Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale–European Prospective Investigation into Cancer and Nutrition cohort1234

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ABSTRACT

Background:

It has been extensively shown, mainly in US populations, that sugar-sweetened beverages (SSBs) are associated with increased risk of type 2 diabetes (T2D), but less is known about the effects of artificially sweetened beverages (ASBs).

Objective:

We evaluated the association between self-reported SSB, ASB, and 100% fruit juice consumption and T2D risk over 14 y of follow-up in the French prospective Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale–European Prospective Investigation into Cancer and Nutrition cohort.

Design:

A total of 66,118 women were followed from 1993, and 1369 incident cases of T2D were diagnosed during the follow-up. Cox regression models were used to estimate HRs and 95% CIs for T2D risk.

Results:

The average consumption of sweetened beverages in consumers was 328 and 568 mL/wk for SSBs and ASBs, respectively. Compared with nonconsumers, women in the highest quartiles of SSB and ASB consumers were at increased risk of T2D with HRs (95% CIs) of 1.34 (1.05, 1.71) and 2.21 (1.56, 3.14) for women who consumed >359 and >603 mL/wk of SSBs and ASBs, respectively. Strong positive trends in T2D risk were also observed across quartiles of consumption for both types of beverage (P = 0.0088 and P < 0.0001, respectively). In sensitivity analyses, associations were partly mediated by BMI, although there was still a strong significant independent effect. No association was observed for 100% fruit juice consumption.

Conclusions:

Both SSB consumption and ASB consumption were associated with increased T2D risk. We cannot rule out that factors other than ASB consumption that we did not control for are responsible for the association with diabetes, and randomized trials are required to prove a causal link between ASB consumption and T2D.

Cited by (0)

1

From the Institut National de la Santé et de la Recherche Médicale U1018, Center for Research in Epidemiology and Population Health, Villejuif, France (GF, AV, ML, BB, and FC-C); the Paris-South University, Villejuif, France (GF, AV, ML, BB, and FC-C); the Department of Social Medicine, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil (DSS); and the Center for Research on Population Health, National Institute of Public Health of Mexico, Cuernavaca, Mexico (ML).

2

Study sponsors had no role in the design of the study, the analysis or interpretation of data, the writing of the manuscript, or the decision to submit the manuscript for publication.

3

Supported by the Institut National du Cancer, the Mutuelle Générale de l’Education Nationale, the Institut de Cancérologie Gustave Roussy, and the Institut National de la Santé et de la Recherche Médicale. The validation of potential diabetes cases was supported by the European Union (Integrated Project LSHM-CT-2006-037197 in the Framework Programme 6 of the European Community) InterAct project.

4

Address reprint requests and correspondence to F Clavel-Chapelon, Center for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale U1018, Team 9, Nutrition, Hormones and Women’s Health, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif Cedex, France. E-mail: [email protected]

5

Abbreviations used: ASB, artificially sweetened beverage; E3N, Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale; SSB, sugar-sweetened beverage; T2D, type 2 diabetes.