Drinking more coffee, tea, water and low-fat milk reduces risk of death in type 2 diabetes

Key points to remember:

• Adults with type 2 diabetes who drink more coffee, tea, water, or low-fat milk have a lower risk of all-cause mortality.
• Replacing a daily sugary drink with an artificially sweetened drink reduces the risk of death by 8%.

Adults with type 2 diabetes who drink more coffee, tea, water, and low-fat milk have a lower risk of all-cause mortality, and replacing sugary drinks with healthier ones after diagnosis of diabetes can reduce the risk of mortality.

In a study published in The BMJresearchers analyzed beverage consumption among a cohort of adults diagnosed with Type 2 diabetes and found that consumption of sugar-sweetened beverages was associated with increased risks of all-cause mortality, incidence of cardiovascular disease, and CVD mortality. Replacing sugary drinks with other drinks, including artificially sweetened drinks, after a diagnosis of type 2 diabetes was associated with a lower risk of death.

“These results provide additional evidence that underscores the importance of beverage choices in maintaining overall health in diabetic adults“, Qi Sun, MD, ScD, associate professor in the departments of nutrition and epidemiology at the Harvard TH Chan School of Public Health and in the Channing Division of Network Medicine at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote.

Qi Sun

The researchers conducted a prospective cohort study of adults with type 2 diabetes who enrolled in either the Nurses’ Health Study in 1980 or the Health Professionals Follow-Up Study in 1986. Participants who had type 2 diabetes at baseline in both studies or who were diagnosed with incident type 2 diabetes during follow-up were included. Beverage consumption was assessed using food frequency questionnaires administered every 2 to 4 years. Adults provided the average amount of servings they drank for sugary drinks, artificially sweetened drinks, fruit juices, coffee, tea, skimmed milk, whole milk or plain water. Five intake groups were formed for each type of drink, with the lowest intake group drinking less than one serving per month and the highest intake group drinking more than one serving per day. Diagnoses of diabetes were self-reported. Mortality data were collected from next of kin or postal authority reports, or national death index data. Cardiovascular incident was defined as fatal and non-fatal coronary heart disease or stroke.

Drinking more coffee, tea and water reduces mortality risk

There were 15,486 adults included in the study (mean age, 61.3 years; 73.6% female). Over an average follow-up of 18.5 years, 49.3% of the cohort died.

Adults who consumed more than one serving per day of sugar-sweetened beverages had a higher risk of all-cause mortality than those in the lowest consumption group (adjusted RR=1.2; 95% CI, 1.04-1 ,37). Compared with adults in the lowest consumption group, those who had more than one serving per day of coffee (aHR = 0.74; 95% CI, 0.63-0.86), tea (aHR = 0.79; 95% CI, 0.71-0.89), plain coffee water (aHR = 0.77; 95% CI, 0.7-0.85) and low-fat milk (aHR = 0.88; 95% CI, 0.8-0.96) had a lower risk of all-cause mortality. No difference in mortality risk was observed for artificially sweetened drinks, fruit juices or whole milk.

“The positive association between consumption of sugary drinks and adverse health effects may be related to high liquid fructose content,” the researchers wrote. “High fructose corn syrup and added sucrose in sugary drinks can lead to weight gain, insulin resistance and inflammation. A postprandial spike in blood glucose and insulin concentrations after consumption of sugary drinks can potentially lead to hyperinsulinemia, lipogenesis, and insulin resistance over time, which is especially harmful for adults with diabetes.

Of the cohort, 22.3% developed a cardiovascular incident during follow-up. Adults who consumed more than one serving of sugar-sweetened beverages per day had a higher risk of CVD than those who did not consume sugar-sweetened beverages (aHR=1.25; 95% CI, 1.03-1.51) . Adults who drank more than one serving of coffee (aHR=0.82; 95% CI, 0.69-0.98) or low-fat milk (aHR=0.88; 95% CI, 0 ,78-1) had a lower cardiovascular risk than those who did not drink these beverages.

Adults who increased their coffee consumption after a diagnosis of diabetes reduced their risk of all-cause mortality by about 18%. Similar associations were observed for those who increased their consumption of tea and low-fat milk. Replacing one serving per day of sugar-sweetened beverages with coffee, tea, water or skim milk reduces the risk of death by 12% or more. Replacing one serving per day of sugar-sweetened beverages with an artificially sweetened beverage also reduces the risk of all-cause mortality by 8% and CVD death by 15%.

More research needed

In a related editorial, Nita G. Forouhi BMedSci, MBBS, MSc, PhD, MRCP, FFPH, The Program Leader of the Nutritional Epidemiology Program in the Medical Research Council Epidemiology Unit at the University of Cambridge School of Clinical Medicine, wrote that the study added to research on health implications of different types of beverages for adults with type 2 diabetes. She noted, however, that several questions remained, including whether associations would vary for coronary artery disease or stroke individually, whether added sugar to coffee or tea would alter the results and whether the reduced risk from tea consumption differed by type of tea. Additionally, Forouhi noted that certain drinks linked to an increased risk of type 2 diabetes, including milkshakes, smoothies, yogurt drinks and hot chocolate, were not included in the study. She said more studies are needed to answer these questions.

“Choice of drink clearly matters,” Forouhi wrote. “The case for avoiding sugary drinks is compelling and supported by various tax measures in more than 45 countries. Although the evidence is less clear for artificially sweetened drinks and fruit juices, it is reasonable to focus on the drinks that are most likely to have positive health effects: coffee, tea, plain water and milk. low fat. »

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