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Effects of Sugary and Sweetened Drinks on Developing Diabetes Mellitus

Updated: Oct 4, 2020

Research paper by Ifunanya Onyima, MS RD




Introduction

Diabetes mellitus type 2 is a metabolic illness that has been diagnosed in many people of different age groups here in the United States. Type 2 diabetes is a disease that causes the cells in the body to be resistant to glucose uptake, leading several symptoms, including high blood sugar, hypertension, excess urination and dehydration. If left untreated, diabetes mellitus will eventually lead to cell and tissue death because of a lack of glucose for energy usage, resulting in the loss of feeling and/or amputation of limbs. Diabetes mellitus is very strongly correlated to excess energy intake in the form of sugar, especially added and refined sugars. In a country where processed and packaged foods are readily available and heavily advertised, it is very easy for people to overload on added sugars and develop this disease. Not only is this illness costly to one’s health – the price tag associated with this disease is often very high. Hospital stays, clinical lab tests and medications can all be causes of health care costs being unnecessarily high. Predictive factors associated with the risk of developing this disease include obesity, sedentary lifestyle, poor diet, low level of nutrition education and limited access to healthy food. This paper discusses the affects of sugary drinks on diabetes development, because these types of drinks are widely available in the U.S. and strongly linked to the development of this disease.


Current Research - Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)


The purpose of this research was to find a correlation between consumption of diet soft drinks and the risk of developing a metabolic syndrome and type 2 diabetes. The hypothesis was that those who consume diet sodas on a regular basis have a difficult time controlling their total energy intake, because they think they can consume more since they drank a soda with no calories. Also, frequent diet soda consumption can lead to an increased desire for energy-dense and/or sugar-sweetened foods.(3) These two components combined can lead to excess energy consumption, excess body weight and some type of metabolic syndrome, including type 2 diabetes. This study was a longitudinal study lasting from 2000-2007 and included 6,814 African-Americans, Caucasians, Hispanic and Chinese adults ranging from 45-84 years old.1 Information about their consumption of diet soda was found using a food-frequency questionnaire. Metabolic syndromes, including type 2 diabetes, were identified in the participants at three separate examinations, each about 1 year apart. The researchers found a strong association with the consumption of diet soda at least once a day and the risk of metabolic syndrome development and type 2 diabetes development. The risk of developing a metabolic syndrome (defined by many different factors, including low HDL cholesterol and high blood glucose) was increased by 36%, while the risk of developing type 2 diabetes increased by 67%, when compared to non-consumption of diet soft-drinks. This data did not prove a cause-and-effect relationship, but did find a significantly greater risk of developing a metabolic syndrome and type 2 diabetes with frequent diet soda consumption.


“Those who drank 2 or more soft-drinks a day had a 24% increase of developing the disease than those who drank less than one drink each month. Similarly, for sugar-sweetened fruit drinks, a 31% increase of diabetes incident was found for those who drank 2 or more drinks a day, compared to those who drank less than 1 fruit drink per month.”

Sugar-Sweetened Beverages and Incidence of Type 2 Diabetes Mellitus in African American Women.


The objective of this study was to find a correlation between the intake of sugar-sweetened drinks, excess body weight and type 2 diabetes in African-American women.(2) The hypothesis is that frequent consumption of these types of beverages are strongly associated with a higher risk of developing diabetes mellitus and overweight/obesity. A longitudinal study followed 59,000 African-American women from 1995-2005. Twice a year during that timeline, questionnaires assessed for the development of type 2 diabetes. The most recent analysis was based on 43,960 women, not including those who reported adverse health status, or abnormal kilocalorie intake at baseline, or those who were 29 years old or younger at the end of the follow-up, those who left 10 or more questions blank on the baseline dietary questionnaire, those who did not have data on sugar-sweetened drink consumption, and those who did not report a height or weight on the questionnaire.(2) An incident of diabetes was defined as the development of the disease without having the disease at baseline. Some women self-reported an incident of diabetes, while some women gave permission for researchers to contact their health-care providers to obtain the information. Results found a positive correlation between the consumption of sugar-sweetened drinks, especially soft-drinks and the development of type 2 diabetes. Those who drank 2 or more soft-drinks a day had a 24% increase of developing the disease than those who drank less than one drink each month. Similarly, for sugar-sweetened fruit drinks, a 31% increase of diabetes incident was found for those who drank 2 or more drinks a day, compared to those who drank less than 1 fruit drink per month.


Conclusions

In the MESA study, I really appreciated the fact that the researchers assembled a very diverse group of participants.(1) I believe that by doing this, the researchers eliminated ethnic-difference biases; anyone who critiqued this article could not say that the results occurred because of a certain ethnic group being more susceptible to a metabolic disease. Another positive element of the MESA study is the large number of participants. Trends are often hard to find amongst larger populations, so the fact that a significant correlation was found in a group of over 6,000 is pretty impressive – and strongly suggests (not causatively) that consumption of diet soda could have a positive relationship with the development of a metabolic disease, including type 2 diabetes. Differences in age amongst the participants in the MESA study also adds to the study’s validity because it suggests that developing a metabolic disease could happen within various age groups. One downside of the MESA research study was the method with which the researchers obtained information about their participants and their diet-soda intake. Self-reported questionnaires gave the researchers information about their participants demographics – age, sex and ethnicity included. Information about their diet soda intake was also obtained via questionnaire, specifically about food frequency. This method of information gathering can be untrustworthy because participants could easily be dishonest, make mistakes, or neglect to report certain details. It is also important to note that throughout the study, the patients were only assessed for the onset of a metabolic illness 3 times, about once a year. A lot can happen to a person within a year’s time that could lead to a metabolic illness, so one could not say for certain that the onset of a metabolic illness was solely due to diet soda consumption.


In the study that focused on type 2 diabetes occurences in African American women, my first concern is similar to a point I made above. One could argue that the increased incidence of type 2 diabetes occurred because of the specific demographic. The focus of the study, however, is important due to relevant research suggesting that the emergence of a metabolic disease increases within the African-American community. A positive aspect of this study was the large number of participants involved and the length of the study. A lengthy study gives the researchers more time to identify trends amongst the variables being tested. The method used to obtain information about soft drink and fruit juice intake was faulty in my opinion. Bi-annual questionnaires were used to asses for a new onset of type 2 diabetes. This type of information gathering could lead to skewed results due to people deciding to not follow-up with the researchers, or give incorrect information. I appreciate that the study focused both on fruit juice and soft-drinks, because it suggests that the onset of diabetes occurred because of the common ingredient in both beverages – added sugar.


Reliable Sources for Information

For more reliable sources on Diabetes mellitus, its causes, symptoms and treatments, there are a variety of resources available within a number of different websites. The American Diabetes Association is a great place to start for researching information related to diabetes, including modified recipes, appropriate exercises and various methods of spreading diabetes education efforts and research.(4) The National Institute of Diabetes and Digestive and Kidney Disease is another great webpage that offers reliable information about diabetes, including risk factors for developing the disease, tips on how to control & possibly reverse the disease, and even a webinar series for health care professionals.(5)



Source(s)

1 – Nettleton S et al. Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). American Diabetes Association. 2009;32(4):688-694


2 – Palmer J, Boggs D, Krishnan S, Hu F, Singer M, Rosenberg L. Sugar-sweetened Beverages and Incidence of Type 2 diabetes Mellitus in African American Women. Arch Intern Med. 2008;168(14):1487-1492


3 – Sakura Mi et al. Sugar-sweetened Beverage and Diet Soda Consumption and the 7-Year Risk for Type 2 Diabetes Mellitus in Middle-Aged Japanese Men. European Journal of Nutrition. 2014;53(1):251-58


4 – American Diabetes Association website. http://www.diabetes.org. Updated 2016. Accessed November 15, 2016.


5 – U.S. Department of Health and Human Services website. https://www.niddk.nih.gov. Updated 2016. Accessed November 15, 2016.


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