Sugar-sweetened beverages, low/no-calorie beverages, fruit juices intake and risks of metabolic syndrome in adults: The SWEET project.

Background and Aims: Metabolic syndrome (MetS) is an important determinant of cardiometabolic disease development, with excessive sugar intake as one of the key modifiable risk factors. However, evidence on the association between sugar-sweetened beverages (SSB), their replacement by low/no caloric beverages (LNCB), and MetS development is still limited.
Methods and Results: Data from participants' of Lifelines (n = 58 220), NQPlus (n = 1094) and Feel4Diabetes (n = 342) were prospectively analysed. Dose-response associations were investigated using restricted cubic spline analyses (Lifelines). Cox proportional hazard regression analysis with robust variance was used to quantify associations between intakes of SSB, fruit juices (FJ) and LNCB and MetS incidence; data were pooled using random-effects models. Associations were adjusted for demographic, lifestyle and other dietary factors. In Lifelines, NQPlus, and Feel4Diabetes, 3853 (7 %), 47 (4 %), and 39 (11 %) participants developed MetS, respectively. Pooled analyses showed that each additional serving of SSB was associated with a 6 % higher risk of MetS (95%CI 1.02-1.10). A J-shaped association was observed for FJ and MetS, with a significant inverse association at moderate intake levels (IPR 0.89, 95 % CI 0.82-0.96). LNCB intake was not associated with MetS (IPR 1.59, 95%CI 0.74-2.43), but findings across studies were inconsistent (I ² 94 %, p-value <0.01). Replacing SSB with FJ or LNCB did not show any associations with MetS incidence.
Conclusion: SSB intake was adversely associated with MetS incidence. A J-shaped association was observed between FJ and MetS. For LNCB, results were inconsistent across studies and therefore findings must be interpreted cautiously.
Competing Interests: Declaration of competing interest SSM-M has received recent research funding for epidemiological studies on dairy products and cardiometabolic diseases from the Dutch Dairy Association and the Danish Dairy Research Foundation. JCGH is a member of Dupont/IFF and Mars Scientific Advisory Boards and has received honorariums from the International Sweeteners Association together with AR. JCGH and JAH are also conducting the SWITCH trial funded by the American Beverage Association. JCGH and AR have received an honorarium from Unilever, the International Sweeteners Association, and Nestlé. In the past, EJMF has received an unrestricted grant from Friesland Campina and the European Beer Institute and conducted a study on added sugar and individual sugars partly funded by Kenniscentrum Suiker en Gezondheid (2011). Other authors have no conflicts of interest to be disclosed.
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