{
    "abstract": "A positive association between sugar-sweetened beverages (SSBs) and diabetes risk has been shown, with inconsistent evidence between artificially sweetened beverages (ASBs) and diabetes. Moreover, it is uncertain if physical activity can mitigate the negative effects of these beverages on diabetes development. Therefore, we aimed to evaluate the independent and joint associations between SSB or ASB consumption and physical activity on the risk of type 2 diabetes.\nWe followed 64,029 women in the Nurses' Health Study (1980-2016), 88,340 women in the Nurses' Health Study II (1991-2017) and 39,436 men in the Health Professionals Follow-up Study (1986-2016). SSB and ASB consumption was calculated from food-frequency questionnaires administered every 4 years, while physical activity data were collected biennially. A validated supplementary questionnaire on diabetes symptoms, diagnostic tests and treatment confirmed type 2 diabetes cases. Multivariable Cox proportional hazards regression models were used to calculate HRs and 95% CIs for developing type 2 diabetes.\nDuring 5,105,351 person-years of follow-up, we recorded 19,940 new cases of type 2 diabetes. Compared with those who never or rarely consumed SSBs or ASBs, those who consumed \u22652 servings/day had a 41% (HR 1.41 [95% CI 1.33, 1.50]) and 11% (HR 1.11 [95% CI 1.07, 1.16]) higher risk of type 2 diabetes, respectively. For participants meeting physical activity guidelines (\u22657.5 metabolic equivalent of task [MET] h/week) and consuming \u22652 servings/week of SSBs or ASBs, the risk was 22% (HR 1.22 [95% CI 1.15, 1.29]) and 7% (HR 1.07 [95% CI 1.02, 1.12]) higher, respectively, compared with those who met physical activity guidelines and never or rarely (<1 serving/month) consumed these beverages. For participants meeting the physical activity guidelines and consuming 1-4 servings/month of SSBs, there was a 9% (HR 1.09 [95% CI 1.02, 1.15]) higher risk of type 2 diabetes. Compared with the reference group (those who met physical activity guidelines and consumed <1 SSB serving/month), adults who did not meet physical activity guidelines (<7.5 MET h/week) and who never or rarely (<1 serving/month) consumed SSBs, had 1-4 SSB servings/month, or had \u22652 SSB servings/week, the HRs (95% CIs) were 1.22 (1.13, 1.31), 1.28 (1.20, 1.37), and 1.51 (1.43, 1.61), respectively. Similarly, for ASB consumption, adults who did not meet physical activity guidelines and who never or rarely (<1 serving/month) consumed ASBs, had 1-4 servings/month, or had \u22652 servings/week, the HRs (95% CIs) were 1.21 (1.14, 1.28), 1.21 (1.13, 1.30), and 1.30 (1.23, 1.37) compared with the reference group (who met physical activity guidelines and consumed <1 ASB serving/month).\nEven when individuals were physically active, a higher consumption of SSBs or ASBs was associated with a higher risk of type 2 diabetes. Meeting physical activity guidelines reduced the impact of SSB and ASB consumption on diabetes risk, underscoring the need to promote physical activity as part of lifestyle modifications to lower diabetes incidence.",
    "authors": [
        {
            "affiliation": "Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. lpacheco@hsph.harvard.edu.",
            "firstname": "Lorena S",
            "initials": "LS",
            "lastname": "Pacheco"
        },
        {
            "affiliation": "Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.\nDivision of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.",
            "firstname": "Deirdre K",
            "initials": "DK",
            "lastname": "Tobias"
        },
        {
            "affiliation": "Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.\nChanning Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.",
            "firstname": "Danielle E",
            "initials": "DE",
            "lastname": "Haslam"
        },
        {
            "affiliation": "Facult\u00e9 de Pharmacie, Universit\u00e9 Laval, Quebec City, Quebec, Canada.\nCentre Nutrition Sant\u00e9 et Societ\u00e9 (NUTRISS), Institut Sur la Nutrition et les Aliments Fonctionnnels (INAF), Universit\u00e9 Laval, Quebec City, Quebec, Canada.",
            "firstname": "Jean-Philippe",
            "initials": "JP",
            "lastname": "Drouin-Chartier"
        },
        {
            "affiliation": "Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.",
            "firstname": "Yanping",
            "initials": "Y",
            "lastname": "Li"
        },
        {
            "affiliation": "Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.\nChanning Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.",
            "firstname": "Shilpa N",
            "initials": "SN",
            "lastname": "Bhupathiraju"
        },
        {
            "affiliation": "Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.\nDepartment of Epidemiology, Harvard School of Public Health, Boston, MA, USA.",
            "firstname": "Walter C",
            "initials": "WC",
            "lastname": "Willett"
        },
        {
            "affiliation": "Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.\nNew Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA.",
            "firstname": "David S",
            "initials": "DS",
            "lastname": "Ludwig"
        },
        {
            "affiliation": "New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA.",
            "firstname": "Cara B",
            "initials": "CB",
            "lastname": "Ebbeling"
        },
        {
            "affiliation": "Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.\nChanning Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.\nDepartment of Epidemiology, Harvard School of Public Health, Boston, MA, USA.",
            "firstname": "Frank B",
            "initials": "FB",
            "lastname": "Hu"
        },
        {
            "affiliation": "Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. marta.guasch@sund.ku.dk.\nDepartment of Public Health, Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. marta.guasch@sund.ku.dk.\nNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. marta.guasch@sund.ku.dk.",
            "firstname": "Marta",
            "initials": "M",
            "lastname": "Guasch-Ferr\u00e9"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2025. The Author(s).",
    "doi": "10.1007/s00125-024-06351-w",
    "journal": "Diabetologia",
    "keywords": [
        "Artificial sweetener",
        "Beverages",
        "Exercise",
        "Incidence",
        "Nutritional epidemiology",
        "Observational study",
        "Sucrose",
        "Type 2 diabetes"
    ],
    "methods": null,
    "publication_date": "2025-01-08",
    "pubmed_id": "39774686\n24910231\n26199070\n28659294\n30354445\n21430119\n31582428\n30602577\n26430511\n27747395\n38185281\n22513989\n23620057\n17327354\n35064240\n33121725\n27090230",
    "results": "During 5,105,351 person-years of follow-up, we recorded 19,940 new cases of type 2 diabetes. Compared with those who never or rarely consumed SSBs or ASBs, those who consumed \u22652 servings/day had a 41% (HR 1.41 [95% CI 1.33, 1.50]) and 11% (HR 1.11 [95% CI 1.07, 1.16]) higher risk of type 2 diabetes, respectively. For participants meeting physical activity guidelines (\u22657.5 metabolic equivalent of task [MET] h/week) and consuming \u22652 servings/week of SSBs or ASBs, the risk was 22% (HR 1.22 [95% CI 1.15, 1.29]) and 7% (HR 1.07 [95% CI 1.02, 1.12]) higher, respectively, compared with those who met physical activity guidelines and never or rarely (<1 serving/month) consumed these beverages. For participants meeting the physical activity guidelines and consuming 1-4 servings/month of SSBs, there was a 9% (HR 1.09 [95% CI 1.02, 1.15]) higher risk of type 2 diabetes. Compared with the reference group (those who met physical activity guidelines and consumed <1 SSB serving/month), adults who did not meet physical activity guidelines (<7.5 MET h/week) and who never or rarely (<1 serving/month) consumed SSBs, had 1-4 SSB servings/month, or had \u22652 SSB servings/week, the HRs (95% CIs) were 1.22 (1.13, 1.31), 1.28 (1.20, 1.37), and 1.51 (1.43, 1.61), respectively. Similarly, for ASB consumption, adults who did not meet physical activity guidelines and who never or rarely (<1 serving/month) consumed ASBs, had 1-4 servings/month, or had \u22652 servings/week, the HRs (95% CIs) were 1.21 (1.14, 1.28), 1.21 (1.13, 1.30), and 1.30 (1.23, 1.37) compared with the reference group (who met physical activity guidelines and consumed <1 ASB serving/month).",
    "title": "Sugar-sweetened or artificially sweetened beverage consumption, physical activity and risk of type 2 diabetes in US adults.",
    "xml": "<Element 'PubmedArticle' at 0x788503733510>"
}