WuXi AppTec Content Team Editor
Overweight and obesity are major risk factors for many chronic diseases. The global prevalence of overweight and obesity has nearly tripled over the past 40 years and is one of the most serious and unsolved public health challenges of the 21st century.
Being overweight or obese is associated with a variety of physiological, environmental, and dietary behaviors, and consumption of sugar-sweetened beverages is an important risk factor. Numerous studies link sugar-sweetened beverages with increased risk of weight gain, type 2 diabetes, cardiovascular disease, and certain types of cancer.
Recently, Harvard HuChang Chang(Frank B. Hu)Professor strong>And Professor Vasanti S. Malik‘s review in Nature Reviews Endocrinology provides an in-depth discussion of the impact of sugar-sweetened beverages in the global obesity and chronic disease epidemics . This article analyzes trends in sugar-sweetened beverage intake, reviews the evidence and potential biological mechanisms associated with sugar-sweetened beverages in obesity, metabolic cardiovascular disease, and cancer, and suggests alternative beverage choices strong>.
Screenshot source: Nature Reviews Endocrinology
There is currently no consensus on the definition of sugar-sweetened beverages in various countries. In this review, the researchers defined it as any beverage with added caloric sweeteners, such as sucrose, high fructose corn syrup, fruit juice concentrates, and starch sugars, as a sugar-sweetened beverage. One serving (355ml) of a typical sugar-sweetened beverage such as soda contains 35.0g to 37.5g sugar and 140kcal to 150kcal.
The study begins by pointing out that the intake of sugar-sweetened beverages has been high globally since the early 2000s. Although the intake in high-income countries has decreased slightly, the overall intake level is still higher than the recommended intake; compared with high-income or low-income countries, the intake of sugar-sweetened beverages in middle-income countries due to economic development has increased Quantity and supply are steadily increasing.
Next, the paper focuses on the effects of sugar-sweetened beverages on metabolic cardiovascular disease (including obesity, cardiovascular disease, diabetes, gout, etc.) and cancer.
Metabolic cardiovascular diseases (cardiometabolic diseases) refer to a causal relationship between metabolic abnormalities and cardiovascular damage. Other cardiovascular causes are excluded, and cardiovascular and cerebrovascular events are the main outcome. a clinical syndrome. The pathogenesis of the disease is complex, and metabolic abnormalities mediated by energy metabolism imbalance play an important role. The main risk factors are lack of exercise, smoking and unhealthy diet.
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Sugar-sweetened beverages are strongly associated with multiple diseases
01
Obesity
Many meta-analyses have combined evidence on sugar-sweetened beverages and weight gain/obesity. Taken together, every additional serving of sugar-sweetened beverages per day was associated with a 1-year weight gain in adults of 0.12 kg to 0.85 kg. Limiting sugar-sweetened beverages may be an effective way to prevent weight gain at all ages and help children develop healthy weights, the study noted.
02
Type 2 diabetes
A large body of literature shows that consumption of sugar-sweetened beverages is associated with a higher risk of type 2 diabetes, whether through weight gain or through other independent metabolic pathways. One study found that adding one sugar-sweetened beverage a day was associated with an 18% increased risk of type 2 diabetes.
03
Cardiovascular disease
A growing body of evidence links sugar-sweetened beverage consumption to risk of cardiovascular disease. A meta-analysis found that one more sugar-sweetened beverage per day was associated with an 8% to 9% increased risk of cardiovascular disease and a 15% increased risk of coronary heart disease. In addition, studies have found that sugar-sweetened beverage intake is associated with increased blood pressure (mean systolic pressure increased by 6.9 mmHg; mean diastolic pressure increased by 5.6 mmHg) and dyslipidemia.
There is also a link between sugar-sweetened beverage consumption and mortality. Participants had an 8% increased risk of death from cardiovascular disease for each additional serving of sugar-sweetened beverages per day; ≥2 per day compared to those who consumed no or less than one sugar-sweetened beverage per month Participants who consumed sugar-sweetened beverages had a 31% increased risk of death from cardiovascular disease.
04
nonalcoholic fatty liver disease
Research has found that every additional serving of sugar-sweetened beverages per day is associated with nonalcoholic fatty liver diseaseA 39% increased risk of disease may be due to excess energy in sugar, which may affect metabolism, induce hepatic steatosis, and increase serum concentrations of liver function biomarkers such as alanine aminotransferase.
05
Gout
Consumption of fructose-containing beverages is associated with hyperuricemia and gout. The meta-analysis found that those with the highest intake of sugar-sweetened beverages had twice the risk of developing gout compared with those with the lowest intake of sugar-sweetened beverages; increasing weekly intake of sugar-sweetened beverages was associated with an increased risk of gout4 % related.
06
Cancer
Consumption of sugar-sweetened beverages may increase the risk of certain cancers due to excess obesity and metabolic disorders. Obesity, insulin resistance and type 2 diabetes are risk factors for different cancers. Consumption of sugar-sweetened beverages was found to be associated with a 14% increased risk of breast cancer and an 18% increased risk of prostate cancer, and sugar-sweetened beverage consumption was also associated with an increased risk of colorectal and pancreatic cancer. No link has been observed between sugar-sweetened beverages and bladder or renal cell cancer.
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Sugar-sweetened beverages disrupt health through these mechanisms
Consumption of sugar-sweetened beverages is related to a variety of diseases. Understanding the underlying biological mechanisms in the process of disease occurrence and development will help to intervene in metabolic disorders, control the disease, and improve the prognosis.
▲Intake of sugar-sweetened beverages and biological mechanisms of obesity, metabolic cardiovascular disease and cancer development. (Source of screenshot: Reference [1])
01
Increased calorie intake
Sugar-sweetened beverages are generally less satiety than solid foods, and people involuntarily consume more energy, although the mechanism for this lack of compensatory responses remains unclear Yes, but consuming fructose itself may increase body weight by reducing resting energy expenditure and inducing leptin resistance.
02
Sugar addiction
Consumption of sugar-sweetened beverages may activate the dopamine reward system and trigger addictive-like behaviors that make us crave more and change our eating tastes and habits.
03
High glycemic load
Sugar-sweetened beverages have a higher glycemic index and are also higher in energy, which can lead to a higher glycemic load when consumed. A high glycemic load causes a rapid rise in blood glucose and insulin levels, which alters metabolism (reduces energy expenditure) and increases hunger and weight.
04
Independent metabolism of fructose
In the presence of glucose, the absorption of fructose (high fructose corn syrup or sucrose) in the intestine is enhanced, and fructose is converted into glucose, lactic acid and fatty acids in the liver, which are rapidly and completely Absorption; however, when fructose is ingested in excess, increased de novo synthesis of fatty acids in the liver can lead to atherosclerotic dyslipidemia and insulin resistance.
Fructose intake has also been found to promote visceral adipose tissue accumulation and ectopic lipid deposition in humans. Metabolism of fructose in the liver also depletes energy in liver cells, resulting in increased uric acid production.
05
Increased uric acid production
Fructose is the only sugar known to increase uric acid production in the liver. Hyperuricemia is not only a precursor to gout, but may also be associated with hypertension, type 2 diabetes and obesity by inducing renal disease, endothelial dysfunction, and activation of the renin-angiotensin system. In addition, overproduction of uric acid was also associated with reduced levels of nitric oxide in endothelial cells, which may partially explain the link between fructose-containing beverages and coronary heart disease.
Sugar-sweetened beverages promote the development of various diseases, partly through weight gain, partly through the independent metabolism of glucose and fructose, and possibly because sugar-sweetened beverages promote insulin Resist, exacerbate the production of inflammatory biomarkers.
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These drinks can replace sugary drinks
01
Artificially sweetened beverages
Artificial sweeteners have almost no calories but are many times sweeter than natural sugars such as cane sugar, such as aspartame, acesulfame potassium, cyclamate, and saccharin. The study showed that replacing sugar-sweetened beverages with artificial sweeteners was associated with a reduction in weight loss, type 2 diabetes prevalence and mortality among participants.
But different artificial sweeteners may cause different physiological effects, such as saccharin and sucralose, which appear to stimulate sweet taste receptors and activate the first-phase insulin response (CPIR, Glucose induces rapid release of insulin “stocks” in beta cells). The study found that sucralose was associated with modest weight loss, but saccharin was associated with modest weight gain, and aspartame had no effect on weight compared with sucrose intake.
While replacing sugar-sweetened beverages with artificial sweeteners may be a useful strategy for reducing cardiometabolic risk, further research is needed to better understand the effects of individual sweeteners, and how Consequences of consuming artificial sweeteners throughout life. The ultimate goal is to switch to water or other healthy beverages.
02
Juice
Whether 100% fruit juice is an alternative to sugar-sweetened beverages is a matter of debate. Studies have found that fruit juice intake is associated with increased risk of weight gain and type 2 diabetes, while fruit consumption has the opposite conclusion. Part of the reason may be that the dietary fiber in fruit reduces the rate at which fructose is absorbed, whereas large amounts of fructose in fruit juice are rapidly absorbed, leading to increased fructose concentrations in the liver, which can affect metabolism.
Higher fruit juice intake was associated with a higher risk of death than lower fruit juice intake. However, there are also studies reporting that drinking fruit juice is beneficial for reducing cardiometabolic risk. Further research on different types of fruit juices is recommended due to the different nutrient content and sugar content of different fruit juices.
03
Water, tea and coffee
Water is sugar-free and calorie-free, making it the best drink for hydration. The study found that replacing one sugar-sweetened beverage with water a day was associated with weight loss and a reduced risk of type 2 diabetes. Using different types of sparkling water or beverages with artificial sweeteners may help us develop the habit of drinking water gradually.
Many studies have shown that drinking 2 to 5 cups of tea per day is associated with a reduced risk of type 2 diabetes and cardiovascular disease due to the high levels of bioactive substances in coffee and tea; Replacing one serving of sugar-sweetened beverages with coffee was associated with a 17% lower risk of type 2 diabetes. Coffee and tea can be a healthy alternative to sugar-sweetened beverages in the absence of any contraindications (eg, in groups such as pregnant women and children) and when caloric sweeteners and creamers are restricted.
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Summary
There is strong evidence that consumption of sugar-sweetened beverages can affect metabolic cardiovascular disease and cancer through multiple mechanisms. Action is urgently needed to prevent obesity, and reducing the intake of sugar-sweetened beverages is an important step in improving overall diet quality.