title: Soft drink intake and the risk of metabolic syndrome: A systematic review and meta-analysis.
abstract: BACKGROUND
  It is unclear whether consumption of sugar- or artificially sweetened beverages is independently associated with the development of metabolic syndrome. A systematic review and meta-analysis was performed to evaluate whether soft drink consumption is associated with the development of metabolic syndrome.
  
  
  METHODS
  Medline and EMBASE were searched in November 2015 for studies which considered soft drink (sugar-sweetened beverage [SSB] and artificially sweetened beverage [ASB]) intake and risk of metabolic syndrome. Pooled risk ratios for adverse outcomes were calculated using inverse variance with a random effects model, and heterogeneity was assessed using the I2statistic.
  
  
  RESULTS
  A total of 12 studies (eight cross-sectional, four prospective cohort studies) with 56 244 participants (age range 6-98 years) were included in the review. Our pooled analysis found that soft drink intake is associated with metabolic syndrome. This relationship is shown in cross-sectional studies of SSB consumption (RR 1.46, 95% CI 1.18-1.91) and both cross-sectional and prospective studies of ASB consumption (RR 2.45; 95% CI 1.15-5.14; RR 1.32, 95% CI 1.21-1.44, respectively). However, pooled results of prospective cohort studies of SSB consumption found no association between intake and risk of developing metabolic syndrome.
  
  
  CONCLUSIONS
  Sugar-sweetened beverage and ASB intake are both associated with metabolic syndrome. This association may be driven by the fact that soft drink intake serves as a surrogate for an unhealthy lifestyle, or an adverse cardiovascular risk factor profile.
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.|University Hospital of North Midlands, Stoke-on-Trent, UK.
authors.forename: Aditya
authors.initials: A
authors.lastname: Narain
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.|University Hospital of North Midlands, Stoke-on-Trent, UK.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.|University Hospital of North Midlands, Stoke-on-Trent, UK.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D002253:Carbonated Beverages; D019422:Dietary Sucrose / Q000009:adverse effects*; D006801:Humans; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000209:etiology; D015596:Nutrition Assessment; D012307:Risk Factors; D013549:Sweetening Agents / Q000009:adverse effects*
chemical_list: D019422:Dietary Sucrose; D013549:Sweetening Agents
keywords: meta-analysis; metabolic syndrome; sweetened beverages