Pacheco Lorena S, Tobias Deirdre K, Haslam Danielle E, Drouin-Chartier Jean-Philippe, Li Yanping, Bhupathiraju Shilpa N, Willett Walter C, Ludwig David S, Ebbeling Cara B, Hu Frank B, Guasch-Ferré Marta
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Diabetologia. 2025 Apr;68(4):792-800. doi: 10.1007/s00125-024-06351-w. Epub 2025 Jan 8.
AIMS/HYPOTHESIS: A positive association between sugar-sweetened beverages (SSBs) and diabetes risk has been shown, with inconsistent evidence between artificially sweetened beverages (ASBs) and diabetes. Moreover, it is uncertain if physical activity can mitigate the negative effects of these beverages on diabetes development. Therefore, we aimed to evaluate the independent and joint associations between SSB or ASB consumption and physical activity on the risk of type 2 diabetes.
We followed 64,029 women in the Nurses' Health Study (1980-2016), 88,340 women in the Nurses' Health Study II (1991-2017) and 39,436 men in the Health Professionals Follow-up Study (1986-2016). SSB and ASB consumption was calculated from food-frequency questionnaires administered every 4 years, while physical activity data were collected biennially. A validated supplementary questionnaire on diabetes symptoms, diagnostic tests and treatment confirmed type 2 diabetes cases. Multivariable Cox proportional hazards regression models were used to calculate HRs and 95% CIs for developing type 2 diabetes.
During 5,105,351 person-years of follow-up, we recorded 19,940 new cases of type 2 diabetes. Compared with those who never or rarely consumed SSBs or ASBs, those who consumed ≥2 servings/day had a 41% (HR 1.41 [95% CI 1.33, 1.50]) and 11% (HR 1.11 [95% CI 1.07, 1.16]) higher risk of type 2 diabetes, respectively. For participants meeting physical activity guidelines (≥7.5 metabolic equivalent of task [MET] h/week) and consuming ≥2 servings/week of SSBs or ASBs, the risk was 22% (HR 1.22 [95% CI 1.15, 1.29]) and 7% (HR 1.07 [95% CI 1.02, 1.12]) higher, respectively, compared with those who met physical activity guidelines and never or rarely (<1 serving/month) consumed these beverages. For participants meeting the physical activity guidelines and consuming 1-4 servings/month of SSBs, there was a 9% (HR 1.09 [95% CI 1.02, 1.15]) higher risk of type 2 diabetes. Compared with the reference group (those who met physical activity guidelines and consumed <1 SSB serving/month), adults who did not meet physical activity guidelines (<7.5 MET h/week) and who never or rarely (<1 serving/month) consumed SSBs, had 1-4 SSB servings/month, or had ≥2 SSB servings/week, the HRs (95% CIs) were 1.22 (1.13, 1.31), 1.28 (1.20, 1.37), and 1.51 (1.43, 1.61), respectively. Similarly, for ASB consumption, adults who did not meet physical activity guidelines and who never or rarely (<1 serving/month) consumed ASBs, had 1-4 servings/month, or had ≥2 servings/week, the HRs (95% CIs) were 1.21 (1.14, 1.28), 1.21 (1.13, 1.30), and 1.30 (1.23, 1.37) compared with the reference group (who met physical activity guidelines and consumed <1 ASB serving/month).
CONCLUSIONS/INTERPRETATION: Even when individuals were physically active, a higher consumption of SSBs or ASBs was associated with a higher risk of type 2 diabetes. Meeting physical activity guidelines reduced the impact of SSB and ASB consumption on diabetes risk, underscoring the need to promote physical activity as part of lifestyle modifications to lower diabetes incidence.
目的/假设：含糖饮料（SSB）与糖尿病风险之间已显示出正相关，而人工甜味饮料（ASB）与糖尿病之间的证据并不一致。此外，体育活动是否能减轻这些饮料对糖尿病发展的负面影响尚不确定。因此，我们旨在评估饮用SSB或ASB以及体育活动与2型糖尿病风险之间的独立和联合关联。
我们对护士健康研究（1980 - 2016年）中的64,029名女性、护士健康研究II（1991 - 2017年）中的88,340名女性以及健康专业人员随访研究（1986 - 2016年）中的39,436名男性进行了随访。通过每4年进行一次的食物频率问卷计算SSB和ASB的摄入量，同时每两年收集一次体育活动数据。一份经过验证的关于糖尿病症状、诊断测试和治疗的补充问卷确认了2型糖尿病病例。使用多变量Cox比例风险回归模型计算发生2型糖尿病的风险比（HR）和95%置信区间（CI）。
在5,105,351人年的随访期间，我们记录了19,940例新的2型糖尿病病例。与从未或很少饮用SSB或ASB的人相比，每天饮用≥2份的人患2型糖尿病的风险分别高41%（HR 1.41 [95% CI 1.33, 1.50]）和11%（HR 1.11 [95% CI 1.07, 1.16]）。对于符合体育活动指南（≥7.5代谢当量任务[MET]小时/周）且每周饮用≥2份SSB或ASB的参与者，与符合体育活动指南且从未或很少（<1份/月）饮用这些饮料的人相比，风险分别高22%（HR 1.22 [95% CI 1.15, 1.29]）和7%（HR 1.07 [95% CI 1.02, 1.12]）。对于符合体育活动指南且每月饮用1 - 4份SSB的参与者，患2型糖尿病的风险高9%（HR 1.09 [95% CI 1.02, 1.15]）。与参考组（符合体育活动指南且每月饮用<1份SSB的人）相比，未达到体育活动指南（<7.5 MET小时/周）且从未或很少（<1份/月）饮用SSB、每月饮用1 - 4份SSB或每周饮用≥2份SSB的成年人，HR（95% CI）分别为1.22（1.13, 1.31）、1.28（1.20, 1.37）和1.51（1.43, 1.61）。同样，对于ASB的饮用情况，与参考组（符合体育活动指南且每月饮用<1份ASB的人）相比，未达到体育活动指南且从未或很少（<1份/月）饮用ASB、每月饮用1 - 4份或每周饮用≥2份的成年人，HR（95% CI）分别为1.21（1.14, 1.28）、1.21（1.13, 1.30）和1.30（1.23, 1.37）。
结论/解读：即使个体进行体育活动，较高的SSB或ASB摄入量也与2型糖尿病风险较高相关。符合体育活动指南可降低SSB和ASB消费对糖尿病风险的影响，强调了促进体育活动作为生活方式改变的一部分以降低糖尿病发病率的必要性。
