title: Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men.
abstract: BACKGROUND
  Sugar-sweetened beverages are risk factors for type 2 diabetes; however, the role of artificially sweetened beverages is unclear.
  
  
  OBJECTIVE
  The objective was to examine the associations of sugar- and artificially sweetened beverages with incident type 2 diabetes.
  
  
  METHODS
  An analysis of healthy men (n = 40,389) from the Health Professionals Follow-Up Study, a prospective cohort study, was performed. Cumulatively averaged intakes of sugar-sweetened (sodas, fruit punches, lemonades, fruit drinks) and artificially sweetened (diet sodas, diet drinks) beverages from food-frequency questionnaires were tested for associations with type 2 diabetes by using Cox regression.
  
  
  RESULTS
  There were 2680 cases over 20 y of follow-up. After age adjustment, the hazard ratio (HR) for the comparison of the top with the bottom quartile of sugar-sweetened beverage intake was 1.25 (95% CI: 1.11, 1.39; P for trend < 0.01). After adjustment for confounders, including multivitamins, family history, high triglycerides at baseline, high blood pressure, diuretics, pre-enrollment weight change, dieting, total energy, and body mass index, the HR was 1.24 (95% CI: 1.09, 1.40; P for trend < 0.01). Intake of artificially sweetened beverages was significantly associated with type 2 diabetes in the age-adjusted analysis (HR: 1.91; 95% CI: 1.72, 2.11; P for trend < 0.01) but not in the multivariate-adjusted analysis (HR: 1.09; 95% CI: 0.98, 1.21; P for trend = 0.13). The replacement of one serving of sugar-sweetened beverage with 1 cup (≈237 mL) of coffee was associated with a risk reduction of 17%.
  
  
  CONCLUSIONS
  Sugar-sweetened beverage consumption is associated with a significantly elevated risk of type 2 diabetes, whereas the association between artificially sweetened beverages and type 2 diabetes was largely explained by health status, pre-enrollment weight change, dieting, and body mass index.
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: de Koning
authors.forename: Vasanti S
authors.initials: VS
authors.lastname: Malik
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D001628:Beverages / Q000009:adverse effects; D002253:Carbonated Beverages; D003069:Coffee; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology*; D004034:Diet Surveys; D019422:Dietary Sucrose / Q000009:adverse effects*; D005638:Fruit; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013549:Sweetening Agents / Q000009:adverse effects*
chemical_list: D003069:Coffee; D019422:Dietary Sucrose; D013549:Sweetening Agents