Sugar-sweetened beverage and diet soda consumption and the 7-year risk for type 2 diabetes mellitus in middle-aged Japanese men

Consumption of sugar sweetened beverages, artificially sweetened beverages and fruit juices and risk of type 2 diabetes, hypertension, cardiovascular disease, and mortality: A meta-analysis

Introduction

Sugar-sweetened beverage (SSB) intake is associated with an increased risk of cardiometabolic diseases. However, evidence regarding associations of artificially sweetened beverages (ASBs) and fruit juices with cardiometabolic diseases is mixed. In this study, we aimed to investigate the association between the SSB, ASB and fruit juice consumption with the incidence of cardiometabolic conditions and mortality.

Methods

Relevant prospective studies were identified by searching PubMed, Web of Science, Embase, and Cochrane Library until December 2022 without language restrictions. The pooled relative risk (RR) and 95% confidence intervals (CIs) were estimated for the association of SSBs, ASBs, and fruit juices with the risk of type 2 diabetes (T2D), cardiovascular disease (CVD), and mortality by using random-effect models.

Results

A total of 72 articles were included in this meta-analysis study. Significantly positive associations were observed between the consumption of individual beverages and T2D risk (RR: 1.27; 95% CI: 1.17, 1.38 for SSBs; RR: 1.32; 95% CI: 1.11, 1.56 for ASBs; and RR:0.98; 95% CI: 0.93, 1.03 for fruit juices). Moreover, our findings showed that intakes of SSBs and ASBs were significantly associated with risk of hypertension, stroke, and all-cause mortality (RR ranging from 1.08 to 1.54; all p < 0.05). A dose-response meta-analysis showed monotonic associations between SSB intake and hypertension, T2D, coronary heart disease (CHD), stroke and mortality, and the linear association was only significant between ASB consumption and hypertension risk. Higher SSB and ASB consumptions were associated with a greater risk of developing cardiometabolic diseases and mortality. Fruit juice intake was associated with a higher risk of T2D.

Conclusion

Therefore, our findings suggest that neither ASBs nor fruit juices could be considered as healthier beverages alternative to SSBs for achieving improved health.

Systematic Review Registration: [PROSPERO], identifier [No. CRD42022307003].

Association between Consumption of Artificial Sweeteners and Breast Cancer Risk: A Systematic Review and Meta-Analysis of Observational Studies

This study intends to conduct a meta-analysis based on existing research results to further investigate their relationship between artificial sweetener exposure and breast cancer risk. An electronic database literature search was performed up to July 2022, using PubMed, Web of Science, Ovid and Scopus. The relationship between artificial sweetener exposure and breast cancer (BC) incidence was evaluated by odds ratio (OR) and 95% confidence interval (CI). Among the five studies (two case-control studies and three cohort studies) that met the inclusion criteria, 314,056 participants were recruited in the cohort study, 4,043 cancer cases and 3,910 controls were recruited in the case-control study. It was found that exposure of artificial sweeteners was not related to the risk of BC (OR = 0.98, 95% CI = [0.94-1.03]). Subgroup analysis showed that compared with the non-exposure/very-low-dose group, the exposure to low, medium and high doses of artificial sweeteners were not associated with the risk of BC, which were OR = 1.01, 95% CI = [0.95-1.07], OR = 0.98, 95% CI = [0.93-1.02], OR = 0.88, 95% CI = [0.74-1.06], respectively. This study confirmed that there was no relationship between the exposure of artificial sweeteners and the incidence of BC.

Sugar Consumption Pattern among Cardiometabolic Risk Individuals: A Scoping Review

BACKGROUND

The global prevalence of noncommunicable diseases has risen rapidly over the past decade. Research has focused on dietary management, particularly dietary sugar, to prevent and treat noncommunicable diseases.

OBJECTIVE

This study undertakes a scoping review of research on the impacts of dietary sugar on cardiometabolic related health outcomes.

METHODS

Ovid Medline, Scopus and Web of Science Core collection databases were used to identify papers published from January 1, 2010 onwards. The included studies had to be cross-sectional or cohort studies, peered review, published in English and in adults, aged 18 years old and above. Articles had to determine the impacts of sugar intake on cardiometabolic related health outcomes. Study quality was measured using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. In addition, a narrative synthesis of extracted information was conducted.

RESULTS

Thirty-one articles were included in this review. All studies had a large sample size, and the exposure measure was clearly defined, valid and applied consistently across all study participants. Exposure was measured using validated questionnaires. All data were statistically analysed and adjusted for critical potential confounding variables. Results showed that dietary sugar intake was significantly associated with metabolic syndrome, blood pressure, blood glucose, blood lipids, and body weight.

CONCLUSION

Dietary sugar intake significantly increased cardiometabolic risks through mechanisms dependent and independent of weight gain. It is essential to create public awareness on the topics of cardiometabolic risk management and dietary sugars intake.

Food and Nutrient Displacement by Walnut Supplementation in a Randomized Crossover Study

The aim of this article is to evaluate the effect of a daily supplement of walnuts on the overall daily diet and nutrient profile of healthy adults. A randomized controlled trial with crossover design was conducted for two 6-month diet periods in southeast Californian communities. Subjects were randomized to receive a control diet or a walnut-supplemented diet, then switched. The walnut supplement represented approximately 12% of their daily energy intake. Trained nutritionists collected seven 24 h dietary recalls from each participant (a total of 14 recalls for both periods). Ninety participants were able to complete the study, including 50 females and 40 males. The average age of the participants was 54.3 years. Diets in the walnut period had significantly higher vegetable protein, total fat, total PUFA, PUFA 18:2, PUFA 22:6, and total dietary fiber (p < 0.05), while also exhibiting significantly lower PUFA 20:5. All mineral levels were higher on the walnut-supplemented diet. Calcium, phosphorus, magnesium, and zinc were, particularly, significantly higher among the walnut-supplemented group (p < 0.05). Displacement occurred in more than one-third of the entire nuts and seeds group; four-fifths of the non-alcoholic beverages and desserts groups; and the majority of the candy, sugar, and sweets group. Walnut supplementation can lead to favorable modifications in nutrient and food intake profiles that may contribute to chronic disease prevention. Nutrient and food displacement may be a mechanism to explain the favourable association between walnut intake and improved diet.

The relationship between the use of artificial sweeteners and cancer: A meta-analysis of case-control studies

Although there are reports that artificial sweeteners (AS) are safe, the relationship between artificial sweeteners and cancer remains controversial. The purpose of the study is to evaluate whether the consumption of artificial sweeteners is associated with the risk of cancers. We conducted a comprehensive search of multiple databases, including MEDLINE, EMBASE, Web of Science, and Cochrane Library. We found all the literature that studied the relationship between artificial sweeteners and cancer. Ten case-control studies were included in the meta-analysis. Our findings indicated that the consumption of artificial sweeteners was not associated with an increase in cancer when all types of cancers are analyzed comprehensively (OR 0.91, 95% CI 0.75-1.11). Interestingly, the use of artificial sweeteners is inversely related to urinary system cancer risk when analyzing women individually (OR 0.76, 95% CI 0.60-0.97). Our meta-analysis found that these is no correlation between artificial sweeteners and occurrence of cancer except urinary system cancer in women. Considering some limitations found in this study, additional data from large clinical trials are needed.

Sugar and artificially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose-response meta-analysis of prospective cohort studies

Although consumption of sugar-sweetened beverages (SSBs) and artificially sweetened beverages (ASBs) has increasingly been linked with obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality, evidence remains conflicted and dose-response meta-analyses of the associations are lacking. We conducted an updated meta-analysis to synthesize the knowledge about their associations and to explore their dose-response relations. We comprehensively searched PubMed, EMBASE, Web of Science, and Open Grey up to September 2019 for prospective cohort studies investigating the associations in adults. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated for the dose-response association. Restricted cubic splines were used to evaluate linear/non-linear relations. We included 39 articles in the meta-analysis. For each 250-mL/d increase in SSB and ASB intake, the risk increased by 12% (RR = 1.12, 95% CI 1.05-1.19, I² = 67.7%) and 21% (RR = 1.21, 95% CI 1.09-1.35, I² = 47.2%) for obesity, 19% (RR = 1.19, 95% CI 1.13-1.25, I² = 82.4%) and 15% (RR = 1.15, 95% CI 1.05-1.26, I² = 92.6%) for T2DM, 10% (RR = 1.10, 95% CI 1.06-1.14, I² = 58.4%) and 8% (RR = 1.08, 95% CI 1.06-1.10, I² = 24.3%) for hypertension, and 4% (RR = 1.04, 95% CI 1.01-1.07, I² = 58.0%) and 6% (RR = 1.06, 95% CI 1.02-1.10, I² = 80.8%) for all-cause mortality. For SSBs, restricted cubic splines showed linear associations with risk of obesity (P_{non-linearity} = 0.359), T2DM (P_{non-linearity} = 0.706), hypertension (P_{non-linearity} = 0.510) and all-cause mortality (P_{non-linearity} = 0.259). For ASBs, we found linear associations with risk of obesity (P_{non-linearity} = 0.299) and T2DM (P_{non-linearity} = 0.847) and non-linear associations with hypertension (P_{non-linearity} = 0.019) and all-cause mortality (P_{non-linearity} = 0.048). Increased consumption of SSBs and ASBs is associated with risk of obesity, T2DM, hypertension, and all-cause mortality. However, the results should be interpreted cautiously because the present analyses were based on only cohort but not intervention studies.

Non-nutritive Sweeteners and Glycaemic Control

PURPOSE OF REVIEW

The consumption of foods and beverages containing non-nutritive sweeteners (NNS) has increased worldwide over the last three decades. Consumers' choice of NNS rather than sugar or other nutritive sweeteners may be attributable to their potential to reduce weight gain.

RECENT FINDINGS

It is not clear what the effects of NNS consumption are on glycaemic control and the incidence of type 2 diabetes. This review aims to examine this question in epidemiological, human intervention and animal studies. It is not clear that NNS consumption has an effect on the incidence of type 2 diabetes or on glycaemic control even though there is some evidence for the modification of the microbiome and for interaction with sweet taste receptors in the oral cavity and the intestines' modification of secretion of glucagon-like peptide-1 (GLP-1), peptide YY (PYY), ghrelin and glucose-dependent insulinotropic polypeptide (GIP), which may affect glycaemia following consumption of NNS. In conclusion, long-term studies of NNS consumption are required to draw a firm conclusion about the role of NNS consumption on glycaemic control.

Effects of the Non-Nutritive Sweeteners on Glucose Metabolism and Appetite Regulating Hormones: Systematic Review of Observational Prospective Studies and Clinical Trials

Background

The effects of non-nutritive sweeteners (NNS) on glucose metabolism and appetite regulating hormones are not clear. There is an ongoing debate concerning NNS use and deleterious changes in metabolism.

Objectives

The aim of this review is to analyze the scientific available evidence regarding the effects of NNS on glucose metabolism and appetite regulating hormones.

Data Sources and Study Eligibility Criteria

We identified human observational studies evaluating the relation between NNS consumption and obesity, diabetes, and metabolic syndrome, in addition to clinical trials evaluating the effects of NNS in glucose metabolism and appetite regulating hormones.

Results

Fourteen observational studies evaluating the association between NNS consumption and the development of metabolic diseases and twenty-eight clinical trials studying the effects of NNS on metabolism were included. Finally, two meta-analyses evaluating the association between the consumption of NNS-containing beverages and the development of type 2 diabetes were identified.

Conclusions

Some observational studies suggest an association between NNS consumption and development of metabolic diseases; however, adiposity is a confounder frequently found in observational studies. The effects of the NNS on glucose metabolism are not clear. The results of the identified clinical trials are contradictory and are not comparable because of the major existing differences between them. Studies evaluating specific NNS, with an adequate sample size, including a homogeneous study group, identifying significant comorbidities, with an appropriate control group, with an appropriate exposure time, and considering adjustment for confounder variables such as adiposity are needed.

Not-so-healthy sugar substitutes?

Replacing sugar-sweetened beverages with diet soft drinks containing sugar substitutes that provide few or no calories has been suggested as one strategy for promoting improved public health outcomes. However, current scientific evidence indicates that routine consumption of beverages with non-nutritive sweeteners not only fails to prevent disease, but is associated with increases in risks for the same health outcomes associated with sugar-sweetened beverages, including type 2 diabetes, cardiovascular disease, hypertension and stroke. Results from pre-clinical studies have provided plausible biological mechanisms that could promote these counterintuitive negative health effects of artificial sweeteners. Taken together, scientific studies currently indicate that public health will be improved by reducing intake of all sweeteners, both caloric and non-caloric.

Dietary carbohydrate intake, presence of obesity and the incident risk of type 2 diabetes in Japanese men

Aims/Introduction

The present cohort study assessed the risk among Japanese men for developing type 2 diabetes, based on the percentage of energy intake from carbohydrates and degree of obesity.

Participants and Methods

The participants were 2,006 male factory employees, and the macronutrient intake of each patient was measured using a self‐administered diet history questionnaire. The incidence of diabetes was determined in annual blood examinations over a 10‐year period.

Results

During the study, 232 participants developed diabetes. The crude incidence rates (/1,000 person‐years) for different levels of carbohydrate intake as a percentage of calories consumed (<50.0, 50.0–57.4, 57.5–65.0, >65.0% of energy intake) were 16.5, 14.4, 12.7 and 17.6. Overall, carbohydrate intake was not associated with the risk of diabetes. However, there was significant interaction between carbohydrate intake and degree of obesity on the incidence of diabetes (P for interaction = 0.024). Higher carbohydrate intake was associated with elevated risk for diabetes among participants with a body mass index ≥25.0 kg/m² (P for trend = 0.034). For obese participants, the multivariate‐adjusted hazard ratio for those with carbohydrate intakes >65% energy was 2.01 (95% confidence interval 1.08–3.71), which was significantly higher than that of participants with carbohydrate intakes 50.0–57.4% energy.

Conclusions

Higher carbohydrate intake was associated with higher risk of diabetes in obese participants, but not in non‐obese participants. Obese participants with carbohydrate intakes >65% energy should reduce their intakes to levels within the desirable carbohydrate energy proportion for Japanese (50–65% energy) to prevent development of type 2 diabetes.

Evidence-based mapping of design heterogeneity prior to meta-analysis: a systematic review and evidence synthesis

BACKGROUND

Assessment of design heterogeneity conducted prior to meta-analysis is infrequently reported; it is often presented post hoc to explain statistical heterogeneity. However, design heterogeneity determines the mix of included studies and how they are analyzed in a meta-analysis, which in turn can importantly influence the results. The goal of this work is to introduce ways to improve the assessment and reporting of design heterogeneity prior to statistical summarization of epidemiologic studies.

METHODS

In this paper, we use an assessment of sugar-sweetened beverages (SSB) and type 2 diabetes (T2D) as an example to show how a technique called 'evidence mapping' can be used to organize studies and evaluate design heterogeneity prior to meta-analysis.. Employing a systematic and reproducible approach, we evaluated the following elements across 11 selected cohort studies: variation in definitions of SSB, T2D, and co-variables, design features and population characteristics associated with specific definitions of SSB, and diversity in modeling strategies.

RESULTS

Evidence mapping strategies effectively organized complex data and clearly depicted design heterogeneity. For example, across 11 studies of SSB and T2D, 7 measured diet only once (with 7 to 16 years of disease follow-up), 5 included primarily low SSB consumers, and 3 defined the study variable (SSB) as consumption of either sugar or artificially-sweetened beverages. This exercise also identified diversity in analysis strategies, such as adjustment for 11 to 17 co-variables and a large degree of fluctuation in SSB-T2D risk estimates depending on variables selected for multivariable models (2 to 95% change in the risk estimate from the age-adjusted model).

CONCLUSIONS

Meta-analysis seeks to understand heterogeneity in addition to computing a summary risk estimate. This strategy effectively documents design heterogeneity, thus improving the practice of meta-analysis by aiding in: 1) protocol and analysis planning, 2) transparent reporting of differences in study designs, and 3) interpretation of pooled estimates. We recommend expanding the practice of meta-analysis reporting to include a table that summarizes design heterogeneity. This would provide readers with more evidence to interpret the summary risk estimates.