Water, Anyone?

Accumulating evidence points the finger more and more at sugar-sweetened beverages—sodas—as a major factor in the widespread increase in type 2 diabetes.

A New Meta-Analysis

Combining data from 21 studies, a recent meta-analysis found that drinking just one 250 mL serving (about 8.3 ounces) daily of a sugar-sweetened beverage increased the risk of developing type 2 diabetes by 18 percent. The risk was independent of whether the person was also overweight or obese. In other words, drinking sodas may lead to both an increase in weight and type 2 diabetes, but the overweight and diabetes occur independently. Someone doesn’t have to become overweight or obese to develop type 2 diabetes.

(A Harvard University website, The Nutrition Source, estimates the sugar content of a larger [12-ounce] serving of some popular drinks as follows: colas, 10 teaspoons; orange, cranberry, and other fruit drinks: 11 to 15 teaspoons. [One teaspoon of sugar = 4.2 grams.])

Combined data from the meta-analysis, published in BMJ, also “showed a positive association” between artificially sweetened beverages and fruit juice, and newly diagnosed cases of type 2 diabetes, but in this case the quality of the evidence was limited.

The 21 studies included in the meta-analysis comprised 38,253 cases of type 2 diabetes. All studies were prospective, meaning that none of the participants had diabetes at the time of enrollment. Investigators assessed the key factors leading to diabetes onset by tracking participants’ dietary habits during 10,126,754 person-years of follow-up.

Implications of the Study

The public health implications are strong: over 10 years, current consumption of sugar-sweetened beverages causes an estimated two million excess cases of type 2 diabetes in the U.S., at a cost of about $9,800 per patient.

Bottom Line

“Although causality has not been established and precision needs to be improved,” the authors note the potential efficacy of reducing consumption of sugar-sweetened drinks to prevent type 2 diabetes. But they consider neither artificially sweetened drinks nor fruit juice to be suitable alternatives.

Water, anyone?

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Imamura F, O’Connor L, Ye Z. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ. 2015; July 21. 351:h3576. doi: 10.1136/bmj.h3576.


Harvard T.H. Chan School of Public Health. Calories, grams of sugar, and teaspoons of sugar in 12 ounces of each beverage. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/30/2012/10/how-sweet-is-it-bw.pdf.