Abstract
Sugar-sweetened beverages (SSBs) are consumed globally, and have been associated with adverse health outcomes, including weight gain, high blood pressure, type 2 diabetes (T2D), and cardiovascular disease (CVD). There is global variation in beverage formulation in terms of glucose and fructose concentration, which may pose unique health risks linked to glycemic control for Australian consumers. However, previous systematic reviews have overlooked Australian-based literature. A systematic review was performed to synthesise evidence for the associations between consumption of SSBs and intense-sweetened beverages with clinical cardiometabolic risk factors in the Australian population. Articles were sourced from Global Health, Health Source: Nursing/Academic Edition, Medline, and Culmative Index to Nursing and Allied Health Literature. To be eligible for review, studies had to report on the consumption of sugar-sweetened (including fruit juice and fruit drinks) and/or intense-sweetened beverages, and at least one clinical cardiometabolic risk factor. Eighteen studies were included in this review. Research has mostly focused on the relationship between SSB consumption and adiposity-related outcomes. No studies have examined indices of glycaemic control (glucose/insulin), and the evidence for the health impact of intense-sweetened drinks is limited. In addition, studies have primarily been of cross-sectional design, and have examined children and adolescents, as opposed to adult populations. In the Australian population, there is modest but consistent evidence that SSB consumption has adverse associations with weight, but there is insufficient data to assess relationships with cardiometabolic outcomes.
Highlights
Sugar-sweetened beverage (SSB) consumption is of major global public health interest, with research suggesting associations with adverse health outcomes including overweight/obesity, high blood pressure, type 2 diabetes, and cardiovascular disease [1,2,3]
Systematic reviews have investigated the prospective relationship of SSB consumption with type 2 diabetes (T2D) [8] and metabolic syndrome [9], evidence is inconsistent as to whether relationships are attenuated when indices of weight are included as a covariate [10,11]
We have recently shown that Australian soft drinks have a 22% higher total glucose concentration compared to U.S.A. formulations, which are sweetened with high-fructose corn syrup [20]
Summary
Sugar-sweetened beverage (SSB) consumption is of major global public health interest, with research suggesting associations with adverse health outcomes including overweight/obesity, high blood pressure, type 2 diabetes, and cardiovascular disease [1,2,3]. Systematic reviews have investigated the prospective relationship of SSB consumption with type 2 diabetes (T2D) [8] and metabolic syndrome [9], evidence is inconsistent as to whether relationships are attenuated when indices of weight are included as a covariate [10,11]. Rarely have systematic reviews included Australian-based studies, with evidence largely limited to Western Europe and North America [12]. There has been a recent growth in the number of Australian-based studies examining SSB consumption (for example, [13,14,15]) and associated health impacts. This, in addition to recent interest in a national obesity strategy including a sugar tax [16], make a systematic review both feasible and timely
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