By Rob Stein | Washington Post | August 25, 2004
Women who drink non-diet soda or fruit punch every day gain weight quickly and face a sharply elevated risk of diabetes, according to a major study released yesterday.
The study of more than 50,000 U.S. nurses found that those who drank just one serving of soda or fruit punch a day tended to gain much more weight than those who drank less than one a month, and had more than an 80 percent increased risk of developing Type 2 diabetes, the most common form of the disease. The risk pertained to drinks sweetened with either sugar or high-fructose corn syrup.
Although previous studies have linked such drinks to obesity and diabetes, the association has been the subject of intense debate as health activists have fought to ban soda vending machines from schools and the sugar industry has lobbied against dietary guidelines that discourage sugar consumption by children and adults. The new study is by far the largest and best-designed and one of the first to examine the issue in adults.
"The message is: Anyone who cares about their health or the health of their family would not consume these beverages," said Walter C. Willett of the Harvard School of Public Health, who helped conduct the study. "Parents who care about their children's health should not keep them at home."
Neither diet soda nor unsweetened fruit juices appear to carry the same risks, the researchers found. Although the study involved only women, the researchers believed that the risks also hold for men.
Other experts agreed, saying the study represented a milestone in the debate over soft drink consumption, which has skyrocketed in the past 20 years with the rising obesity epidemic.
"While it shouldn't be surprising to anyone that soda causes weight gain because it's high in calories, these findings are very significant. I think they are really a wake-up call to the consumer of soft drink beverages, to the government, to the community, to primary care providers," said Caroline M. Apovian of the Boston University School of Medicine, who wrote an editorial accompanying the findings in today's Journal of the American Medical Association.
The sugar and beverage industries said the study was fundamentally flawed.
"The conclusions from this study are scientifically unsound, and they are at odds with all that's known in the scientific community," said Richard Adamson, vice president for scientific and technical affairs at the American Beverage Association. "These allegations are inflammatory."
Among the study's many problems, Adamson said, the researchers failed to take into consideration a host of other variables that could account for the apparent risk. Women who drink a lot of soda may simply have generally unhealthy lifestyles, he said.
"If they would have adjusted for all the confounding factors, they would not have found any risk at all," he said.
Any increased risk for diabetes in the study could be attributed to the weight the women gained, not their sugar intake, said Charles Baker, vice president for scientific affairs for the Sugar Association.
"It's not about sugar. It's about calorie imbalance," Baker said.
But other nutrition experts hailed the research.
"This is a strong study, which joins a number of others in showing that soft drink consumption is related to poor diet and obesity, yet the soft drink industry says the opposite," said Kelly Brownell, who is director of the Yale University Center for Eating and Weight Disorders. "They lose credibility by the day. Reducing soft drink consumption may be a powerful means of addressing the obesity crisis."
In the study, Willett and his colleagues analyzed data collected from Nurses' Health Study II, an ongoing project involving 91,249 women designed to examine an abundance of health issues by regularly questioning the women in depth over many years.
Data collected from 51,603 women over an average of four years found that the women who gained the most weight were those who increased their consumption of non-diet drinks from one or fewer per week to one or more per day, the researchers found. Such women gained an average of 10.3 pounds, compared with an average of slightly less than three pounds for those who consumed one drink or less per week.
In addition, those who had one or more drinks containing sugar or corn syrup per day were 83 percent more likely to develop Type 2 diabetes than those who drank less than one such drink per month. Diabetes, a chronic blood sugar disorder that puts victims at risk for a variety of serious complications, is becoming increasingly common in the United States.
High sugar intake may increase the risk for diabetes by taxing the pancreas, Willett said in a telephone interview. "It's probably that high amounts of sugar in the bloodstream put an increased demand for insulin on the pancreas," he said.
"Putting down all that sugar is not a healthy thing to do," Willett said. "That's the bottom line."
He said the findings held true even after the researchers adjusted for a variety of factors that could explain the findings, such as how much exercise the women were getting and how well they ate overall.
The findings suggest that there is something especially unhealthy about calories consumed in liquid form, Apovian said.
"It seems that when you drink your calories as opposed to eating them, your body may not sense that you've just taken in those calories and your appetite doesn't seem to compensate," Apovian said. "The appetite circuit might not be programmed to register liquid calories."
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