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.
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.
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DOI：
10.1136/bmj.h3576
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发表时间：
2015-07-21
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影响因子：
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通讯作者：
Forouhi NG
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文献类型：
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作者：
Imamura F;O'Connor L;Ye Z;Mursu J;Hayashino Y;Bhupathiraju SN;Forouhi NG
目的研究在肥胖校正前后，含糖饮料、人工加糖饮料和果汁的消费与2型糖尿病之间的前瞻性关联，并估计美国和英国含糖饮料消费对2型糖尿病的人群归因比例。设计系统综述和荟萃分析。数据来源和合格性PubMed、Embase、奥维德和Web of Knowledge，用于无糖尿病成人前瞻性研究，发表时间截至2014年2月。在2009-10年美国（n=4729，代表1.891亿无糖尿病的成年人）和2008-12年英国（n=1932，代表4470万）的国家调查中估计了人群归因分数。合成方法随机效应荟萃分析和调查分析与含糖饮料消费相关的人口归因分数。结果从17个队列（38253例/10126754人年）中提取了预先规定的信息。高含糖饮料的消费量与2型糖尿病的发病率增加有关，每一份/天增加18（95%置信区间9%-28%，异质性I2 =89%）和13%（6%至21%，I2=79%）调整前和调整后的肥胖;对于人工加糖饮料，25%（18%至33%，I2=70%）和8%（2%至15%，I2=64%）;对于果汁，5%（−1%至11%，I2=58%）和7%（1%至14%，I2=51%）。含糖饮料的异质性或偏倚的潜在来源并不明显。对于人工加糖饮料，指出了发表偏倚和残留混杂。对于果汁，这一发现在客观确定2型糖尿病的研究中无显著性（异质性P =0.008）。在特定的人群归因分数假设下，预计美国10年内将发生2090万例2型糖尿病事件（绝对事件发生率11.0%），180万例可归因于含糖饮料的消费（人群归因分数8.7%，95%置信区间3.9%至12.9%）;在英国有260万个活动（绝对事件率5.8%），79000例可归因于饮用含糖饮料（人口归因分数3.6%，1.7%至5.6%）。结论：习惯性饮用含糖饮料与2型糖尿病的发病率较高相关，与肥胖无关。尽管人工加糖饮料和果汁也显示出与2型糖尿病发病率的正相关，但研究结果可能存在偏见。尽管如此，人工加糖饮料和果汁都不太可能成为预防2型糖尿病的含糖饮料的健康替代品。在因果关系假设下，多年来饮用含糖饮料可能与大量新发糖尿病病例有关。
Objectives To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom. Design Systematic review and meta-analysis. Data sources and eligibility PubMed, Embase, Ovid, and Web of Knowledge for prospective studies of adults without diabetes, published until February 2014. The population attributable fraction was estimated in national surveys in the USA, 2009-10 (n=4729 representing 189.1 million adults without diabetes) and the UK, 2008-12 (n=1932 representing 44.7 million). Synthesis methods Random effects meta-analysis and survey analysis for population attributable fraction associated with consumption of sugar sweetened beverages. Results Prespecified information was extracted from 17 cohorts (38 253 cases/10 126 754 person years). Higher consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, by 18% per one serving/day (95% confidence interval 9% to 28%, I2 for heterogeneity=89%) and 13% (6% to 21%, I2=79%) before and after adjustment for adiposity; for artificially sweetened beverages, 25% (18% to 33%, I2=70%) and 8% (2% to 15%, I2=64%); and for fruit juice, 5% (−1% to 11%, I2=58%) and 7% (1% to 14%, I2=51%). Potential sources of heterogeneity or bias were not evident for sugar sweetened beverages. For artificially sweetened beverages, publication bias and residual confounding were indicated. For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity=0.008). Under specified assumptions for population attributable fraction, of 20.9 million events of type 2 diabetes predicted to occur over 10 years in the USA (absolute event rate 11.0%), 1.8 million would be attributable to consumption of sugar sweetened beverages (population attributable fraction 8.7%, 95% confidence interval 3.9% to 12.9%); and of 2.6 million events in the UK (absolute event rate 5.8%), 79 000 would be attributable to consumption of sugar sweetened beverages (population attributable fraction 3.6%, 1.7% to 5.6%). Conclusions Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showd positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes. Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes.