Sugar-sweetened beverages: Changing the tide (含糖饮料：潮流的改变)
Article first published online: 5 FEB 2013
© 2013 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd
Journal of Diabetes
Volume 5, Issue 1, pages 1–2, March 2013
How to Cite
Bloomgarden, Z. and Handelsman, Y. (2013), Sugar-sweetened beverages: Changing the tide (含糖饮料：潮流的改变). Journal of Diabetes, 5: 1–2. doi: 10.1111/1753-0407.12021
- Issue published online: 5 FEB 2013
- Article first published online: 5 FEB 2013
- Accepted manuscript online: 10 JAN 2013 01:31AM EST
Various aspects of lifestyle are associated with the development of obesity, including physical activity, cigarette use (and its cessation), alcohol, television watching, computers, and sleep. Dietary factors are particularly important, both those leading to weight gain, such as starches, meats, fats, and sugar-sweetened beverages, and those contributing to weight maintenance if not loss, including vegetables, whole grains, fruits, nuts, and yoghurt. The important role of sugar consumption in obesity, contributing to diabetes and atherosclerosis, is supported not only by these epidemiologic findings, but also by the concept that this nutrient group particularly increases insulin levels in the setting of Insulin resistance, with hyperinsulinemia potentially further contributing to adverse outcome.
In the October 11 issue of the New England Journal of Medicine, two important studies firmly showed an association between sugar-sweetened beverages (SSB) and the development and worsening of obesity. de Ruyter and coworkers in Amsterdam gave children SSB or a non-caloric-sweetened drink every school day; after 6, 12, and 18 months the latter group had less weight gain. Liquid sugar did not, then, induce satiety. Furthermore, non caloric drinks did not increase hunger, instead reducing the degree of increase in body fat. Ebbeling et al. randomized overweight and obese adolescents to an even simpler intervention, simply offering home delivery of bottled water and “diet” beverages every 2 weeks for a year, with monthly 30-min phone calls to motivate parents and three 20-min check-in visits by the participants. The intervention led to a 15–20% reduction in energy intake with modest weight loss. Interestingly, the control group reported a nearly 10% reduction in energy intake, although not losing weight, suggesting that the increased awareness stemming from participation in the trial may in and of itself constitute a modestly effective intervention. These reports add to prior studies showing that reduction in SSB consumption may be more effective than reduction in calorie intake from solid foods in achieving weight loss. In the Nurses' Health Study of more than 50 000 women followed prospectively from 1991 to 1998, those reducing SSB consumption stabilized weight, while those continuing to drink these beverages had progressive weight gain. Daily SSB consumption doubled the risk of developing diabetes over that among women not consuming these beverages. A similar study among African American women followed from 1995 to 2001 showed a 25 to 30% increase in diabetes risk with daily SSB consumption, with weight gain likely the mediator. A metaanalysis similarly suggested an adverse SSB effect on weight gain and on diabetes risk. Evidence relating SSB consumption to obesity has also been reported in studies in China, among children  and among adolescents, a pattern similar to that observed in US studies. Reducing SSB may also lower blood pressure.
Consumption statistics suggest that the use of sugar-sweetened beverages increased in US children age 6-11 from 1990 to 2008. Total beverage calorie consumption was stable, while caloric nutritional beverage, principally high fat low sugar milk, decreased from 210 to 133 Kcal/d, and SSB increased from 130 to 212 Kcal/d. In US studies over the past decade, however, consumption of added sugars overall and of SSB decreased, although still above desirable levels.[13, 14] Production statistics from the Coca-Cola Company and PepsiCo Inc, together responsible for over one third of SSB sold globally, also suggest a reduction in SSB use in the US during this period, although alarmingly showing progressive increase in such beverage consumption in China.
At the end of the nineteenth century, Robert Koch formulated a set of postulates to establish that a given microbe causes disease. Analogously, products of SSB are found in abundance in humans with obesity and its cardiometabolic complications, SSB cause disease when administered in animal models, and replacing SSB with non-caloric beverages prevents the development of these conditions. Paradigms similar to those used in combating the infectious disease epidemics of the past can and should be applied to the epidemic of non-communicable diseases. Here is, then, a simple, proven intervention to reduce the development of obesity and, perhaps, of diabetes, hypertension, and cardiovascular disease. Is it not time to act?
消费统计结果表明，从1990年至2008年，年龄介于6-11岁的美国儿童含糖饮料的消费量有所增加。总的饮料热卡消费量保持不变，而含热卡的营养性饮料，主要是高脂肪低糖牛奶，从210 Kcal/d减少至133 Kcal/d，同时SSB从130 Kcal/d增加至212 Kcal/d。然而，在美国过去十年的研究中，所有的含糖饮料以及SSB的消费量都有所下降，虽然消费量仍在理想水平之上[13, 14]。可口可乐公司与百事公司的产量（加在一起占全球SSB销售量的三分之一以上）统计结果也表明这一时期美国的SSB消费量有所减少，但令人担忧的是这种饮料在中国的消费量却在进行性地增加。
- 9Report on childhood obesity in China: Sugar-sweetened beverages consumption and obesity. Biomed Environ Sci. 2012; 25: 125–32., , et al.
- 10Sugary beverage intakes and obesity prevalence among junior high school students in Beijing - a cross-sectional research on SSBs intake. Asia Pac J Clin Nutr. 2012; 21: 425–30., , et al.