̽��ֱ�� of Cambridge - drink

Regular consumption of sugary drinks associated with type 2 diabetes

cjb250 — Wed, 22 Jul 2015 08:48:09 +0000

An international team of researchers led by the MRC Epidemiology Unit at the ̽��ֱ�� of Cambridge set out to assess whether or not habitual consumption of sugar sweetened drinks, artificially sweetened drinks, or fruit juice was associated with the incidence of type 2 diabetes – and to estimate the 10-year risk attributable to sugar sweetened drinks in the USA and UK.

̽��ֱ��researchers analysed the results of 17 observational studies and found that habitual consumption of sugar sweetened drinks was positively associated with incidence of type 2 diabetes, independently of obesity status.

̽��ֱ��association between artificially sweetened drinks or fruit juice and type 2 diabetes was less evident. Yet, the researchers found little evidence for benefits of these beverages, and therefore concluded these drinks are unlikely to be healthy alternatives to sugar sweetened drinks for preventing type 2 diabetes.

̽��ֱ��researchers point out that the studies analysed were observational, so no definitive conclusions can be drawn about cause and effect. However, assuming a causal association, they estimate that two million new-onset type 2 diabetes events in the USA and 80,000 in the UK from 2010 to 2020 would be related to consumption of sugar sweetened beverages.

This latest review builds on ongoing research into the health impact of sugar sweetened drinks, including recent findings from the EPIC-InterAct study in eight European countries as well as work in the EPIC-Norfolk study in the UK, which found that drinking water or unsweetened tea or coffee in place of one sugary drink per day can help to reduce the risk of type 2 diabetes.

Dr Fumiaki Imamura, lead author of the study at the MRC Epidemiology Unit, said: “These findings together indicate that substituting sugar sweetened drinks with artificially sweetened drinks or fruit juice is unlikely to be the best strategy in reducing the risk of developing type 2 diabetes: water or other unsweetened beverages are better options.”

Dr Nita Forouhi, senior author of the study at the MRC Epidemiology Unit, said: “Our new findings provide further evidence to support the recent UK Scientific Advisory Committee on Nutrition (SACN) recommendation that minimising the consumption of sugary drinks presents a clear opportunity towards the goal of free sugars contributing to no more than 5% of daily energy intake and to improve health.”

̽��ֱ��study was supported by the Medical Research Council.

Reference
Imamura, F et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. ̽��ֱ��BMJ 21 July 2015.

Adapted from a press release from ̽��ֱ��BMJ.

Sugar sweetened drinks may give rise to nearly two million diabetes cases over ten years in the US and 80,000 in the UK, estimates a study published in the BMJ.

Substituting sugar sweetened drinks with artificially sweetened drinks or fruit juice is unlikely to be the best strategy in reducing the risk of developing type 2 diabetes

Fumiaki Imamura

Mike Schmid

Yummy Soda (cropped)

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Replacing one sugary drink per day could cut risk of type 2 diabetes

cjb250 — Thu, 30 Apr 2015 23:00:41 +0000

̽��ֱ��study indicates that for each 5% increase of a person’s total energy intake provided by sweet drinks including soft drinks, the risk of developing type 2 diabetes may increase by as much as 18%.

̽��ֱ��research is based on the EPIC-Norfolk study, which included more than 25,000 men and women aged 40–79 years living in Norfolk, UK. Study participants recorded everything that they ate and drank for seven consecutive days covering weekdays and weekend days, with particular attention to type, amount and frequency of consumption, and whether sugar was added by the participants. During approximately 11 years of follow-up, 847 study participants were diagnosed with new-onset type 2 diabetes.

Dr Nita Forouhi, of the Medical Research Council (MRC) Epidemiology Unit, ̽��ֱ�� of Cambridge, who led the study, says: “By using this detailed dietary assessment with a food diary, we were able to study several different types of sugary beverages as well as artificially sweetened beverages – such as diet soft drinks – and fruit juice, and to examine what would happen if water, unsweetened tea or coffee or artificially sweetened beverages were substituted for sugary drinks.”

In an analysis that accounted for a range of important factors including total energy intake, the researchers found that there was an approximately 22% increased risk of developing type 2 diabetes per extra serving per day habitually of each of soft drinks, sweetened milk beverages and artificially sweetened beverages consumed, but that consumption of fruit juice and sweetened tea or coffee was not related to diabetes. After further accounting for body mass index and waist girth as markers of obesity, there remained a higher risk of diabetes associated with consumption of both soft drinks and sweetened milk drinks, but the link with artificially sweetened beverages consumption no longer remained, likely explained by their greater consumption by those who were already overweight or obese.

This new research adds to previous research published in Diabetologia, which collected information from food frequency questionnaires across eight European countries. That previous work indicated that habitual daily consumption of sugar sweetened beverages was linked with higher risk of type 2 diabetes, consistent with the current new findings.

In the new study, the authors also found that if study participants had replaced a habitual daily serving of soft drinks with a serving of water or unsweetened tea or coffee, the risk of diabetes could have been cut by 14%, and by replacing a habitual serving of sweetened milk beverage with water or unsweetened tea or coffee, that reduction could have been 20%–25%. However, consuming artificially sweetened beverages instead of any sugar-sweetened drink was not associated with a statistically significant reduction in type 2 diabetes, when accounting for baseline obesity and total energy intake.

Dr Forouhi adds: “ ̽��ֱ��good news is that our study provides evidence that replacing a habitual daily serving of a sugary soft drink or sugary milk drink with water or unsweetened tea or coffee can help to cut the risk of diabetes, offering practical suggestions for healthy alternative drinks for the prevention of diabetes. This adds further important evidence to the recommendation from the World Health Organization to limit the intake of free sugars in our diet.”

̽��ֱ��authors acknowledge limitations of dietary research which relies on asking people what they eat, but their sample size was large with long follow-up and had detailed assessment of diet that was collected in real-time as people consumed the food/drinks, rather than relying on memory.

̽��ֱ��research was supported by the Medical Research Council and Cancer Research UK.

Adapted from a press release from Diabetologia.

Reference
O’Connor, L et al. Prospective associations and population impact of sweet beverage intake and type 2 diabetes, and effects of substitutions with alternative beverages. Diabetologia; 30 April 2015

Drinking water or unsweetened tea or coffee in place of one sugary drink per day can reduce the risk of type 2 diabetes, according to research published today in the journal Diabetologia.

Our study adds further important evidence to the recommendation from the World Health Organization to limit the intake of free sugars in our diet

Nita Forouhi

Sharon & Nikki McCutcheon

Soft drink with ice

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Intoxicating history

lw355 — Fri, 18 May 2012 09:00:43 +0000

As the Department of Health gears up to publish its alcohol strategy for England later this year, it does so amidst newly published figures estimating that a failure to reform alcohol laws could lead to 210,000 preventable deaths in England and Wales in the next 20 years.

Substance abuse too is recognised as an increasing threat to public health. Although the first international drug treaty was signed a century ago in efforts to halt the opium, morphine and cocaine trade, last year the Global Commission on Drug Policy concluded that the global war on drugs had failed. According to estimates by the United Nations (UN), opiate use increased worldwide from 1998 to 2008 by 35%, cocaine by 27% and cannabis by 8.5%.

How should governments respond? What is the best policy to safeguard public health against the dangers of intoxicants? Should policy makers treat these substances as separate or related? While scientific risk assessments provide one answer, we can also learn valuable lessons for policy making by looking at how society has tackled the issue in the past. If we want to understand how to design more appropriate international policies we need to understand how current policies developed and why they have failed.

In many respects, our understanding of this historical context has been distorted by the dominance of the prohibitionist and criminalisation models of intoxication management. But, if we look at the policies of Germany – a country which deviated from the more common model of increased criminalisation favoured by the West over the past century – we can see that prohibition was not the only history of intoxication management, and can gain new insights into how these alternative strategies managed the public dangers (and benefits) of intoxicants.

Rauschmittel

On 21 August 1883, ̽��ֱ��New York Times reported the emergence of a new temperance movement in Germany. Previous attempts to instil in Germans the desire to abstain from alcohol had been an utter failure. Alcohol had a central ritual and nutritional function, and the brewing industry was powerful.

̽��ֱ��new movement was savvier, no longer urging Germans to pledge ‘total abstinence’. Nor did it any longer condemn politicians drinking beer while talking politics. Nor even the ‘jovial drunkenness’ of students. This contrasted sharply with Britain’s temperance movement which, by the late 19th century, urged abstinence. Teetotalism reached its most extreme legislative incarnation in the USA, where alcohol was illegal between 1920 and 1933.

When compared to American prohibition, German temperance activists’ acceptance of drunkenness seems bizarre. But not when compared to Germany’s treatment of other intoxicants. Germany introduced the world to cocaine, heroin, amphetamines and MDMA; it was also reluctant to criminalise them. Even with tobacco, Germans have been permissive, refusing to implement a European Union directive banning smoking in public spaces in 2008. In fact the German language treats intoxicants together: the word Rauschmittel describes alcohol, medicines, illicit drugs and cigarettes, and means ‘articles of intoxication’.

My research explores why and how Germany took this approach to managing Rauschmittel. It connects political and everyday history, examining how cultures of intoxication shaped and were shaped by policy, and what this tells us about German society. It asks: why was a country famous for its repressive dictatorship and its obsession with national health also so permissive?

Given smoking’s well-publicised dangers, it is initially hard to view Germany’s intoxicant policy as public health orientated. However, its approach to temperance demonstrates an early preference for recognising a user’s positive experiences and negative abuses of a substance, rather than treating a substance as inherently problematic. This attitude has informed Germany’s intoxicant policy and its treatment of users throughout the modern period. By closely regulating users’ activities, one could reduce a substance’s potential harm rather than criminalise it and, by extension, its users.

By contrast, prohibitionist-based policies and their corresponding histories have focused on the path to and from criminalisation and rarely on individual users and the society in which they lived. Because prohibitionist-orientated histories classify substances by their legal position, past trends in intoxicant use have become distorted by present-day legal realities. This is equally problematic for illegal drugs as for substances like alcohol and cigarettes, for which the lines of acceptability or taboo are more fluid, and for which a defensive justification for their legality in the West has developed.

Of course, effective regulation necessitates public acceptance of governmental interference. This might not have worked in the UK, with its history of liberal individualism. But in Germany, a country with a highly interventionist state, which boasted numerous positive and negative regulations that did not exist in the UK, intoxicant regulation was more culturally acceptable. However, it did not proceed smoothly. International treaties, which Germany chose or was compelled to support, increasingly favoured supply-side prohibition, undermining Germany’s preference for consumption-side regulation.

Christiane’s story

Despite its success in regulating alcohol consumption in a culturally acceptable manner, Germany was not immune to the destabilising effects of new ‘trends’ in intoxicant use. ̽��ֱ��most famous example is heroin which, although first produced in Germany in the late 19th century, was relatively well controlled until the late 1960s, despite (or perhaps because of) its legality. Addiction was a problem, but it was limited to doctors, their patients and their social circles.

This changed when younger, poorer, West Germans gained a taste for the drug. In 1967, the West Berlin police reported 57 drug offences; in 1970, 858; and in 1980, 4,429. By 1971, heroin was criminalised in Germany via a UN treaty.

But perhaps Germany’s most famous ‘heroin statistic’ is Christiane Felscherinow, who started using the drug aged 13 in 1975. Her experiences, recorded by two journalists and later made into a film, demonstrated to Germans the Berlin authorities’ lack of expertise in treating heroin. Individuals like Christiane were visible manifestations of a serious social ill, and less easy to stereotype as devilish deviants because of their youth and vulnerability. As a result, the authorities began to treat heroin use as a threat to public health, not as a criminal problem.

̽��ֱ��Berlin authorities implemented a tightly regulated therapy chain, which followed users from the street through their social reintegration, and by 1981 Germany had changed its drug policy to legally favour therapy not punishment. Needle programmes were established in 1984, and today Germany has the largest number of needle vending machines in the world. Methadone treatment for addicts began in 1992; since 2003, Germany has also treated addicts with heroin. Switzerland and the Netherlands, which have similar intoxicant histories, have done likewise. Four cities from these three countries declared the ‘war on drugs’ a failure in 1990, calling most drug use a ‘temporary’ part of most users’ biography, best regulated, not criminalised – and 21 years later much of the world has followed suit.

Lessons from history

When the Global Commission on Drug Policy declared in 2011 that attempts to reduce drug use through supply-side prohibition had failed, they urged a science-based debate to develop ideas for new international policy. My research emphasises the importance of also taking a historical approach, one that does not base its exploration of substances on their current criminal or cultural status, but instead takes as its focus the entire category of intoxicants.

This historical approach demonstrates the importance of connecting policy to everyday experience. Doing so prevents the marginalisation of users in discussions of intoxicant policy and allows for a better understanding of intoxication’s dangers and enticements.

Dr Harris is at the Faculty of History.

In tracing the modern history of Germany’s policy on intoxicant and drug use, which favours therapy rather than punishment, Cambridge historian Dr Victoria Harris highlights that criminalisation may not be the only route.

If we want to understand how to design more appropriate international policies we need to understand how current policies developed and why they have failed.

Dr Victoria Harris

Karina Junqueira on flickr

Eu, Christiane F., 13 anos drogada e prostituída (published by Bertrand Brasil)

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