Sugary drinks linked to type 2 diabetes regardless of obesity: Meta analysis

By Niamh Michail

- Last updated on GMT

“Although more research on cause and effect needs to be carried out, this study indicates the potential health gains that may be achieved by reducing the consumption of sugar sweetened drinks,” the authors wrote.
“Although more research on cause and effect needs to be carried out, this study indicates the potential health gains that may be achieved by reducing the consumption of sugar sweetened drinks,” the authors wrote.

Related tags Sugary drinks Nutrition Obesity

Sugary drinks may cause type 2 diabetes regardless of obesity – and artificially-sweetened drinks or fruit juice are not necessarily healthier alternatives, according to new research.

Reviewing 17 independent studies, researchers led by Fumiaki Imamura from the University of Cambridge, estimated that a daily serving of one sugar-sweetened beverage was associated with an 18% increase in diabetes. This fell to 13% once obesity, a possible confounding factor, had been taken into account.

For artificially sweetened beverages they calculated an 8% increase and 7% for fruit juice. Although admitting the findings for artificially-sweetened rinks and fruit juice may be weak due to publication bias, the researchers nonetheless said there was little evidence for the benefits of these drinks as healthy alternatives.

“Our findings have strong public health implications, ​they wrote. “Despite the limitations of this review, the current consumption of sugar sweetened beverages was estimated to cause approximately two million excess events of type 2 diabetes in the USA and 80 000 in the UK over 10 years. This could cost nearly £12.0bn in the USA and £206m in the UK.”

The authors admitted their findings were limited by the observational nature of the studies under review, ruling out any definite causal conclusions.

'No strong evidence'

The findings, published in the British Medical Journal​, have also been questioned by other scientists.

Dr Alasdair Rankin, director of research at Diabetes UK, said that while the study added to evidence that sugary drinks were bad for health and could increase the risk of type 2 diabetes, it did not provide strong evidence about whether this was because of the calories they contained or because of “something else going on in the body that was leading to an increase in risk.”

Tom Sanders, professor emeritus of nutrition and dietetics at King’s College London, said the findings – based on soft drink consumption in the years preceding a diabetes diagnosis – did not prove a causal effect because people tend to drink more in the early stages of type 2 diabetes.   

“It is important to stress that this study does not prove a cause-effect relationship and there are no trials as yet showing that reducing sugar sweetened beverages decreases the incidence of type 2 diabetes."

The main risk factors remained age, obesity and physical inactivity, he said.

Nonetheless, Kawther Hashem, nutritionist at Action on Sugar said that this study added to the increasing evidence of the alarming impact of sugary drinks on public health.

It’s therefore imperative that reformulation, a duty on sugary drinks and protecting children from the industry's aggressive marketing of such products are key components of David Cameron’s obesity strategy,” ​she said.

The findings come as the UK government’s SACN report ditched a 10% upper limit on free sugar intake last week, instead recommending that people get no more than 5% of daily energy from free sugars.

Source: British Medical Journal
Published online 21 July 2015, doi: 10.1136/bmj.h3576 
“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”
Authors: Fumiaki Imamura et al.  

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1 thing not to need to remember about this study

Posted by Food insight,

Studies in meta-analysis adjusted for age, physical activity, and obesity status. This can be identified by reading the paper easily. Age is a standard variable to adjust for. Analyses comparing results before and after adjustment for obesity or physical activity produced results giving similar conclusion, unsurprisingly.

Other comments are quite general. Based on biological plausibility, it seems fine to keep assuming causality. It also seems ok to recommend to anyone regardless of energy intake not consuming sugary beverages for cutting energy and also for general health.

A trial would be nice, if available, and can be done. But, although it is treated as a gold standard, we should assume that a trial finding should be applicable to reallife setting. Anytime, assumption is needed.

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4 things to remember about this study

Posted by Food Insight,

Since some of the conversations on this study are a bit out on a limb, we’ve got to chime in:
• We’ve said it before and we’ll say it again. It can be really dangerous to assume that correlation means causation. The Imamura study associated self-reported sugar-sweetened beverage consumption with health effects – this does not demonstrate cause or directly test effect. (
• Randomized clinical trials are the gold standard for assessing the effects of any behavior, like consuming sugar-sweetened beverages, on health. This study utilized meta-analysis from self-reported survey analysis, which aggregates data and compares the prevalence of health conditions with self-reported consumption data. This type of study design simply can’t show causation. (
• The results indicated a positive association with beverages sweetened with low-calorie sweeteners as well, which suggests a sugar-independent effect that isn’t explained.
• The study did not control for the proven risk factors for type II diabetes such as age, obesity, and physical inactivity. That’s a big omission.
The bottom line is that consuming too many calories from any single calorie source (SSBs included) can lead to weight gain. Being overweight or obese is a risk factor for Type-II Diabetes and other chronic diseases. An actionable step to managing weight is identifying what your major sources of excess calories are and then working to cut back on those items. Keep splurges sensible; focus on getting the nutrients you need from fruits and vegetables, whole grains, dairy, and lean protein; and make sure you’re balancing your intake with physical activity.
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