Study shows drinking one 12oz sugar-sweetened soft drink a day can increase the risk of type 2 diabetes by 22 percent

Contact: Sam Wong Press Office sam.wong@imperial.ac.uk 44-020-759-42198 Diabetologia

Drinking one (or one extra)* 12oz serving size of sugar-sweetened soft drink a day can be enough to increase the risk of developing type 2 diabetes by 22%, a new study suggests. The research is published in  Diabetologia (the journal of the European Association for the Study of Diabetes) and comes from data in the InterAct consortium**. The research is by Dr Dora Romaguera, Dr Petra Wark and Dr Teresa Norat, Imperial College London, UK, and colleagues.

Since most research in this area has been conducted in North American populations, the authors wanted to establish if a link between sweet beverage consumption and type 2 diabetes existed in Europe. They used data on consumption of juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks collected across eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC study; UK, Germany, Denmark, Italy, Spain, Sweden, France, Italy, Netherlands)***, covering some 350,000 participants.

As part of the InterAct project, the researchers did a study which included 12,403 type 2 diabetes cases and a random sub-cohort of 16,154 identified within EPIC. The researchers found that, after adjusting for confounding factors, consumption of one 12oz (336ml) serving size of sugar-sweetened soft drink per day increased the risk of type 2 diabetes by 22%. This increased risk fell slightly to 18% when total energy intake and body-mass index (BMI) were accounted for**** (both factors that are thought to mediate the association between sugar-sweetened soft drink consumption and diabetes incidence). This could indicate that the effect of sugar-sweetened soft drink on diabetes goes beyond its effect on body weight.

The authors also observed a statistically significant increase in type 2 diabetes incidence related to artificially sweetened soft drink consumption, however this significant association disappeared after taking into account the BMI of participants; this probably indicates that the association was not causal but driven by the weight of participants (i.e. participants with a higher body weight tend to report higher consumption of artificially sweetened drinks, and are also more likely to develop diabetes). Pure fruit juice and nectar***** consumption was not significantly associated with diabetes incidence, however it was not possible using the data available to study separately the effect of 100% pure juices from those with added sugars.

The authors say the increased risk of diabetes among sugar-sweetened soft drink consumers in Europe is similar to that found in a meta-analysis of previous studies conducted mostly in North America (that found a 25% increased risk of type 2 diabetes associated with one 12 oz daily increment of sugar-sweetened beverage consumption).

Dr Romaguera concludes: “Given the increase in sweet beverage consumption in Europe, clear messages on the unhealthy effect of these drinks should be given to the population.”

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Notes to editors:

*The increased risk of 22% is for each extra 12oz sugar sweetened drink, so would apply to someone who had 1 drink versus someone who had 0, or someone who had 2 drinks versus someone who had 1, etc.

**The InterACT consortium is investigating, among other things, nutritional factors and physical activity to study the association of nutritional, dietary and physical activity behaviours with incident diabetes in the nested case-cohort study and to contribute to the analysis of gene-lifestyle interaction. It is a sub-division of the EPIC study, which was designed to investigate the relationships between diet, nutritional status, lifestyle and environmental factors and the incidence of cancer and other chronic diseases.

***The centres involved were France, Italy, Spain, Denmark, UK (Oxford, Cambridge), Netherlands (Bilthoven, Utrecht), Germany (Heidelberg, Potsdam), Sweden (Umea, Malmo)

****Extra info from Dr Romaguera:  The 22% figure is used as the top line because it is widely accepted by the scientific community that these models should not be adjusted for BMI. In the meta-analysis comparison with other studies from the USA, the risk is those studies is NOT adjusted by BMI. That makes it possible to compare the two sets of results (25% increased risk in North American studies versus 22% in Europe).

*****nectars (UK and USA definition) are fruit juices that have been diluted to some extent and may contain additives (sugar or sweeteners)

Super-sizing the soldier: Is obesity going to pose a huge recruiting problem?: At present, 62 percent of active duty military members over the age of 20 have a body mass index that falls into either the overweight or obese category

Posted By Thomas E. RicksTuesday, October 9, 2012 – 10:22 AM

By Jim Gourley

Best Defense department of physical fitness and national security

Obesity and weight-related health conditions have become a prevalent concern to American policy in the last decade. National military leadership was also exposed to obesity’s potential risks to national security with the release of the report “Too Fat to Fight” by Mission Readiness in 2010. The group’s primary message is that a burgeoning population of overweight American children will drastically reduce an already diminished pool of viable candidates for military service in the next ten years. However, these reports indicate only the most general aspects of the problem and focus on projections of future implications. When the scope of the American obesity epidemic is examined specifically within the context of its impact on the armed forces, data shows clearly that the threat is not imminent, but existential.

At present, 62 percent of active duty military members over the age of 20 have a body mass index that falls into either the overweight or obese category. For personnel under the age of 20, the number stands at 35 percent. That is actually an improvement from a 2005 rate of 46 percent. These statistics are often challenged due to the disputable methods of calculating Body Mass Index (BMI). However, the 2011 Annual Summary of the Armed Forces Health Survey Center cites 21,185 medical diagnoses for overweight, obesity and hyperalimentation (overeating). Research also dispels service culture stigmas. No service is immune to overweight issues. Comparing the relative percentages of overweight/obese service members, the Navy is the fattest service at 62.7 percent, followed by the Army at 61 percent, the Air Force at 58.8 percent. The Marines register the fittest at 55.1 percent, still substantially more than half overweight. Closer examination shows that more than 12 percent of active duty service members in each service are obese. The Marines break the trend more significantly in this category with a 6.1 percent obesity rate.

The increase of girth in the military progressed at a linear rate between 1995 and 2005, but has remained fairly consistent since then. However, emerging data indicates that the overweight population may rise further in the next ten years if the military is to meet recruiting goals. A new study by the Trust for America’s Health predicts that more than half of Americans in 39 states will be obese by 2030. This is disturbing enough, but it becomes even more troubling for the armed forces when individual state recruitment trends are compared to their childhood obesity rates. All ten states that contributed the most military inductees in 2010 have childhood obesity rates greater than 15 percent. Three of them (including Texas, which was second in total recruitment with over 15,000 new military members) exhibit rates between 20-25 percent. The preponderance of our young military members come from the most ponderous states.

The problem is not simply one of cosmetics or intangible metrics of combat performance. The costs of an unfit military carry a real-dollar value. A 2007 joint study by The Lewin Group and TRICARE management activity estimated that the Defense Department spends $1.1 billion annually on medical care for obesity and overweight conditions. This study included dependents and retirees who qualified for TRICARE Prime coverage. More restricted to the active duty component are the costs to manpower. The AFHSC report tallied 245 “bed days” for medical treatment directly linked to weight issues, and 4,555 service members were involuntarily separated for failing to meet weight standards in 2008. The recruiting and initial entry training costs alone represent a loss of $225 million. Adding in specific military job training, logistics, equipment and the cost of lost duty days brings the annual price tag of overweight service members to about $1.5 billion. That exceeds the military’s budget for Predator drones in 2010. Themilitary still fails to grasp the true scale of the problem so long as comorbidities of overweight and obesity remain unexamined. There were more than 42,000 service members affected by hypertension and another 5,700 by diabetes in 2011. Hypertension alone ranks in the top thirty conditions affecting active duty service members. Also overlooked is the expense of XXL chemical warfare suits and development of other plus-sized uniform items.

The military’s response to the problem has been mixed. The Army provided waivers to 1,500 new recruits who failed to meet weight standards in 2007. The program remains in place but the numbers of waivers issued in subsequent years have not been published. The Navy had a similar program until 2010. The Air Force never offered such a program and the Marines actually tightened standards in the 2009-2011 time period. Trends suggest that weight standards are on a sliding scale driven largely by manpower requirements and retention problems in a wartime military.

Therein lies the greatest problem. It seems all but certain that American society will continue gaining weight over the next decade. In this regard, the military may be a kind of canary in the cave given its emphasized dependence on physical fitness for mission success. However, without an established position on the matter of physical fitness standards and given the likelihood that leaders at every level will themselves be at an unhealthy weight, it is possible that the military will experience substantial increases in operating costs and diminished capability in the next decade.

Jim Gourley is a Best Defense jolly good fellow.

http://ricks.foreignpolicy.com/posts/2012/10/09/super_sizing_the_soldier_is_obesity_going_to_pose_a_huge_recruiting_problem

Obese kids’ artery plaque similar to middle-aged adults

Contact: AHA News Media Staff Office
bridgette.mcneill@heart.org
504-670-6524
American Heart Association

Abstract 6077; this abstract is also featured in a news conference

The neck arteries of obese children and teens look more like those of 45-year-olds, according to research presented at the American Heart Association’s Scientific Sessions 2008.

“There’s a saying that ‘you’re as old as your arteries,’ meaning that the state of your arteries is more important than your actual age in the evolution of heart disease and stroke,” said Geetha Raghuveer, M.D., M.P.H., associate professor of pediatrics at the University of Missouri Kansas City School of Medicine and cardiologist at Children’s Mercy Hospital. “We found that the state of the arteries in these children is more typical of a 45-year-old than of someone their own age.”

Researchers used ultrasound to measure the thickness of the inner walls of the neck (carotid) arteries that supply blood to the brain. Increasing carotid artery intima-media thickness (CIMT) indicates the fatty buildup of plaque within arteries feeding the heart muscle and the brain, which can lead to heart attack or stroke.

Investigators calculated CIMT in 34 boys and 36 girls who were “at-risk,” (average age 13, 89 percent white) and found:

  • These children had abnormal levels of one or more types of cholesterol – elevated levels of low-density lipoprotein (LDL), which is known as “bad cholesterol;” low levels of high-density lipoprotein (HDL), which is the “good cholesterol;” or high triglyceride levels.
  • Forty (57 percent) had a body mass index (BMI, a calculation of weight for height) above the 95th percentile.

 

Their average CIMT was 0.45 millimeters (mm), with a maximum of 0.75 mm.

The children’s “vascular age” — the age at which the level of thickening would be normal for their gender and race — was about 30 years older than their actual age, Raghuveer said.

The children were deemed at high risk for future heart disease because of obesity, abnormal cholesterol, and/or a family history of early heart disease.

On average, these children had:

  • total cholesterol levels of 223.4 milligrams per deciliter (mg/dL) (less than 170 is considered acceptable by American Heart Association recommendations);
  • LDL cholesterol levels of 149.8 mg/dL (less than 110 is considered acceptable); and
  • triglycerides levels of 151.9 mg/dL (below 150 is considered acceptable).

 

Researchers found that having a higher BMI and higher systolic blood pressure had the most impact on CIMT.

Of the various risk factors, the children with triglycerides over 100 mg/dL were most likely to have an advanced vascular age. Thirty-eight children with high triglycerides had a CIMT above the 25th percentile for 45-year-olds, while only five in the group were below the 25th percentile. Children with lower triglycerides were evenly divided between those who scored below (13) or above (14) the 25th percentile on the charts for 45-year-olds.

“Vascular age was advanced the furthest in the children with obesity and high triglyceride levels, so the combination of obesity and high triglycerides should be a red flag to the doctor that a child is at high risk of heart disease,” Raghuveer said.

Further studies are needed to determine whether artery build-up will decrease if children lose weight, exercise, or are treated for abnormal lipids. Some studies have shown that CIMT can be reduced when children at extremely high risk are treated with cholesterol-lowering statin medications, and that exercise can improve blood vessel function in children with a high BMI.

“I’m optimistic that something can be done,” Raghuveer said. “In children, the buildup in the vessels is not hardened and calcified. We can improve the vessel walls and blood flow in adults through treatment, and I’m sure we can help children even more.”

Other risk factors for high CIMT in children are high blood pressure, exposure to secondhand smoke and insulin resistance – which is frequently seen in obese children.

 

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Co-authors are: Joseph Le, medical student; Menees Spencer, medical student; David McCrary, M.D.; Danna Zhang, M.S.; and Chen Jie, Ph.D. Individual author disclosures are available on the abstract.

The Sarah Morrison Medical Student Research Grant from the University of Missouri, Kansas City, funded the research.

Editor’s note: In May 2005, the American Heart Association and the William J. Clinton Foundation formed the Alliance for a Healthier Generation. The alliance is working to reduce the nationwide increase in childhood obesity by 2010, and to empower kids nationwide to make healthy lifestyle choices. For more information visit: www.HealthierGeneration.org.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

NR08-1135 (SS08/Raghuveer)

Regular consumption of sugary beverages linked to increased genetic risk of obesity

Contact: Todd Datz
tdatz@hsph.harvard.edu
617-432-8413
Harvard School of Public Health

 

Researchers from Harvard School of Public Health have found that greater consumption of sugar-sweetened beverages (SSBs) is linked with a greater genetic susceptibility to high body mass index (BMI) and increased risk of obesity. The study reinforces the view that environmental and genetic factors may act together to shape obesity risk.

The study appears September 21, 2012 in an advance online edition of the New England Journal of Medicine.

“Our study for the first time provides reproducible evidence from three prospective cohorts to show genetic and dietary factors—sugar-sweetened beverages—may mutually influence their effects on body weight and obesity risk. The findings may motivate further research on interactions between genomic variation and environmental factors regarding human health,” said Lu Qi, assistant professor in the Department of Nutrition at HSPH and senior author of the study.

In the past three decades, consumption of SSBs has increased dramatically worldwide. Although widespread evidence supports a link between SSBs, obesity and chronic diseases such as diabetes, there has been little research on whether environmental factors, such as drinking sugary beverages, influence genetic predisposition to obesity.

The research was based on data from three large cohorts, 121,700 women in the Nurses’ Health Study, 51,529 men in the Health Professionals Follow-up Study and 25,000 in the Women’s Genome Health Study. All of the participants had completed food-frequency questionnaires detailing their food and drink consumption over time.

The researchers analyzed data from 6,934 women from NHS, 4,423 men from HPFS, and 21,740 women from WGHS who were of European ancestry and for whom genotype data based on genome-wide association studies were available. Participants were divided into four groups according to how many sugary drinks they consumed: less than one serving of SSB per month, between 1-4 servings per month, between 2-6 servings per week, and one or more servings per day. To represent the overall genetic predisposition, a genetic predisposition score was calculated on the basis of the 32 single-nucleotide polymorphisms known to be associated with BMI (weight in kilograms divided by the square of the height in meters).

The results showed that the genetic effects on BMI and obesity risk among those who drank one or more SSBs per day were about twice as large as those who consumed less than one serving per month. The findings suggest that regular consumption of sugary beverages may amplify the genetic risk of obesity. In addition, individuals with greater genetic predisposition to obesity appear to be more susceptible to harmful effects of SSBs on BMI. “SSBs are one of the driving forces behind the obesity epidemic,” says Frank Hu, professor of nutrition and epidemiology at HSPH and a coauthor of this study. “The implication of our study is that the genetic effects of obesity can be offset by healthier food and beverage choices.”

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Support for the study was provided by grants DK091718, HL071981, HL073168, CA87969, CA49449, CA055075, HL34594, HL088521, U01HG004399, DK080140, 5P30DK46200, U54CA155626, DK58845, U01HG004728-02, EY015473, DK70756, and DK46200 from the National Institutes of Health (NIH); and Merck Research Laboratories. The WGHS is supported by NIH grants HL043851, HL69757, and CA047988.

“Sugar-Sweetened Beverages and Genetic Risk of Obesity,” Qibin Qi, Audrey Y. Chu, Jae H. Kang, Majken K. Jensen, Gary C. Curhan, Louis R. Pasquale, Paul M. Ridker, David J. Hunter, Walter C. Willett, Eric B. Rimm, Daniel I. Chasman, Frank B. Hu, Lu Qi, New England Journal of Medicine, online Sept. 21, 2012

Higher levels of BPA in children and teens associated with obesity

Contact: Jessica Guenzel Jessica.Guenzel@nyumc.org 212-404-3591 JAMA and Archives Journals

NEW YORK – In a nationally representative sample of nearly 3,000 children and adolescents, those who had higher concentrations of urinary bisphenol A (BPA), a manufactured chemical found in consumer products, had significantly increased odds of being obese, according to a study in the September 19 issue of JAMA, and theme issue on obesity.

Leonardo Trasande, M.D., M.P.P., of the NYU School of Medicine, New York City, presented the findings of the study at a JAMA media briefing.

“In the U.S. population, exposure [to BPA] is nearly ubiquitous, with 92.6 percent of persons 6 years or older identified in the 2003-2004 National Health and Nutrition Examination Survey (NHANES) as having detectable BPA levels in their urine. A comprehensive, cross-sectional study of dust, indoor and outdoor air, and solid and liquid food in preschool-aged children suggested that dietary sources constitute 99 percent of BPA exposure,” according to background information in the article. “In experimental studies, BPA exposure has been shown to disrupt multiple metabolic mechanisms, suggesting that it may increase body mass in environmentally relevant doses and therefore contribute to obesity in humans.” BPA exposure is plausibly linked to childhood obesity, but evidence is lacking.

Dr. Trasande and colleagues conducted a study to examine association between urinary BPA concentrations and body mass in children. The study consisted of a cross-sectional analysis of a nationally representative subsample of 2,838 participants, ages 6 through 19 years, randomly selected for measurement of urinary BPA concentration in the 2003-2008 National Health and Nutrition Examination Surveys. Body mass index (BMI), converted to sex- and age-standardized z scores (indicates how many units [of the standard deviation] a child’s BMI is above or below the average BMI value for their age group and sex) was used to classify participants as overweight (BMI 85th percentile or greater for age/sex) or obese (BMI 95th percentile or greater). The median (midpoint) urinary BPA concentration for participants in the study was 2.8 ng/mL. The prevalence of obesity was 17.8 percent (n = 590), and overweight 34.1 percent (n = 1,047). The BPA concentrations of the participants were divided into quartiles (four groups). Controlling for race/ethnicity, age, caregiver education, poverty to income ratio, sex, serum cotinine level, caloric intake, television watching, and urinary creatinine level, children in the lowest urinary BPA quartile had a lower estimated prevalence of obesity (10.3 percent) than those in quartiles 2 (20.1  percent), 3 (19.0 percent), and 4 (22.3 percent). Compared with the first quartile, participants in the third quartile had approximately twice the odds for obesity. Participants in the fourth quartile had a 2.6 higher odds of obesity.

Further analyses showed this association to be statistically significant in only 1 racial subpopulation, white children and adolescents. The researchers also found that obesity was not associated with exposure to other environmental phenols commonly used in other consumer products, such as sunscreens and soaps.

“To our knowledge, this is the first report of an association of an environmental chemical exposure with childhood obesity in a nationally representative sample,” the authors write.

The researchers note that advocates and policy makers have long been concerned about BPA exposure. “We note the recent FDA ban of BPA in baby bottles and sippy cups, yet our findings raise questions about exposure to BPA in consumer products used by older children. Last year, the FDA declined to ban BPA in aluminum cans and other food packaging, announcing ‘reasonable steps to reduce human exposure to BPA in the human food supply’ and noting that it will continue to consider evidence on the safety of the chemical. Carefully conducted longitudinal studies that assess the associations identified here will yield evidence many years in the future.”

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Editor’s Note: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

(JAMA. 2012;308[11]:1113-1121. Available pre-embargo to the media at http://media.jamanetwork.com)

To contact Leonardo Trasande, M.D., M.P.P., call Jessica Guenzel at 212-404-3591 or email Jessica.Guenzel@nyumc.org.