Substitution of Sugar-Sweetened Beverages for Other Beverages: Can It Be the Next Step Towards Healthy Aging?

Artificially sweetened beverages do not influence metabolic risk factors: a systematic review and meta-analysis

Introduction

The influence of artificially sweetened beverages (ASBs) on metabolic risk factors for non-communicable diseases (NCDs) remains unclear. This study aimed to systematically review the literature concerning whether the effects of ASBs on body weight and metabolic risk factors are equivalent to those of unsweetened beverages (USBs).

Methods

We searched PubMed, Embase, Web of Science, and Cochrane Library databases from their establishment until March 3, 2025. Only randomized controlled trials (RCTs) comparing ASBs and USBs were included. Literature screening, data extraction, and bias evaluations were performed. Statistical analyses were performed using Review Manager 5.4 and Stata 15.0 software.

Results

Nine RCTs involving 1,457 individuals were included. Meta-analysis findings indicated no statistically significant differences between ASB and USB groups in terms of weight, waist circumference, fasting blood glucose, glycated hemoglobin, homeostatic model assessment for insulin resistance, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure (all p > 0.05).

Conclusion

The study findings do not support the hypothesis that ASBs pose significant risks or benefits in terms of metabolic risk factors for NCDs. However, given this study applied a heterogeneous ASB formula, it could not adequately consider the role of specific artificial sweeteners. Further research is needed to evaluate the potential effect of different artificial sweeteners and their doses on health.

Systematic review registration

https://www.crd.york.ac.uk, identifier CRD420251027794.

Global Burden of Cardiovascular Disease Attributable to Sugar-Sweetened Beverages in Middle-Aged Adults: An Age-Period-Cohort Modelling Study

BACKGROUND

Cardiovascular disease (CVD) presents a significant burden among middle-aged adults (aged 35-64). Diet high in sugar-sweetened beverages is a notable CVD risk factor.

METHODS

Using Global Burden of Disease data from 1990 to 2019, age-standardized rates (ASRs) and average annual percentage change of ASRs were used to describe this burden and its changing trend.

RESULTS

In 2019, global CVD-related ASR (per 100 000) of deaths attributable to sugar-sweetened beverages in middle-aged adults reached 1.91 (95% uncertainty interval [UI], 1.07-2.63) compared with 2.75 (95% UI, 1.76-3.59) in 1990. The global ASR of disability-adjusted life years (DALYs) reached 69.71 in 2019 (95% UI, 38.38-96.36) compared with 97.98 (95% UI, 62.29-128.39) in 1990. Men had more than twice the deaths and DALYs as women. Low and low-middle sociodemographic index regions exhibited a higher burden of DALYs and deaths. In 2019, India and China had the highest numbers of deaths and DALYs and the Solomon Islands and Afghanistan recorded the highest ASRs of deaths and DALYs. A negative linear correlation was observed between sociodemographic index and ASRs of deaths (R=-0.10, P=0.010) and DALYs (R=-0.09, P=0.031) across 21 Global Burden of Disease regions. An inequalities analysis indicated that DALYs due to CVD were disproportionately higher in countries with lower sociodemographic index in 2019 (concentration index of inequality=-0.05 [95% CI, -0.1 to -0.01]).

CONCLUSIONS

Globally, sugar-sweetened beverages have contributed to a substantial increase in DALYs and deaths related to CVD in middle-aged adults over the past 30 years, especially among men and in low sociodemographic index countries.

Sugar-sweetened beverage intake, gut microbiota, circulating metabolites, and diabetes risk in Hispanic Community Health Study/Study of Latinos

No population-based studies examined gut microbiota and related metabolites associated with sugar-sweetened beverage (SSB) intake among US adults. In this cohort of US Hispanic/Latino adults, higher SSB intake was associated with nine gut bacterial species, including lower abundances of several short-chain-fatty-acid producers, previously shown to be altered by fructose and glucose in animal studies, and higher abundances of fructose- and glucose-utilizing Clostridium bolteae and Anaerostipes caccae. Fifty-six serum metabolites were correlated with SSB intake and a gut microbiota score based on these SSB-related species in consistent directions. These metabolites were clustered into several modules, including a glycerophospholipid module, two modules comprising branched-chain amino acid (BCAA) and aromatic amino acid (AAA) derivatives from microbial metabolism, etc. Higher glycerophospholipid and BCAA derivative levels and lower AAA derivative levels were associated with higher incident diabetes risk during follow-up. These findings suggest a potential role of gut microbiota in the association between SSB intake and diabetes.

Sugary beverages intake and risk of chronic kidney disease: the mediating role of metabolic syndrome

Background

Although several studies linked the sugary beverages to chronic kidney disease (CKD), the role of different types of sugary beverages in the development of CKD remained inconsistent. This study aimed to examine the associations of sugar-sweetened beverages (SSBs), artificially-sweetened beverages (ASBs), and natural juices (NJs) with CKD risk, and assess the extent to which the associations were mediated through metabolic syndrome (MetS).

Methods

This is a prospective analysis of 191,956 participants from the UK Biobank. Participants with information on beverage consumption and no history of CKD at recruitment were included. Daily consumptions of SSBs, ASBs and NJs were measured via 24-h dietary recall. Cox models were fitted to calculate the hazard ratios (HRs) and confidence intervals (CIs) of sugary beverages intakes on CKD risk. The causal mediation analyses were conducted to investigate whether MetS explained the observed associations.

Results

We documented 4,983 CKD cases over a median of 10.63 years follow-up. Higher consumption of SSBs and ASBs (>1 units/d compared with none) was associated with an elevated risk of CKD (HR: 1.45; 95% CI: 1.30-1.61, P-trend < 0.001 for SSBs and 1.52, 95% CI: 1.36-1.70 for ASBs). In contrast, we observed a J-shaped association between NJs and CKD with the with lowest risk at 0-1 unit/day (0-1 unit/d vs. 0, HR 0.86; 95% CI 0.81-0.91). The proportions of the observed association of higher intakes of SSBs and ASB with CKD mediated by MetS were 12.5 and 18.0%, respectively.

Conclusions

Higher intakes of ASBs and SSBs were positively associated with the development of CKD, while moderate consumption of NJs was inversely associated with CKD risk. More intensified policy efforts are warranted to reduce intake of SSBs and ASBs for CKD prevention.

Intake of sugary beverages with chronic conditions and multimorbidity: a prospective cohort study of UK Biobank

BACKGROUND

The burden of chronic conditions associated with sugary beverages is increasing but little is known about the role of different types of sugary beverages in the co-occurrence of multiple chronic conditions ('multimorbidity'). To inform future sugar-reduction guidelines, we aimed to examine the associations of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB) and natural juices (NJ) with multimorbidity.

METHODS

This prospective cohort study included 184 093 UK Biobank participants aged 40-69 years at baseline who completed at least one occasion of 24-h dietary recall between 2009 and 2012. Daily consumptions of SSB, ASB and NJ were assessed using 24-h dietary recall. Participants were followed from the first 24-h assessment until the onset of two or more new chronic conditions, or the end of follow-up (31 March 2017), whichever occurred first. Logistic regression models, Cox proportional hazard models and quasi-Poisson mixed effects models were used to estimate the association of beverages intakes with chronic conditions and multimorbidity.

RESULTS

A total of 19 057 participants had multimorbidity at baseline and 19 968 participants developed at least two chronic conditions during follow-up. We observed dose-response relationships of SSB and ASB consumptions with the prevalence and incidence of multimorbidity. For example, the adjusted hazard ratios (HRs) and 95% CIs of the incidence of developing at least two chronic conditions ranged from 1.08 (1.01-1.14) for SSB intake of 1.1-2 units/day to 1.23 (1.14-1.32) for >2 units/day compared with 0 units/day. Also, the adjusted HRs (95% CIs) of ASB consumption ranged from 1.08 (1.03-1.13) for 0.1-1 unit/day to 1.28 (1.17-1.40) for >2 units/day compared with non-consumers. Conversely, moderate consumption of NJ was associated with a smaller risk of the prevalence and incidence of multimorbidity. Moreover, higher intakes of SSB and ASB were positively associated whereas moderate intake of NJ was inversely associated with increased number of new-onset chronic conditions during follow-up.

CONCLUSIONS

Higher SSB and ASB intakes were positively associated whereas moderate NJ intake was inversely associated with the higher risk of multimorbidity and increased number of chronic conditions. Current and intended policy options to decrease the burden of chronic conditions and multimorbidity need a formulation of SSB and ASB reduction strategies.

Obesity, Diabetes Mellitus, and Vascular Impediment as Consequences of Excess Processed Food Consumption

Regular intake of ready-to-eat meals is related to obesity and several noninfectious illnesses, such as cardiovascular diseases, hypertension, diabetes mellitus (DM), and tumors. Processed foods contain high calories and are often enhanced with excess refined sugar, saturated and trans fat, Na⁺ andphosphate-containing taste enhancers, and preservatives. Studies showed that monosodium glutamate (MSG) induces raised echelons of oxidative stress, and excessive hepatic lipogenesis is concomitant to obesity and type 2 diabetes mellitus (T2DM). Likewise, more than standard salt intake adversely affects the cardiovascular system, renal system, and central nervous system (CNS), especially the brain. Globally, excessive utilization of phosphate-containing preservatives and additives contributes unswervingly to excessive phosphate intake through food. In addition, communities and even health experts, including medical doctors, are not well-informed about the adverse effects of phosphate preservatives on human health. Dietary phosphate excess often leads to phosphate toxicity, ultimately potentiating kidney disease development. The mechanisms involved in phosphate-related adverse effects are not explainable. Study reports suggested that high blood level of phosphate causes vascular ossification through the deposition of Ca²⁺ and substantially alters fibroblast growth factor-23 (FGF23) and calcitriol.

Effects of Energy Drink Acute Assumption in Gastrointestinal Tract of Rats

Energy drinks (EDs) are non-alcoholic beverages containing high amounts of caffeine and other psychoactive substances. EDs also contain herbal extract whose concentration is usually unknown. EDs can have several adverse effects on different organs and systems, but their effects on the gastrointestinal (GI) tract have been poorly investigated. To determine the acute effects of EDs on the GI tract, we administered EDs, coffee, soda cola, or water to Sprague–Dawley rats (n = 7 per group, randomly assigned) for up to five days, and analyzed the histopathological changes in the GI tract. Data were compared among groups by Kruskal–Wallis or Mann–Whitney tests. We found that, while EDs did not cause any evident acute lesion to the GI tract, they triggered eosinophilic infiltration in the intestinal mucosa; treatment with caffeine alone at the same doses found in EDs leads to the same effects, suggesting that it is caffeine and not other substances present in the EDs that causes this infiltration. The interruption of caffeine administration leads to the complete resolution of eosinophilic infiltration. As no systemic changes in pro-inflammatory or immunomodulating molecules were observed, our data suggest that caffeine present in ED can cause a local, transient inflammatory status that recruits eosinophils.

The Joint Association Between Multiple Dietary Patterns and Depressive Symptoms in Adults Aged 55 and Over in Northern China

Background

Depression is a common psychiatric disorder in older adults that affects their health-related quality of life. Two percent of adults over the age of 55 suffer from major depression, and the prevalence of depression increases with age. Even in the absence of major depressive disorder, 10–15% of older adults have clinically significant depressive symptoms.

Objectives

Epidemiological studies on the association between different gender eating patterns and depression show inconsistent associations. Our study examined whether different gender eating patterns are related to depression. We consider eating patterns individually and as a joint exposure to predefined eating patterns.

Methods

Principal component analysis (PCA) was performed on the data of the 24-h diet recall dietary intake, and the dietary pattern was determined. Linear regression models are used to explore the relationship between different diets and depression of men and women; weighted quantile sum (WQS) regression, quantile g calculation (qgcomp) and Bayesian kernel machine regression (BKMR) are performed as Secondary analysis.

Results

In the dietary patterns model, we found that the vegetable and fruit-based diet has a significant inhibitory effect in women, and the egg-milk-based diet has a significant inhibitory effect in men. We found that when all dietary factors are above the 55th percentile, there is a significant positive correlation between multiple dietary patterns and depression risk. We also determined a positive correlation between meat and obesity risk and a negative correlation between egg and milk and vegetables and fruits.

Conclusions

In the study population, after controlling for other baseline indicators and predictors of dietary pattern exposure, a fruit and vegetable-based diet was associated with a slightly healthier and lower risk of depression, while a meat-based dietary pattern associated with a higher risk of depression, and this association effect varies between genders.