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Matthias B. Schulze, DrPH; JoAnn E. Manson, MD; David S. Ludwig, MD; Graham A. Colditz, MD; Meir J. Stampfer, MD; Walter C. Willett, MD; Frank B. Hu, MD

JAMA. 2004;292:927-934.

Context  Sugar-sweetened beverages like soft drinks and fruit punches contain large amounts of readily absorbable sugars and may contribute to weight gain and an increased risk of type 2 diabetes, but these relationships have been minimally addressed in adults.

Objective  To examine the association between consumption of sugar-sweetened beverages and weight change and risk of type 2 diabetes in women.

Design, Setting, and Participants  Prospective cohort analyses conducted from 1991 to 1999 among women in the Nurses' Health Study II. The diabetes analysis included 91 249 women free of diabetes and other major chronic diseases at baseline in 1991. The weight change analysis included 51 603 women for whom complete dietary information and body weight were ascertained in 1991, 1995, and 1999. We identified 741 incident cases of confirmed type 2 diabetes during 716 300 person-years of follow-up.

Main Outcome Measures  Weight gain and incidence of type 2 diabetes.

Results  Those with stable consumption patterns had no difference in weight gain, but weight gain over a 4-year period was highest among women who increased their sugar-sweetened soft drink consumption from 1 or fewer drinks per week to 1 or more drinks per day (multivariate-adjusted means, 4.69 kg for 1991 to 1995 and 4.20 kg for 1995 to 1999) and was smallest among women who decreased their intake (1.34 and 0.15 kg for the 2 periods, respectively) after adjusting for lifestyle and dietary confounders. Increased consumption of fruit punch was also associated with greater weight gain compared with decreased consumption. After adjustment for potential confounders, women consuming 1 or more sugar-sweetened soft drinks per day had a relative risk [RR] of type 2 diabetes of 1.83 (95% confidence interval [CI], 1.42-2.36; P<.001 for trend) compared with those who consumed less than 1 of these beverages per month. Similarly, consumption of fruit punch was associated with increased diabetes risk (RR for 1 drink per day compared with <1 drink per month, 2.00; 95% CI, 1.33-3.03; P = .001).

Conclusion  Higher consumption of sugar-sweetened beverages is associated with a greater magnitude of weight gain and an increased risk for development of type 2 diabetes in women, possibly by providing excessive calories and large amounts of rapidly absorbable sugars.

Author Affiliations: Departments of Nutrition (Drs Schulze, Stampfer, Willett, and Hu) and Epidemiology (Drs Manson, Colditz, Willett, and Hu), Harvard School of Public Health, Division of Preventive Medicine (Drs Manson and Stampfer) and Channing Laboratory (Drs Manson, Colditz, Stampfer, Willett, and Hu), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Medicine, Children's Hospital (Dr Ludwig), Boston, Mass. Dr Schulze is now with the Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany.

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