healthy beverage choices and of and cardiometabolicdiseases · coke ® pepsi ® mountain dew ® ......
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Healthy Beverage Choices and Prevention of Obesity, Diabetes, and
Cardiometabolic Diseases
Frank B. Hu, MD, PhDProfessor of Nutrition and Epidemiology
Harvard School of Public HealthProfessor of Medicine
Harvard Medical School
Harvard Public Health Review
What are Sugar-Sweetened Beverages?Examples
Sodas Fruit Drinks Energy Drinks
Coke ®
Pepsi ®
Mountain Dew ®
Orange SodaRoot BeerSprite ®
7-Up ®
Capri Sun ®Fruitopia ®
Hawaiian Punch ®
Hi-C ®
Kool-Aid ®
Minute Maid ®
Snapple juices ®
Adrenaline Rush ®
Full Throttle ®
MDX ®
No Fear ®
RockStar ®EnergyVault ®
Sports DrinksGatorade ®
Powerade ®
Wang et al. Pediatrics. 2008
Per capita calories from SSB in US children: 1988-2004
Soft drink ingredients
• Energy: 12-14 kcal/ounce
or ~120-150 kcal/12 ounce can
• Sugars: 3.1-3.6 g/ounce
(~10 tsp/12 ounce can)
• Sweetened by high fructose corn syrups (55%
fructose and 40% glucose)
0
10
20
30
40
50
60
70
Year
1969
1973
1977
1981
1985
1989
1993
1997
US Per Capita High Fructose Corn Syrup Disappearance1967 – 2000, Pounds / Year
SSB and ObesityStrong evidence points to a positive relationship between SSB and obesity
Teens: For every can of sugared soda per day, increased risk of obesity by 60%
In adults, regular consumption of SSB leads to greater weight gain
Source: Ludwig et al., Lancet, 2001; Schulze et al., JAMA, 2004
SSB and Obesity: Why? Fluids are not be as satiating as solid foods.
The body doesn't seem to "register" fluid calories as carefully as it does those from solid food.
Sweet‐tasting soft drinks might stimulate the appetite for other sweet, high‐carbohydrate foods.
1.501.85
1.061.001.39 1.41
1.00 1.11
0.00.51.01.52.02.5
<1/mo 1-4/mo 2-6/wk >=1/dSugar-sweetened soft drink consumption
Rel
ativ
e R
isk
multivariate adjusted multivariate + BMI
P<0.001 for trend
SSB and Risk of Type 2 Diabetes in the Nurses’ Health Study
Emerging evidence on heart disease The Nurses' Health Study, which tracked the health of nearly 90,000 women over two decades, found that women who drank more than two servings of SSB each day had a 40 percent higher risk of heart attacks or death from heart disease than women who rarely drank SSB.
Frequent consumption of SSB is also associated with high blood pressure and high triglycerides.
Fung et al, AJCN, 2009
SSB and Risk of Gout Gout is inflammatory arthritis with uric acid building up in the joints
Convincing evidence that regular consumption of SSB induces the production of uric acid and leads to high levels of blood uric acid.
One serving per day of SSB is associated with 50% increased risk of developing gout.
Juice: A healthier option?
Source: www.odwalla.com
Which has the most sugar?per 12 ounce serving
Source: www.thecoca-colacompany.com/presscenter/imagegallery.html, www.pepsiproductfacts.com/infobyproduct.php, http://www.welchs.com/products/juices-and-drinks/100-percent-grape-juice/100-percent-grape-juice, http://pomwonderful.com/products/
150 calories 195 calories 255 calories 240 calories
per 12 ounce serving
100% fruit juice
Fruit juice has vitamins and minerals, but it is high in calories, so stick to no more than a small glass (four to six ounces) a day.
Healthier beverage alternativesWater Coffee and tea Diet soda ?Milk ?
Beverage choices and weight gain
Changes in beverage intake and changes in weight
An Pan, 2011 (unpublished data)
Weight change associated with each increased daily servings, per 4-y period (Ib)
Beverage substitutions and type 2 diabetes
An Pan, 2011 (unpublished data)
Substitution model for type 2 diabetes
0.7 0.75 0.8 0.85 0.9 0.95 1
SSB by water
SSB by coffee
SSB by milk
SSB by tea
Fruit juice by water
Fruit juice by coffee
Fruit juice by milk
Fruit juice by tea
Diet Soda Some long‐term studies show that regular consumption of diet soda reduces calories and promotes weight loss or maintenance. Others show no effect, while some show weight gain.
“Diet” drinks with artificial sweeteners may condition our taste buds to crave super‐sweet foods.
SSB vs. Diet Sodas and Diabetes Risk ≥ 1/day P for trend
SSB
Age‐adjusted 1.25 (1.11‐1.39) <0.001
Multivariate 1.24 (1.08‐1.35) <0.001
Diet soda
Age‐adjusted 1.91 (1.09‐1.37) <0.001
Multivariate 1.09 (0.98‐1.21) 0.13
De Konning et al. AJCN 2011Adjusted for diabetes risk factors, high TG, HBP, previous weight change, dieting, baseline BMI
Harvard beverage guidelines Red: High sugar, drink sparingly
Yellow: New beverage industry targetNo more than 1 gram sugar/oz 70% less sugar than a typical soft drinkCannot contain calorie‐free sweeteners (no Splenda, Nutrasweet, Stevia, etc.)
Green: Best choice – sugar free or nearly sugar free
http://www.hsph.harvard.edu/nutritionsource/
Healthy beverage recommendations Quit the sugar habit. The average can of sugar‐sweetened soda or fruit punch has 150 calories. If you were to drinks just one can of SSB every day, and not cut back on calories elsewhere, you could gain up to 15 pounds in a year.
Cutting back on sugary drinks can help control your weight and lower risk of diabetes, heart disease, hypertension, and gout.
www.thenutritionsource.org
Healthy beverage recommendations Go calorie‐free naturally. “Diet” drinks with artificial sweeteners may condition our taste buds to crave super‐sweet foods.
Plain water is the best calorie‐free beverage—but if it’s just too plain, try adding a squeeze of lemon or lime or a splash of 100% fruit juice.
Un‐sweetened coffee and tea are also healthy calorie‐free choices.
Focus on healthier drinksBeverage manufacturersIndividualsFamily food shoppersFood service (schools, worksites), restaurantsGovernment
AcknowledgementLilian ChuengSari KalinAn PanVasanti MalikLarry DeKoningWalter Willet