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Sugary beverages are associated with cardiovascular risk factors in diabetic patients

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Abstract

Purpose

Sugar-sweetened beverages (SSBs) containing high amount of added sugars have increased over the last decades. Due to increased risk of cardiovascular events in type 2 diabetes mellitus (T2DM) patients, we designed a study to assess the association between SSBs and metabolic syndrome, a collection of cardiovascular risk factors, in these patients.

Methods

A cross-sectional study was performed on T2DM adults (N = 157). Participants had no serious disease or insulin treatment. SSBs records were obtained from a validated food frequency questionnaire. Metabolic syndrome status was extracted from biochemical and anthropometric measurements. Subjects risk factors were compared based on their usual SSBs consumption.

Results

About half of participants consumed at least one serving of SSBs (Mean intake: 145.6 mL/d) on a weekly basis. Men and women had a similar SSBs pattern. Demographic and anthropometric characteristics were identical in both groups. Higher SSBs intake (≥ 0.5 vs <0.5 serving/ week) was positively associated with hypertension (OR: 3.48, 95% CI: 1.31, 9.26) and obesity (OR: 4.61, 95% CI: 1.31, 16.25). After adjustment for confounders, a higher risk of the metabolic syndrome was observed in those with higher SSBs intake (OR: 4.23, 95% CI: 1.42, 12.62).

Conclusion

Drinking SSBs, even in low amounts, could potentially elevate the risk of cardiovascular risk factors in diabetic patients. Reduction of sugary drinks would be an urgent recommendation.

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References

  1. Ogurtsova K, da Rocha FJ, Huang Y, Linnenkamp U, Guariguata L, Cho N, et al. IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40–50.

    Article  CAS  PubMed  Google Scholar 

  2. Bleich SN, Wang YC. Consumption of sugar-sweetened beverages among adults with type 2 diabetes. Diabetes Care. 2011;34:551–5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fuller JH, Stevens LK, Wang SL. Risk factors for cardiovascular mortality and morbidity: the WHO Mutinational study of vascular disease in diabetes. Diabetologia. 2001;44:S54–64.

    Article  CAS  PubMed  Google Scholar 

  4. International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. IDF Communication 2006. Available online at https://www.idf.org/e-library/consensus-statements/60-idfconsensus-worldwide-definitionof-the-metabolic-syndrome.html

  5. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84:274–88 Pubmed Central PMCID: PubMed: 16895873.

    Article  CAS  PubMed  Google Scholar 

  6. Olsen NJ, Heitmann BL. Intake of calorically sweetened beverages and obesity. Obes Rev. 2009;10:68–75 Pubmed Central PMCID: PubMed: 18764885.

    Article  CAS  PubMed  Google Scholar 

  7. Fung TTMV, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr. 2009;89:1037–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Anari R, Amani R, Veissi M. Sugar-sweetened beverages consumption is associated with abdominal obesity risk in diabetic patients. Diabetes Metab Syndr. 2017;11S:S675–S8.

    Article  Google Scholar 

  9. Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr. 2004;80:348–56.

    Article  CAS  PubMed  Google Scholar 

  10. Mehta V. Emergence of new risk factors for causing hypertension. J Medical Res Innov. 2017;1(1):9–11.

    Article  Google Scholar 

  11. Ma J, Mckeown NM, Hwang SJ, Hoffmann U, Jacques PF, Fox CS. Sugar-sweetened beverage consumption is associated with change of visceral adipose tissue over 6 years of follow-up. Circulation. 2016;133(4):370–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Odegaard AO, Choh AC, Czerwinski SA, Towne B, Demerath EW. Sugar-sweetened and diet beverages in relation to visceral adipose tissue. Obesity. 2012;20(3):689–91.

    Article  PubMed  Google Scholar 

  13. Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, et al. Consuming fructose-sweetened, not glucose sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009;119:1322–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Richelsen B. Sugar-sweetened beverages and cardio-metabolic disease risks. Curr Opin Clin Nutr Metab Care. 2013;16(4):478–84.

    Article  CAS  PubMed  Google Scholar 

  15. Dhingra R, Sullivan L, Jacques PF, Wang TJ, Fox CS, Meigs JB, et al. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation. 2007;116:480–8.

  16. Xu F, Park S, Siegel KR. Factors associated with frequency of sugar-sweetened beverage consumption among US adults with diabetes or prediabetes. Am J Health Promot. 2018 Sep;32(7):1489–97 Epub 2017/12/20. eng.

  17. Basu S, Vellakkal S, Agrawal S, Stuckler D, Popkin B, Ebrahim S. Averting obesity and type 2 diabetes in India through sugar-sweetened beverage taxation: an economic-epidemiologic modeling study. PLoS Med. 2014 Jan;11(1):e1001582 Pubmed Central PMCID: PMC3883641. Epub 2014/01/11. eng.

  18. Nguyen S, Choi HK, Lustig RH, Hsu CY. Sugar-sweetened beverages, serum uric acid, and blood pressure in adolescents. J Pediatr. 2009;154:807–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Sorensen LBRA, Stender S, Astrup A. Effect of sucrose on inflammatory markers in overweight humans. Am J Clin Nutr. 2005;82:421–7.

    Article  CAS  PubMed  Google Scholar 

  20. Schulze MBHK, Manson JE, Willett WC, Meigs JB, Weikert C, Heidemann C, et al. Dietary pattern, inflammation, and incidence of type 2 diabetes in women. Am J Clin Nutr. 2005;82:675–84.

  21. Liu SMJ, Buring JE, Stampfer MJ, Willett WC, Ridker PM. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002;75:492–8.

    Article  CAS  PubMed  Google Scholar 

  22. Singh GM, Micha R, Khatibzadeh S, Shi P, Lim S, Andrews KG, et al. Global, regional, and national consumption of sugar-sweetened beverages, fruit juices, and milk: a systematic assessment of beverage intake in 187 countries. PloS one. 2015;10(8):e0124845.

  23. Ejtahed HS, Bahadoran Z, Mirmiran P, Azizi F. Sugar-sweetened beverage consumption is associated with metabolic syndrome in Iranian adults: Tehran lipid and glucose study. Endocrinol Metab. 2015;30(3):334-42.

  24. Eyre H, Kahn R, Robertson RM, Clark NG, Doyle C, Hong Y, et al. Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Circulation. 2004;109(25):3244-55.

  25. Zabetian A, Hadaegh F, Azizi F. Prevalence of metabolic syndrome in Iranian adult population, concordance between the IDF with the ATPIII and the WHO definitions. Diabetes Res Clin Pract. 2007;77(2):251-7.

  26. Veissi M, Anari R, Amani R, Shahbazian H, Latifi SM. Mediterranean diet and metabolic syndrome prevalence in type 2 diabetes patients in Ahvaz, southwest of Iran. Diabetes Metab Syndr. 2016;10S:S26–S9.

    Article  Google Scholar 

  27. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36:S67–74.

    Article  Google Scholar 

  28. International Physical Activity Research Committee. IPAQ Research Committee Guidelines for data processing and analysis of the international physical activity questionnaire (IPAQ). 2005.

  29. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.

    CAS  PubMed  Google Scholar 

  30. Kannel WB, Mcgee DL. Diabetes and cardiovascular risk factors: the Framingham study. Circulation. 1979;59(1):8-13.

  31. Mirmiran P, Ejtahed H, Bahadoran Z, Bastan S, Azizi F. Sugar-sweetened beverage consumption and risk of general and abdominal obesity in Iranian adults: Tehran lipid and glucose study. Iran J Public Health. 2015;44:1535–43.

    PubMed  PubMed Central  Google Scholar 

  32. Colosia AD, Palencia R, Khan S. Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review Diabetes. Metab Syndr Obes. 2013;6:327–38.

    Article  Google Scholar 

  33. Zhou X, Ji L, Ran X, Su B, Ji Q, Pan C, et al. Prevalence of obesity and its influence on achievement of cardiometabolic therapeutic goals in chinese type 2 diabetes patients: an analysis of the nationwide, cross-sectional 3B study. PLoS One. 2016;11(1):e0144179.

  34. De Koning L, Merchant AT, Pogue J, Anand SS. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J. 2007;28(7):850–6.

    Article  PubMed  Google Scholar 

  35. Suganami T, Nishida J, Ogawa Y. A paracrine loop between adipocytes and macrophages aggravates inflammatory changes: role of free fatty acids and tumor necrosis factor α. Arterioscler Thromb Vasc Biol. 2005;25(10):2062–8.

    Article  CAS  PubMed  Google Scholar 

  36. Friedman JM, Halaas JL. Leptin and the regulation of body weight in mammals. Nature. 1998;395(6704):763–70.

    Article  CAS  PubMed  Google Scholar 

  37. Paz-Filho G, Mastronardi C, Franco CB, Wang KB, Wong M-L, Licinio J. Leptin: molecular mechanisms, systemic pro-inflammatory effects, and clinical implications. Arq Bras Endocrinol Metabol. 2012;56(9):597–607.

    Article  PubMed  Google Scholar 

  38. Janghorbani M, Amini M. Metabolic syndrome in type 2 diabetes mellitus in Isfahan, Iran: prevalence and risk factors. Metab Syndr Relat Disord. 2007;5(3):243–54.

    Article  PubMed  Google Scholar 

  39. Te Morenga LA, Howatson AJ, Jones RM, Mann J. Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J of Clin Nutr. 2014;100(1):65-79.

  40. DiNicolantonio JJ, Lucan SC. The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. Open Heart. 2014;1(1):e000167.

  41. Brown CM, Dulloo AG, Yepuri G, Montani JP. Fructose ingestion acutely elevates blood pressure in healthy young humans. Am J Physiol Regul Integr Comp Physiol. 2008;294(3): R730-7.

  42. Welsh JA, Sharma A, Abramson JL, Vaccarino V, Gillespie C, Vos MB. Caloric sweetener consumption and dyslipidemia among US adults. JAMA. 2010;303:1490–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Green AK, Jacques PF, Rogers G, Fox CS, Meigs JB, Nicola MM. Sugar-sweetened beverages and prevalence of the metabolically abnormal phenotype in the Framingham Heart Study. Obesity (Silver Spring). 2014;22:E157–63.

    Article  CAS  Google Scholar 

  44. Haus JM, Kashyap SR, Kasumov T, Zhang R, Kelly KR, DeFronzo RA, et al. Plasma ceramides are elevated in obese subjects with type 2 diabetes and correlate with the severity of insulin resistance. Diabetes. 2009;58(2):337–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Hostmark AT, Haug A. Does cheese intake blunt the association between soft drink intake and risk of the metabolic syndrome? Results from the cross-sectional Oslo Health Study. BMJ Open. 2012;(2):e001476.

  46. Malik AH, Akram Y, Shetty S, Malik SS, Yanchou NV. Impact of sugar-sweetened beverages on blood pressure. Am J Cardiol. 2014;113:1574–80.

    Article  PubMed  Google Scholar 

  47. Nakagawa T, Hu H, Zharikov S, Tuttle KR, Short RA, Glushakova O, et al. A causal role for uric acid in fructose-induced metabolic syndrome. Am J Physiol Renal Physiol. 2006;290:F625–31.

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Acknowledgments

We would like to thank the Head and the staff of the Diabetes Research Center and all the participants. The authors’ contribution to the research was as the following: R. Anari suggested the first idea, did the data collection and wrote the first draft; R. Amani and M. Veissi supervised the research; R. Anari did the statistical analysis; R. Amani did the final revision of the manuscript. All authors have approved the final content of the article.

Funding

This work was supported by Vice-Chancellor for Research at Ahvaz Jundishapur University of Medical Sciences (Grant number B-94011).

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Authors and Affiliations

  1. National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Science, Tehran, Iran

    Razieh Anari

  2. Food Security Research Center, Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

    Reza Amani

  3. Nutrition Research center, Department of Clinical Nutrition, School of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Masoud Veissi

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  1. Razieh Anari
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Correspondence to Reza Amani.

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Anari, R., Amani, R. & Veissi, M. Sugary beverages are associated with cardiovascular risk factors in diabetic patients. J Diabetes Metab Disord 18, 7–13 (2019). https://doi.org/10.1007/s40200-019-00383-5

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