Although consumption of sugar-sweetened beverages (SSBs) and artificially sweetened beverages (ASBs) has increasingly been linked with obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality, evidence remains conflicted and dose–response meta-analyses of the associations are lacking. We conducted an updated meta-analysis to synthesize the knowledge about their associations and to explore their dose–response relations. We comprehensively searched PubMed, EMBASE, Web of Science, and Open Grey up to September 2019 for prospective cohort studies investigating the associations in adults. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated for the dose–response association. Restricted cubic splines were used to evaluate linear/non-linear relations. We included 39 articles in the meta-analysis. For each 250-mL/d increase in SSB and ASB intake, the risk increased by 12% (RR = 1.12, 95% CI 1.05–1.19, I2 = 67.7%) and 21% (RR = 1.21, 95% CI 1.09–1.35, I2 = 47.2%) for obesity, 19% (RR = 1.19, 95% CI 1.13–1.25, I2 = 82.4%) and 15% (RR = 1.15, 95% CI 1.05–1.26, I2 = 92.6%) for T2DM, 10% (RR = 1.10, 95% CI 1.06–1.14, I2 = 58.4%) and 8% (RR = 1.08, 95% CI 1.06–1.10, I2 = 24.3%) for hypertension, and 4% (RR = 1.04, 95% CI 1.01–1.07, I2 = 58.0%) and 6% (RR = 1.06, 95% CI 1.02–1.10, I2 = 80.8%) for all-cause mortality. For SSBs, restricted cubic splines showed linear associations with risk of obesity (Pnon-linearity = 0.359), T2DM (Pnon-linearity = 0.706), hypertension (Pnon-linearity = 0.510) and all-cause mortality (Pnon-linearity = 0.259). For ASBs, we found linear associations with risk of obesity (Pnon-linearity = 0.299) and T2DM (Pnon-linearity = 0.847) and non-linear associations with hypertension (Pnon-linearity = 0.019) and all-cause mortality (Pnon-linearity = 0.048). Increased consumption of SSBs and ASBs is associated with risk of obesity, T2DM, hypertension, and all-cause mortality. However, the results should be interpreted cautiously because the present analyses were based on only cohort but not intervention studies.
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Azais-Braesco V, Sluik D, Maillot M, Kok F, Moreno LA. A review of total & added sugar intakes and dietary sources in Europe. Nutr J. 2017;16(1):6. https://doi.org/10.1186/s12937-016-0225-2.
Drewnowski A, Rehm CD. Consumption of added sugars among US children and adults by food purchase location and food source. Am J Clin Nutr. 2014;100(3):901–7. https://doi.org/10.3945/ajcn.114.089458.
Shan Z, Rehm CD, Rogers G, et al. Trends in dietary carbohydrate, protein, and fat intake and diet quality among US adults, 1999-2016. JAMA. 2019;322(12):1178–87. https://doi.org/10.1001/jama.2019.13771.
Stern D, Piernas C, Barquera S, Rivera JA, Popkin BM. Caloric beverages were major sources of energy among children and adults in Mexico, 1999-2012. J Nutr. 2014;144(6):949–56. https://doi.org/10.3945/jn.114.190652.
Popkin BM, Hawkes C. Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses. The lancet. Diabetes Endocrinol. 2016;4(2):174–86. https://doi.org/10.1016/S2213-8587(15)00419-2.
Powell ES, Smith-Taillie LP, Popkin BM. Added sugars intake across the distribution of US children and adult consumers: 1977–2012. J Acad Nutr Dietetics. 2016;116(10):1543-50 e1. https://doi.org/10.1016/j.jand.2016.06.003.
Singh GM, Micha R, Khatibzadeh S, 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. https://doi.org/10.1371/journal.pone.0124845.
Welsh JA, Sharma AJ, Grellinger L, Vos MB. Consumption of added sugars is decreasing in the United States. Am J Clin Nutr. 2011;94(3):726–34. https://doi.org/10.3945/ajcn.111.018366.
Mullee A, Romaguera D, Pearson-Stuttard J, et al. Association between soft drink consumption and mortality in 10 European countries. JAMA Intern Med. 2019. https://doi.org/10.1001/jamainternmed.2019.2478.
Cohen L, Curhan G, Forman J. Association of sweetened beverage intake with incident hypertension. J Gen Intern Med. 2012;27(9):1127–34.
Ferreira-Pego C, Babio N, Bes-Rastrollo M, et al. Frequent consumption of sugar- and artificially sweetened beverages and natural and bottled fruit juices is associated with an increased risk of metabolic syndrome in a mediterranean population at high cardiovascular disease risk. J Nutr. 2016;146(8):1528–36.
Kwak JH, Jo G, Chung HK, Shin MJ. Association between sugar-sweetened beverage consumption and incident hypertension in Korean adults: a prospective study. Eur J Nutr. 2019;58(3):1009–17. https://doi.org/10.1007/s00394-018-1617-1.
Odegaard AO, Koh WP, Yuan JM, Pereira MA. Beverage habits and mortality in Chinese adults. J Nutr. 2015;145(3):595–604.
Paynter NP, Yeh HC, Voutilainen S, et al. Coffee and sweetened beverage consumption and the risk of type 2 diabetes mellitus: the atherosclerosis risk in communities study. Am J Epidemiol. 2006;164(11):1075–84. https://doi.org/10.1093/aje/kwj323.
Trumbo PR, Rivers CR. Systematic review of the evidence for an association between sugar-sweetened beverage consumption and risk of obesity. Nutr Rev. 2014;72(9):566–74. https://doi.org/10.1111/nure.12128.
Gardener H, Moon YP, Rundek T, Elkind MSV, Sacco RL. Diet soda and sugar-sweetened soda consumption in relation to incident diabetes in the Northern Manhattan study. Curr Dev Nutr. 2018;2(5):nzy008.
de Koning L, Malik VS, Rimm EB, Willett WC, Hu FB. Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am J Clin Nutr. 2011;93(6):1321–7. https://doi.org/10.3945/ajcn.110.007922.
Duffey KJ, Popkin BM. Shifts in patterns and consumption of beverages between 1965 and 2002. Obesity. 2007;15(11):2739–47. https://doi.org/10.1038/oby.2007.326.
Fakhouri TH, Kit BK, Ogden CL. Consumption of diet drinks in the United States, 20092010. NCHS Data Brief. 2012;109:1–8.
Duffey KJ, Gordon-Larsen P, Steffen LM, Jacobs DR Jr, Popkin BM. Drinking caloric beverages increases the risk of adverse cardiometabolic outcomes in the coronary artery risk development in young adults (CARDIA) study. Am J Clin Nutr. 2010;92(4):954–9.
Hinkle SN, Rawal S, Bjerregaard AA, et al. A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk. Am J Clin Nutr. 2019;110(1):221–32.
Nettleton JA, Lutsey PL, Wang Y, Lima JA, Michos ED, Jacobs DR Jr. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the multi-ethnic study of atherosclerosis (MESA). Diabetes Care. 2009;32(4):688–94. https://doi.org/10.2337/dc08-1799.
Sakurai M, Nakamura K, Miura K, et al. Sugar-sweetened beverage and diet soda consumption and the 7-year risk for type 2 diabetes mellitus in middle-aged Japanese men. Eur J Nutr. 2014;53(4):1137–8.
Malik VS, Li Y, Pan A, et al. Long-term consumption of sugar-sweetened and artificially sweetened beverages and risk of mortality in US adults. Circulation. 2019;139(18):2113–25.
Ruanpeng D, Thongprayoon C, Cheungpasitpom W, Harindhanavudhi T. Sugar and artificially sweetened beverages linked to obesity: a systematic review and meta-analysis. Qjm-an Inte J Medi. 2017;110(8):513–20. https://doi.org/10.1093/qjmed/hcx068.
Schlesinger S, Neuenschwander M, Schwedhelm C, et al. Food groups and risk of overweight, obesity, and weight gain: a systematic review and dose-response meta-analysis of prospective studies. Adv Nutr. 2019;10(2):205–18.
Greenwood DC, Threapleton DE, Evans CEL, et al. Association between sugar-sweetened and artificially sweetened soft drinks and type 2 diabetes: systematic review and dose-response meta-analysis of prospective studies. Br J Nutr. 2014;112(5):725–34.
Imamura F, O’Connor L, Ye Z, et al. 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. Br J Sports Med. 2016;50(8):496–504.
Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care. 2010;33(11):2477–83.
Wang M, Yu M, Fang L, Hu R-Y. Association between sugar-sweetened beverages and type 2 diabetes: a meta-analysis. J Diabetes Invest. 2015;6(3):360–6. https://doi.org/10.1111/jdi.12309.
Schwingshackl L, Hoffmann G, Lampousi AM, et al. Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol. 2017;32(5):363–75.
Cheungpasitporn W, Thongprayoon C, Edmonds PJ, et al. Sugar and artificially sweetened soda consumption linked to hypertension: a systematic review and meta-analysis. Clin Exp Hypertens. 2015;37(7):587–93. https://doi.org/10.3109/10641963.2015.1026044.
Jayalath VH, de Souza RJ, Ha V, et al. Sugar-sweetened beverage consumption and incident hypertension: a systematic review and meta-analysis of prospective cohorts. Am J Clin Nutr. 2015;102(4):914–21. https://doi.org/10.3945/ajcn.114.102160.
Kim Y, Je Y. Prospective association of sugar-sweetened and artificially sweetened beverage intake with risk of hypertension. Arch Cardiovasc Dis. 2016;109(4):242–53.
Xi B, Huang Y, Reilly KH, et al. Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis. Br J Nutr. 2015;113(5):709–17.
Schwingshackl L, Schwedhelm C, Hoffmann G, et al. Food groups and risk of hypertension: a systematic review and dose-response meta-analysis of prospective studies. Adv Nutr. 2017;8(6):793–803. https://doi.org/10.3945/an.117.017178.
Schwingshackl L, Schwedhelm C, Hoffmann G, et al. Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 2017;105(6):1462–73. https://doi.org/10.3945/ajcn.117.153148.
Narain A, Kwok CS, Mamas MA. Soft drinks and sweetened beverages and the risk of cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Clin Pract. 2016;70(10):791–805.
Stern D, Mazariegos M, Ortiz-Panozo E, et al. Sugar-sweetened soda consumption increases diabetes risk among Mexican women. J Nutr. 2019;149(5):795–803. https://doi.org/10.1093/jn/nxy298.
Papier K, D’Este C, Bain C, et al. Consumption of sugar-sweetened beverages and type 2 diabetes incidence in Thai adults: results from an 8-year prospective study. Nutr Diabetes. 2017;7(6):e283.
Huang M, Quddus A, Stinson L, et al. Artificially sweetened beverages, sugar-sweetened beverages, plain water, and incident diabetes mellitus in postmenopausal women: the prospective women’s health initiative observational study. Am J Clin Nutr. 2017;106(2):614–22.
Hirahatake KM, Jacobs DR, Shikany JM, et al. Cumulative intake of artificially sweetened and sugar-sweetened beverages and risk of incident type 2 diabetes in young adults: the coronary artery risk development in young adults (CARDIA) study. Am J Cli Nutr. 2019;110:733–41.
Mossavar-Rahmani Y, Kamensky V, Manson JE, et al. Artificially sweetened beverages and stroke, coronary heart disease, and all-cause mortality in the women’s health initiative. Stroke. 2019;50(3):555–62.
Ramne S, Alves Dias J, Gonzalez-Padilla E, et al. Association between added sugar intake and mortality is nonlinear and dependent on sugar source in 2 swedish population-based prospective cohorts. Am J Clin Nutr. 2019;109(2):411–23.
La Moher D, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):97. https://doi.org/10.1371/journal.pmed.1000097.
Wells GA SB, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Ottawa (Canada): Ottawa Health Research Institute.. Pediatrics [serial online] 2005:http//www.ohri.ca/programs/clinical_epidemiolgy/oxford (Accessed 2005). https://doi.org/10.1002/jrsm.1193.
Lo TS, Chua S, Kao CC, Hsieh WC, Wu MP, Tseng LH. Prophylactic midurethral sling insertion during transvaginal pelvic reconstructive surgery for advanced prolapse patients with high-risk predictors of postoperative de novo stress urinary incontinence. Int Urogynecol J. 2019;30(9):1541–9.
Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active smoking and the risk of type 2 diabetes. JAMA. 2007;298(22):2654–64.
Bekkering GE, Harris RJ, Thomas S, et al. How much of the data published in observational studies of the association between diet and prostate or bladder cancer is usable for meta-analysis? Am J Epidemiol. 2008;167(9):1017–26. https://doi.org/10.1093/aje/kwn005.
Tamakoshi A, Lin Y, Kawado M, et al. Effect of coffee consumption on all-cause and total cancer mortality: findings from the JACC study. Eur J Epidemiol. 2011;26(4):285–93. https://doi.org/10.1007/s10654-011-9548-7.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.
DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials. 2015;45(Pt A):139–45. https://doi.org/10.1016/j.cct.2015.09.002.
Greenland S, Longnecker MP. Methods for trend estimation from summarized dose response data, with applications to meta-analysis. Am J Epidemiol. 1992;135:1301–9.
Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D. Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2012;175(1):66–73. https://doi.org/10.1093/aje/kwr265.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.
de Araujo Pio CS, Marzolini S, Pakosh M, Grace SL. Effect of cardiac rehabilitation dose on mortality and morbidity: a systematic review and meta-regression analysis. Mayo Clin Proc. 2017;92(11):1644–59. https://doi.org/10.1016/j.mayocp.2017.07.019.
Boggs DA, Rosenberg L, Coogan PF, Makambi KH, Adams-Campbell LL, Palmer JR. Restaurant foods, sugar-sweetened soft drinks, and obesity risk among young African American women. Ethn Dis. 2013;23(4):445–51.
Dhingra R, Sullivan L, Jacques PF, 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(5):480–8. https://doi.org/10.1161/circulationaha.107.689935.
Fresan U, Gea A, Bes-Rastrollo M, Ruiz-Canela M, Martinez-Gonzalez MA. Substitution models of water for other beverages, and the incidence of obesity and weight gain in the SUN cohort. Nutrients. 2016;8(11):688.
Funtikova AN, Subirana I, Gomez SF, et al. Soft drink consumption is positively associated with increased waist circumference and 10-year incidence of abdominal obesity in Spanish adults. J Nutr. 2015;145(2):328–34.
Bhupathiraju SN, Pan A, Malik VS, et al. Caffeinated and caffeine-free beverages and risk of type 2 diabetes. Am J Clin Nutr. 2013;97(1):155–66. https://doi.org/10.3945/ajcn.112.048603.
Duffey KJ, Steffen LM, Van Horn L, Jacobs DR Jr, Popkin BM. Dietary patterns matter: diet beverages and cardiometabolic risks in the longitudinal coronary artery risk development in young adults (CARDIA) study. Am J Clin Nutr. 2012;95(4):909–15. https://doi.org/10.3945/ajcn.111.026682.
Eshak ES, Iso H, Mizoue T, Inoue M, Noda M, Tsugane S. Soft drink, 100% fruit juice, and vegetable juice intakes and risk of diabetes mellitus. Clin Nutr. 2013;32(2):300–8. https://doi.org/10.1016/j.clnu.2012.08.003.
Fagherazzi G, Vilier A, Saes Sartorelli D, Lajous M, Balkau B, Clavel-Chapelon F. Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidemiologique aupres des femmes de la Mutuelle Generale de l’Education Nationale-European Prospective Investigation into Cancer and Nutrition cohort. Am J Clin Nutr. 2013;97(3):517–23. https://doi.org/10.3945/ajcn.112.050997.
Montonen J, Knekt P, Heliövaara M, Reunanen A. Consumption of sweetened beverages and intakes of fructose and glucose predict type 2 diabetes occurrence. J Nutr. 2007;137:1447–54.
Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L. Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med. 2008;168(14):1487–92.
O’Connor L, Imamura F, Lentjes MA, Khaw KT, Wareham NJ, Forouhi NG. Prospective associations and population impact of sweet beverage intake and type 2 diabetes, and effects of substitutions with alternative beverages. Diabetologia. 2015;58:1474–83. https://doi.org/10.1007/s00125-015-3572-1.
Ma J, Jacques PF, Meigs JB, et al. Sugar-sweetened beverage but not diet soda consumption is positively associated with progression of insulin resistance and prediabetes. J Nutr. 2016;146(12):2544–50. https://doi.org/10.3945/jn.116.234047.
Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, Hu FB. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004;292:927–34.
Odegaard AO, Koh WP, Arakawa K, Yu MC, Pereira MA. Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes: the Singapore Chinese health study. Am J Epidemiol. 2010;171(6):701–8. https://doi.org/10.1093/aje/kwp452.
Sayon-Orea C, Martinez-Gonzalez MA, Gea A, Alonso A, Pimenta AM, Bes-Rastrollo M. Baseline consumption and changes in sugar-sweetened beverage consumption and the incidence of hypertension: the SUN project. Clin Nutr. 2015;34(6):1133–40. https://doi.org/10.1016/j.clnu.2014.11.010.
Barrington WE, White E. Mortality outcomes associated with intake of fast-food items and sugar-sweetened drinks among older adults in the Vitamins and Lifestyle (VITAL) study. Public Health Nutr. 2016;19(18):3319–26. https://doi.org/10.1017/s1368980016001518.
Collin LJ, Judd S, Safford M, Vaccarino V, Welsh JA. Association of sugary beverage consumption with mortality risk in US adults: a secondary analysis of data from the REGARDS study. JAMA Netw Open. 2019;2(5):e193121. https://doi.org/10.1001/jamanetworkopen.2019.3121.
Paganini-Hill A, Kawas CH, Corrada MM. Non-alcoholic beverage and caffeine consumption and mortality: the leisure world cohort study. Prev Med. 2007;44(4):305–10.
Tasevska N, Park Y, Jiao L, Hollenbeck A, Subar AF, Potischman N. Sugars and risk of mortality in the NIH-AARP diet and health study. Am J Clin Nutr. 2014;99(5):1077–88.
Liu ZM, Tse SLA, Chen B, et al. Dietary sugar intake does not pose any risk of bone loss and non-traumatic fracture and is associated with a decrease in all-cause mortality among Chinese elderly: finding from an 11-year longitudinal study of Mr. and Ms. OS Hong Kong. Bone. 2018;116:154–61. https://doi.org/10.1016/j.bone.2018.07.011.
Fowler SP, Williams K, Resendez RG, Hunt KJ, Hazuda HP, Stern MP. Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain. Obesity. 2008;16(8):1894–900.
Malik VS, Hu FB. Fructose and cardiometabolic health: what the evidence from sugar-sweetened beverages tells us. J Am Coll Cardiol. 2015;66(14):1615–24. https://doi.org/10.1016/j.jacc.2015.08.025.
Hallfrisch J. Metabolic effects of dietary fructose. FASEB J: Off Publ Feder Am Soc Exp Biol. 1990;4(9):2652–60. https://doi.org/10.1096/fasebj.4.9.2189777.
Elliott SS, Keim NL, Stern JS, Teff K, Havel PJ. Fructose, weight gain, and the insulin resistance syndrome. Am J Clin Nutr. 2002;76:911–22.
Itani SI, Ruderman NB, Schmieder F, Boden G. Lipid-induced insulin resistance in human muscle is associated with changes in diacylglycerol, protein kinase C, and IκB-α. Diabetes. 2002;51(7):2005–11. https://doi.org/10.2337/diabetes.51.7.2005.
Johnson RJ, Nakagawa T, Sanchez-Lozada LG, et al. Sugar, uric acid, and the etiology of diabetes and obesity. Diabetes. 2013;62(10):3307–15. https://doi.org/10.2337/db12-1814.
Carran EL, White SJ, Reynolds AN, Haszard JJ, Venn BJ. Acute effect of fructose intake from sugar-sweetened beverages on plasma uric acid: a randomised controlled trial. Eur J Clin Nutr. 2016;70(9):1034–8. https://doi.org/10.1038/ejcn.2016.112.
Ramalingam L, Menikdiwela K, LeMieux M, et al. The renin angiotensin system, oxidative stress and mitochondrial function in obesity and insulin resistance. Biochimica et biophysica acta. Mol Basis Disease. 2017;1863(5):1106–14. https://doi.org/10.1016/j.bbadis.2016.07.019.
Das UN. Renin-angiotensin-aldosterone system in insulin resistance and metabolic syndrome. J Transl Intern Med. 2016;4(2):66–72. https://doi.org/10.1515/jtim-2016-0022.
Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med. 2008;359(17):1811–21. https://doi.org/10.1056/NEJMra0800885.
Park S, Blanck HM, Sherry B, Brener N, O’Toole T. Factors associated with sugar-sweetened beverage intake among United States high school students. J Nutr. 2012;142(2):306–12. https://doi.org/10.3945/jn.111.148536.
Bleich SN, Wolfson JAUS. adults and child snacking patterns among sugar-sweetened beverage drinkers and non-drinkers. Prev Med. 2015;72:8–14. https://doi.org/10.1016/j.ypmed.2015.01.003.
Schwingshackl L, Bogensberger B, Hoffmann G. Diet quality as assessed by the healthy eating index, alternate healthy eating index, dietary approaches to stop hypertension score, and health outcomes: an updated systematic review and meta-analysis of cohort studies. J Acad Nutr Dietetics. 2018;118(1):74–100. https://doi.org/10.1016/j.jand.2017.08.024.
Ludwig DS. Artificially sweetened beverages: cause for concern. JAMA. 2009;302(22):2477–8. https://doi.org/10.1001/jama.2009.1822.
Rother KI, Conway EM, Sylvetsky AC. How non-nutritive sweeteners influence hormones and health. Trends Endocrinol Metabol: TEM. 2018;29(7):455–67. https://doi.org/10.1016/j.tem.2018.04.010.
Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514(7521):181–6. https://doi.org/10.1038/nature13793.
Bryant C, McLaughlin J. Low calorie sweeteners: evidence remains lacking for effects on human gut function. Physiol Behav. 2016;164(Pt B):482–5. https://doi.org/10.1016/j.physbeh.2016.04.026.
Singer-Englar T, Barlow G, Mathur R. Obesity, diabetes, and the gut microbiome: an updated review. Exp Rev Gastroenterol Hepatol. 2019;13(1):3–15. https://doi.org/10.1080/17474124.2019.1543023.
Green E, Murphy C. Altered processing of sweet taste in the brain of diet soda drinkers. Physiol Behav. 2012;107(4):560–7. https://doi.org/10.1016/j.physbeh.2012.05.006.
Ma Y, He FJ, Yin Y, Hashem KM, MacGregor GA. Gradual reduction of sugar in soft drinks without substitution as a strategy to reduce overweight, obesity, and type 2 diabetes: a modelling study. The lancet. Diabetes Endocrinol. 2016;4(2):105–14. https://doi.org/10.1016/s2213-8587(15)00477-5.
We thank Laura Smales (BioMedEditing) for proofreading of the manuscript.
This meta-analysis was supported by the National Natural Science Foundation of China (Grant Nos. 81373074, 81402752 and 81673260); the Natural Science Foundation of Guangdong Province (Grant No. 2017A030313452); the Medical Research Foundation of Guangdong Province (Grant No. A2017181); and the Science and Technology Development Foundation of Shenzhen (Grant Nos. CYJ20140418091413562, JCYJ20160307155707264, JCYJ20170412110537191, and JCYJ20170302143855721).
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Qin, P., Li, Q., Zhao, Y. et al. Sugar and artificially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose–response meta-analysis of prospective cohort studies. Eur J Epidemiol 35, 655–671 (2020). https://doi.org/10.1007/s10654-020-00655-y
- Sweetened beverages
- Type 2 diabetes mellitus
- All-cause mortality
- Prospective cohort studies