Choice of Beverage May Help Reduce Mortality and CVD in Adults with Type 2 DM

According to the results of a recent prospective cohort research, adults with type 2 diabetes (T2D) who drank more sugar-sweetened beverages (SSB) had a greater chance of dying from any cause as well as cardiovascular disease (CVD) and CVD mortality. According to their findings, the risk of all-cause death was 20% higher.

Conversely, the authors found a strong negative relationship between use of healthy non-sugary drinks such coffee, tea, plain water, or low-fat milk and all-cause mortality among study participants, with decreases in risk of 26%, 21%, 23%, and 12%, respectively.

According to the authors, lead by Qi Sun, MD, associate professor in the departments of nutrition and epidemiology at the Harvard TH Chan School of Public Health, the range of health consequences of drinks depending on sugar content have been extensively established. Low-energy density drinks, such as water and low-fat milk, are categorically linked to a lower risk of cardiometabolic illness in the general population, while SSB are linked to a greater risk.

Even though some studies have found a beneficial relationship between coffee or tea, artificially sweetened beverages (ASB), and cardiometabolic risk factors in adults with T2D, the relationship between specific beverage consumption and CVD and mortality risk in this vulnerable population "remains largely unexplored."

The purpose of their research, according to the authors, was to investigate the relationship between individual beverage intake after a T2D diagnosis as well as changes in beverage preferences before and after a T2D diagnosis with the ensuing risk of CVD and all-cause death. Sun and colleagues also looked at the relationships between switching between different drinks and mortality and CVD risk.

Study population.

The Nurses' Health Study (1980–2018) and the Health Professionals Follow-Up Study (1986–2018) participants with prevalent T2D at baseline and those who received an incident T2D diagnosis during follow-up until 2018 were included in the analysis. Total individuals included in the study were 11 399 from the Nurses' Health Study and 4087 from the Health Professionals Follow-up Study (74% women; mean age 61 years), following exclusions for type 1 diabetes, CVD, or cancer at baseline and for inadequate dietary information.

Researchers only included 9252 women and 3519 men in the examination of change in beverage intake from before to after diagnosis after excluding those who had T2D at baseline or those with missing data.

Beverage intake was evaluated using a validated meal frequency questionnaire, which was revised every two to four years. The frequency of consumption of SSBs, ASBs, fruit juice, coffee, tea, full-fat milk, low-fat milk, or plain water of a certain portion size was inquired of the participants. All-cause mortality was the main outcome that was studied, whereas CVD incidence and mortality were secondary outcomes.

RESULTS

overall mortality - A total of 7638 (49.3%) deaths over an average of 18.5 years were reported. According to Sun and colleagues, those who consumed the most SSBs (more than one serving per day) had a 20% higher risk of dying from any cause than those who consumed the least (less than one serving per month). The all-cause mortality increased by 8% (95% CI, 2–14) for every serving per day spike in SSBs.

Researchers discovered, however, that drinking a lot of several drinks was linked to a decreased all-cause death rate: 26% for coffee, 21% for tea, 23% for plain water, and 12% for low-fat milk.

According to the study's findings, there was no discernible pattern of relationship shown for other drinks such ASBs, fruit juice, or full-fat milk.

Incident CVD - The study team identified a total of 3447 (22.3%) people with incident CVD throughout the course of the mean 18.5-year follow-up. greater consumption of SSBs was substantially related with a greater risk of CVD in the fully adjusted model, which is consistent with the results of all-cause mortality. When the greatest consumption was contrasted with the lowest intake, the multivariable HR of CVD was 1.25 (95% CI, 1.03 - 1.51). Increased use of coffee and low-fat milk was inversely linked with CVD incidence, with an 18% and 12% decreased risk, respectively, reflecting the results for all-cause mortality.

Coffee association - It's interesting to note that Sun et al discovered a substantial decrease in the risk of all-cause mortality was connected with an increase in coffee intake from before to after the diagnosis of T2D. Following a T2D diagnosis, participants who increased their coffee intake had an 18% lower risk of dying from any cause than participants who did not. Both low-fat milk (12% lower) and tea (16% lower) had similar patterns of relationship.

The researchers found that substituting 1 serving per day of SSBs with 1 serving per day of coffee was linked to an 18% lower risk of all-cause mortality and a 20% lower risk of CVD mortality; substituting 1 serving per day of SSBs with 1 serving per day of tea or plain water each reduced risk of all-cause death by 16% and CVD mortality by 24% and 20% respectively; and substituting 1 serving per day of SSBs with 1 serving per day of low-fat milk

Researchers found significant links between 8% and 15% decreased all-cause mortality and CVD mortality when a serving of ASB was substituted for 1 of SSB daily. According to the research, substituting coffee, tea, or plain water for one/serving of ASBs per day was likewise linked to decreased all-cause mortality.

Study advantages and disadvantages Nita G. Forouhi, MD, PhD, of the University of Cambridge School of Clinical Medicine, wrote in an editorial in the same issue, "As previous research was conducted in general populations, the new study credibly extends our understanding of the health implications of different beverages to adults with T2D." She continued by stating that large-scale, long-term randomized trials assessing therapies including many beverage kinds and dosages are impractical and commended Sun and colleagues for their large-scale research design, repeated data collecting, extensive follow-up, and thorough confounding variable correction.

Forouhi listed a number of unresolved issues, however, including whether findings would differ for coronary heart disease and stroke, the effects of adding sugar to coffee or tea, the preferable kind of tea, the effect of commonly consumed drinks that have not been evaluated. She also expressed doubts over the generalizability of the research's results to other demographic groups and to T2D of various severity as the study population was mostly white.

These knowledge gaps should be filled by further study. To get beyond the limits of subjective, perhaps inaccurate, and biased reporting of beverage intake, researchers might alternatively employ objective biomarkers.

Overall, these findings provide further evidence emphasizing the significance of beverage selection in preserving overall health in persons with diabetes.

Reference:

Ma L, Hu Y, Alperet DJ, et al. Beverage consumption and mortality among adults with type 2 diabetes: prospective cohort study. BMJ. 2023;381:e073406. Published online April 19, 2023. doi:10.1136/bmj-2022-073406