Sugar and artificially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose–response meta-analysis of prospective cohort studies

Although consumption of sugar-sweetened beverages (SSBs) and artificially sweetened beverages (ASBs) has increasingly been linked with obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality, evidence remains conflicted and dose-response meta-analyses of the associations are lacking. We conducted an updated meta-analysis to synthesize the knowledge about their associations and to explore their dose-response relations. We comprehensively searched PubMed, EMBASE, Web of Science, and Open Grey up to September 2019 for prospective cohort studies investigating the associations in adults. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated for the dose-response association. Restricted cubic splines were used to evaluate linear/non-linear relations. We included 39 articles in the meta-analysis. For each 250-mL/d increase in SSB and ASB intake, the risk increased by 12% (RR = 1.12, 95% CI 1.05-1.19, I 2  = 67.7%) and 21% (RR = 1.21, 95% CI 1.09-1.35, I 2  = 47.2%) for obesity, 19% (RR = 1.19, 95% CI 1.13-1.25, I 2  = 82.4%) and 15% (RR = 1.15, 95% CI 1.05-1.26, I 2  = 92.6%) for T2DM, 10% (RR = 1.10, 95% CI 1.06-1.14, I 2  = 58.4%) and 8% (RR = 1.08, 95% CI 1.06-1.10, I 2  = 24.3%) for hypertension, and 4% (RR = 1.04, 95% CI 1.01-1.07, I 2  = 58.0%) and 6% (RR = 1.06, 95% CI 1.02-1.10, I 2  = 80.8%) for all-cause mortality. For SSBs, restricted cubic splines showed linear associations with risk of obesity (P non-linearity  = 0.359), T2DM (P non-linearity  = 0.706), hypertension (P non-linearity  = 0.510) and all-cause mortality (P non-linearity  = 0.259). For ASBs, we found linear associations with risk of obesity (P non-linearity  = 0.299) and T2DM (P non-linearity  = 0.847) and non-linear associations with hypertension (P non-linearity  = 0.019) and all-cause mortality (P non-linearity  = 0.048). Increased consumption of SSBs and ASBs is associated with risk of obesity, T2DM, hypertension, and all-cause mortality. However, the results should be interpreted cautiously because the present analyses were based on only cohort but not intervention studies.