{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzmkvq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzmkvq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;9\\\/2\\\/33\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;9\\\/2\\\/33\u0022}],\u0022ac\u0022:{\u0022spmdc;9\\\/2\\\/33\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;9\\\/2\\\/33\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThere has been a significant increase in the consumption of refined sugars across the globe over the past 20 years, with the main source of this increase from sugar-sweetened beverages, including soft drinks, fruit drinks, energy drinks, and vitamin and other functional beverage waters. This article presents new updates on the relationship between sugar-sweetened beverages and the metabolic syndrome.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiometabolic Disorder\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENursing\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAt the recent 3\u003Csup\u003Erd\u003C\/sup\u003E International Congress on Prediabetes and the Metabolic Syndrome in Nice, France, opinion leaders gathered during a dedicated symposium to present new updates on the relationship between sugar-sweetened beverages and the metabolic syndrome.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EBarry Popkin, PhD, University of North Carolina, Chapel Hill, NC, highlighted the significant increase in the consumption of refined sugars across the globe over the past 20 years, noting that the main source of this increase has come from sugar-sweetened beverages, including soft drinks, fruit drinks, energy drinks, and vitamin and other functional beverage waters (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/33\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Steepest Increase in Calories of Added Sugar from Soda, per Capita and Consumer Estimates.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1160343603\u0022 data-figure-caption=\u0022Steepest Increase in Calories of Added Sugar from Soda, per Capita and Consumer Estimates.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/33\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/33\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/33\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11536\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003ESteepest Increase in Calories of Added Sugar from Soda, per Capita and Consumer Estimates.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EDuring this same time, there was little change in water consumption and essentially no reduction in food intake to compensate for these additional beverage-related calories [Duffey KJ \u0026amp; Popkin BM. \u003Cem\u003EObesity\u003C\/em\u003E 2007]. \u201cThis upward trend in the consumption of sugar-sweetened beverages, combined with an accelerated shift toward inactivity, poor diet, and obesity, presents a serious global public health threat,\u201d Dr. Popkin said.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe upswing in the prevalence of obesity in the United States began around 1980, about the same time that high-fructose corn syrup was adopted as the sweetener of choice for soft drinks. \u201cAs the consumption of soft drinks increased, the intake of fructose from sucrose and high-fructose corn syrup also increased,\u201d said George A. Bray, MD, Pennington Center, Baton Rouge, LA.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe deleterious effects of overconsumption of sugar-sweetened beverages are well documented. In a study that compared the metabolic effects of fructose in 16 healthy male and female subjects, short-term fructose overfeeding produced significant (p\u0026lt;0.05) increases in fasting triglyceride levels (71%), endogenous glucose production (12%), alanine aminotransferase concentration (38%), and fasting insulin concentrations (14%) in male subjects versus insignificant increases in female subjects [Couchepin C et al. \u003Cem\u003EDiab Care\u003C\/em\u003E 2008]. Oral ingestion of fructose has also been shown to result in a significant (p\u0026lt;0.01) increase in blood pressure that is not gender-related [Brown CM et al. \u003Cem\u003EAm J Physiol Regulatory Integrative Comp Physiol\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EIn overweight individuals, a diet that is high in sucrose versus one that is high in artificial sweeteners has been shown to produce increases in several markers of inflammation (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Sorensen LB et al. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E 2005]. Of particular relevance to the metabolic syndrome, fructose appears to have a much greater effect on increases in visceral fat than other sugars [Stanhope KL et al. \u003Cem\u003EJ Clin Invest\u003C\/em\u003E 2009; Stanhope KL \u0026amp; Havel PJ. \u003Cem\u003ECurr Opin Lipidol\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003E\u201dDuring 1999 and 2000, regular soft drinks represented a surprising 7% of calories in the US diet,\u201d said Frank B. Hu, MD, Harvard Medical School, Cambridge, MA. \u201cThat number has since increased to an estimated 9% to 10%.\u201d\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11543\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11543\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11543\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EChanges in Concentrations of Inflammatory Markers Associated with Sugar-Sweetened Beverages.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-12\u0022\u003ESeveral large prospective cohort studies are currently underway to study the effects of diet and lifestyle on the development of chronic disease. Participants in these studies are contacted every 2 to 4 years using a validated dietary questionnaire. Biological and DNA samples are also collected to study the effect of diet and lifestyle on biochemical markers and the interaction between genes and diet on disease risk.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EEight-year data from the Nurses\u0027 Health Study II showed that individuals who increased their consumption of soft drinks during the first 5 years of the study and maintained a high level of consumption until the end of the study gained \u223c8 kg, whereas individuals who had a relatively low level of consumption at baseline and maintained that level until the end of the study only gained 2 kg. Increased consumption of sugar-sweetened beverages was associated with a significant (p\u0026lt;0.001) trend for an increased risk of diabetes, regardless of whether the data were controlled for body mass index (BMI) [Schulze MB et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2004] (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). These results suggest that the detrimental effects of soft drinks on type 2 diabetes are not completely mediated through energy balance or body weight.\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/33\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Sugar-Sweetened Soft Drinks and Type 2 Diabetes; Data from the Nurses\u0027 Health Study 2 for 1991\u0026#x2013;1998.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1160343603\u0022 data-figure-caption=\u0022Sugar-Sweetened Soft Drinks and Type 2 Diabetes; Data from the Nurses\u0027 Health Study 2 for 1991\u0026#x2013;1998.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/33\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/33\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/2\/33\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11540\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003ESugar-Sweetened Soft Drinks and Type 2 Diabetes; Data from the Nurses\u0027 Health Study 2 for 1991\u20131998.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-15\u0022\u003EA similar association was identified for sugar-sweetened beverages and gestational diabetes (GDM) in this same cohort. \u201cWomen who consumed soft drinks regularly before pregnancy had more than a 20% increased risk of GDM,\u201d said Dr. Hu, \u201cwith a slightly stronger association for sugar-sweetened cola versus other sugar-sweetened beverages.\u201d Data from the Black Women\u0027s Health study also showed a significant relationship between sugar-sweetened soft drink consumption and the risk for diabetes [Palmer JR et al. \u003Cem\u003EArch Int Med\u003C\/em\u003E 2008]. Because of the increased risk of developing obesity and type 2 diabetes for African Americans, reducing caloric intake from sugar-sweetened soft drinks has a very important public health implication in reducing the health disparity for diabetes risk.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003ERecent data from the Framingham and Atherosclerosis Risk in Communities (ARIC) studies have identified a very strong association between soft drink consumption and the prevalence of the metabolic syndrome, as well as the risk of developing individual components of the metabolic syndrome. In the Framingham study, middle-aged adults who consumed at least 1 soft drink per day had a 44% higher adjusted risk (95% CI, 20% to 74%) of developing metabolic syndrome compared with those who consumed soft drinks infrequently [Dhingra R et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2007]. More recently, data from ARIC showed that diet soda intake, in particular, was strongly associated with an increased risk for the metabolic syndrome (HR, 1.34; 95% CI, 1.11 to 1.29) [Lutsey PL et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EOther recent data from the Nurses\u0027 Health Study showed that regular soft drink consumption was associated with an almost 49% increase in risk of coronary heart disease in women, even after adjusting for BMI [Fung TT. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EIt is clear that the lack of food compensation when caloric beverages are consumed is one major cause of these health concerns. It is possible that an additional problem is the high glycemic load of sugar-sweetened soft drinks. Several mechanisms have been proposed, including evidence that high glycemic index\/load diets lead to postprandial hyperglycemia, which in turn leads to hyperinsulimia and increased beta-cell demand. An alternative pathway may involve increased production of free fatty acids that leads to increased insulin resistance [Ludwig DS. \u003Cem\u003EJAMA\u003C\/em\u003E 2002].\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EIn summary, the symposium moderator called for an increased awareness of the role of sugar-sweetened beverages in precipitating metabolic syndrome. \u201cClearly, management of energy balance has become an issue. The evidence indicates that we need to be careful not only about the refined sugar in the foods we eat \u2013 but also in the beverages we drink.\u201d said Jean Pierre Despres, Scientific Director, International Chair on Cardiometabolic Risk, Universit\u00e9 Laval, Quebec, Canada.\u003C\/p\u003E\u003Cp id=\u0022p-20\u0022\u003EThe International Chair on Cardiometabolic Risk provides many free tools and resources to physicians and caregivers to support their management and education efforts with patients. For more information, visit \u003Ca href=\u0022http:\/\/www.cardiometabolic-risk.org\u0022\u003Ewww.cardiometabolic-risk.org\u003C\/a\u003E.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/2\/33.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmkvq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmkvq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmkvq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}