Beverage Choice: Impact on Prediabetes, Weight


Two studies examined the effects of sugar-sweetened beverages on prediabetes and insulin resistance and of low-calorie beverages on weight loss.

Regular consumption of sugar-sweetened beverages, but not diet soda, is associated with increased risk of prediabetes and increased insulin resistance, according to a new study.

“Although our study cannot establish causality, our results suggest that high sugar-sweetened beverage intake increases the chances of developing early warning signs for type 2 diabetes. If lifestyle changes are not made, individuals with prediabetes are on the trajectory to developing diabetes," said senior author Nicola McKeown, PhD, associate professor at the Friedman School of Nutrition Science and Policy at Tufts University. “Our findings support recommendations to limit sugar-sweetened beverage intake, which can be achieved by replacing sugary beverages with healthier alternatives such as water or unsweetened coffee or tea. This is a simple dietary modification that could be of substantial health benefit to people who consume sugary drinks daily and who are at increased risk of diabetes.”

The researchers published their results in The Journal of Nutrition.

McKeown and colleagues analyzed longitudinal data on 1685 middle-aged adults over a period of 14 years, obtained from the Framingham Heart Study's Offspring cohort. The participants did not have diabetes or prediabetes during an initial baseline examination. Using food frequency questionnaires, they self-reported long-term sugar-sweetened beverage and diet soda consumption. Sugar-sweetened beverages were defined as colas and other carbonated beverages, and non-carbonated fruit drinks, such as lemonade and fruit punch, but not fruit juice.

After adjustment for multiple potential confounders, including baseline BMI, sugar-sweetened beverage intake was positively associated with prediabetes. The highest consumers (more than three servings per week, with median six servings per week) had a 46% higher risk of developing prediabetes and higher insulin resistance than did those who did not drink sugar-sweetened beverages.

There were no associations between diet soda intake -- defined as low-calorie cola or other carbonated low-calorie beverages -- and risk of prediabetes or changes in insulin resistance, even after additional adjustments for change in BMI.

The researchers noted that the participants were mostly middle-aged and Caucasian, more likely to be women, and had lower body mass index and waist circumference.

The results are consistent with other studies that support the health benefits of reducing sugar intake, noted the researchers.

Replacing Diet Drinks with Water Speeds Weight Loss in Type 2 Diabetes

Another new study suggests that replacing low-calorie diet drinks with water can help increase the rate of weight loss in obese women with type 2 diabetes mellitus (T2DM) and improve their insulin sensitivity.

A group of 81 overweight and obese women with T2DM, who usually consumed diet beverages, were asked to either substitute those drinks for water or continue drinking diet beverages five times a week after lunch for 24 weeks during a weight loss program.

The water group not only lost more weight but also had decreases in BMI, fasting plasma glucose, fasting insulin, insulin resistance, and in two-hour postprandial glucose as compared to the diet beverage group.

The researchers published their results in Diabetes, Obesity and Metabolism.


1. Ma J, et al. Sugar-sweetened beverage but not diet soda consumption is positively associated with progression of insulin resistance and prediabetes. J Nutr. 2016 Nov 30.

2. Madjd A, et al. Beneficial effects of replacing diet beverages with water on type 2 diabetic obese women following a hypo-energetic diet: a randomized, 24-week clinical trial. Diabetes Obes Metab. 2016 Oct 16.

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