Table 2.
Sources and magnitudes of the effects of SSBs on diabetes, SSB on BMI, and BMI on chronic disease outcomes.
| Risk factor |
Type of effect estimate |
Source of effect estimate |
Unit of effect estimate |
Sex | Effect size by age group | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 25–34 | 35–44 | 45–54 | 55–64 | 65–74 | 75–84 | 85+ | |||||
| SSB- diabetes |
relative risk |
published meta- analysis of 8 prospective cohort studiesβ |
per SSB serving/day |
Both | 1.41 (1.19, 1.66) |
1.39 (1.18, 1.63) |
1.32 (1.15, 1.51) |
1.26 (1.12, 1.41) |
1.21 (1.10, 1.33) |
1.16 (1.08, 1.24) |
1.08 (1.04, 1.12) |
| SSB-BMI (for baseline BMI < 25) |
linear effect |
original meta- analysis of 3 prospective cohort studies† |
kg/m2 increase in BMI per SSB serving/day |
Both | 0.10 (0.05, 0.15) |
0.10 (0.05, 0.15) |
0.10 (0.05, 0.15) |
0.10 (0.05, 0.15) |
0.10 (0.05, 0.15) |
0.10 (0.05, 0.15) |
0.10 (0.05, 0.15) |
| SSB-BMI (for baseline BMI ≥ 25) |
linear effect |
original meta- analysis of 3 prospective cohort studies† |
kg/m2 increase in BMI per 8 oz SSB serving/day |
Both | 0.23 (0.14, 0.32) |
0.23 (0.14, 0.32) |
0.23 (0.14, 0.32) |
0.23 (0.14, 0.32) |
0.23 (0.14, 0.32) |
0.23 (0.14, 0.32) |
0.23 (0.14, 0.32) |
| BMI- ischemic stroke |
relative risk |
pooled analysis of APCSC, PSC, and ERFC international pooling projects‡ |
per kg/m2 increase in BMI |
Both | 2.09 (1.81, 2.40) |
1.86 (1.67, 2.08) |
1.67 (1.53, 1.81) |
1.50 (1.40, 1.60) |
1.35 (1.28, 1.41) |
1.21 (1.16, 1.26) |
1.04 (0.96, 1.12) |
| BMI- ischemic heart disease |
relative risk |
pooled analysis of APCSC, PSC, and ERFC international pooling projects‡ |
per 5 kg/m2 increase in BMI |
Both | 1.79 (1.56, 2.06) |
1.66 (1.51, 1.84) |
1.55 (1.46, 1.64) |
1.44 (1.40, 1.48) |
1.35 (1.32, 1.38) |
1.26 (1.20, 1.32) |
1.14 (1.04, 1.26) |
| BMI- hypertensive heart disease |
relative risk |
pooled analysis of APCSC, PSC, and ERFC international pooling projects‡ |
per 5 kg/m2 increase in BMI |
Both | 2.30 (0.66, 7.95) |
2.15 (0.80, 5.78) |
2.02 (0.97, 4.21) |
1.90 (1.17, 3.07) |
1.81 (1.45, 2.26) |
1.63 (1.53, 1.74) |
1.45 (1.05, 2.01) |
| BMI- diabetes |
relative risk |
pooled analysis of APCSC, PSC, and ERFC international pooling projects‡ |
per 5 kg/m2 increase in BMI |
Both | 3.55 (2.41, 5.23) |
3.07 (2.28, 4.15) |
2.66 (2.15, 3.30) |
2.32 (2.04, 2.63) |
2.03 (1.95, 2.11) |
1.70 (1.61, 1.79) |
1.38 (1.23, 1.56) |
| BMI- breast cancer |
relative risk |
meta-analysis of 221 cohort studies§ |
per 5 kg/m2 increase in BMI |
Female | 1.12 (1.08, 1.16) |
1.12 (1.08, 1.16) |
1.12 (1.08, 1.16) |
1.12 (1.08, 1.16) |
1.12 (1.08, 1.16) |
1.12 (1.08, 1.16) |
1.12 (1.08, 1.16) |
| BMI- colon cancer |
relative risk |
meta-analysis of 221 cohort studies§ |
per 5 kg/m2 increase in BMI |
Female | 1.07 (1.03, 1.12) |
1.07 (1.03, 1.12) |
1.07 (1.03, 1.12) |
1.07 (1.03, 1.12) |
1.07 (1.03, 1.12) |
1.07 (1.03, 1.12) |
1.07 (1.03, 1.12) |
| Male | 1.20 (1.17, 1.24) |
1.20 (1.17, 1.24) |
1.20 (1.17, 1.24) |
1.20 (1.17, 1.24) |
1.20 (1.17, 1.24) |
1.20 (1.17, 1.24) |
1.20 (1.17, 1.24) |
||||
| BMI- pancreatic cancer |
relative risk |
meta-analysis of 221 cohort studies§ |
per 5 kg/m2 increase in BMI |
Female | 1.12 (1.03, 1.23) |
1.12 (1.03, 1.23) |
1.12 (1.03, 1.23) |
1.12 (1.03, 1.23) |
1.12 (1.03, 1.23) |
1.12 (1.03, 1.23) |
1.12 (1.03, 1.23) |
| Male | 1.07 (0.93, 1.23) |
1.07 (0.93, 1.23) |
1.07 (0.93, 1.23) |
1.07 (0.93, 1.23) |
1.07 (0.93, 1.23) |
1.07 (0.93, 1.23) |
1.07 (0.93, 1.23) |
||||
| BMI- esophageal cancer |
relative risk |
meta-analysis of 221 cohort studies§ |
per 5 kg/m2 increase in BMI |
Female | 1.51 (1.31, 1.74) |
1.51 (1.31, 1.74) |
1.51 (1.31, 1.74) |
1.51 (1.31, 1.74) |
1.51 (1.31, 1.74) |
1.51 (1.31, 1.74) |
1.51 (1.31, 1.74) |
| Male | 1.52 (1.33, 1.74) |
1.52 (1.33, 1.74) |
1.52 (1.33, 1.74) |
1.52 (1.33, 1.74) |
1.52 (1.33, 1.74) |
1.52 (1.33, 1.74) |
1.52 (1.33, 1.74) |
||||
| BMI- uterine cancer |
relative risk |
meta-analysis of 221 cohort studies§ |
per 5 kg/m2 increase in BMI |
Female | 1.59 (1.5, 1.68) |
1.59 (1.5, 1.68) |
1.59 (1.5, 1.68) |
1.59 (1.5, 1.68) |
1.59 (1.5, 1.68) |
1.59 (1.5, 1.68) |
1.59 (1.5, 1.68) |
| BMI- kidney cancer |
relative risk |
meta-analysis of 221 cohort studies§ |
per 5 kg/m2 increase in BMI |
Female | 1.34 (1.25, 1.43) |
1.34 (1.25, 1.43) |
1.34 (1.25, 1.43) |
1.34 (1.25, 1.43) |
1.34 (1.25, 1.43) |
1.34 (1.25, 1.43) |
1.34 (1.25, 1.43) |
| Male | 1.24 (1.15, 1.34) |
1.24 (1.15, 1.34) |
1.24 (1.15, 1.34) |
1.24 (1.15, 1.34) |
1.24 (1.15, 1.34) |
1.24 (1.15, 1.34) |
1.24 (1.15, 1.34) |
||||
| BMI-gall bladder cancer |
relative risk |
meta-analysis of 221 cohort studies§ |
per 5 kg/m2 increase in BMI |
Female | 1.59 (1.02, 2.47) |
1.59 (1.02, 2.47) |
1.59 (1.02, 2.47) |
1.59 (1.02, 2.47) |
1.59 (1.02, 2.47) |
1.59 (1.02, 2.47) |
1.59 (1.02, 2.47) |
| Male | 1.09 (0.98, 1.2) |
1.09 (0.98, 1.2) |
1.09 (0.98, 1.2) |
1.09 (0.98, 1.2) |
1.09 (0.98, 1.2) |
1.09 (0.98, 1.2) |
1.09 (0.98,1.2) |
||||
References:
Malik VS, Popkin BM, Bray GA, Despres JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation, 2010;121:1356–64.; A meta-analysis of 8 prospective cohorts (310,819 participants, 15,043 incident cases of diabetes), comparing the highest (1–2 servings/d) vs. lowest (<1 serving/mo) category of intake. Three cohorts included adjustment for BMI, most appropriate for our modeling of direct (non-obesity mediated) effects; but these also adjusted for total energy intake, which could result in underestimation of true effects. A more recent meta-analysis of 6 cohorts, published after finalization of our dietary RRs, reported a similar pooled dose-response association per daily SSB serving of 1.20 (95% CI: 1.12, 1.29)30
Khatibzadeh S, Micha R, Afshin A, Rao M, Yakoob MY, Mozaffarian D. Major dietary risk factors for chronic diseases: a systematic review of the current evidence for causal effects and effect sizes. Circulation, 2012, AP060.
Singh GM, Danaei G, Farzadfar F, et al. The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS One, 2013, 8:e65174.
Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet, 2008;371:569-78