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

This study aimed to determine the prospective relationship between the consumption of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and fruit juice with the incidence of type 2 diabetes. The authors also sought to estimate the population-level impact of SSB consumption on diabetes incidence in the United States and the United Kingdom.

The researchers conducted a systematic review and meta-analysis of 17 prospective cohort studies, involving over 38,000 cases of type 2 diabetes across more than 10 million person-years. They analyzed associations both before and after adjusting for adiposity (body weight) to account for potential mediation and confounding. Additionally, they used national survey data from the US and UK to calculate the population attributable fraction—the proportion of new diabetes cases that could be linked to SSB consumption.

• Sugar-Sweetened Beverages: Higher consumption was consistently associated with an 18% greater incidence of type 2 diabetes per serving per day, which remained a 13% increase even after adjusting for adiposity. The authors estimate that this link accounts for approximately 1.8 million excess diabetes cases in the US and 79,000 in the UK over a 10-year period.
• Artificially Sweetened Beverages and Fruit Juice: While these also showed positive associations with diabetes incidence, the evidence was of lower quality. The results for ASBs were likely skewed by publication bias and residual confounding, while the findings for fruit juice were unstable and varied significantly based on study design.
• Public Health Implications: The study concludes that neither ASBs nor fruit juice should be considered healthy alternatives to SSBs for the prevention of type 2 diabetes. The findings underscore the importance of reducing SSB intake as a primary prevention strategy.