美国布列根和妇女医院和哈佛医学院Qi Sun团队研究了成人2型糖尿病患者的饮料消费与死亡率的相关性。这一研究成果发表在2023年4月19日出版的《英国医学杂志》上。

为了研究特定类型饮料的摄入与2型糖尿病成年人死亡率和心血管疾病（CVD）结局的关系，美国卫生专业人员进行了一项前瞻性队列研究。15486名男性和女性在基线和随访期间被诊断为2型糖尿病（护士健康研究：1980-2018；卫生专业人员随访研究：1986-2018）。使用经验证的食物频率问卷对饮料消费进行评估，并每两到四年更新一次。主要结局为全因死亡率。次要结局是心血管疾病的发病率和死亡率。

在平均18.5年的随访中，共记录了3447名（22.3%）CVD患者和7638名（49.3%）死亡患者。经过多变量校正后，当比较最低饮料摄入量和最高饮料摄入量的类别时，加糖饮料（SSBs）的全因死亡率合并危险比为1.20，人工加糖饮料（ASBs）为0.96，果汁为0.98，咖啡为0.74，茶为0.79，白开水为0.77，低脂牛奶为0.88，全脂牛奶为1.20。

在特定饮料与心血管疾病发病率和死亡率之间也观察到类似的相关性。特别是，摄入SSB与更高的心血管疾病发病风险（风险比为1.25）和心血管疾病死亡率（1.29）相关，而咖啡和低脂牛奶的摄入与心血管疾病发病率之间存在显著的负相关。

此外，与那些在糖尿病诊断后一段时间内没有改变咖啡消费量的人相比，增加咖啡消费的人全因死亡率较低。在茶和低脂牛奶中也观察到了与全因死亡率相关的类似模式。用ABSs代替SSBs与降低全因死亡率和CVD死亡率显著相关，而用咖啡、茶或白开水代替SSBs、ASBs、果汁或全脂牛奶与降低全因死亡率一致相关。

研究结果表明，对于患有2型糖尿病的成年人，个别饮料与全因死亡率和心血管疾病结果之间存在不同的关联。SSBs摄入量越高，全因死亡率、CVD发病率和死亡率越高，而咖啡、茶、白开水和低脂牛奶摄入量与全因死亡率呈负相关。这些发现强调了健康选择饮料在管理2型糖尿病成年人心血管疾病和过早死亡风险方面的潜在作用。

附：英文原文

Title: Beverage consumption and mortality among adults with type 2 diabetes: prospective cohort study

Author: Le Ma, Yang Hu, Derrick J Alperet, Gang Liu, Vasanti Malik, JoAnn E Manson, Eric B Rimm, Frank B Hu, Qi Sun

Issue&Volume: 2023/04/19

Abstract:

Objective To investigate the intake of specific types of beverages in relation to mortality and cardiovascular disease (CVD) outcomes among adults with type 2 diabetes.

Design Prospective cohort study.

Setting Health professionals in the United States.

Participants 15486 men and women with a diagnosis of type 2 diabetes at baseline and during follow-up (Nurses’ Health Study: 1980-2018; and Health Professionals Follow-Up Study: 1986-2018). Beverage consumption was assessed using a validated food frequency questionnaire and updated every two to four years.

Main outcome measures The main outcome was all cause mortality. Secondary outcomes were CVD incidence and mortality.

Results During an average of 18.5 years of follow-up, 3447 (22.3%) participants with incident CVD and 7638 (49.3%) deaths were documented. After multivariable adjustment, when comparing the categories of lowest intake of beverages with the highest intake, the pooled hazard ratios for all cause mortality were 1.20 (95% confidence interval 1.04 to 1.37) for sugar sweetened beverages (SSBs), 0.96 (0.86 to 1.07) for artificially sweetened beverages (ASBs), 0.98 (0.90 to 1.06) for fruit juice, 0.74 (0.63 to 0.86) for coffee, 0.79 (0.71 to 0.89) for tea, 0.77 (0.70 to 0.85) for plain water, 0.88 (0.80 to 0.96) for low fat milk, and 1.20 (0.99 to 1.44) for full fat milk. Similar associations were observed between the individual beverages and CVD incidence and mortality. In particular, SSB intake was associated with a higher risk of incident CVD (hazard ratio 1.25, 95% confidence interval 1.03 to 1.51) and CVD mortality (1.29, 1.02 to 1.63), whereas significant inverse associations were observed between intake of coffee and low fat milk and CVD incidence. Additionally, compared with those who did not change their consumption of coffee in the period after a diabetes diagnosis, a lower all cause mortality was observed in those who increased their consumption of coffee. A similar pattern of association with all cause mortality was also observed for tea, and low fat milk. Replacing SSBs with ABSs was significantly associated with lower all cause mortality and CVD mortality, and replacing SSBs, ASBs, fruit juice, or full fat milk with coffee, tea, or plain water was consistently associated with lower all cause mortality.

Conclusions Individual beverages showed divergent associations with all cause mortality and CVD outcomes among adults with type 2 diabetes. Higher intake of SSBs was associated with higher all cause mortality and CVD incidence and mortality, whereas intakes of coffee, tea, plain water, and low fat milk were inversely associated with all cause mortality. These findings emphasize the potential role of healthy choices of beverages in managing the risk of CVD and premature death overall in adults with type 2 diabetes.

DOI: 10.1136/bmj-2022-073406

Source: https://www.bmj.com/content/381/bmj-2022-073406