details on 6 epidemiological studies since 2004 on diet soda (mainly aspartame) correlations, as well as 13 other mainstream studies on aspartame toxicity since summer 2005: Murray 2007.11.14
http://rmforall.blogspot.com/2007_11_01_archive.htmWednesday, November 14, 2007
http://groups.yahoo.com/group/aspartameNM/message/1490"Of course, everyone chooses, as a natural priority, to enjoy peace, joy, and love by helping to find, quickly share, and positively act upon evidence about healthy and safe food, drink, and environment."
Rich Murray, MA Room For All rmforall@comcast.net
505-501-2298 1943 Otowi Road, Santa Fe, New Mexico 87505
http://RMForAll.blogspot.com new primary archive
http://groups.yahoo.com/group/aspartameNM/messagesgroup with 112 members, 1,490 posts in a public,
searchable archive
http://rmforall.blogspot.com/2007_09_01_archive.htmSaturday, September 15, 2007
http://groups.yahoo.com/group/aspartameNM/message/1472bias, omissions, incuriosity = opportunity, aspartame safety evaluation, Magnuson BA, Burdock GA, Williams GM, 7 more, 2007 Sept, Ajinomoto funded 98 pages html [$ 32 781888262_content.pdf]: Murray 2007.09.15
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[ This layman review gives detailed access to the gist of six
epidemiological studies since 2004, two in 2007, that show correlations of diet soda (largely aspartame) with health issues.
Probably studies of the correlations at the top 0.1 to 1.0 % level of use over periods of years by people in vulnerable groups are needed.
http://groups.yahoo.com/group/aspartameNM/message/1141Nurses Health Study can quickly reveal the extent of aspartame
(methanol, formaldehyde, formic acid) toxicity: Murray 2004.11.21
The Nurses Health Study is a bonanza of information about the health of probably hundreds of nurses who use 6 or more cans daily of diet soft drinks -- they have also stored blood and tissue samples from their immense pool of subjects, over 100,000 for decades.
In total, there are 19 mainstream studies about negative effects with aspartame since summer, 2005, listed in this review, included many about the detailed biochemistry involved. ]
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http://RMForAll.blogspot.com September 21, 2007
http://groups.yahoo.com/group/aspartameNM/message/147519,000 people, the 4% of users of aspartame who drink average 5 cans daily, have more problems in NIH AARP study of 474,000 people: Murray 2007.09.21
This is the first good data about the percentage of aspartame users who
use over 3 cans daily, averaging 5 cans daily at 200 mg per 12 oz can
diet soda.
About 4% of 473,984 is 19,000 people, with a peak intake of 17 cans
daily, and average 5 cans daily.
It would be worthwhile to investigate a wide variety of symptoms for the
0.1% of highest level users, about 500 people.
For about 200 million USA aspartame users, this would be 200,000 people.
Table 1 reveals consistent increase in problems from
--------------------- zero to (400 - 600) to (over 600) mg/d
aspartame intake:
% of cohert ---------- 46 -------- 5 -------- 4 %
mean aspartame mg/d --- 0 -------441 ------ 986
16+ education -------- 37 ------- 40 ------- 34 %
diabetes history ------ 3 ------- 22 ------- 26 %
alcohol g/d ---------- 14 ------- 11 ------- 13
never smoke ---------- 36 ------- 31 ------- 29 %
Body Mass Index ------ 26 ------- 29 ------- 29
18.5 - 25 ------------ 42 ------- 21 ------- 19 %
30 - 35 -------------- 13 ------- 23 ------- 26 %
over 35 --------------- 4 ------- 10 ------- 13 %
Physical activity %:
under 3-4/mo --------- 32 ------- 32 ------- 37 %
under 1-2/wk --------- 22 ------- 21 ------- 19 %
over 3-4/wk ---------- 45 ------- 45 ------- 43 %
Calories kcal ----- 1,919 ---- 1,855 ---- 2,044 %
Caffeine mg/d ------- 393 ------ 364 ------ 424
There do seem to be many increases of problems
from the second to third row, as mean aspartame use doubles.
Granted, this is cherry picking the data, selecting interesting patterns.
Correlations alone do not prove any direction of causation.
Nevertheless, it may be of value to study the correlations for
increasing aspartame intake among the 4 % using over 600 mg, the
equivalent of 3 cans 12-oz cans diet soda daily.
The average use for this group is 5 cans daily.
For instance, are a minority of these heavy users displaying the great
majority of the problems that are reflected in the mean for each level
of use, with most users only having little or no increase in problems?
This is a group of about 20,000 people.
"We cannot exclude the possibility that higher aspartame consumption
than that observed in this study may be associated with an elevated risk
of hematopoietic or brain cancers."
http://cebp.aacrjournals.org/cgi/content/full/15/9/1654 free full text
http://cebp.aacrjournals.org/cgi/reprint/15/9/1654 free full text pdf
Cancer Epidemiology Biomarkers & Prevention Vol. 15, 1654-1659,
September 2006
© 2006 American Association for Cancer Research
Consumption of Aspartame-Containing Beverages and Incidence of
Hematopoietic and Brain Malignancies
Unhee Lim 1,
Amy F. Subar 2, subara@mail.nih.gov,
Traci Mouw 1,
Patricia Hartge 1,
Lindsay M. Morton 1,
Rachael Stolzenberg-Solomon 1,
David Campbell 3,
Albert R. Hollenbeck 4
and Arthur Schatzkin 1
1 Division of Cancer Epidemiology and Genetics,
2 Division of Cancer Control and Population Sciences, National Cancer
Institute, NIH, Department of Health and Human Services;
3 Information Management Services, Inc., Rockville, Maryland; and
4 AARP, Washington, District of Columbia
Requests for reprints: Amy Subar,
Division of Cancer Control and Population Sciences,
National Cancer Institute,
6130 Executive Boulevard, EPN 4005, Rockville, MD 20852-7344.
Phone: 301-594-0831; Fax: 301-435-3710. E-mail: subara@mail.nih.gov,
BACKGROUND:
In a few animal experiments, aspartame has been linked to hematopoietic
and brain cancers.
Most animal studies have found no increase in the risk of these or other
cancers.
Data on humans are sparse for either cancer.
Concern lingers regarding this widely used artificial sweetener.
OBJECTIVE:
We investigated prospectively whether aspartame consumption is
associated with the risk of hematopoietic cancers or gliomas (malignant
brain cancer).
METHODS:
We examined 285,079 men and 188,905 women ages 50 to 71 years in the
NIH-AARP Diet and Health Study cohort
Daily aspartame intake was derived from responses to a baseline
self-administered food frequency questionnaire that queried consumption
of four aspartame-containing beverages (soda, fruit drinks, sweetened
iced tea, and aspartame added to hot coffee and tea) during the past year.
Histologically confirmed incident cancers were identified from eight
state cancer registries.
Multivariable-adjusted relative risks (RR) and 95% confidence intervals
(CI) were estimated using Cox proportional hazards regression that
adjusted for age, sex, ethnicity, body mass index, and history of diabetes.
RESULTS:
During over 5 years of follow-up (1995-2000), 1,888 hematopoietic
cancers and 315 malignant gliomas were ascertained.
Higher levels of aspartame intake were not associated with the risk of
overall hematopoietic cancer
(RR for >/=600 mg/d, 0.98; 95% CI, 0.76-1.27),
glioma (RR for >/=400 mg/d, 0.73; 95% CI, 0.46-1.15;
P for inverse linear trend = 0.05),
or their subtypes in men and women.
CONCLUSIONS:
Our findings do not support the hypothesis that aspartame increases
hematopoietic or brain cancer risk. PMID: 16985027
"We cannot exclude the possibility that higher aspartame consumption
than that observed in this study may be associated with an elevated risk
of hematopoietic or brain cancers.
In the laboratory study with positive findings, animals were fed doses
starting from 4 mg up to 5,000 mg per kg body weight.
Significantly elevated lymphomas and leukemias were observed in female
rats fed 20 mg of aspartame and higher (e.g., 1,200 mg for humans
weighing 60 kg or 132 lb; refs. 13, 14).
The reported aspartame intake in our data ranged from 0 to 3,400 mg/d
with sparse numbers in the upper intake categories
(1,200 or 2,000 mg/d, which is equivalent to ~7 to 11 cans of soft
drinks daily) compared with the lowest categories,
and the associations were similarly null in both men and women."
////////////////////////////////////////////////////////////
http://RMForAll.blogspot.com October 12, 2007
http://groups.yahoo.com/group/aspartameNM/message/147913,620 seniors using more than 1 can/week artificially sweetened
[aspartame] soft drinks had 8% higher death risk, 1981-2004,
Paganini-Hill A, Kawas CH, Corrada MM, U. Southern Cal., Prev. Med. 2007
April 44(4) 305-10: Murray 2007.10.12
"Individuals who drank more than 1 can/week of artificially sweetened
(but not sugar-sweetened) soft drink (cola and other) had an 8 %
increased risk (95 % CI: 1.01-1.16)."
"The increased death risk with consumption of artificially sweetened,
but not sugar-sweetened, soft drinks suggests an effect of the sweetener
rather than other components of the soft drinks, although residual
confounding remains a possibility."
Prev Med. 2007 Apr; 44(4): 305-10. Epub 2006 Dec 29.
Non-alcoholic beverage and caffeine consumption and mortality: the
Leisure World Cohort Study.
Paganini-Hill A, annliahi@usc.edu,
Kawas CH, ckawas@uci.edu,
Corrada MM. mcorrada@uci.edu,
Department of Preventive Medicine, Keck School of Medicine of the
University of Southern California, CA, USA.
OBJECTIVE:
To examine the effects of non-alcoholic beverage and caffeine
consumption on all-cause mortality in older adults.
METHODS:
The Leisure World Cohort Study is a prospective study of residents of a
California retirement community.
A baseline postal health survey included details on coffee, tea, milk,
soft drink, and chocolate consumption.
Participants were followed for 23 years (1981-2004).
Risk ratios (RRs) of death were calculated using Cox regression for 8644
women and 4980 men (median age at entry, 74 years) and adjusted for age,
gender, and multiple potential confounders.
RESULTS:
Caffeine consumption exhibited a U-shaped mortality curve.
Moderate caffeine consumers had a significantly reduced risk of death
(multivariable-adjusted RR = 0.94, 95 % CI: 0.89, 0.99 for 100-199 mg/day
and RR = 0.90, 95 % CI: 0.85, 0.94 for 200-399 mg/day
compared with those consuming <50 mg/day).
Individuals who drank more than 1 can/week of artificially sweetened
(but not sugar-sweetened) soft drink (cola and other) had an 8 %
increased risk (95 % CI: 1.01-1.16).
Neither milk nor tea had a significant effect on mortality after
multivariable adjustment.
CONCLUSIONS:
Moderate caffeine consumption appeared beneficial in reducing risk of death.
Attenuation in the observed associations between mortality and intake of
tea and milk with adjustment for potential confounders suggests that
such consumption identifies those with other mortality-associated
lifestyle and health risks.
The increased death risk with consumption of artificially sweetened, but
not sugar-sweetened, soft drinks suggests an effect of the sweetener
rather than other components of the soft drinks, although residual
confounding remains a possibility. PMID: 17275898
Age Ageing. 2007 Mar; 36(2): 203-9.
Type of alcohol consumed, changes in intake over time and mortality: the
Leisure World Cohort Study.
Paganini-Hill A, Kawas CH, Corrada MM.
Department of Preventive Medicine,
Keck School of Medicine of University of Southern California, USA.
annliahi@usc.edu
BACKGROUND:
modifiable behavioural risk factors including smoking and alcohol
consumption are major contributing or actual causes of mortality.
OBJECTIVE:
to examine the effect of alcohol intake on all-cause mortality in older
adults.
Design and SETTING:
prospective population-based cohort study of residents of a California,
United States retirement community.
SUBJECTS:
8,877 women and 5,101 men (median age, 74 years) who in the early 1980s
completed a postal health survey incluing details on alcohol consumption.
METHODS:
participants were followed for 23 years (1981-2004) including two
follow-up questionnaires (in 1992 and 1998) asking about current alcohol
intake.
Age-adjusted and multivariate-adjusted risk ratios of death and 95 %
confidence intervals were calculated separately for men and women, using
proportional hazard regression.
RESULTS:
of the 8,644 women and 4,980 men with complete information on the
variables of interest and potential confounders,
6,930 women and 4,456 men had died (median age, 87 years).
Both men and women who drank alcohol had decreased mortality compared
with non-drinkers.
Those who drank two or more drinks per day had a 15 % reduced risk of death.
The reduced risk was not limited to one type of alcohol.
Stable drinkers (those who reported drinking both at baseline and
follow-up) had a significantly decreased risk of death compared with
stable non-drinkers.
Those who started drinking at follow-up also had a significantly lower risk.
Women who quit drinking were at increased risk of death.
CONCLUSION:
in elderly men and women, moderate alcohol intake exhibits a beneficial
effect on mortality.
Those who quit may do so for health reasons that affect mortality.
PMID: 17350977
////////////////////////////////////////////////////////////
" Analyses that used food frequency questionnaire data suggested that
intake of over 1 drink per day of either regular or diet soft drinks was
associated with a over 50% higher incidence of metabolic syndrome
compared with intake of under 1 soft drink per week.
" Although the association of high fructose corn syrup intake and
insulin resistance may be a contributory mechanism, 31 in the present
study, both regular and diet soft drinks appeared to pose similar
metabolic hazards,
which suggests that other factors may be operational. "
" The caramel content of both regular and diet drinks may be a potential
source of advanced glycation end products, 5 which may promote insulin
resistance 36 and can be proinflammatory. 37 "
" It is conceivable, though,
that there may be residual confounding caused by lifestyle factors not
adjusted for in the present analyses. "
" As noted above, it is conceivable that residual confounding by
lifestyle/dietary factors not adjusted for may have contributed to the
metabolic risks associated with soft drink intake. "
" The similar metabolic hazard posed by both regular and diet soft
drinks is noteworthy given the lack of calories in the latter; however,
other studies have also reported associations of diet soft drinks with
weight gain in boys 29 and with hypertension in adult women. 7 "
29. Berkey CS, Rockett HRH, Field AE, Gillman MW, Colditz GA.
Sugar-added beverages and adolescent weight change.
Obesity Res. 2004; 12: 778–788.[Abstract/Free Full Text]
7. Winkelmayer WC, Stampfer MJ, Willett WC, Curhan GC.
Habitual caffeine intake and the risk of hypertension in women.
JAMA. 2005; 294: 2330–2335.[Abstract/Free Full Text]
http://circ.ahajournals.org/cgi/content/full/116/5/480 free full text
[ Extracts ]
doi:10.1161/CIRCULATIONAHA.107.689935
CLINICAL PERSPECTIVE
Circulation. 2007; 116: 480-488.
© 2007 American Heart Association, Inc.
Epidemiology
Circulation. 2007 Jul 31; 116(5): 480-8. Epub 2007 Jul 23.
Soft drink consumption and risk of developing cardiometabolic risk
factors and the metabolic syndrome in middle-aged adults in the community.
Ravi Dhingra, MD;
Lisa Sullivan, PhD;
Paul F. Jacques, PhD;
Thomas J. Wang, MD;
Caroline S. Fox, MD; foxca@nhlbi.nih.gov,
James B. Meigs, MD, MPH;
Ralph B. D’Agostino, PhD;
J. Michael Gaziano, MD, MPH;
Ramachandran S. Vasan, MD vasan@bu.edu,
From the National Heart, Lung, and Blood Institute’s Framingham Heart
Study (R.D., T.J.W., C.S.F., R.S.V.), Framingham, Mass;
Massachusetts Veterans Epidemiology Research and Information Center
(R.D., J.M.G.), VA Boston Healthcare System, Boston, Mass;
Division of Aging (R.D., J.M.G.), Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass; Alice Peck Day Memorial Hospital (R.D.),
Lebanon, NH;
Department of Biostatistics (L.S., R.B.D.), Boston University School of
Public Health, Boston, Mass;
Jean Mayer USDA Human Nutrition Research Center on Aging (P.F.J.), Tufts
University, Boston, Mass; Division of Cardiology (T.J.W.) and Department
of Medicine (J.B.M.), Massachusetts General Hospital, Harvard Medical
School, Boston, Mass;
National Heart, Lung, and Blood Institute (C.S.F.), Bethesda, Md;
Divisions of Preventive Medicine and Cardiovascular Medicine (J.M.G.),
Brigham and Women’s Hospital, Boston, Mass;
and Cardiology Section and the Department of Preventive Medicine and
Epidemiology (R.S.V.), Boston University School of Medicine, Boston, Mass.
Correspondence to Ramachandran S. Vasan, MD, Framingham Heart Study, 73
Mount Wayte Ave, Suite 2, Framingham, MA 01702-5803. vasan@bu.edu,
Received January 12, 2007; accepted May 15, 2007.
BACKGROUND:
Consumption of soft drinks has been linked to obesity in children and
adolescents, but it is unclear whether it increases metabolic risk in
middle-aged individuals.
METHODS AND RESULTS:
We related the incidence of metabolic syndrome and its components to
soft drink consumption in participants in the Framingham Heart Study
(6,039 person-observations, 3,470 in women; mean age 52.9 years) who
were free of baseline metabolic syndrome.
Metabolic syndrome was defined as the presence of over of the following:
waist circumference over 35 inches (women) or over 40 inches (men);
fasting blood glucose over 100 mg/dL;
serum triglycerides over 150 mg/dL;
blood pressure over 135/85 mm Hg;
and high-density lipoprotein cholesterol under 40 mg/dL (men)
or under 50 mg/dL (women).
Multivariable models included adjustments for age, sex, physical
activity, smoking, dietary intake of saturated fat, trans fat, fiber,
magnesium, total calories, and glycemic index.
Cross-sectionally, individuals consuming over 1 soft drink per day had a
higher prevalence of metabolic syndrome
(odds ratio [OR], 1.48; 95 % CI, 1.30 to 1.69)
than those consuming under 1 drink per day.
On follow-up (mean of 4 years), new-onset metabolic syndrome developed
in 765 (18.7 %) of 4095 participants consuming under 1 drink per day and
in 474 (22.6 %) of 2059 persons consuming over 1 soft drink per day.
Consumption of over 1 soft drink per day
was associated with increased odds of developing
metabolic syndrome (OR, 1.44; 95% CI, 1.20 to 1.74),
obesity (OR, 1.31; 95 % CI, 1.02 to 1.68),
increased waist circumference (OR, 1.30; 95 % CI, 1.09 to 1.56),
impaired fasting glucose (OR, 1.25; 95% CI, 1.05 to 1.48),
higher blood pressure (OR, 1.18; 95 % CI, 0.96 to 1.44),
hypertriglyceridemia (OR, 1.25; 95 % CI, 1.04 to 1.51), and
low high-density lipoprotein cholesterol
(OR, 1.32; 95 % CI 1.06 to 1.64).
CONCLUSIONS:
In middle-aged adults, soft drink consumption is associated with a
higher prevalence and incidence of multiple metabolic risk factors.
PMID: 17646581
Key Words: diabetes mellitus • metabolic syndrome • epidemiology •
obesity • risk factors • carbonated beverages
* Introduction
Several reports from the United States and Europe indicate increasing
consumption of soft drinks among children, adolescents, and adults over
the past 3 decades. 1,2
Many clinical studies have linked the rising consumption of soft drinks
to the present epidemic of obesity and diabetes mellitus among children
and adolescents 3–6 and to the development of hypertension in adults. 7
Furthermore, added sweeteners in soft drinks have been linked to an
increase in serum triglycerides levels in some reports 8,9 but not in
others. 10,11
The association of soft drink consumption with obesity and higher
insulin resistance has been attributed to multiple factors, including
greater caloric intake, the high fructose corn syrup content, 12 less
satiety and compensation, and a general effect of consuming refined
carbohydrates (see review by Drewnowski and Bellisle 13).
The aforementioned data raise the possibility that the consumption of
soft drinks can fuel metabolic derangements, including insulin
resistance, that can translate into a greater risk of developing
abdominal obesity, high triglyceride levels, low levels of high-density
lipoprotein cholesterol (HDL-C), elevated blood pressure, and impaired
glucose tolerance; this constellation of metabolic traits has been
collectively referred to as the metabolic syndrome. 14
Higher prevalence of the metabolic syndrome poses greater risk for
cardiovascular disease in the community, 15 although the independent
contribution of this entity to vascular risk beyond its components has
been questioned 16
In the present prospective investigation, we tested the hypothesis that
greater soft drink consumption increases the risk of developing
metabolic risk factors (alone and in combination [metabolic syndrome])
in middle-aged adults in the community.
Additionally, we evaluated whether metabolic risk varied on the basis of
consumption of sugar-sweetened ("regular") versus artificially sweetened
("diet") soft drinks.
* Methods
Study Sample
The Framingham Heart Study began in 1948 with the enrollment of 5,209
participants into the original study cohort. 17
In 1971, children of the original cohort participants and the spouses of
the children were enrolled into the Framingham Offspring Study (n=5,124). 18
Offspring study participants are evaluated approximately every 4 years.
Information on daily consumption of soft drinks was collected via a
physician-administered questionnaire at each study visit from the fourth
(1987–1991) through the sixth (1995–1998) examination cycles.
That examination questionnaire did not elicit information regarding
consumption of regular versus diet soft drinks; however, such
information was available from the self-administered food frequency
questionnaires (FFQ; Willett questionnaire) 19 completed by participants
at the fifth (1992–1995) and sixth examination cycles (see below).
For the present investigation, we selected offspring cohort participants
who attended any 2 consecutive examinations from the fourth through the
seventh (1998–2001) examination cycles.
We excluded participants with missing data on covariates (n = 207) and
those with prevalent cardiovascular disease (n = 926).
After exclusions, a total of 8997 person-observations (4871 in women)
were eligible for the cross-sectional analyses.
For prospective analyses, we excluded individuals with baseline
metabolic syndrome (n = 2897 person-observations; metabolic syndrome as
defined below) and those with any missing metabolic syndrome components
on follow-up (n = 61 person-observations).
The schema for selection of individuals eligible for cross-sectional and
longitudinal analyses is displayed in the Figure.
All participants provided written informed consent, and the protocol for
the study was approved by institutional review board of Boston Medical
Center.
Figure 1185095
Selection of study sample from baseline examinations using the
examination cola questionnaire and from the sample with available FFQ
data (within parentheses, for examinations 5 and 6).
Eligible participants and exclusions are indicated in the Figure.
CVD indicates cardiovascular disease.
Measurement of Covariates
At each Framingham Heart Study examination, participants provided a
medical history and underwent a complete standardized physical
examination that included anthropometry, blood pressure measurements,
and laboratory assessment of vascular risk factors.
Fasting levels of blood glucose, triglycerides, and HDL-C were measured
with standard assays.
Blood pressure was measured by a physician using a mercury
sphygmomanometer and with the participant resting in a seated position
for 5 minutes; the average of 2 readings obtained on the participant’s
left arm constituted the examination blood pressure.
Physical activity was assessed by calculating a "physical activity
index"; participants were asked specific questions regarding how many
hours in a typical day they spent sitting, sleeping, or performing
light-moderate or heavy physical activities. 20
Alcohol intake was assessed by averaging the number of alcoholic
beverages consumed per week.
Participants who reported smoking 1 or more cigarettes per day in the
year before the Framingham Heart Study examination were considered
current smokers.
Assessment of Soft Drink Consumption and Dietary Intake of Other Foods
At the index examinations, participants reported the average number of
12-oz servings of soft drinks (Coke, Pepsi, Sprite, or other carbonated
soft drinks, separately categorized into caffeinated or decaffeinated
drinks) consumed per day in the year preceding the examination.
The responses to the questions were entered as integers (0 or more)
separately for caffeinated and decaffeinated soft drinks.
This questionnaire (referred to as the "examination cola questionnaire")
did not separate nondrinkers from infrequent drinkers (<1 drink per day).
Accordingly, we compared individuals who reported consuming 1, over 1,
or over 2 soft drinks per day with attendees who reported consuming
under 1 soft drink per day (infrequent drinkers and nondrinkers, who
served as the referent).
Intake of regular and diet soft drinks was assessed from FFQs 19 that
were administered at the fifth and sixth examinations.
We also assessed the dietary information on consumption of total
calories, saturated fat, trans fat, fiber, magnesium, and glycemic index
from the FFQ. 19
Because a FFQ was not administered at the fourth examination cycle,
dietary covariate data from the fifth examination cycle were used for
analyses using information from the examination cola questionnaire at
all 3 examinations.
Data from the FFQ were considered valid only if total energy intakes
reported were over 2.51 MJ/d (600 kcal/d) for men and women but under
17.54 MJ/d (4200 kcal/d) for men or under 16.74 MJ/d (4000 kcal/d) for
women and if fewer than 13 food items were left blank.
Each food item was categorized in 9 categories that ranged from never or
under 1 serving per month to over 6 servings per day.
For assessment of saturated fat, trans fat, or dietary fiber, the
nutrient intakes from all specific food items were multiplied by the
frequency of consumption.
The validity of the FFQ has been demonstrated previously. 21
Definition and Components of the Metabolic Syndrome
The metabolic syndrome was considered present if 3 or more of the
following individual components were present 14,22:
waist circumference over 35 inches (88 cm) for
or over 40 inches (102 cm) for men;
fasting blood sugar over 100 mg/dL (5.5 mmol/L) or treatment with oral
hypoglycemic agents or insulin;
blood pressure over 135/85 mm Hg or treatment for hypertension;
serum triglycerides over 150 mg/dL (1.7 mmol/L)
or treatment for hypertriglyceridemia (with niacin or fibrates);
and HDL-C under 40 mg/dL (1.03 mmol/L) in men
or under 50 mg/dL (1.3 mmol/L) in women.
Statistical Analyses
Age- and sex-adjusted baseline characteristics of the participant groups
defined according to the number of soft drinks consumed in 1 day
(under 1, 1, or over 2 per day) were compared by multiple linear and
multiple logistic regression analysis for continuous and categorical
characteristics, respectively.
Data on consumption of soft drinks at each of the 3 eligible baseline
examinations (examination cola questionnaire) were used for this purpose.
Tests for trend in baseline characteristics across soft drink
consumption categories were performed with multiple regression.
We also assessed the baseline characteristics after excluding
participants with prevalent metabolic syndrome at baseline
examinations (sample used for incidence analyses; see below).
Soft Drink Consumption and Prevalence of the Metabolic Syndrome
We used data from examinations 4, 5, and 6 (examination cola
questionnaire) and generalized estimating equations to compare the
prevalence of metabolic syndrome in participants who consumed over 1
soft drink per day with those who consumed under 1 soft drink per day
(referent).
Each participant could contribute up to 3 person-examinations of data
for analysis.
We also evaluated a dose response by comparing individuals
who consumed 1 soft drink per day and those who consumed over 2 soft
drinks per day with the referent group.
We constructed multivariable models in hierarchical fashion with
adjustment for age and sex (model I)
and for age, sex, physical activity index, smoking, dietary consumption
of saturated fat, trans fat, fiber, magnesium, total calories, and
glycemic index (model II).
We used soft drink consumption data from FFQs at examinations 5 and 6,
which yielded a smaller sample (Figure), to relate the prevalence of
metabolic syndrome across the following categories of intake of regular
versus diet soft drinks using generalized estimating equations:
(1) under 1 diet or regular soft drink per week (referent),
(2) 1 to 6 diet soft drinks per week,
(3) over 1 diet soft drink per day,
(4) 1 to 6 regular soft drinks per week,
(5) 1 to 6 regular or diet soft drinks per week,
and (6) over 1 regular soft drink per day.
Individuals reporting consumption of both diet and regular soft drinks
over 1/d (n = 16) were grouped into the last category empirically.
We evaluated the 2 sets of models (I and II) noted above.
Soft Drink Consumption and Incidence of the Metabolic Syndrome
To assess the relations of soft drink consumption to the incidence of
metabolic syndrome, we excluded participants with prevalent metabolic
syndrome at each of examination cycles 4, 5, and 6 (n = 2,897
person-observations).
Then, we used pooled logistic regression analyses
by combining each 4-year follow-up period of observations to relate the
number of soft drinks consumed per day (examination cola questionnaire)
to the incidence of metabolic syndrome (from examination cycles 4 to 5,
5 to 6, and 6 to 7).23
The eligible participants were free of metabolic syndrome
at each baseline examination,
and in this setting, pooled logistic regression has been shown to
provide risk estimates similar to time-dependent Cox models.24
We compared the consumption of soft drinks over 1 per day with
infrequent drinkers (under 1 per day; referent) and also
tested for a dose response by comparing groups consuming 1 and over 2
soft drinks per day with the referent group.
We evaluated 2 sets of models
(covariates as in models I and II above),
which paralleled the analyses of prevalence of metabolic syndrome.
Consumption of soft drinks varies with age and by sex.25
It has also been suggested that the effects of soft drinks and
carbohydrates on metabolic traits may vary according to age, sex,26
and baseline body weight.27
Therefore, we assessed for effect modification by age (modeled
as a continuous variable), sex, and body mass index
(under 30 versus over 30 kg/m2) by incorporating appropriate interaction
terms in the multivariable models.
We repeated analyses with additionally adjustment
for alcohol consumption and baseline levels of systolic and diastolic
blood pressure, blood glucose, serum triglycerides, and HDL-C.
These models were constructed to account for baseline levels of
metabolic traits.
Additionally, we repeated analyses to examine the association
between consumption of caffeinated and decaffeinated soft drinks,
considered separately, and incidence of the metabolic syndrome.
Because individuals with diabetes mellitus are a particularly high-risk
group for developing metabolic abnormalities, we also repeated our
analyses after excluding those with prevalent diabetes mellitus at baseline.
To compare the risk of new-onset metabolic syndrome according to the
type of soft drink consumed (regular versus diet),
we used data from the FFQs at examinations 5 and 6
and evaluated the incidence of the metabolic syndrome across categories
of soft drinks consumed.
The 6 categories of regular and diet soft drinks were those noted above
(for the analyses of the prevalence of metabolic syndrome),
and 2 sets of models were evaluated
(models I and II, as described above).
Incidence of Individual Components of Metabolic Syndrome
We used multivariable logistic regression to evaluate the relations of
soft drink consumption to the incidence of each individual component of
metabolic syndrome using data from the examination cola questionnaire.
We excluded participants who had the specific metabolic trait prevalent
at baseline; for example, we excluded individuals with blood glucose
over 100 mg/dL (5.5 mmol/L) from the "at-risk" group for analysis that
examined the incidence of impaired fasting glucose.
Thus, we examined the incidence of increased waist circumference,
impaired fasting glucose, high blood pressure, hypertriglyceridemia, and
low HDL-C (all defined as above) according to the number of soft drinks
consumed per day.
We evaluated 2 sets of models (I and II, as noted above) and compared
the risk of developing metabolic traits associated with consumption of
over 1 soft drinks per day
with that in infrequent drinkers (under 1 soft drinks per day).
We also evaluated for a dose response as detailed above.
We did not perform analyses of development of individual metabolic
syndrome components in relation to regular versus diet soft drink intake
using the FFQ data at examinations 5 and 6 because the grouping of
incident events into 6 categories resulted in modest numbers of events
in each category.
All analyses were performed with SAS software version 9.0 (SAS
Institute, Cary, NC). A 2-sided probability value of under 0.05 was
considered statistically significant.
The authors had full access to and take full responsibility for the
integrity of the data. All authors have read and agree to the manuscript
as written.
Results
The baseline characteristics of participants according to the categories
of soft drinks consumed per day are presented in Table 1.
Approximately 35 % of the participants reported consuming over 1 soft
drink per day in response to the examination cola questionnaire
(data based on all 3 examinations).
In comparison, only 22 % of participants reported intake of at least 1
soft drink (diet or regular) per day in response to the FFQ (data
available for examinations 5 and 6 only).
The lower proportion reporting daily intake on the FFQ may be related to
the greater number of options available to indicate soft drink intake;
participants drinking 1 to 6 soft drinks per week (also 22 % on the FFQ)
may have rounded their responses on the examination cola questionnaire
to the nearest integer.
View this table:
TABLE 1. Baseline Characteristics of Participants According to
Soft Drink Consumption (n = 8997)
In age- and sex-adjusted models, the prevalence of obesity (assessed
both by body mass index and by waist circumference), high blood
pressure, glucose intolerance, low HDL-C, and hypertriglyceridemia was
significantly higher in those who consumed a greater number of soft
drinks per day.
Serum total cholesterol, low-density lipoprotein cholesterol, physical
activity index, and alcohol consumption did not vary across categories
of soft drinks consumed.
Similar trends were obtained when we excluded individuals with prevalent
metabolic syndrome (Data Supplement, Table I).
Prevalence of the Metabolic Syndrome
There was a 48 % higher adjusted prevalence of metabolic syndrome among
those who consumed 1 or more soft drinks per day relative to individuals
with infrequent soft drink consumption (Table 2).
We observed a rising prevalence of metabolic syndrome across categories
of 1 and over 2 soft drinks per day
In parallel analyses with the data from the FFQ (Table 2), participants
who consumed over 1 diet or regular soft drink per day had nearly a
1.8-fold adjusted prevalence of metabolic syndrome compared with
infrequent drinkers (under 1 per week).
TABLE 2. Cross-Sectional Relationships of Soft Drink Consumption With
Prevalence of Metabolic Syndrome
Incidence of the Metabolic Syndrome
Individuals who consumed at least 1 soft drink per day had a 44 % higher