disclosures: J Ma, PF Jacques, JB Meigs, CS Fox, GT Rogers, CE Smith, A Hruby, E Saltzman, and NM McKeown, no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Study sample and exclusion criteria. *Participants who developed type 2 diabetes after baseline and had complete covariate data were included in the secondary analysis for a composite endpoint of prediabetes and type 2 diabetes (n = 1751) and for changes in HOMA-IR (n = 2195). OGTT, oral-glucose-tolerance test.

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