Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
BMJ. 2023 Apr 19;381:e073406. doi: 10.1136/bmj-2022-073406.
To investigate the intake of specific types of beverages in relation to mortality and cardiovascular disease (CVD) outcomes among adults with type 2 diabetes.
Prospective cohort study.
Health professionals in the United States.
15 486 men and women with a diagnosis of type 2 diabetes at baseline and during follow-up (Nurses' Health Study: 1980-2018; and Health Professionals Follow-Up Study: 1986-2018). Beverage consumption was assessed using a validated food frequency questionnaire and updated every two to four years.
The main outcome was all cause mortality. Secondary outcomes were CVD incidence and mortality.
During an average of 18.5 years of follow-up, 3447 (22.3%) participants with incident CVD and 7638 (49.3%) deaths were documented. After multivariable adjustment, when comparing the categories of lowest intake of beverages with the highest intake, the pooled hazard ratios for all cause mortality were 1.20 (95% confidence interval 1.04 to 1.37) for sugar sweetened beverages (SSBs), 0.96 (0.86 to 1.07) for artificially sweetened beverages (ASBs), 0.98 (0.90 to 1.06) for fruit juice, 0.74 (0.63 to 0.86) for coffee, 0.79 (0.71 to 0.89) for tea, 0.77 (0.70 to 0.85) for plain water, 0.88 (0.80 to 0.96) for low fat milk, and 1.20 (0.99 to 1.44) for full fat milk. Similar associations were observed between the individual beverages and CVD incidence and mortality. In particular, SSB intake was associated with a higher risk of incident CVD (hazard ratio 1.25, 95% confidence interval 1.03 to 1.51) and CVD mortality (1.29, 1.02 to 1.63), whereas significant inverse associations were observed between intake of coffee and low fat milk and CVD incidence. Additionally, compared with those who did not change their consumption of coffee in the period after a diabetes diagnosis, a lower all cause mortality was observed in those who increased their consumption of coffee. A similar pattern of association with all cause mortality was also observed for tea, and low fat milk. Replacing SSBs with ABSs was significantly associated with lower all cause mortality and CVD mortality, and replacing SSBs, ASBs, fruit juice, or full fat milk with coffee, tea, or plain water was consistently associated with lower all cause mortality.
Individual beverages showed divergent associations with all cause mortality and CVD outcomes among adults with type 2 diabetes. Higher intake of SSBs was associated with higher all cause mortality and CVD incidence and mortality, whereas intakes of coffee, tea, plain water, and low fat milk were inversely associated with all cause mortality. These findings emphasize the potential role of healthy choices of beverages in managing the risk of CVD and premature death overall in adults with type 2 diabetes.
探讨 2 型糖尿病成人特定类型饮料的摄入与死亡率和心血管疾病（CVD）结局的关系。
前瞻性队列研究。
美国健康专业人员。
15486 名在基线和随访期间（护士健康研究：1980-2018 年；和健康专业人员随访研究：1986-2018 年）被诊断为 2 型糖尿病的男性和女性。使用经过验证的食物频率问卷评估饮料摄入量，并每两到四年更新一次。
主要结局为全因死亡率。次要结局为 CVD 发生率和死亡率。
在平均 18.5 年的随访期间，记录了 3447 名（22.3%）发生 CVD 的参与者和 7638 名（49.3%）死亡。在多变量调整后，与饮料摄入量最高组相比，摄入量最低组的全因死亡率的合并危险比为 1.20（95%置信区间 1.04 至 1.37）的含糖饮料（SSB）、0.96（0.86 至 1.07）的人工甜味饮料（ASB）、0.98（0.90 至 1.06）的果汁、0.74（0.63 至 0.86）的咖啡、0.79（0.71 至 0.89）的茶、0.77（0.70 至 0.85）的白开水、0.88（0.80 至 0.96）的低脂牛奶和 1.20（0.99 至 1.44）的全脂牛奶。个体饮料与 CVD 发生率和死亡率之间也存在类似的关联。具体而言，SSB 摄入与 CVD 发生率（危险比 1.25，95%置信区间 1.03 至 1.51）和 CVD 死亡率（1.29，1.02 至 1.63）升高相关，而咖啡和低脂牛奶摄入与 CVD 发生率呈显著负相关。此外，与那些在诊断出糖尿病后没有改变咖啡摄入量的人相比，那些增加咖啡摄入量的人全因死亡率较低。与全因死亡率相关的类似模式也见于茶和低脂牛奶。用 ASB 替代 SSB 与全因死亡率和 CVD 死亡率降低显著相关，用咖啡、茶或白开水替代 SSB、ASB、果汁或全脂牛奶与全因死亡率降低持续相关。
不同类型的饮料与 2 型糖尿病成人的全因死亡率和 CVD 结局存在不同的关联。较高的 SSB 摄入量与全因死亡率和 CVD 发生率和死亡率升高相关，而咖啡、茶、白开水和低脂牛奶的摄入量与全因死亡率呈负相关。这些发现强调了在 2 型糖尿病成人中，选择健康饮料可能对降低 CVD 和全因死亡风险具有潜在作用。
