title: Prospective associations and population impact of sweet beverage intake and type 2 diabetes, and effects of substitutions with alternative beverages.
abstract: OBJECTIVE
  This study aimed to evaluate the association of types of sugar-sweetened beverages (SSB) (soft drinks, sweetened-milk beverages, sweetened tea/coffee), artificially sweetened beverages (ASB) and fruit juice with incident type 2 diabetes and determine the effects of substituting non-SSB for SSB and the population-attributable fraction of type 2 diabetes due to total sweet beverages.
  
  
  METHODS
  Beverage consumption of 25,639 UK-resident adults without diabetes at baseline (1993-1997) in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk study was assessed using 7-day food diaries. During 10.8 years of follow-up 847 incident type 2 diabetes cases were verified.
  
  
  RESULTS
  In adjusted Cox regression analyses there were positive associations (HR [95% CI] per serving/day]) for soft drinks 1.21 (1.05, 1.39), sweetened-milk beverages 1.22 (1.05, 1.43) and ASB 1.22 (1.11, 1.33), but not for sweetened tea/coffee 0.98 (0.94, 1.02) or fruit juice 1.01 (0.88, 1.15). Further adjustment for adiposity attenuated the association of ASB, HR 1.06 (0.93, 1.20). There was a positive dose-response relationship with total sweet beverages: HR per 5% energy 1.18 (1.11, 1.26). Substituting ASB for any SSB did not reduce the incidence in analyses accounting for energy intake and adiposity. Substituting one serving/day of water or unsweetened tea/coffee for soft drinks and for sweetened-milk beverages reduced the incidence by 14%-25%. If sweet beverage consumers reduced intake to below 2% energy, 15% of incident diabetes might be prevented.
  
  
  CONCLUSIONS
  The consumption of soft drinks, sweetened-milk beverages and energy from total sweet beverages was associated with higher type 2 diabetes risk independently of adiposity. Water or unsweetened tea/coffee appear to be suitable alternatives to SSB for diabetes prevention. These findings support the implementation of population-based interventions to reduce SSB consumption and increase the consumption of suitable alternatives.
authors.affiliation: Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, PO Box 285, Cambridge, CB2 0QQ, UK, laura.oconnor@mrc-epid.cam.ac.uk.
authors.forename: Laura
authors.initials: L
authors.lastname: O'Connor
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Imamura
authors.forename: Marleen A H
authors.initials: MA
authors.lastname: Lentjes
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: Nita G
authors.initials: NG
authors.lastname: Forouhi
mesh_terms: D050154:Adiposity; D000328:Adult; D000368:Aged; D000818:Animals; D001628:Beverages / Q000009:adverse effects*; D003069:Coffee; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004032:Diet; D015930:Diet Records; D004305:Dose-Response Relationship, Drug; D005260:Female; D005638:Fruit; D006801:Humans; D008297:Male; D008875:Middle Aged; D008892:Milk; D011153:Population; D011446:Prospective Studies; D013549:Sweetening Agents / Q000009:adverse effects*; D013662:Tea; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D003069:Coffee; D013549:Sweetening Agents; D013662:Tea