含糖饮料：导致全世界每年18万人死亡

       一项大型的国际流行病学研究指出，饮用大量含糖饮料与体重指数(BMI)增加相关，BMI增加进而可导致与之相关的糖尿病、心血管疾病(CVD)癌症死亡。

　　具体来说，研究人员发现2010年全球132,000例糖尿病死亡、44,000例心血管疾病死亡、6000例癌症死亡可以归因于饮用含糖软饮料、果汁或运动饮料。

　　哈佛大学公共健康学院的Gitanjali Singh博士及其同事在流行病学和预防/营养、体力活动和代谢2013年科学会议(EPI|NPAM 2013)上报告了研究结果。

　　Singh博士表示，“这一数量是令人惊讶的——成千上万例死亡是饮用含糖饮料所致，75%的BMI相关性死亡是糖尿病，这表明，限制含糖饮料的摄入是降低糖尿病患者死亡的一个重要步骤。”

　　改变病人生活习惯和公共政策是“艰苦的战斗”

　　Singh博士说，本研究强调临床医师应鼓励病人少喝含糖饮料。此外，尽管改变公共政策肯定是一场艰苦的战斗，但这是医生、心脏科专科医生、公共卫生科学家和政策制定者真正需要倡导和支持的。

　　作为全球疾病负担研究的组成部分，研究人员采集了114个国家膳食调查数据，占世界总人口的60%以上。

　　基于大型前瞻性队列研究数据，研究人员分析了含糖饮料消费量的变化如何影响BMI以及BMI如何影响心血管疾病、糖尿病和肥胖相关性癌症(乳腺癌、子宫癌、食管癌、胆囊癌、结直肠癌、肾癌和胰腺癌)。使用世界卫生组织的数据，计算20~44岁、45~64岁和65岁及以上男性和女性BMI相关的心血管病、糖尿病和癌症死亡例数。

　　平均含糖饮料的消费差异很大——中国老年女性每天不超过226.8克，但年轻古巴男性每天超过1134.0克。

　　大多数摄入过多含糖饮料致死亡(78%)病例来自低收入和中等收入国家。

　　墨西哥是世界上人均喝含糖饮料最多的国家之一，与含糖饮料相关的死亡数量最多：每百万成年人318例死亡。

　　相反，日本含糖饮料的人均消费量最低，这一风险因素的归因死亡人数最少：约每百万成年人10人死亡。

　　在2010年，下述死亡发生与饮用含糖饮料有关：

　　• 美洲和加勒比国家38,000例糖尿病死亡

　　• 东部和中部 - 欧亚国家11,000例心血管疾病死亡

　　• 美国25,000例死亡

　　研究小组得出结论：含糖饮料是慢性疾病可预防死亡的重要原因，不仅见于高收入国家，也见于低收入和中等收入国家。

　　专家建议患者避免含糖饮料

　　美国心脏协会(AHA)发言人Rachel K. Johnson博士评论到，“大量证据表明，含糖饮料与体重增加过多相关，本研究的作者更进一步指出由于含糖饮料引起体重过度增加，进而增加糖尿病、心血管疾病和癌症的死亡风险。”

　　Johnson博士指出，研究的优势包括规模大，但由于是一项流行病学研究，它并不能说明因果。不过，这肯定是一种[生物学上]看似合理的关联，我们应该认真对待它。我们应该建议患者避免饮用含糖饮料，因为有越来越多的证据表明，饮用含糖饮料不是一个很好的选择。

　　Johnson博士说，“特别麻烦”的是饮料不像固体食物那样具有饱腹机制。如果你下午4点饮用了含糖饮料，你可能不会减少晚餐进食量，但如果你下午4点进食的是固体食物，你很可能会晚餐会少吃点。

　　美国心脏协会(AHA)建议，成年人每天饮用不超过450卡路里热量(一周不超过1020.6克)的含糖饮料。美国心脏协会(AHA)和美国糖尿病协会(ADA)在2012年发布的立场声明指出，非营养性人工甜味剂可帮助人们减少糖和热量的摄入，前提是人们除了饮用低热量饮料外不再额外补充多余热量。

原来链接：

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Sugary Drinks May Explain 180,000 Deaths Worldwide Each Year

NEW ORLEANS — A large, international epidemiologic study reports that slurping back large amounts of sugary beverages was associated with an increased body-mass index (BMI), which in turn was linked with BMI-related deaths from diabetes, cardiovascular disease (CVD), and cancer.

Specifically, the researchers found that in 2010, 132,000 deaths from diabetes, 44,000 deaths from CVD, and 6000 deaths from cancer in the world could be attributed to drinking sugar-sweetened soft drinks, fruit juice, or sports beverages.

The study byGitanjali Singh, PhD, from Harvard School of Public Health, Boston, Massachusetts, and colleagues was reported at EPI|NPAM 2013, the Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions.

"It is a [surprisingly] large number of deaths — tens of thousands of deaths — that are being caused by consuming sugary beverages," Dr. Singh commented to Medscape Medical News. Three quarters of these BMI-related deaths were from diabetes, which "suggests that limiting sugary-beverage intake is an important step in reducing diabetes deaths," she noted.

"Uphill Battle" to Change Patient Habits, Public Policy

The study reinforces the need for clinicians to encourage patients to drink fewer sugary beverages, Dr. Singh said. In addition, even though "it's certainly an uphill battle [to change public policy] — it's one that…physicians, cardiologists, public-health scientists, [and] policy makers…really need to advocate for and show support for," she noted.

As part of the Global Burden of Disease study, the researchers obtained data from 114 national dietary surveys, representing more than 60% of the world's population.

Based on data from large prospective cohort studies, they determined how changes in consumption of sugary drinks affected BMI, and next, how elevated BMI affected CVD, diabetes, and 7 obesity-related cancers (breast, uterine, esophageal, gallbladder, colorectal, kidney, and pancreatic cancer). Using data from the World Health Organization, they calculated the number of deaths from BMI-related CVD, diabetes, and cancer for men and for women aged 20 to 44, 45 to 64, and 65 years and older.

Average sugary-drink consumption varied tremendously — from less than 1 drink (8 oz) a day in elderly Chinese women to more than 5 drinks (40 oz) a day in younger Cuban men.

Most deaths (78%) from excess sugary drinks were in low- and middle-income countries.

Mexico, which has one of the world's highest per capita rates of drinking sweetened drinks, had the greatest number of deaths related to this risk factor: 318 deaths per million adults.

In contrast, Japan, with one of the lowest per-capita rates of imbibing these beverages, had the smallest number of deaths attributable to this risk factor: about 10 deaths per million adults.

In 2010, drinking sugar-sweetened beverages was associated with about:

38,000 deaths from diabetes in Latin American and Caribbean countries.

11,000 deaths from CVD in Eastern- and Central-Eurasian countries.

25,000 deaths in the United States.

"Sugar-sweetened beverages are a major cause of preventable deaths due to chronic diseases, not only in high-income countries, but also in low and middle-income countries," the group concludes.

Bottom Line: Advise Patients to Avoid Sugary Drinks

"The evidence base that sugar-sweetened beverages are associated with excess weight gain is well established; what these investigators have done is to take it a step further by saying the excess weight gain that is attributable to sugary drinks actually increases the risk of death from diabetes, CVD, and cancer," American Heart Association(AHA) spokesperson Rachel K. Johnson, PhD, from the University of Vermont, Burlington, commented.

Study strengths include its large scope, but since it was an epidemiologic study, it does not demonstrate cause and effect, Johnson noted. Nevertheless, "it is certainly a [biologically] plausible association, and we should take it seriously," she added.


According to Dr. Johnson, "The bottom line is to [advise patients to] avoid sugar-sweetened drinks, [since we have] more and more evidence that it's not a good choice."

It is "particularly problematic" that satiety mechanisms don't kick in with beverages in the same way as with solid foods. "If you have a sugary drink at 4 o'clock, you're not as likely to cut back on what you eat for dinner in the same way you would if you'd had a snack of solid food at 4 o'clock," she said.

The AHA recommends that adults don't exceed 450 calories  (36 oz) a week from sugar-sweetened beverages. In a 2012 statement position statement, the AHA and American Diabetes Association stated that nonnutritive artificial sweeteners can be a tool to help people lower their added sugar and calorie intake, as long as they don't eat extra calories to compensate for the lower calories in the diet drinks.

The authors have disclosed no relevant financial relationships.

来源：医脉通