Associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incident type 2 diabetes: meta-analysis of prospective cohort studies
| Beverages (No of cohorts) and models of meta-analysis* | Not adjusted for adiposity† | Adjusted for adiposity† | ||
|---|---|---|---|---|
| Relative risk (95% CI) | I2 (%) | Relative risk (95% CI) | I2 (%) | |
| Sugar sweetened beverages (n=17) | ||||
| Meta-analysis, crude: | 1.25 (1.14 to 1.37) | 89 | — | — |
| +multivariable adjusted | 1.18 (1.09 to 1.28) | 89 | 1.13 (1.06 to 1.21) | 79 |
| +calibration for information bias | 1.43 (1.20 to 1.70) | 86 | 1.28 (1.12 to 1.46) | 73 |
| +calibration for publication bias | 1.42 (1.19 to 1.69) | 85 | 1.27 (1.10 to 1.46) | 73 |
| Artificially sweetened beverages (n=10) | ||||
| Meta-analysis, crude: | 1.48 (1.35 to 1.62) | 85 | — | — |
| +multivariable adjusted | 1.25 (1.18 to 1.33) | 70 | 1.08 (1.02 to 1.15) | 64 |
| +calibration for information bias | 2.13 (1.57 to 2.88) | 72 | 1.29 (1.08 to 1.54) | 50 |
| +calibration for publication bias | 1.81 (1.33 to 2.47) | 76 | 1.22 (0.98 to 1.52) | 64 |
| Fruit juices (n=13) | ||||
| Meta-analysis, crude: | 0.97 (0.90 to 1.06) | 79 | — | |
| +multivariable adjusted | 1.05 (0.99 to 1.11) | 58 | 1.07 (1.01 to 1.14) | 51 |
| +calibration for information bias | 1.06 (0.98 to 1.14) | 49 | 1.10 (1.01 to 1.20) | 29 |
| +calibration for publication bias | Not detected | — | Not detected | — |
*Number of cohorts varied slightly by models (see figure 1). Crude meta-analysis pooled estimates without any adjustment. Multivariable adjusted estimates were based on meta-analysis of estimates adjusted for demographic and lifestyle covariates (see supplementary table S4 for details). Calibration for information bias accounted for within person variation for dietary consumption and imprecise ascertainment of self reported diabetes. Calibration for publication bias was carried out, if indicated in trim and fill analysis.
†Relative risk and 95% confidence intervals per serving/day before and after adjustment for adiposity. All relative risks were significant (P<0.05), except for artificially sweetened beverages after adjustment for publication bias (P=0.07).