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Front Page

Sugary Drinks Raise Risk of Obesity, Type 2 Diabetes

Sugar-sweetened soft drinks and faux fruit juices increase the risk of type 2 diabetes in adult women, independent of the weight gained by quaffing one or more a day, according to a new study by Frank Hu, Matthias Schulze (not pictured), and their co-authors. (Photo by Graham Ramsay)

"This is a landmark study, with profound public health and policy implications," said Frank Hu, HSPH associate professor of nutrition and epidemiology and co-author of the study in the Aug. 25 Journal of the American Medical Association. "If people just cut their soft drink consumption, society can go a long way toward reducing the rates of obesity and diabetes."

Obesity is on the verge of overtaking tobacco as the leading preventable cause of death in the U.S. About 64 percent of all Americans are overweight, and half of these are obese. Each extra pound increases the risk of type 2 diabetes. The blame goes to poor diet and inactivity.

"This is a landmark study, with profound public health and policy implications."

To some, the idea that sugar-sweetened beverages might contribute to weight gain and type 2 diabetes might sound obvious, but scientific evidence for the link has been elusive and controversial, especially in adults.

It is difficult to study the relationship between added sugar and obesity because many overweight or obese persons switch to diet soda to lose weight, according to an accompanying commentary by Caroline Apovian, director of the Nutrition and Weight Management Center at Boston Medical Center. That means cross-sectional studies, which take a snapshot in time of body weight and beverage consumption, may underestimate the link between obesity and sugary beverages.

One of the significant features of the new HSPH study is its design. "This is a longitudinal epidemiological study, and longitudinal studies provide good data," Apovian wrote in an e-mail. "It is the first study to show a strong, positive association between sugar-sweetened beverages and type 2 diabetes risk."

The study was led by former HSPH research fellow Matthias Schulze, now an epidemiologist at the German Institute of Human Nutrition. He and his colleagues compared consumption of sugar-sweetened beverages and weight change over eight years in almost 52,000 women and the risk of type 2 diabetes in about 91,000 women, all from the Brigham and Women's Hospital-based Nurses' Health Study II.

Women who increased their consumption from the low of one or fewer drinks per week to the high of one or more a day gained almost 18 extra pounds in eight years. In contrast, women who gained the least weight, about 6 pounds, were those who cut back drastically on sugary beverages.

Independent of the weight gain, more sugar-sweetened beverages proportionally increased the risk of type 2 diabetes. For women who quaffed more than one soda or fruit punch a day, the risk of diabetes virtually doubled, compared to women who drank less than one a month. Weight gain accounted for only half the extra risk. Diet soda and real fruit juices posed no such significant extra risk, they found.

Excess sugars may be working through two or more different biological mechanisms to increase diabetes, Hu said. The extra calories contribute to extra body fat. Also, the simple sugars can wreak havoc with glucose and insulin regulation. More speculative is the notion that increased sugary drinks may indicate a bigger lifestyle problem, such as unhealthy diet and lack of exercise.

--Carol Cruzan Morton