Regular consumption of soft drinks is associated with type 2 diabetes incidence in Mexican adults: findings from a prospective cohort study

How Health Systems World-wide Fail Type 2 Diabetics

For over 50 years, health systems the world over have failed people with type 2 diabetes mellitus (T2DM). The WHO documents a quadrupling of people with diabetes in a 34-year period to 422 million in 2014, the overwhelming majority of whom were T2DM. This happened despite extensive scientific literature on the causes of, as well as proven treatments for, this disease. Using a health systems prism to review the extensive medical and nutritional T2DM published research, we identified three main shortcomings of health systems in T2DM: (i) failure in early detection; (ii) failure in understanding the actionable lifestyle drivers; and (iii) subsidizing the causes of the disease. Although small-scale success stories in T2DM control exist, the lack of documented evidence of any country-wide health system's successful attempt to address this epidemic is alarming. The immense and ever-growing health and economic burdens of T2DM should provide all the motivation needed for national and global efforts to counteract the political-economy constraints standing in the way of successful whole-of-system approaches to T2DM.

The health impacts and genetic architecture of food liking in cardio-metabolic diseases

We evaluated temporal and genetic relationships between 176 food-liking-traits and cardio-metabolic diseases using data from the UK Biobank (N = 182,087) for observational analyses and summary-level GWAS data from FinnGen and other consortia (N = 406,565-977,323) for genetic analyses. Integrating observational and genetic results, we identified two detrimental food-liking-traits (bacon and diet-fizzy-drinks) and three protective food-liking-traits (broccoli, pizza, and lentils/beans). These food-liking-traits are associated with habitual food intake and influence cardio-metabolic proteins and biological processes. Notably, we found three genetic links: diet-fizzy-drinks with heart-failure, bacon with type-2-diabetes, and lentils/beans with type-2-diabetes, identifying 54 pleiotropic single-nucleotide-variants, impacting both phenotypes. Our data show the diet-fizzy-drinks and heart-failure link maybe not direct, as diet-fizzy-drinks liking correlates with sweet food consumption and shares variants linked to BMI, adiposity, platelet count and cardio-metabolic traits. The pleiotropic single-nucleotide-variants map to 251 tissue-specific genes, with four showing high druggability potential, highlighting personalized dietary strategies for cardio-metabolic diseases.

Dietary Sugar Intake and Incident Type 2 Diabetes Risk: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

The dose-response relationship between dietary sugar and type 2 diabetes (T2D) risk is uncertain. MEDLINE, Embase, CINAHL, Web of Science and Cochrane databases were searched through July 9, 2024 for prospective cohort studies reporting relative measures of incident T2D risk by categories of dietary sugar (total, free, added, fructose, sucrose) or 2 beverage sources (non-diet sugar-sweetened beverages [SSBs], fruit juice) in healthy adults. Linear and restricted cubic spline dose-response models were fitted for each exposure, and study-specific slopes and confidence intervals (CIs) were calculated. Heterogeneity was evaluated using Q-statistics. Risk of bias was evaluated using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to assess the certainty of evidence. Of 10,384 studies, 29 cohorts were included: SSB: 18 (n = 541,288); fruit juice: 14 (n = 490,413); sucrose: 7 (n = 223,238); total sugar: 4 (n = 109,858); fructose: 5 (n = 158,136); and added sugar: 2 (n = 31,004). Studies were conducted in Europe (13), United States (11), Asia (6), Australia (4), and Latin America (3). Each additional serving of SSB and fruit juice was associated with a higher risk of T2D (risk ratio [RR]: 1.25; 95% CI: 1.17, 1.35 and RR: 1.05; 95% CI: >1.00, 1.11, respectively; moderate certainty). In contrast, 20 g/d intakes of total sugar and sucrose were inversely associated with T2D (RR: 0.96; 95% CI: 0.94, 0.98; low certainty; and RR: 0.95; 95% CI: 0.91, <1.00; moderate certainty, respectively). No associations were found for added sugar (RR: 0.99; 95% CI: 0.96, 1.01; low certainty) or fructose (RR: 0.98; 95% CI: 0.83, 1.15; very low certainty). These findings suggest that dietary sugar consumed as a beverage (SSB and fruit juice) is associated with incident T2D risk. The results do not support the common assumption that dietary sugar (i.e., total sugar and sucrose), irrespective of type and amount, is consistently associated with increased T2D risk. This study was registered in PROSPERO as CRD42023401800.

Psychometric Properties of the Turkish Version of the Soft Drink Addiction Scale

BACKGROUND

Considering the increasing consumption of soft drinks and their adverse health effects, identifying addiction to these drinks in the population is significant. Accordingly, this study aimed to evaluate the reliability and validity of the Turkish version of the Soft Drink Addiction Scale.

METHODS

For this purpose, we included 669 participants and distributed them homogeneously for exploratory and confirmatory factor analyses. To assess the psychometric properties of the scale, we used the Soft Drink Addiction Scale, the Beverage Intake Questionnaire-15, and a questionnaire that included questions assessing self-efficacy regarding soft drinks and attitudes toward alternatives.

RESULTS

The mean age of 669 participants was 34.05 ± 9.26 years. A total of 93.72% were female and 6.28% were male. The scale's Cronbach's alpha coefficient was 0.942. An exploratory factor analysis revealed the following three-factor structure: withdrawal syndrome symptoms, persistent desire, and decrease in social and recreational activities, which explained 29.1%, 16%, and 16.9% of the total variance, respectively. A confirmatory factor analysis also confirmed this construct. Moreover, soft drink addiction was associated with self-efficacy and total calories from beverages questioned in the beverage consumption questionnaire.

CONCLUSIONS

In conclusion, the Turkish version of the Soft Drink Addiction Scale is a reliable and valid tool.

Evaluation of the Soda Tax on Obesity and Diabetes in California: A Cost-Effectiveness Analysis

Introduction. Consumption of sugar-sweetened beverages (SSBs) contributes to weight gain, obesity, and diabetes. Soda tax has been proposed to reduce consumption of SSBs. What remains unclear is whether the soda tax has an effect on health and health care costs. We evaluated the cost-effectiveness of a 1-cent-per-ounce soda tax on obesity and diabetes in California. Methods. A microsimulation state-transition model was used to evaluate the cost-effectiveness of the soda tax. Health outcomes were measured in quality-adjusted life-years (QALYs). Health care costs were projected from 2015 to 2035. Results. In a simulated cohort of Californian adults, the soda tax policy prevented 2.28 million cases of overweight (95% confidence interval [CI] -0.06 to 6.63) and 0.49 million cases of obesity (95% CI -0.19 to 1.18). From the health care perspective, the incremental cost-effectiveness ratio of the soda tax was $124,839 dollars per QALY (95% CI -1,151,983 to 557,660). From the health care perspective, the soda tax policy was cost-effective 80% of the time in the probabilistic sensitivity analysis using a willingness-to-pay threshold of $100,000 per QALY. Conclusions. The 1-cent-per-ounce soda tax reduced the number of obesity cases, diabetes cases, and related complications. In addition, the soda tax policy implemented in California was cost-effective most of the time.

Highlights

Question: What remains unclear is whether the soda tax has an effect on health and health care costs.Findings: The 1-cent-per-ounce soda tax reduced the number of obesity cases, diabetes, and related complications. In addition, the soda tax policy brought large amounts of revenue.Meaning: This study provides additional evidence regarding the health care costs and cost-effectiveness related to the implementation of a soda tax.

Individuals' perceptions of the factors linked to everyday soft drink consumption among university students: qualitative study

Background

Soft drink consumption is continuing to grow worldwide, posing an increasing threat to people's health and general wellbeing. Consequently, we must understand the factors driving soft drink consumption to support improvements to nutrition. This paper adopts a qualitative research approach to explore individuals' perceptions of the factors linked to daily soft drink consumption among university students in Saudi Arabia.

Materials and methods

This research employed purposive sampling to recruit a total of 19 students attending university in Al Madinah Province, Saudi Arabia, all of whom reported that they had previously consumed soft drinks. Over 3 months, data was gathered through a mixture of online and in-person semi-structured interviews. Once completed, the interviews were then transcribed and analyzed using inductive thematic analysis to identify the themes that emerged from the data.

Results

This study reveals five core themes: taste, habit, price, environment and social context, and health concerns. Regarding health concerns, this study finds that the public's increasing concerns about health can reduce people's consumption of soft drinks. Significantly, this research reveals that the rise in health concerns among the public is being driven by the growing conversation about healthy food and the negative impact of consuming sugary soft drinks occurring in wider society.

Conclusion

To conclude, this research underlines the value of adopting a holistic approach to promoting healthier drink choices (and thus reducing soft drink consumption). Interventions that focus on factors associated with soft drink consumption, such as habits, price, environment, social settings, health concerns, and taste, will be better able to decrease soft drink consumption and improve people's nutritional intake.

Consumption of Tap Water and Sociodemographic-Associated Characteristics: A Nationwide Cross-Sectional Study

Safe water is a global public health concern amid increasing scarcity and pollution. Bottled water production and consumption contribute to these problems. This study examines tap water consumption in Italy, assessing associated sociodemographic factors and related health outcomes such as obesity and self-perceived health status. Data from the Italian National Statistics Institute's "Aspects of daily life" survey (N = 45,597) were analyzed. Covariates included education, age, gender, economic status, region, concerns about waste and climate change, consumption of carbonated drinks excluding water, alcohol consumption, consumption of vegetables, consumption of snacks, body mass index, and self-perceived health status. Bivariate analyses and mixed-effect logistic regression models explored the associations. People who drink tap water made up 19,674, with a higher prevalence in people aged 45 to 59 old, people with a graduate/post-graduate degree diploma, with optimal economic resources, people concerned about waste production and climate change, and those coming from the north-east regions of Italy. Underweight people showed a higher prevalence of TW consumption as well as those who less than occasionally drank carbonated drinks, drank alcohol, consumed vegetables more than once a day and snacks less than once a week, dairy products more than once a day, sweet less than once a week, cured meat less than once a week, and chicken meat less than once a week, those with no consumption of sheep meat, consumption of beef meat less than once a week and consumption of pork meat less than once a week, and those with a satisfactory level of perceived health status. Regressions showed that all other age classes are less likely to drink tap water than people younger than 20 years old. The category with "inadequate" economic resources is more likely to consume tap water. Low educational classes show a low likelihood of consuming tap water as well as islands. A concern about waste production and climate change is associated with an increased likelihood of consuming tap water. Tap water consumption was negatively associated with obesity but not with a satisfactory self-perceived health status. Insights from this study can inform public health strategies.

Triglyceride-glucose index is associated with hypertension incidence up to 13 years of follow-up in mexican adults

The triglyceride-glucose index (TyG index) is an indicator of insulin resistance that has been studied recently. The relationship between insulin resistance and the risk of hypertension has been documented previously. However, there is limited knowledge regarding the association of the TyG index with hypertension incidence. This study aimed to evaluate the association of the TyG index with changes in blood pressure (BP) and hypertension incidence in Mexican adults. This analysis was performed using the Health Workers Cohort Study data. The TyG index was estimated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2] and divided into categories defined by tertiles. The analysis was conducted using fixed-effects linear regression models (n = 1,545) and Cox proportional hazards regression models (n = 1,113), adjusting for potential confounding variables. The incidence rates (95% CI) for the low, medium, and high categories of the TyG index were 22.1 (17.8, 27.5), 35.8 (30.1, 42.7), and 49.4 (42.1, 57.9), respectively. An increase in the levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP) was observed when changing from a low to a medium (DBP: β 2.55 mmHg, 95% CI 0.81, 4.29) and from a low to a high category of the TyG index (SBP: β 3.10 mmHg, 95% CI 1.16, 5.04; DBP: β 4.91 mmHg, 95% CI 2.88, 6.94). Furthermore, participants within the top category of the TyG index had a 56% higher risk of hypertension than those in the bottom category (HR = 1.56; 95% CI 1.18, 2.08). These results support the hypothesis that the TyG index is associated with high blood pressure in Mexican adults.

Consumption of sweetened beverages is associated with the incidence of type 2 diabetes in Brazilian adults (CUME project)

BACKGROUND AND AIM

To evaluate the association between the energy consumption of sweetened beverages (SBs) adjusted for daily energy intake and the incidence of type 2 diabetes.

METHODS AND RESULTS

This was a prospective study with 2480 type 2 diabetes mellitus (T2DM)-free Cohort of Universities of Minas Gerais (CUME) participants at baseline and 2-4 years of follow-up. A longitudinal analysis was performed with generalized equation estimation to verify the effect of SB consumption, adjusted for sociodemographic and lifestyle variables, on the incidence of T2DM. The incidence of T2DM was 2.78%. The median calorie intake of daily SB consumption adjusted for energy was 47.7 kcal/day. Participants with the highest consumption of SBs (≥47.7 kcal/day) were 63% (odds ratio [OR] = 1.63; p value-0.049) more likely to acquire T2DM over time compared to the lowest consumption (<47.7 kcal/day).

CONCLUSIONS

Higher energy consumption from SBs favored a higher incidence of T2DM among CUME participants. The results reinforce the need for marketing restrictions on these foods and taxation to reduce the consumption of these beverages to prevent T2DM and other chronic noncommunicable diseases.

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 &lt; 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].

Trends in risk factors and management strategies used by people with type 2 diabetes in New South Wales, Australia

Adopting healthy lifestyle behaviours is an important component of Type 2 diabetes (T2D) self-management, which can lower risks of further health complications. Monitoring lifestyle risk factors including overweight or obesity, healthy diet and physical activity behaviours, alcohol consumption, smoking and psychological distress remain important. This study examined prevalence trends in these factors and adoption of three diabetes lifestyle self-management strategies in adults (aged 40+) with T2D in New South Wales (NSW), Australia. Analyses were conducted on NSW Adult Population Health Survey data, 2004-2019 (n = 142,168), using predicted probabilities from generalised linear models, weighted to population estimates. Throughout the study period overweight or obesity prevalence remained higher amongst those with T2D (83.1% to 81.7%) compared to those without diabetes (61.0 to 61.2%); only 8.9% of those with T2D were trying to lose weight. During the study period, there were declines in the proportions of those with T2D reporting sufficient fruit consumption [63.9% to 50.1%], moderate vegetable consumption (3 serves) [49.0% to 37.7%], and achieving sufficient physical activity [40.0% to 34.0%]. There were also declines in those reporting they manage their diabetes through following a special diet [73.6% to 55.9%] and exercising most days [33.5% to 22.2%]. This study highlights potential gaps in T2D secondary prevention and suggests more targeted diabetes education services are needed to address lifestyle risks. Increased understanding of why fewer people with T2D adopt these lifestyle management strategies is needed to inform policy and practice.