Soft Drink Consumption and Risk of Developing Cardiometabolic Risk Factors and the Metabolic Syndrome in Middle-Aged Adults in the Community
Ravi Dhingra, MD; Lisa Sullivan, PhD; Paul F. Jacques, PhD; Thomas J. Wang, MD; Caroline S. Fox, MD; James B. Meigs, MD, MPH; Ralph B. D’Agostino, PhD; J. Michael Gaziano, MD, MPH; Ramachandran S. Vasan, MD
Background—Consumption of soft drinks has been linked to obesity in children and adolescents, but it is unclear whether it increases metabolic risk in middle-aged individuals. Methods and Results—We related the incidence of metabolic syndrome and its components to soft drink consumption in participants in the Framingham Heart Study (6039 person-observations, 3470 in women; mean age 52.9 years) who were free of baseline metabolic syndrome. Metabolic syndrome was defined as the presence of 3 of the following: waist circumference 35 inches (women) or 40 inches (men); fasting blood glucose 100 mg/dL; serum triglycerides 150 mg/dL; blood pressure 135/85 mm Hg; and high-density lipoprotein cholesterol 40 mg/dL (men) or 50 mg/dL (women). Multivariable models included adjustments for age, sex, physical activity, smoking, dietary intake of saturated fat, trans fat, fiber, magnesium, total calories, and glycemic index. Cross-sectionally, individuals consuming 1 soft drink per day had a higher prevalence of metabolic syndrome (odds ratio [OR], 1.48; 95% CI, 1.30 to 1.69) than those consuming 1 drink per day. On follow-up (mean of 4 years), new-onset metabolic syndrome developed in 765 (18.7%) of 4095 participants consuming 1 drink per day and in 474 (22.6%) of 2059 persons consuming 1 soft drink per day. Consumption of 1 soft drink per day was associated with increased odds of developing metabolic syndrome (OR, 1.44; 95% CI, 1.20 to 1.74), obesity (OR, 1.31; 95% CI, 1.02 to 1.68), increased waist circumference (OR, 1.30; 95% CI, 1.09 to 1.56), impaired fasting glucose (OR, 1.25; 95% CI, 1.05 to 1.48), higher blood pressure (OR, 1.18; 95% CI, 0.96 to 1.44), hypertriglyceridemia (OR, 1.25; 95% CI, 1.04 to 1.51), and low high-density lipoprotein cholesterol (OR, 1.32; 95% CI 1.06 to 1.64). Conclusions—In middle-aged adults, soft drink consumption is associated with a higher prevalence and incidence of multiple metabolic risk factors. (Circulation. 2007;116:480-488.)
Key Words: diabetes mellitus metabolic syndrome epidemiology obesity risk factors carbonated beverages
S everal reports from the United States and Europe indicate increasing consumption of soft drinks among children, adolescents, and adults over the past 3 decades.1,2 Many clinical studies have linked the rising consumption of soft drinks to the present epidemic of obesity and diabetes mellitus among children and adolescents3– 6 and to the development of hypertension in adults.7 Furthermore,
Clinical Perspective p 488
added sweeteners in soft drinks have been linked to an increase in serum triglycerides levels in some reports8,9 but not in others.10,11 The association of soft drink consumption with obesity and higher insulin resistance has been attributed to multiple factors, including greater caloric intake, the high
Received January 12, 2007; accepted May 15, 2007. From the National Heart, Lung, and Blood Institute’s Framingham Heart Study (R.D., T.J.W., C.S.F., R.S.V.), Framingham, Mass; Massachusetts Veterans Epidemiology Research and Information Center (R.D., J.M.G.), VA Boston Healthcare System, Boston, Mass; Division of Aging (R.D., J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; Alice Peck Day Memorial Hospital (R.D.), Lebanon, NH; Department of Biostatistics (L.S., R.B.D.), Boston University School of Public Health, Boston, Mass; Jean Mayer USDA Human Nutrition Research Center on Aging (P.F.J.), Tufts University, Boston, Mass; Division of Cardiology (T.J.W.) and Department of Medicine (J.B.M.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; National Heart, Lung, and Blood Institute (C.S.F.), Bethesda, Md; Divisions of Preventive Medicine and Cardiovascular Medicine (J.M.G.), Brigham and Women’s Hospital, Boston, Mass; and Cardiology Section and the Department of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, Mass.
The online-only Data Supplement, consisting of tables, is available with this article at http://circ.ahajournals.org/cgi/content/full/ CIRCULATIONAHA.107.689935/DC1.
Guest Editor for this article was Gregory L. Burke, MD, MSc. Correspondence to Ramachandran S. Vasan, MD, Framingham Heart Study, 73 Mount Wayte Ave, Suite 2, Framingham, MA 01702-5803. E-mail
firstname.lastname@example.org © 2007 American Heart Association, Inc.
Circulation is available at http://www.circulationaha.org