Cited by 1,641Diet, Metabolism, and DiseaseObesity, Physical Activity, DietNutritional Studies and Diet

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Sugar-Sweetened Beverages, Obesity, Type 2 Diabetes Mellitus, and Cardiovascular Disease Risk

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Malik, Vasanti S., Popkin, Barry M., Bray, George A., Després, Jean-Pierre, Hu, Frank B.·2010·Circulation

DOI 10.1161/circulationaha.109.876185PMC PMC2862465

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Abstract

Obesity has recently emerged as a major global health problem. According to World Health Organization estimates, ≈1.6 billion adults worldwide were overweight (body mass index [BMI] ≥25 kg/m2) and at least 400 million were obese (BMI ≥30 kg/m2) in 2005, numbers that are expected to reach 2.3 billion and 700 million, respectively, by 2015. In the United States, the percentage of overweight and obese adults increased markedly from 47% and 15% in 1976 to 1980 to >66% and 33% in 2005 to 2006, with the greatest proportion of increase seen among non-Hispanic black and Mexican American women.1,2 The implications of excess body weight are far-reaching. Epidemiological studies indicate that overweight and obesity are important risk factors for type 2 diabetes mellitus (T2DM), cardiovascular disease, cancer, and premature death.3 In the United States, healthcare expenditures attributable to overweight and obesity are estimated to be $147 billion or 9.1% of total healthcare costs per year.4 Such excess costs could have serious repercussions for resource-poor countries, which must manage the dual burdens of chronic and infectious disease. In the setting of a pandemic of obesity and related chronic diseases, the American Heart Association recently released a scientific statement recommending reductions in added-sugar intake to no more than 100 to 150 kcal/d for most Americans.5 The statement identified sugar-sweetened beverages (SSBs) as the primary source of added sugars in the American diet.6 Although it has long been suspected that SSBs contribute at least in part to the obesity epidemic, only in recent years have large epidemiological studies been able to substantiate the relationship between SSB consumption and long-term weight gain, T2DM, and cardiovascular risk. It is thought that SSBs contribute to weight gain because of their high added-sugar content, low satiety, and potential incomplete compensation for total energy, leading to increased energy intake.7,8 In addition, because of their high amounts of rapidly absorbable carbohydrates such as various forms of sugar and high-fructose corn syrup (HFCS) and the large quantities consumed, SSBs may increase T2DM and cardiovascular risk independently of obesity as a contributor to a high dietary glycemic load (GL), leading to inflammation, insulin resistance, and impaired β-cell function.9 Fructose from any sugar or HFCS may also increase blood pressure and promote the accumulation of visceral adiposity, dyslipidemia, and ectopic fat deposition because of increased hepatic de novo lipogenesis.10 Here, we review temporal patterns in SSB consumption and clinically relevant effects on obesity, T2DM, and cardiovascular disease risk, emphasizing potential underlying biological mechanisms, clinical implications, and consideration of methodological issues inherent in the literature.

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Authors: Malik, V. S., Popkin, B. M., Bray, G. A., Després, J.-P., & Hu, F. B.
Affiliations: Pennington Biomedical Research Center (US)
From the Departments of Nutrition and Epidemiology, Harvard School of Public Health (V.S.M., F.B.H.), and Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School (F.B.H.), Boston, Mass; Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada (J.P.D.); Dietary Obesity Laboratory, Pennington Biomedical Research Center, Baton Rouge, La (G.A.B.); and Department of Nutrition, Gillings School of...
ORCID: Malik, Vasanti S.
Popkin, Barry M.
Bray, George A.
Hu, Frank B.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2010-03-23
Volume: 121
Issue: 11
Pages: 1356-1364
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/circulationaha.109.876185
PMC: PMC2862465
OpenAlex: W2043947812
Cited by: 1,641
References: 104
Citations by year: 2026: 41 · 2025: 72 · 2024: 79 · 2023: 93 · 2022: 114 · 2021: 150 · 2020: 163 · 2019: 119 · 2018: 130 · 2017: 99 · 2016: 106 · 2015: 114 · 2014: 119 · 2013: 97 · 2012: 87
FWCI: 10.85
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
UNC Libraries
Funders: American Heart Association
Abbott Laboratories
Eli Lilly and Company
Pfizer
AstraZeneca
GlaxoSmithKline
National Institutes of Health (2r24hd050924-06)
Pfizer Canada
Eli Lilly Canada
Canadian Institutes of Health Research
National Heart, Lung, and Blood Institute (HL60712, R01HL060712)
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058845, DK58845)
National Institute of Environmental Health Sciences (P30ES010126)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24 HD-050924)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords: sugar-sweetened beverages, obesity, type 2 diabetes, cardiovascular risk, added sugars, high fructose corn syrup, fructose, glycemic load, insulin resistance, inflammation, weight gain, energy intake, health care costs, obesity prevention, dietary recommendations, American Heart Association scientific statement, chronic disease burden, low- and middle-income countries
MeSH terms: Beverages, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Obesity, Risk Factors, World Health Organization, Dietary Sucrose, Metabolic Syndrome

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