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J Nutr. 2016 Dec;146(12):2544-2550. Epub 2016 Nov 9.

Sugar-Sweetened Beverage but Not Diet Soda Consumption Is Positively Associated with Progression of Insulin Resistance and Prediabetes.

Author information

Nutritional Epidemiology Laboratory.
Division of General Internal Medicine, Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA; and.
Framingham Heart Study, Population Science Branch, National Heart, Lung, and Blood Institute, Framingham, MA.
Nutrition and Genomics Laboratory, and.
Energy Metabolism Laboratory, USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA.
Nutritional Epidemiology Laboratory,



Previous studies have shown an inconsistent relation between habitual beverage consumption and insulin resistance and prediabetes.


The objective of the present study was to test the hypothesis that the consumption of sugar-sweetened beverages (SSBs), rather than diet soda, is associated with long-term progression of insulin resistance and the development of prediabetes.


We analyzed the prospective association between cumulative mean consumption of SSBs or diet soda and incident prediabetes (n = 1685) identified across a median of 14 y of follow-up in participants [mean ± SD age: 51.9 ± 9.2 y; 59.6% women; mean ± SD body mass index (BMI; kg/m2): 26.3 ± 4.4] of the Framingham Offspring cohort. The prospective association between beverage consumption and change in homeostasis model assessment of insulin resistance (HOMA-IR; n = 2076) over ∼7 y was also analyzed. The cumulative mean consumption of SSBs and diet soda was estimated by using food-frequency questionnaires. Multivariable Cox proportional hazards models and linear regression models were implemented to estimate the HRs of incident prediabetes and change in HOMA-IR, respectively.


After adjustment for multiple potential confounders, including baseline BMI, we observed that SSB intake was positively associated with incident prediabetes (P-trend < 0.001); the highest SSB consumers (>3 servings/wk; median: 6 servings/wk) had a 46% higher risk of developing prediabetes than did the SSB nonconsumers (HR: 1.46; 95% CI: 1.16, 1.83). Higher SSB intake was also associated with a greater increase in HOMA-IR (P-trend = 0.006). No prospective associations were observed between diet soda intake and risk of prediabetes (P-trend = 0.24) or changes in HOMA-IR (P-trend = 0.25). These associations were similar after additional adjustment for change in BMI.


Regular SSB intake, but not diet soda intake, is associated with a greater increase in insulin resistance and a higher risk of developing prediabetes in a group of middle-aged adults.


HOMA-IR; diet soda; insulin resistance; prediabetes; sugar-sweetened beverages

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