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Schulze MB, Manson JE, Ludwig DS, et al. Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged Women. JAMA. 2004;292(8):927–934. doi:10.1001/jama.292.8.927
Author Affiliations: Departments of Nutrition (Drs Schulze, Stampfer, Willett, and Hu) and Epidemiology (Drs Manson, Colditz, Willett, and Hu), Harvard School of Public Health, Division of Preventive Medicine (Drs Manson and Stampfer) and Channing Laboratory (Drs Manson, Colditz, Stampfer, Willett, and Hu), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Medicine, Children's Hospital (Dr Ludwig), Boston, Mass. Dr Schulze is now with the Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany.
Context Sugar-sweetened beverages like soft drinks and fruit punches contain
large amounts of readily absorbable sugars and may contribute to weight gain
and an increased risk of type 2 diabetes, but these relationships have been
minimally addressed in adults.
Objective To examine the association between consumption of sugar-sweetened beverages
and weight change and risk of type 2 diabetes in women.
Design, Setting, and Participants Prospective cohort analyses conducted from 1991 to 1999 among women
in the Nurses' Health Study II. The diabetes analysis included 91 249
women free of diabetes and other major chronic diseases at baseline in 1991.
The weight change analysis included 51 603 women for whom complete dietary
information and body weight were ascertained in 1991, 1995, and 1999. We identified
741 incident cases of confirmed type 2 diabetes during 716 300 person-years
Main Outcome Measures Weight gain and incidence of type 2 diabetes.
Results Those with stable consumption patterns had no difference in weight gain,
but weight gain over a 4-year period was highest among women who increased
their sugar-sweetened soft drink consumption from 1 or fewer drinks per week
to 1 or more drinks per day (multivariate-adjusted means, 4.69 kg for 1991
to 1995 and 4.20 kg for 1995 to 1999) and was smallest among women who decreased
their intake (1.34 and 0.15 kg for the 2 periods, respectively) after adjusting
for lifestyle and dietary confounders. Increased consumption of fruit punch
was also associated with greater weight gain compared with decreased consumption.
After adjustment for potential confounders, women consuming 1 or more sugar-sweetened
soft drinks per day had a relative risk [RR] of type 2 diabetes of 1.83 (95%
confidence interval [CI], 1.42-2.36; P<.001 for
trend) compared with those who consumed less than 1 of these beverages per
month. Similarly, consumption of fruit punch was associated with increased
diabetes risk (RR for ≥1 drink per day compared with <1 drink per month,
2.00; 95% CI, 1.33-3.03; P = .001).
Conclusion Higher consumption of sugar-sweetened beverages is associated with a
greater magnitude of weight gain and an increased risk for development of
type 2 diabetes in women, possibly by providing excessive calories and large
amounts of rapidly absorbable sugars.
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