title: Frequent Consumption of Sugar- and Artificially Sweetened Beverages and Natural and Bottled Fruit Juices Is Associated with an Increased Risk of Metabolic Syndrome in a Mediterranean Population at High Cardiovascular Disease Risk.
abstract: The relation between the consumption of sweetened beverages and metabolic syndrome (MetS) is controversial.
  
  
  
  This analysis evaluated the associations between intakes of sugar-sweetened beverages (SSBs), artificially sweetened beverages, and natural and bottled fruit juices and the incidence of MetS in elderly individuals at high risk of cardiovascular disease (CVD) and without MetS at baseline.
  
  
  
  We prospectively examined 1868 participants free of MetS at baseline from the PREDIMED (PREvención con DIeta MEDiterránea) study. MetS was defined by using the updated harmonized criteria of the International Diabetes Federation, the American Heart Association, and National Heart, Lung, and Blood Institute. Energy and nutrient intakes were evaluated at baseline and then yearly by using a validated 137-item food-frequency questionnaire. Multivariable-adjusted HRs for MetS and its components were estimated from mean intakes during follow-up. We compared the 2 highest consumption categories (1-5 and >5 servings/wk) with the lowest category (<1 serving/wk).
  
  
  
  A total of 930 incident cases of MetS were documented during a median follow-up of 3.24 y. When we compared consumption of >5 servings/wk with consumption of <1 serving/wk, multivariable HRs (95% CIs) for MetS incidence were 1.43 (1.00, 2.15), 1.74 (1.26, 2.41), 1.30 (1.00, 1.69), and 1.14 (1.04, 1.65) for SSBs, artificially sweetened beverages, natural fruit juices, and bottled fruit juices, respectively.
  
  
  
  The occasional consumption of SSBs and artificially sweetened beverages (1-5 servings/wk) was not associated with the incidence of MetS in middle-aged and elderly individuals at high risk of CVD. The consumption of >5 servings/wk of all of the types of beverages analyzed was associated with an increased risk of MetS and some of its components. However, for SSBs and bottled fruit juices these associations must be interpreted with caution because of the low frequency of consumption in this population. This trial was registered at clinicaltrials.gov as ISRCTN35739639.
authors.affiliation: Human Nutrition Unit, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Biochemistry Biotechnology Department, Universitat Rovira i Virgili, Reus, Spain; CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and.
authors.forename: Cíntia
authors.initials: C
authors.lastname: Ferreira-Pêgo
authors.affiliation: Human Nutrition Unit, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Biochemistry Biotechnology Department, Universitat Rovira i Virgili, Reus, Spain; CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and.
authors.forename: Nancy
authors.initials: N
authors.lastname: Babio
authors.affiliation: CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain; IDISNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain.
authors.forename: Maira
authors.initials: M
authors.lastname: Bes-Rastrollo
authors.affiliation: CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and Department of Preventive Medicine, University of Valencia, Valencia, Spain;
authors.forename: Dolores
authors.initials: D
authors.lastname: Corella
authors.affiliation: CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and Prevention with Mediterranean Diet Research Network (PREDIMED), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Internal Medicine and.
authors.forename: Ramon
authors.initials: R
authors.lastname: Estruch
authors.affiliation: CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and Lipid Clinic, Endocrinology, and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain;
authors.forename: Emilio
authors.initials: E
authors.lastname: Ros
authors.affiliation: CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and Cardiovascular Risk and Nutrition Research Group, Medical Research Institute of Del Mar Hospital, Barcelona, Spain;
authors.forename: Montserrat
authors.initials: M
authors.lastname: Fitó
authors.affiliation: CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and Prevention with Mediterranean Diet Research Network (PREDIMED), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain;
authors.forename: Lluís
authors.initials: L
authors.lastname: Serra-Majem
authors.affiliation: CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and Prevention with Mediterranean Diet Research Network (PREDIMED), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Cardiology, University Hospital Araba, Vitoria, Spain;
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.affiliation: CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and Palma Institute of Health Research, Hospital Son Espases, Palma de Mallorca, Spain;
authors.forename: Miguel
authors.initials: M
authors.lastname: Fiol
authors.affiliation: CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and Department of Family Medicine, Distrito Sanitario Atención Primaria Sevilla, Centro de Salud San Pablo, Seville, Spain;
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Santos-Lozano
authors.affiliation: Department of Public Health and Psychiatry, University of Malaga, Malaga, Spain;
authors.forename: Carlos
authors.initials: C
authors.lastname: Muñoz-Bravo
authors.affiliation: Department of Internal Medicine and Lipids and Vascular Risk Unit, Internal Medicine Service, University Hospital of Bellvitge, Barcelona, Spain; and.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pintó
authors.affiliation: CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain; IDISNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Canela
authors.affiliation: Human Nutrition Unit, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Biochemistry Biotechnology Department, Universitat Rovira i Virgili, Reus, Spain; CIBEROBN (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición) and Prevention with Mediterranean Diet Research Network (PREDIMED), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; jordi.salas@urv.cat.
authors.forename: Jordi
authors.identifier: 0000-0003-2700-7459
authors.initials: J
authors.lastname: Salas-Salvadó
mesh_terms: D000368:Aged; D001628:Beverages; D002318:Cardiovascular Diseases / Q000209:etiology*; D004032:Diet; D004034:Diet Surveys; D019422:Dietary Sucrose / Q000008:administration & dosage / Q000009:adverse effects*; D005247:Feeding Behavior; D005260:Female; D000067030:Fruit and Vegetable Juices; D006801:Humans; D015994:Incidence; D008297:Male; D019083:Mediterranean Region; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D064306:Non-Nutritive Sweeteners / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D013549:Sweetening Agents / Q000009:adverse effects
chemical_list: D019422:Dietary Sucrose; D064306:Non-Nutritive Sweeteners; D013549:Sweetening Agents
keywords: PREDIMED study; artificially sweetened beverages; fruit juices; metabolic syndrome; metabolic syndrome components; sugar-sweetened beverages