Table 2.

Bradford Hill Criteria for causality applied to evidence evaluating SSB consumption and risk of Type 2 Diabetes (T2D)

Bradford Hill Criteria	SSB consumption and risk of T2D
1) Strength of Association	Significant positive association RR: 1.26 (1.12, 1.41) for 1–2 servings/day
2) Consistency	Consistent data from large prospective cohort studies
3) Specificity	SSB has been shown to increase risk of related metabolic conditions and unrelated conditions such as dental caries and reductions in bone mineral density
4) Temporality	Prospective studies have established temporality
5) Biological Gradient (dose-response)	Increase 1 SSB/d associated with about 15% increased risk of T2D RR: 1.15 (1.11, 1.20)
6) Biological Plausibility	Evidence regarding incomplete compensation for liquid calories, glycemic effects of consuming large amounts of rapidly absorbable sugars and metabolic effects of fructose provide biological plausibility
7) Experimental Evidence	RCTs with clinical T2D as an endpoint are logistically difficult; however, experimental evidence from studies of biomarkers of T2D and cardiovascular risk provide support.

Malik VS, Hu FB. Sweeteners and Risk of Obesity and Type 2 Diabetes: The Role of Sugar-Sweetened Beverages. Current Diabetes Reports. 2012.