Drinking more coffee, tea, water, low-fat milk cuts mortality risk in type 2 diabetes
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Key takeaways:
- Adults with type 2 diabetes who drink more coffee, tea, water or low-fat milk have lower all-cause mortality risk.
- Replacing one daily sugar-sweetened drink for artificially sweetened cut risk for death by 8%.
Adults with type 2 diabetes who drink more coffee, tea, water and low-fat milk have a lower risk for all-cause mortality, and replacing sugar-sweetened beverages with healthier drinks after diabetes diagnosis can reduce mortality risk.
In a study published in The BMJ, researchers analyzed beverage consumption among a cohort of adults diagnosed with type 2 diabetes and found drinking sugar-sweetened beverages was associated with increased risks for all-cause mortality, cardiovascular disease incidence and CVD mortality. Replacing sugar-sweetened beverages with other drinks, including artificially-sweetened beverages, after type 2 diabetes diagnosis was linked with a lower risk for death.
“Beverages are an important component of diet for diabetes patients,” Qi Sun, MD, ScD, associate professor in the departments of nutrition and epidemiology at Harvard T.H. Chan School of Public Health and in the Channing Division of Network Medicine at Brigham and Women’s Hospital and Harvard Medical School, told Healio. “Individuals living with diabetes shall be picky about what beverages they consume each day to maintain hydration. Healthy beverages such as coffee, tea, plain water and low-fat milk shall be considered in lieu of sugar-sweetened beverages or high-fat milk.”
Researchers conducted a prospective cohort study of adults with type 2 diabetes who enrolled in either the Nurses’ Health Study in 1980 or the Health Professionals Follow-Up Study in 1986. Participants who had type 2 diabetes at baseline in both studies or who were diagnosed with incident type 2 diabetes during follow-up were included. Beverage intake was assessed using food frequency questionnaires administered every 2 to 4 years. Adults provided the average amount of servings they drank for sugar-sweetened beverages, artificially-sweetened beverages, fruit juice, coffee, tea, low-fat milk, full-fat milk or plain water. Five intake groups were formed for each beverage type, with the lowest intake group drinking less than one serving per month and the highest intake group drinking more than one serving per day. Diabetes diagnoses were self reported. Mortality data were collected from reports by next of kin or postal authorities, or data from the National Death Index. Incident CVD was defined as fatal and nonfatal coronary heart disease or stroke.
Drinking more coffee, tea and water reduces mortality risk
There were 15,486 adults included in the study (mean age, 61.3 years; 73.6% women). Over a mean follow-up of 18.5 years, 49.3% of the cohort died.
Adults who consumed more than one serving per day of sugar-sweetened beverages had a higher all-cause mortality risk compared with those in the lowest intake group (adjusted HR = 1.2; 95% CI, 1.04-1.37). Compared with adults in the lowest intake group, those who had more than one serving per day of coffee (aHR = 0.74; 95% CI, 0.63-0.86), tea (aHR = 0.79; 95% CI, 0.71-0.89), plain water (aHR = 0.77; 95% CI, 0.7-0.85) and low-fat milk (aHR = 0.88; 95% CI, 0.8-0.96) had a lower risk for all-cause mortality. No difference in mortality risk was observed for artificially-sweetened beverages, fruit juice or full-fat milk.
“The positive association between sugar-sweetened beverage intake and adverse health outcomes may relate to the high fructose content in liquid form,” the researchers wrote. “The added high fructose corn syrup and sucrose in sugar-sweetened beverages may lead to weight gain, insulin resistance and inflammation. A postprandial spike in blood glucose and insulin concentrations after sugar-sweetened beverage consumption may potentially lead to hyperinsulinemia, lipogenesis and insulin resistance over time, which is particularly harmful for adults with diabetes.”
Of the cohort, 22.3% developed incident CVD during follow-up. Adults who consumed more than one serving of sugar-sweetened beverages per day had a higher risk for CVD than those who didn’t consume sugar-sweetened beverages (aHR = 1.25; 95% CI, 1.03-1.51). Adults who drank more than one serving of coffee (aHR = 0.82; 95% CI, 0.69-0.98) or low-fat milk (aHR = 0.88; 95% CI, 0.78-1) had a lower CVD risk than those who did not drink those beverages.
Adults who increased their coffee consumption after diabetes diagnosis reduced their risk for all-cause mortality by about 18%. Similar associations were seen for those who increased their tea and low-fat milk consumption. Replacing one serving per day of sugar-sweetened beverages with coffee, tea, water or low-fat milk cut mortality risk by 12% or more. Replacing one serving per day of sugar-sweetened beverages with an artificially-sweetened beverage also cut the risk for all-cause mortality by 8% and for CVD death by 15%.
“These findings clearly showed that different beverages lead to divergent health effects among diabetes patients,” Sun said. “Glycemic control is critical for diabetes patients to manage the disease. Beverages such as sugar-sweetened beverages will exacerbate the glycemia, whereas beverages such as coffee, tea and plain water do the opposite. Just like dietary advice for foods, quality is critical for the choice of beverages.”
More research needed
In a related editorial, Nita G. Forouhi BMedSci, MBBS, MSc, PhD, MRCP, FFPH, program leader of the nutritional epidemiology program in the Medical Research Council Epidemiology Unit at the University of Cambridge School of Clinical Medicine, wrote that the study added to research on the health implications of different beverage types for adults with type 2 diabetes. She noted, however, that several questions remained, including whether associations would vary for CHD or stroke individually, whether sugar added to coffee or tea would change the results and whether the reduced risk with tea consumption differed by the type of tea. Additionally, Forouhi noted some drinks that are linked to an increased risk for type 2 diabetes, including milkshakes, smoothies, yogurt drinks and hot chocolate, were not included in the study. She said more studies are needed to answer those questions.
“Choice of beverage clearly matters,” Forouhi wrote. “The case for avoiding sugar-sweetened beverages is compelling, and it is supported by various fiscal measures in more than 45 countries. Although the evidence is less clear for artificially sweetened beverages and fruit juice, it is reasonable to shift the focus to drinks that are most likely to have positive health impacts: coffee, tea, plain water and low-fat milk.”
For more information:
Qi Sun, MD, ScD, can be reached at qisun@hsph.harvard.edu.
Reference:
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