Sugar sweetened beverages intake and risk of obesity and cardiometabolic diseases in longitudinal studies: A systematic review and meta-analysis with 1.5 million individuals.

Abstract

Sugar-sweetened beverages (SSB) are associated with adverse outcomes in adults and understanding the strength, consistency and biological gradient of the association between SSB consumption and health-related outcomes is important. We aimed to examine longitudinal associations between sugar-sweetened beverages (SSB) intake and obesity and cardiometabolic diseases (type 2 diabetes, coronary heart disease and stroke) in adults. We performed a systematic review and meta-analysis searching for articles published until December 2021 in the Pubmed, Lilacs, Web of Science, Cochrane, Embase, and Scopus databases (PROSPERO CRD42021234206). After screening of more than 18 thousand titles and abstracts, 27 longitudinal studies were included in the review with all of them presenting medium or high methodological quality. None of the selected studies were from low-income countries and only three were conducted in middle-income countries. Type 2 diabetes was the most investigated disease - outcome in 15 out of 27 studies. Around 80% of the studies enrolled more than 10,000 individuals in the sample, and almost half of them followed the subjects for less than 10 years. A total of 1.5 million individuals were included in the pooled analyses, and results indicated that SSB intake increased the risk of type 2 diabetes (RR=1.20; 95% C.I. 1.13-1.28), obesity (RR=1.17; 95% C.I. 1.10-1.25), coronary heart disease (RR=1.15; 9% C.I. 1.06-1.25), and stroke (RR=1.10; 9% C.I. 1.01-1.19) in adults after adjustment for all potential confounders. Our systematic review and meta-analysis demonstrated that consumption of SSB intake appears to increase the risk obesity and cardiometabolic diseases, being the strongest evidence for type 2 diabetes. Actions are needed to be taken to reduce the SSB intake and its consequences worldwide.