title: Sweetened Beverage Consumption, Incident Coronary Heart Disease, and Biomarkers of Risk in Men A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Effects of replacing the habitual consumption of sugar-sweetened beverages with milk in Chilean children. Dietary pattern, inflammation, and incidence of type 2 diabetes in women. Potato and french fry consumption and risk of type 2 diabetes in women. Fructose prefeeding reduces the glycemic response to a high-glycemic index, starchy food in humans. Consumption of fatty foods and incident type 2 diabetes in populations from eight European countries Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Effects of fructose vs glucose on regional cerebral blood flow in brain regions involved with appetite and reward pathways. A dictionary of epidemiology Acute fructose administration improves oral glucose tolerance in adults with type 2 diabetes. Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases triglycerides in women. Changes in Intake of Fruits and Vegetables and Weight Change in United States Men and Women Followed for Up to 24 Years: Analysis from Three Prospective Cohort Studies A prospective study of sugar intake and risk of type 2 diabetes in women. Association of Sweetened Beverage Intake with Incident Hypertension Beverage vs. solid fruits and vegetables: effects on energy intake and body weight. The effect of reduced extrinsic sucrose intake on plasma triglyceride levels. Exercise performed immediately after fructose ingestion enhances fructose oxidation and suppresses fructose storage. Liquid versus solid carbohydrate: effects on food intake and body weight Ad libitum intake of low-fat diets rich in either starchy foods or sucrose: effects on blood lipids, factor VII coagulant activity, and fibrinogen. Soda consumption and the risk of stroke in men and women. Dietary patterns, meat intake, and the risk of type 2 diabetes in women. Dietary patterns and the risk of coronary heart disease in women. Dietary Patterns and Risk for Type 2 Diabetes Mellitus in U.S. Men Acute fructose administration decreases the glycemic response to an oral glucose tolerance test in normal adults. Fructose-rich beverages and risk of gout in women. Effects of sucrose drinks on macronutrient intake, body weight, and mood state in overweight women over 4 weeks Estimated Global, Regional, and National Disease Burdens Related to Sugar-Sweetened Beverage Consumption in 2010 Fried-food consumption and risk of type 2 diabetes and coronary artery disease: a prospective study in 2 cohorts of US women and men.
abstract: Background — Sugar-sweetened beverage consumption is associated with weight gain and risk of type 2 diabetes mellitus .  Few studies have tested for a relationship with coronary heart disease ( CHD ) or intermediate biomarkers . The role of artificially sweetened beverages is also unclear . Methods and Results — We performed an analysis of the Health Professionals Follow-Up Study , a prospect i ve cohort study including 42 883 men . Associations of cumulatively averaged sugar-sweetened ( eg , sodas ) and artificially sweetened ( eg , diet sodas ) beverage intake with incident fatal and nonfatal CHD ( myocardial infa rct ion ) were examined with proportional hazard models . There were 3683 CHD cases over 22 years of follow-up . Participants in the top quartile of sugar-sweetened beverage intake had a 20 % higher relative risk of CHD than those in the bottom quartile ( relative risk=1.20 ; 95 % confidence interval , 1.09–1.33 ; P for trend < 0.01 ) after adjustment for age , smoking , physical activity , alcohol , multivitamins , family history , diet quality , energy intake , body mass index , pre-enrollment weight change , and dieting . Artificially sweetened beverage consumption was not significantly associated with CHD ( multivariate relative risk=1.02 ; 95 % confidence interval , 0.93–1.12 ; P for trend=0.28 ) . Adjustment for self-reported high cholesterol , high triglycerides , high blood pressure , and diagnosed type 2 diabetes mellitus slightly attenuated these associations . Intake of sugar-sweetened but not artificially sweetened beverages was significantly associated with increased plasma triglycerides , C-reactive protein , interleukin-6 , and tumor necrosis factor receptors 1 and 2 and decreased high-density lipoprotein , lipoprotein(a ) , and leptin ( P<0.02 ) . Conclusions — Consumption of sugar-sweetened beverages was associated with increased risk of CHD and some adverse changes in lipids , inflammatory factors , and leptin . Artificially sweetened beverage intake was not associated with CHD risk or biomarkers BACKGROUND Little is known about the effects of the amount and type of carbohydrates on risk of coronary heart disease ( CHD ) .  OBJECTIVE The objective of this study was to prospect ively evaluate the relations of the amount and type of carbohydrates with risk of CHD . DESIGN A cohort of 75521 women aged 38 - 63 y with no previous diagnosis of diabetes mellitus , myocardial infa rct ion , angina , stroke , or other cardiovascular diseases in 1984 was followed for 10 y. Each participant 's dietary glycemic load was calculated as a function of glycemic index , carbohydrate content , and frequency of intake of individual foods reported on a vali date d food-frequency question naire at baseline . All dietary variables were up date d in 1986 and 1990 . RESULTS During 10 y of follow-up ( 729472 person-years ) , 761 cases of CHD ( 208 fatal and 553 nonfatal ) were documented . Dietary glycemic load was directly associated with risk of CHD after adjustment for age , smoking status , total energy intake , and other coronary disease risk factors . The relative risks from the lowest to highest quintiles of glycemic load were 1.00 , 1.01 , 1 . 25 , 1.51 , and 1.98 ( 95 % CI : 1.41 , 2.77 for the highest quintile ; P for trend < 0.0001 ) . Carbohydrate classified by glycemic index , as opposed to its traditional classification as either simple or complex , was a better predictor of CHD risk . The association between dietary glycemic load and CHD risk was most evident among women with body weights above average ¿ ie , body mass index ( in kg/m(2 ) ) > /= 23 . CONCLUSION These epidemiologic data suggest that a high dietary glycemic load from refined carbohydrates increases the risk of CHD , independent of known coronary disease risk factors BACKGROUND During the nutrition transition in Chile , dietary changes were marked by increased consumption of high-energy , nutrient-poor products , including sugar-sweetened beverages ( SSBs ) . Obesity is now the primary nutritional problem in posttransitional Chile . OBJECTIVE We conducted a r and omized controlled trial to examine the effects on body composition of delivering milk beverages to the homes of overweight and obese children to displace SSBs . DESIGN We r and omly assigned 98 children aged 8 - 10 y who regularly consumed SSBs  to intervention and control groups . During a 16-wk intervention , children were instructed to drink 3 servings/d ( approximately 200 g per serving ) of the milk delivered to their homes and to not consume SSBs .  Body composition was measured by dual-energy X-ray absorptiometry . Data were analyzed by multiple regression analysis according to the intention-to-treat principle . RESULTS For the intervention group , milk consumption increased by a mean ( + /- SEM ) of 452.5 + /- 37.7 g/d ( P < 0.0001 ) , and consumption of SSBs  decreased by -711.0 + /- 33.7 g/d ( P < 0.0001 ) . For the control group , milk consumption did not change , and consumption of SSBs  increased by 71.9 + /- 33.6 g/d ( P = 0.04 ) . Changes in percentage body fat , the primary endpoint , did not differ between groups . Nevertheless , the mean ( + /- SE ) accretion of lean body mass was greater ( P = 0.04 ) in the intervention ( 0.92 + /- 0.10 kg ) than in the control ( 0.62 + /- 0.11 kg ) group . The increase in height was also greater ( P = 0.01 ) in the intervention group ( 2.50 + /- 0.21 cm ) than in the control group ( 1.77 + /- 0.20 cm ) for boys but not for girls . CONCLUSION Replacing habitual consumption of SSBs with milk may have beneficial effects on lean body mass and growth in children , despite no changes in percentage body fat . This trial was registered at clinical trials.gov as NCT00149695 BACKGROUND Inflammation is considered a key mechanism leading to type 2 diabetes , but dietary exposures that lead to inflammation and diabetes are largely unknown . OBJECTIVE Our objective was to investigate the relation between a dietary pattern associated with biomarkers of inflammation and the incidence of type 2 diabetes . DESIGN We conducted a nested case-control study of 656 cases of type 2 diabetes and 694 controls among women in the Nurses ' Health Study and 2 prospect i ve cohort studies of 35,340 women in the Nurses ' Health Study and 89,311 women in the Nurses ' Health Study II who were followed for incident diabetes . RESULTS Through the use of reduced rank regression , we identified a dietary pattern that was strongly related to inflammatory markers in the nested case-control study . This pattern , which was high in sugar-sweetened soft drinks , refined grains , diet soft drinks , and processed meat but low in wine , coffee , cruciferous vegetables , and yellow vegetables , was associated with an increased risk of diabetes ( multivariate-adjusted odds ratio comparing extreme quintiles : 3.09 ; 95 % CI : 1.99 , 4.79 ) . We identified 1517 incident cases of confirmed type 2 diabetes in the Nurses ' Health Study ( 458,991 person-years ) and 724 incident cases in the Nurses ' Health Study II ( 701,155 person-years ) . After adjustment for body mass index and other potential lifestyle confounders , the relative risks comparing extreme quintiles of the pattern were 2.56 ( 95 % CI : 2.10 , 3.12 ; P for trend < 0.001 ) in the Nurses ' Health Study and 2.93 ( 95 % CI : 2.18 , 3.92 ; P for trend < 0.001 ) in the Nurses ' Health Study II . CONCLUSION The dietary pattern identified may increase chronic inflammation and raise the risk of developing type 2 diabetes BACKGROUND Potatoes , a high glycemic form of carbohydrate , are hypothesized to increase insulin resistance and risk of  type 2 diabetes . OBJECTIVE The objective was to examine prospect ively the relation between potato consumption and the risk of  type 2 diabetes .  DESIGN We conducted a prospect i ve study of 84,555 women in the Nurses ' Health Study . At baseline , the women were aged 34 - 59 y , had no history of chronic disease , and completed a vali date d food-frequency  question naire . The participants were followed for 20 y with repeated assessment of diet . RESULTS We documented 4496 new cases of type 2 diabetes .  Potato and french fry consumption were both positively associated with risk of type 2 diabetes after adjustment for age and dietary and nondietary factors . The multivariate relative risk ( RR ) in a comparison between the highest and the lowest quintile of potato intake was 1.14 ( 95 % CI : 1.02 , 1.26 ; P for trend = 0.009 ) . The multivariate RR in a comparison between the highest and the lowest quintile of french fry intake was 1.21 ( 95 % CI : 1.09 , 1.33 ; P for trend < 0.0001 ) . The RR of type 2 diabetes was 1.18 ( 95 % CI : 1.03 , 1.35 ) for 1 daily serving of potatoes and 1.16 ( 95 % CI : 1.05 , 1.29 ) for 2 weekly servings of french fries . The RR of type 2 diabetes for substituting 1 serving potatoes/d for 1 serving whole grains/d was 1.30 ( 95 % CI : 1.08 , 1.57 ) . The association between potato consumption and risk of type 2 diabetes was more pronounced in obese women . CONCLUSIONS Our findings suggest a modest positive association between the consumption of potatoes  and the  risk of type 2 diabetes in women . This association was more pronounced when potatoes were substituted for whole grains The study objective was to determine whether a small dose of fructose administered before or simultaneously with a high glycemic index , starchy food decreases postpr and ial glycemic response .  Nondiabetic healthy adults ( n = 31 ; mean + /- SEM : age , 26 + /- 1 y ; weight , 66.1 + /- 2.6 kg ; body mass index , 23.3 + /- 0.6 kg/m(2 ) ) were studied in a r and omized crossover design . Treatments consisted of 50 g available carbohydrate from instant mashed potatoes fed alone ( control ) or with 10 g fructose fed 60 , 30 or 0 min before the potato meal . Capillary finger-stick blood sample s were analyzed for glucose concentration at -60 , -30 , 0 , 15 , 30 , 45 , 60 , 90 and 120 min relative to the ingestion of the potato meal . Compared with the control , the positive incremental area under the glucose curve was reduced 25 and 27 % ( P < 0.01 ) when fructose was fed either 60 or 30 min before the meal , respectively . In contrast to previous studies demonstrating that immediate administration of a small amount of fructose lowers the glycemic response to a glucose solution , we found that fructose must be consumed before a starchy food to reduce postpr and ial glycemia Background / Objectives : Diets high in saturated and trans fat and low in unsaturated fat may increase type 2 diabetes ( T2D ) risk , but studies on foods high in fat per unit weight are sparse . We assessed whether the intake of vegetable oil , butter , margarine , nuts and seeds and cakes and cookies is related to incident T2D.Subjects/ Methods : A case-cohort study was conducted , nested within eight countries of the European Prospect i ve Investigation into Cancer ( EPIC ) , with 12 403 incident T2D cases and a subcohort of 16 835 people , identified from a cohort of 340 234 people . Diet was assessed at baseline ( 1991–1999 ) by country-specific question naires . Country-specific hazard ratios ( HRs ) across four categories of fatty foods ( nonconsumers and tertiles among consumers ) were combined with r and om-effects meta- analysis . Results : After adjustment not including body mass index ( BMI ) , nonconsumers of butter , nuts and seeds and cakes and cookies were at higher T2D risk compared with the middle tertile of consumption . Among consumers , cakes and cookies were inversely related to T2D ( HRs across increasing tertiles 1.14 , 1.00 and 0.92 , respectively ; P-trend < 0.0001 ) . All these associations attenuated upon adjustment for BMI , except the higher risk of nonconsumers of cakes and cookies ( HR 1.57 ) . Higher consumption of margarine  became positively associated after BMI adjustment ( HRs across increasing consumption tertiles : 0.93 , 1.00 and 1.12 ; P-trend 0.03 ) . Within consumers , vegetable oil , butter and nuts and seeds were unrelated to T2D . Conclusions : Fatty foods were generally not associated with T2D , apart from weak positive association for margarine . The higher risk among nonconsumers of cakes and cookies needs further explanation BACKGROUND The consumption of sucrose-sweetened soft drinks ( SSSDs ) has been associated with obesity , the metabolic syndrome , and cardiovascular disorders in observational and short-term intervention studies . Too few long-term intervention studies in humans have examined the effects of soft drinks . OBJECTIVE We compared the effects of SSSDs with those of isocaloric milk and a noncaloric soft drink on changes in total fat mass and ectopic fat deposition ( in liver and muscle tissue ) . DESIGN Overweight subjects ( n = 47 ) were r and omly assigned to 4 different test drinks ( 1 L/d for 6 mo ) : SSSD ( regular cola ) , isocaloric semiskim milk , aspartame-sweetened diet cola , and water . The amount of intrahepatic fat and intramyocellular fat was measured with (1)H-magnetic resonance spectroscopy . Other endpoints were fat mass , fat distribution ( dual-energy X-ray absorptiometry and magnetic resonance imaging ) , and metabolic risk factors . RESULTS The relative changes between baseline and the end of 6-mo intervention were significantly higher in the regular cola group than in the 3 other groups for liver fat ( 132 - 143 % , sex-adjusted mean ; P < 0.01 ) , skeletal muscle fat ( 117 - 221 % ; P < 0.05 ) , visceral fat ( 24 - 31 % ; P < 0.05 ) , blood triglycerides ( 32 % ; P < 0.01 ) , and total cholesterol ( 11 % ; P < 0.01 ) . Total fat mass was not significantly different between the 4 beverage groups . Milk and diet cola reduced systolic blood pressure by 10 - 15 % compared with regular cola ( P < 0.05 ) . Otherwise , diet cola had effects similar to those of water . CONCLUSION Daily intake of SSSDs for 6 mo increases ectopic fat accumulation and lipids compared with milk , diet cola , and water . Thus , daily intake of SSSDs is likely to enhance the risk of cardiovascular and metabolic diseases . This trial is registered at clinical trials.gov as NCT00777647 IMPORTANCE Increases in fructose consumption have paralleled the increasing prevalence of obesity , and high-fructose diets are thought to promote weight gain and insulin resistance . Fructose ingestion produces smaller increases in circulating satiety hormones compared with glucose ingestion , and central administration of fructose provokes feeding in rodents , whereas central ly administered glucose promotes satiety . OBJECTIVE To study neurophysiological factors that might underlie associations between fructose consumption and weight gain . DESIGN , SETTING , AND PARTICIPANTS Twenty healthy adult volunteers underwent 2 magnetic resonance imaging sessions at Yale University in conjunction with fructose or glucose drink ingestion in a blinded , r and om-order , crossover design . MAIN OUTCOME MEASURES Relative changes in hypothalamic regional cerebral blood flow ( CBF ) after glucose or fructose ingestion . Secondary outcomes included whole-brain analyses to explore regional CBF changes , functional connectivity analysis to investigate correlations between the hypothalamus and other brain region responses , and hormone responses to fructose and glucose ingestion . RESULTS There was a significantly greater reduction in hypothalamic CBF after glucose vs fructose ingestion ( -5.45 vs 2.84 mL/g per minute , respectively ; mean difference , 8.3 mL/g per minute [ 95 % CI of mean difference , 1.87 - 14.70 ] ; P = .01 ) . Glucose ingestion ( compared with baseline ) increased functional connectivity between the hypothalamus and the thalamus and striatum . Fructose  increased connectivity between the hypothalamus and thalamus but not the striatum . Regional CBF within the hypothalamus , thalamus , insula , anterior cingulate , and striatum ( appetite and reward regions ) was reduced after glucose ingestion compared with baseline ( P < .05 significance threshold , family-wise error [ FWE ] whole-brain corrected ) . In contrast , fructose  reduced regional CBF in the thalamus , hippocampus , posterior cingulate cortex , fusiform , and visual cortex ( P < .05 significance threshold , FWE whole-brain corrected ) . In whole-brain voxel-level analyses , there were no significant differences between direct comparisons of fructose vs glucose sessions following correction for multiple comparisons . Fructose vs glucose ingestion result ed in lower peak levels of serum glucose ( mean difference , 41.0 mg/dL [ 95 % CI , 27.7 - 54.5 ] ; P < .001 ) , insulin ( mean difference , 49.6 μU/mL [ 95 % CI , 38.2 - 61.1 ] ; P < .001 ) , and glucagon-like polypeptide 1 ( mean difference , 2.1 pmol/L [ 95 % CI , 0.9 - 3.2 ] ; P = .01 ) . CONCLUSION AND RELEVANCE In a series of exploratory analyses , consumption of fructose compared with glucose result ed in a distinct pattern of regional CBF and a smaller increase in systemic glucose , insulin , and glucagon-like polypeptide 1 levels When the first edition of A Dictionary of Epidemiology was launched in 1983 , its principal aim was to facilitate communication among health professionals . The field was relatively young and comprised complex interdisciplinary relations ranging from the biomedical sciences to statistics and the social sciences . The International Epidemiological Association ( IEA ) co-sponsored the project with the aim of developing certain st and ards for teaching , research reports and communication of epidemiological findings to the public . This is a well-known history : John M Last , the emeritus professor of epidemiology and community medicine from the University of Ottawa , Canada , was appointed as the editor of A Dictionary ... , and kept ahead of the task during the subsequent decades . The original slim pocket book grew substantially with each re-edit , keeping pace with the remarkable developments in the discipline . When the fourth edition was launched in 2001 , John Last told me with a smile that he would die soon , supposedly to increase the value of the signature he had just h and written in my book . Fortunately , he did not , and his love for dictionary-making allowed him to produce his A Dictionary of Public Health , and to collaborate in the recently launched fifth edition of A Dictionary ... , now edited by Miquel Porta , professor of preventive medicine and public health from the Universitat Autònoma de Barcelona , senior scientist of the Institut Municipal d’Investigació Mèdica in Barcelona , Spain , and collaborator in the previous editions . If he had to limit his professional bookcase to a single volume , Professor Charles du V Florey , the former president of the IEA , would choose to keep A Dictionary .... I argue that anybody among us — epidemiologists and would-be epidemiologists ( hopefully with a larger shelf)—should also have a copy of this book at h and for frequent consultation . The collective effort gathered in its making is impressive . Miquel Porta has built over the previously crafted editions , and has relied on the support of a wide network of professionals to up date each entry and to exp and the selection of subjects . The Journal of Epidemiology and Community Health joined the initiative by publishing a call for su bmi ssions . Items already selected from the previous edition have been revised and up date d ; several new items have been added . As a result , the fifth edition of A Dictionary ... performs normative and informative functions : you will be informed on important matters and instructed on how to proceed in the epidemiological field . Readers with different needs and anxieties with knowledge will find straightforward writing , authoritative definitions and pertinent bibliographical references . How to differentiate a rate from a ratio , incidence from prevalence , confounding from intervening variables , type I from type II error ? How to appraise emerging themes in the epidemiological literature such as genetic polymorphisms and Bayesian statistics ? Key method ological issues such as meta- analysis , multilevel analysis and regression models : the list solely enrols a small sample of possible search es . The selection of issues was broad in scope ; intelligent and synthetic writing contemplated from the easier to the more intricate subjects . You may want to up date conceptual and method ological issues relevant to your teaching and research activities , to resolve doubts or to confirm an impression . You may want to check on terminology , fulfil curiosities or learn about topics unrelated to your preferential themes . You may be a professional applied to other health specialities , an undergraduate or a high school student . Several users will meet their needs by consulting A Dictionary ... ; even those who aim lessly scan the text may find some valuable insight . While it will not resolve all your needs in the epidemiological field , it surely provides enough substance to build on — a very good start or ammunition for more comprehensive search es . Miquel Porta dealt with the challenge of preparing reader-friendly texts on a wide range of subjects , which will satisfy both a beginner and an experienced epidemiologist . He seems to have transposed Occam ’s razor ( see the correspondent entry : ‘ ‘ the philosophical principle of parsimony ... assumptions to explain a phenomenon must not be multiplied beyond necessity ... ’ ’ ) to the writing of the book . If I may indulge in selftestimony , I found my teenage daughter consulting the book and it motivated a conversation on subjects so dear to me .... Arousing the interest of the young for a speciality admittedly perceived as difficult by adolescents ; as goes the popular saying , this is priceless ! ‘ ‘ Epidemiology is the study of the occurrence and distribution of healthrelated states or events in specified population s , including the study of the determinants influencing such states , and the application of this knowledge to control the health problems ’ ’ . The definition has matured over the years and presents slight modifications from its previous formulation in the fourth edition . The entry for ‘ ‘ Epidemiology ’ ’ exp and s the conceptualisation of terms comprised in the definition and includes historical aspects . In subsequent years , this definition will be the benchmark of the discipline , until Miquel Porta and his collaborators eventually prepare a further edition to meet the new needs that the future may bring forth . I dare to guess that the prospect i ve sixth edition of A Dictionary ... will have an online dynamic interface interacting with the hard copy . I also dare to guess that it will include a new entry for A Dictionary of Epidemiology , whose importance to the professional field will surely have earned it OBJECTIVE In normal adults , a small ( catalytic ) dose of fructose administered with glucose decreases the glycemic response to a glucose load , especially in those with the poorest glucose tolerance . We hypothesized that an acute catalytic dose of fructose would also improve glucose tolerance in individuals with type 2 diabetes . RESEARCH DESIGN AND METHODS Five adults with type 2 diabetes underwent an oral glucose tolerance test ( OGTT ) on two separate occasions , at least 1 week apart . Each OGTT consisted of 75 g glucose with or without the addition of 7.5 g fructose ( OGTT + F or OGTT - F ) , in r and om order . Arterialized blood sample s were collected from a heated dorsal h and vein twice before ingestion of the carbohydrate and every 15 min for 3 h afterward . RESULTS The area under the curve ( AUC ) of the plasma glucose response was reduced by fructose administration in all subjects ; the mean AUC during the OGTT + F was 14 % less than that during the OGTT - F ( P < 0.05 ) . The insulin AUC was decreased 21 % with fructose administration ( P = 0.2 ) . Plasma glucagon concentrations declined similarly during OGTT - F and OGTT + F. The incremental AUC of the blood lactate response during the OGTT - F was approximately 50 % of that observed during the OGTT + F ( P < 0.05 ) . Neither nonesterified fatty acid nor triglyceride concentrations differed between the two OGTTs . CONCLUSIONS Low-dose fructose improves the glycemic response to an oral glucose load in adults with type 2 diabetes , and this effect is not a result of stimulation of insulin secretion Previous studies indicate that leptin secretion is regulated by insulin-mediated glucose metabolism . Because fructose , unlike glucose , does not stimulate insulin secretion , we hypothesized that meals high in fructose would result in lower leptin concentrations than meals containing the same amount of glucose . Blood sample s were collected every 30 - 60 min for 24 h from 12 normal-weight women on 2 r and omized days during which the subjects consumed three meals containing 55 , 30 , and 15 % of total kilocalories as carbohydrate , fat , and protein , respectively , with 30 % of kilocalories as either a fructose-sweetened [ high fructose ( HFr ) ] or glucose-sweetened [ high glucose ( HGl ) ] beverage . Meals were isocaloric in the two treatments . Postpr and ial glycemic excursions were reduced by 66 + /- 12 % , and insulin responses were 65 + /- 5 % lower ( both P < 0.001 ) during HFr consumption . The area under the curve for leptin during the first 12 h ( -33 + /- 7 % ; P < 0.005 ) , the entire 24 h ( -21 + /- 8 % ; P < 0.02 ) , and the diurnal amplitude ( peak - nadir ) ( 24 + /- 6 % ; P < 0.0025 ) were reduced on the HFr day compared with the HGl day . In addition , circulating levels of the orexigenic gastroenteric hormone , ghrelin , were suppressed by approximately 30 % 1 - 2 h after ingestion of each HGl meal ( P < 0.01 ) , but postpr and ial suppression of ghrelin was significantly less pronounced after HFr meals ( P < 0.05 vs. HGl ) . Consumption of HFr meals produced a rapid and prolonged elevation of plasma triglycerides compared with the HGl day ( P < 0.005 ) . Because insulin and leptin , and possibly ghrelin , function as key signals to the central nervous system in the long-term regulation of energy balance , decreases of circulating insulin and leptin and increased ghrelin concentrations , as demonstrated in this study , could lead to increased caloric intake and ultimately contribute to weight gain and obesity during chronic consumption of diets high in fructose Background Current dietary guidelines recommend eating a variety of fruits and vegetables . However , based on nutrient composition , some particular fruits and vegetables may be more or less beneficial for maintaining or achieving a healthy weight . We hypothesized that greater consumption of fruits and vegetables with a higher fiber content or lower glycemic load would be more strongly associated with a healthy weight . Methods and Findings We examined the association between change in intake of specific fruits and vegetables and change in weight in three large , prospect i ve cohorts of 133,468 United States men and women . From 1986 to 2010 , these associations were examined within multiple 4-y time intervals , adjusting for simultaneous changes in other lifestyle factors , including other aspects of diet , smoking status , and physical activity . Results were combined using a r and om effects meta- analysis . Increased intake of fruits was inversely associated with 4-y weight change : total fruits -0.53 lb per daily serving ( 95 % CI -0.61 , -0.44 ) , berries -1.11 lb ( 95 % CI -1.45 , -0.78 ) , and apples/pears -1.24 lb ( 95 % CI -1.62 , -0.86 ) . Increased intake of several vegetables was also inversely associated with weight change : total vegetables -0.25 lb per daily serving ( 95 % CI -0.35 , -0.14 ) , tofu/soy -2.47 lb ( 95 % CI , -3.09 to -1.85 lb ) and cauliflower -1.37 lb ( 95 % CI -2.27 , -0.47 ) . On the other h and , increased intake of starchy vegetables , including corn , peas , and potatoes , was associated with weight gain . Vegetables having both higher fiber and lower glycemic load were more strongly inversely associated with weight change compared with lower-fiber , higher-glycemic-load vegetables ( p < 0.0001 ) . Despite the measurement of key confounders in our analyses , the potential for residual confounding can not be ruled out , and although our food frequency question naire specified portion size , the assessment of diet using any method will have measurement error . Conclusions Increased consumption of fruits and non-starchy vegetables is inversely associated with weight change , with important differences by type suggesting that other characteristics of these foods influence the magnitude of their association with weight change OBJECTIVE To investigate prospect ively whether intake of total or type of sugar is associated with the risk of developing type 2 diabetes . The contribution of sugar intake to the pathogenesis of type 2 diabetes has not been settled in the context of primary prevention because of limited prospect i ve data . RESEARCH DESIGN AND METHODS The Women 's Health Study is a r and omized controlled trial of aspirin and vitamin E in the prevention of cardiovascular disease and cancer . A vali date d semiquantitative food frequency question naire was completed by 39,345 women aged 45 years and older . The main outcome was the incidence of type 2 diabetes . The predictor was sugar intake , including sucrose , glucose , fructose , and lactose . Using Cox proportional hazard models , multivariate RRs of type 2 diabetes for increasing quintiles of sugar intake compared with the lowest quintile were estimated . RESULTS Compared with the lowest quintile of sugar intake , the RRs and 95 % CIs for the highest quintiles were 0.84 ( 0.67 - 1.04 ) for sucrose , 0.96 ( 0.78 - 1.19 ) for fructose , 1.04 ( 0.85 - 1.28 ) for glucose , and 0.99 ( 0.80 - 1.22 ) for lactose , after adjustment for known risk factors for type 2 diabetes . Similar findings of no association were obtained in subgroup analyses stratified by BMI . CONCLUSIONS Intake of sugars does not appear to play a deleterious role in primary prevention of type 2 diabetes . These prospect i ve data support the recent American Diabetes Association 's guideline that a moderate amount of sugar can be incorporated in a healthy diet BACKGROUND Consumption of sugar-sweetened beverages ( SSBs ) is associated with an increased risk of hypertension  in cross-sectional studies . However , prospect i ve data are limited . OBJECTIVE To examine the associations between SSBs and artificially sweetened beverages ( ASBs ) with incident hypertension . DESIGN AND SETTING Prospect i ve analysis using Cox proportional hazards regression to examine the association between SSBs and ASBs with incident hypertension in three large , prospect i ve cohorts , the Nurses ' Health Studies I ( n = 88,540 women ) and II ( n = 97,991 women ) and the Health Professionals ' Follow-Up Study ( n = 37,360 men ) . MEASUREMENTS Adjusted hazard ratios for incident clinical ly diagnosed hypertension . RESULTS Higher SSB  and ASB intake was associated with an increased risk of developing hypertension in all three cohorts . In a pooled analysis , participants who consumed at least one SSB daily had an adjusted HR for incident hypertension of 1.13 ( 95 % CI , 1.09–1.17 ) compared with those who did not consume SSBs ; for persons who drank at least one ASB daily , the adjusted HR was 1.14 ( 95 % CI , 1.09–1.18 ) . The association between sweetened beverage intake and hypertension was stronger for carbonated beverages versus non-carbonated beverages , and for cola-containing versus non-cola beverages in the NHS I and NHS II cohorts only . Higher fructose intake from SSBs as a percentage of daily calories was associated with increased hypertension risk in NHS I and NHS II ( p-trend = 0.001 in both groups ) , while higher fructose intake from sources other than SSBs was associated with a decrease in hypertension risk in NHS II participants ( p-trend = 0.006 ) . LIMITATIONS Residual confounding factors may interfere with the interpretation of results . CONCLUSIONS SSBs and ASBs are independently associated with an increased risk of incident hypertension after controlling for multiple potential confounders . These associations may be mediated by factors common to both SSBs and ASBs ( e.g. , carbonation or cola ) , but are unlikely to be due to fructose Beverage consumption has been implicated in weight gain , but questions remain about the veracity of the association , whether the relationship is causal and what property of beverages is responsible . It was hypothesized that food form is the most salient attribute . Thus , a r and omized controlled trial of food form was conducted . Energy-matched beverage or solid forms of fruits and vegetables were provided to 34 , lean or overweight/obese adults for two 8-week periods with a 3-week washout interspersed . Dietary compensation was incomplete ( beverage 53 % ; solid 78 % ) and body weight increased after the beverage ( 1.95 ± 0.33 kg ) ( 77 % fat mass ) and solid ( 1.36 ± 0.30 kg ) ( 85 % fat mass ) treatments ( both P < 0.0005 ) . Differences between food forms were not significant . The lean group had the highest dietary compensation ( 119 % ) and no significant weight change ( 0.84 ± 0.53 kg ) after consuming the solid fruits and vegetables whereas the overweight/obese group had lower compensation and significant weight gain during the solid arm ( 46 % , 1.77 ± 0.32 kg , P < 0.0001 ) . In contrast , incomplete dietary compensation and weight gain occurred in both the lean ( 43 % , 1.61 ± 0.44 kg , P = 0.003 ) and overweight/obese ( 61 % , 2.22 ± 0.47 kg , P < 0.0005 ) groups during the beverage arm . Secondary analyses revealed the obese group gained more weight than the lean and overweight groups during the beverage intervention ( P = 0.024 ) . These data demonstrate energy consumed as beverages may be especially problematic for weight gain . They also indicate that advice to increase fruit and vegetable consumption should emphasize total energy intake because the additional energy contributed may promote weight gain , especially among overweight and obese individuals OBJECTIVE To examine the effect on plasma triglycerides of removing most of the extrinsic sugar from the diet of free living hypertriglyceridaemic individuals while controlling weight loss . DESIGN Free living subjects were r and omly assigned to intervention and control groups . The intervention group undertook to consume a " sugar free ' diet for six months after a three month baseline period . The control group maintained their usual diets for the nine month period . The results from the two groups were compared using repeated measures ANOVA . SUBJECTS Thirty two hypertriglyceridaemic individuals , selected from members of the public in Dunedin , New Zeal and . RESULTS Subjects in the intervention group were able to achieve a mean reduction in sucrose intake of > 70 % , largely extrinsic sucrose , result ing in a group mean reduction in plasma triglyceride levels of > 20 % and a mean weight loss over the six month period of about 2 % . Repeated measures ANOVA on the mean triglyceride figures after the individual figures had been adjusted for this small weight loss , showed that there was a significant fall in triglyceride levels over the study period compared with the baseline . CONCLUSIONS Hypertriglyceridaemia can be reduced in some individuals by the reduction of extrinsic sucrose in the diet . When allowance is made for weight loss the reduction is still significant BACKGROUND Exercise prevents the adverse effects of a  high-fructose diet through mechanisms that remain unknown . OBJECTIVE We assessed the hypothesis that exercise prevents fructose-induced increases in very-low-density lipoprotein ( VLDL ) triglycerides by decreasing the fructose conversion into glucose and VLDL-triglyceride and fructose carbon storage into hepatic glycogen and lipids . DESIGN Eight healthy men were studied on 3 occasions after 4 d consuming a  weight-maintenance , high-fructose diet . On the fifth day , the men ingested an oral (13)C-labeled fructose load ( 0.75 g/kg ) , and their total fructose oxidation ( (13)CO2 production ) , fructose storage ( fructose ingestion minus (13)C-fructose oxidation ) , fructose conversion into blood (13)C glucose ( gluconeogenesis from fructose ) , blood VLDL-(13)C palmitate ( a marker of hepatic de novo lipogenesis ) , and lactate concentrations were monitored over 7 postpr and ial h. On one occasion , participants remained lying down throughout the experiment [ fructose treatment alone with no exercise condition ( NoEx ) ] , and on the other 2 occasions , they performed a 60-min exercise either 75 min before fructose ingestion [ exercise , then fructose condition ( ExFru ) ] or 90 min after fructose ingestion [ fructose , then exercise condition ( FruEx ) ] . RESULTS Fructose oxidation was significantly ( P < 0.001 ) higher in the FruEx ( 80 % ± 3 % of ingested fructose ) than in the ExFru ( 46 % ± 1 % ) and NoEx ( 49 % ± 1 % ) . Consequently , fructose storage was lower in the FruEx than in the other 2 conditions ( P < 0.001 ) . Fructose conversion into blood (13)C glucose , VLDL-(13)C palmitate , and postpr and ial plasma lactate concentrations was not significantly different between conditions . CONCLUSIONS Compared with sedentary conditions , exercise performed immediately after fructose ingestion increases fructose oxidation and decreases fructose storage . In contrast , exercise performed before fructose ingestion does not significantly alter fructose oxidation and storage . In both conditions , exercise did not abolish fructose conversion into glucose or its incorporation into VLDL triglycerides . This trial was registered at clinical trials.gov as NCT01866215 BACKGROUND : Beverages are contributing an increased proportion of energy to the diet . Because they elicit a weak compensatory dietary response , they may increase risk of positive energy balance . OBJECTIVES : This study aim ed to document the differential effects of matched liquid and solid carbohydrate loads on diet and body weight . DESIGN : In a cross-over design , seven males and eight females consumed dietary carbohydrate loads of 1880 kJ/day as a liquid ( soda ) or solid ( jelly beans ) during two 4 week periods separated by a 4 week washout . Subjects were permitted to consume the loads however they chose . In addition to baseline measurements , diet records were obtained on r and om days throughout the study , body composition was measured weekly , physical activity was assessed before and after treatments and hunger was assessed during washout and midway through each treatment . RESULTS : Free-feeding energy intake during the solid period was significantly lower than intake prior to this period . Dietary energy compensation was precise ( 118 % ) . No decrease in free-feeding energy intake occurred during the liquid period . Total daily energy intake increased by an amount equal to the load result ing in dietary compensation of −17 % . Consequently , body weight and BMI increased significantly only during the liquid period . Physical activity and hunger were unchanged . CONCLUSIONS : This study indicates that liquid carbohydrate promotes positive energy balance , whereas a comparable solid carbohydrate elicits precise dietary compensation . Increased consumption of energy-yielding fluids may promote positive energy balance People are advised to reduce their intake of saturated fat and replace it by carbohydrate to avoid coronary heart disease . It is unknown whether sucrose and starchy foods , two major sources of carbohydrates , have similar effects on cardiovascular risk markers if incorporated as a replacement for saturated fat into diets eaten ad libitum . We served 20 healthy , normal-weight women aged 21 to 52 years three strictly controlled diets ad libitum : FAT , high in total fat ( 46 % of total energy [ E% ] ) and saturated fat ( 21 E% ) ; STARCH , high in total carbohydrates ( 59 E% ) and low in sucrose ( 2.5 E% ) ; and SUCROSE , high in total carbohydrates ( 59 E% ) and sucrose ( 23.2 E% ) . The diets were eaten in r and omized order for a period of 2 weeks . Blood lipids , factor VII coagulant activity ( FVIIc ) , and fibrinogen concentrations were measured with subjects in the fasted state ( 9:45 AM ) and the postabsorptive state ( 6:00 PM ) . STARCH was associated with lower total cholesterol ( mean difference , 0.34 mmol/L ; 95 % confidence interval [ CI ] , 0.18 to 0.50 ) , low-density lipoprotein ( LDL ) cholesterol ( 0.25 mmol/L ; 95 % CI , 0.13 to 0.37 ) , fasting triglycerides ( 0.15 mmol/L ; 95 % CI , 0.07 to 0.23 ) , nonfasting triglycerides ( 0.44 mmol/L ; 95 % CI , 0.30 to 0.58 ) , and nonfasting FVIIc ( 9.8 % ; 95 % CI , 3.8 to 15.8 ) than SUCROSE . Compared with FAT , STARCH result ed in a desirable decrease of LDL cholesterol and nonfasting FVIIc .  STARCH was also associated with a minor weight loss ( 0.7 kg ) that was not found on the other 2 diets . We conclude that starchy foods with a natural content of dietary fiber can be recommended as substitutes for saturated fat in the dietary prevention of coronary heart disease . According to the present short-term findings in healthy females , substitution with sucrose is not advisable BACKGROUND Consumption of sugar-sweetened soda has been associated with an increased risk of cardiometabolic disease . The relation with cerebrovascular disease has not yet been closely examined . OBJECTIVE Our objective was to examine patterns of soda consumption and substitution of alternative beverages for soda in relation to stroke risk . DESIGN The Nurses ' Health Study , a prospect i ve cohort study of 84,085 women followed for 28 y ( 1980 - 2008 ) , and the Health Professionals Follow-Up Study , a prospect i ve cohort study of 43,371 men followed for 22 y ( 1986 - 2008 ) , provided data on soda consumption and incident stroke . RESULTS We documented 1416 strokes in men during 841,770 person-years of follow-up and 2938 strokes in women during 2,188,230 person-years of follow-up .  The pooled RR of total stroke for ≥ 1 serving of sugar-sweetened soda/d , compared with none , was 1.16 ( 95 % CI : 1.00 , 1.34 ) . The pooled RR of total stroke for ≥ 1 serving of low-calorie soda/d , compared with none , was 1.16 ( 95 % CI : 1.05 , 1.28 ) . Compared with 1 serving of sugar-sweetened soda/d , 1 serving of decaffeinated coffee/d was associated with a 10 % ( 95 % CI : 1 % , 19 % ) lower risk of stroke and 1 serving of caffeinated coffee/d with a 9 % ( 95 % CI : 0 % , 17 % ) lower risk . Similar estimated reductions in risk were seen for substitution of caffeinated or decaffeinated coffee for low-calorie soda . CONCLUSIONS Greater consumption of sugar-sweetened and low-calorie sodas was associated with a significantly higher risk of stroke . This risk may be reduced by substituting alternative beverages for soda BACKGROUND Although obesity is the most important risk factor for type 2 diabetes , evidence is emerging that certain foods and dietary factors may be associated with diabetes . To examine the association between major dietary patterns and risk of type 2 diabetes mellitus in a cohort of women . METHODS We prospect ively assessed the associations between major dietary patterns  and  risk of type 2 diabetes in women .  Dietary information was collected in 1984 , 1986 , 1990 , and 1994 from 69,554 women aged 38 to 63 years without a history of diabetes , cardiovascular disease , or cancer in 1984 . We conducted factor analysis and identified 2 major dietary patterns : " prudent " and " Western . " We then calculated pattern scores for each participant and examined prospect ively the associations between dietary pattern scores and type 2 diabetes risks . RESULTS The prudent pattern was characterized by higher intakes of fruits , vegetables , legumes , fish , poultry , and whole grains , while the Western pattern included higher intakes of red and processed meats , sweets and desserts , french fries , and refined grains . During 14 years of follow-up , we identified 2699 incident cases of type 2 diabetes .  After adjusting for potential confounders , we observed a relative risk for diabetes of 1.49 ( 95 % confidence interval [ CI ] , 1.26 - 1.76 , P for trend , < .001 ) when comparing the highest to lowest quintiles of the Western pattern . Positive associations were also observed between type 2 diabetes and red meat and other processed meats . The relative risk for diabetes for every 1-serving increase in intake is 1.26 ( 95 % CI , 1.21 - 1.42 ) for red meat , 1.38 ( 95 % CI , 1.23 - 1.56 ) for total processed meats , 1.73 ( 95 % CI , 1.39 - 2.16 ) for bacon , 1.49 ( 95 % CI , 1.04 - 2.11 ) for hot dogs , and 1.43 ( 95 % CI , 1.22 - 1.69 ) for processed meats . CONCLUSION The Western pattern , especially a diet higher in processed meats , may increase the risk of type 2 diabetes in women BACKGROUND Although substantial information on individual nutrients or foods and risk of coronary heart disease ( CHD ) is available , little is known about the role of overall eating pattern . METHODS Using dietary information from a food frequency question naire in 1984 from the Nurses ' Health Study , we conducted factor analysis and identified 2 major dietary patterns-"prudent " and " Western"- and calculated factor scores of each pattern for individuals in the cohort . We used logistic regression to examine prospect ively the associations between dietary patterns and CHD risk among 69 017 women aged 38 to 63 years in 1984 without history of major chronic diseases . RESULTS The prudent pattern was characterized by higher intakes of fruits , vegetables , legumes , fish , poultry , and whole grains , while the Western pattern was characterized by higher intakes of red and processed meats , sweets and desserts , french fries , and refined grains . Between 1984 and 1996 , we documented 821 CHD cases . After adjusting for coronary risk factors , the prudent diet score was associated with a relative risk ( RR ) of 0.76 ( 95 % confidence interval ( CI ) , 0.60 - 0.98 ; P for trend test,.03 ) comparing the highest with lowest quintile . Extreme quintile comparison yielded an RR of 1.46 ( 95 % CI , 1.07 - 1.99 ; P for trend test,.02 ) for the Western pattern . Those who were jointly in the highest prudent diet quintile and lowest Western diet quintile had an RR of 0.64 ( 95 % CI , 0.44 - 0.92 ) compared with those with the opposite pattern profile . CONCLUSION A diet high in fruits , vegetables , whole grains , legumes , poultry , and fish and low in refined grains , potatoes , and red and processed meats may lower risk of CHD The prevalence of type 2 diabetes mellitus is rapidly increasing in the United States ( 1 , 2 ) and worldwide ( 3 ) . Ecologic studies ( 4 ) , migration studies ( 4 , 5 ) , and analyses of secular trends ( 4 , 6 ) suggest that adoption of a western diet may be associated with increased incidence of type 2 diabetes . However , these studies could not separate the effects of diet from those of other risk factors , such as obesity and physical activity . Studies of the relation between diet and incidence of type 2 diabetes on an individual level have predominantly focused on intake of macronutrients and fiber ( 7 ) . However , these dietary factors alone probably explain only part of the effect of diet on glucose metabolism . Other nutrients , additives , contaminants , and unknown compounds and the physical properties of foods and interactions between nutrients ( for example , with respect to bioavailability ) may play a role in the deterioration of glucose metabolism . Hence , the examination of effects of food consumption may be an important complementary approach . Recently , the analysis of patterns of food consumption by using factor analysis has emerged as a useful tool for elucidating relationships between diet and health ( 8 - 11 ) . The overall dietary pattern may affect health more than individual foods and nutrients do . Furthermore , dietary patterns reflect the way foods are consumed in reality , which may provide insight into possibilities for dietary changes and may facilitate the translation of findings to public health recommendations . Recent dietary intervention studies have indicated that interventions focused on dietary patterns can decrease blood pressure ( 12 ) and reduce cardiovascular complications ( 13 ) . Data on dietary patterns and risk for type 2 diabetes are sparse . Although two cross-sectional studies of dietary patterns and diabetes have been conducted ( 11 , 14 ) , these studies incompletely controlled for confounding by other lifestyle factors . Therefore , we prospect ively examined the association between major dietary patterns and risk for type 2 diabetes in a large prospect i ve study of U.S. professional men with extensive , repeatedly obtained information on diet and other lifestyle factors . Methods Participants The Health Professionals Follow-up Study started in 1986 , when 51 529 male health professionals ( dentists , veterinarians , pharmacists , optometrists , osteopathic physicians , and podiatrists ) completed a detailed mailed question naire on medical history , diet , and other potential risk factors for major diseases .  The participants lived in all 50 U.S. states , were predominantly white , and were 40 to 75 years of age in 1986 . We excluded from the current analysis 1595 men who did not satisfy the a priori criteria of reporting daily energy intake of 3.3 to 17.6 MJ ( 800 to 4200 kcal/24 h ) and leaving fewer than 70 responses blank of the 131 food items on the diet question naire ( < 5 % had > 11 blanks ) . We also excluded men who reported having diabetes , cardiovascular disease ( myocardial infa rct ion , angina pectoris , coronary artery surgery , or stroke ) , or cancer ( except nonmelanoma skin cancer ) at baseline because having these diagnoses may affect diet or reporting of diet . After exclusions , the study sample comprised 42 504 men , who were followed for incidence of type 2 diabetes and other diseases for 12 years ( 1986 to 1998 ) . Every 2 years , the participants received question naires by mail that asked for up date d information on exposures and newly diagnosed diseases . The follow-up rate for potential person-years was about 97 % for nonfatal events . We identified deaths by reports from family members , coworkers , or postal authorities or through systematic search es of the National Death Index . Assessment of Dietary Patterns To assess dietary intake , we used a 131-item semiquantitative food-frequency question naire in 1986 , 1990 , and 1994 . The question naire specified for each food a commonly used unit or portion size , and the participants were asked to indicate how often , on average , they had consumed a given amount of the specified food during the past year . Each such item provided nine possible responses , ranging from never or less than once a month to 6 or more times per day . To reduce within-respondent variation and to best represent long-term dietary habits , we averaged the dietary intakes from all available dietary question naires up to the start of each follow-up interval ( the average of the 1986 and 1990 dietary intakes was related to incidence of type 2 diabetes between 1990 and 1994 ) ( 15 ) . To identify dietary patterns , we applied factor analysis to data from the food-frequency question naire . First , we grouped the food items on the question naire into 37 predefined food groups . We combined food items that were similar in nutrient profile and culinary use ( for example , spinach , iceberg or head lettuce , and romaine or leaf lettuce were combined into green leafy vegetables ) . We classified a food item individually if its composition differed substantially from that of other foods ( for example , eggs or pizza ) or if we suspected that it represents a particular dietary habit ( for example , wine or French fries ) . Second , we applied the principal components program for factor analysis of SAS software ( 16 ) with varimax rotation to the 37 food groups . Factor analysis aggregates correlated variables . The obtained factors are linear combinations of the included variables , explaining as much of the variation in the original variables as possible . Our analysis retained two factors based on the eigenvalue of the factors , the Scree test , and the interpretability of the derived factors , and we labeled these diets as the prudent pattern and the western pattern ( 9 ) . Third , for each participant , we calculated a  prudent pattern score and a  western pattern score  by summing the st and ardized intake of foods , weighted by the factor loadings of the foods ( 17 ) . We used these scores to rank participants according to the degree to which they conformed to each dietary pattern . We divided dietary pattern scores into quintiles ; thus , on this basis of his scores , each participant was grouped in a prudent-pattern quintile and a western-pattern quintile . To test the validity and reproducibility of the assessment of the dietary pattern scores by the food-frequency question naire , we examined a subgroup of 127 participants ( 9 ) . The Pearson correlation coefficient ( corrected for week-to-week variation in the diet records ) for a comparison between the responses to the food-frequency question naire and the diet records was 0.52 for the prudent dietary pattern and 0.74 for the western dietary pattern . Assessment of Nondietary Exposures The 1986 question naire and each biennial follow-up question naire assessed weight , smoking status , and physical activity .  Participants provided information on age , diagnosis of hypertension and hypercholesterolemia , and height in 1986 and on family history of diabetes in 1987 . The criterion for family history of type 2 diabetes was having at least one first-degree relative with a diagnosis of diabetes after 30 years of age . For each participant , we determined a physical activity level , measured in weekly metabolic equivalent hours , on the basis of reported time spent on various activities , which we weighted according to intensity level ( 18 ) . The validity of self-reported weight ( 19 ) and physical activity ( 18 ) in this cohort has been reported previously . Ascertainment of Type 2 Diabetes Mellitus We mailed a supplementary question naire on symptoms , diagnostic tests , and medication use to participants who indicated on any biennial follow-up question naire that he had received a diagnosis of diabetes mellitus . Confirmation of diabetes required at least one of the following : 1 ) an elevated plasma glucose level ( fasting plasma glucose level 7.8 mmol/L [ 140 mg/dL ] ; r and om plasma glucose level 11.1 mmol/L [ 200 mg/dL ] ; or  plasma glucose level after 2 hours or more during an oral glucose tolerance test 11.1 mmol/L [ 200 mg/dL ] ) plus at least one classic symptom [ excessive thirst , polyuria , weight loss , or hunger ] ; 2 ) at least two elevated plasma glucose levels measured on different occasions ; or 3 ) treatment with insulin or oral hypoglycemic medication . We excluded men who reported having type 1 diabetes on the supplementary question naire . These criteria for diabetes are consistent with those from the World Health Organization in 1985 ( 20 ) . We did not use the current diabetes classification of the American Diabetes Association ( 21 ) because among the men in our study , most cases of diabetes were diagnosed before these criteria were published . The validity of our assessment of type 2 diabetes was verified with medical records in a sub sample of 71 participants . A physician blinded to the information on the supplementary question naire review ed the records according to the diagnostic criteria . Of the 71 participants classified as having type 2 diabetes , 12 had incomplete medical recordsfor example , absent laboratory data ( n = 2 ) or only one set of laboratory data ( n = 9 ) . We confirmed the classification of type 2 diabetes in 57 ( 97 % ) of the other 59 other men in the sub sample . One participant denied having diabetes , and another participant lacked evidence of diabetes in his su bmi tted records . Statistical Analysis We used pooled logistic regression analyses with 2-year intervals to estimate the adjusted relative risk for each quintile compared with the lowest quintile of intake . With short time intervals and low rates of events , this approach gives results very similar to those of Cox proportional-hazards analyses ( 22 ) . Participants who died or received a diagnosis of diabetes during a 2-year cycle were censored at the end of that 2-year period and were not entered in any subsequent 2-year cycle . We used the cumulative average of available dietary assessment s up to the start of each 2-year follow-up interval ( 15 ) . We stopped updating a participant 's dietary In animal models , a small ( catalytic ) dose of fructose administered with glucose decreases the glycemic response to the glucose load . Therefore , we examined the effect of fructose on glucose tolerance in 11 healthy human volunteers ( 5 men and 6 women ) . Each subject underwent an oral glucose tolerance test ( OGTT ) on 2 separate occasions , at least 1 week apart . Each OGTT consisted of 75 g glucose with or without 7.5 g fructose ( OGTT+F or OGTT-F ) , in r and om order .  Arterialized blood sample s were obtained from a heated dorsal h and vein twice before ingestion of the carbohydrate and every 15 min for 2 h afterward . The area under the curve ( AUC ) of the change in plasma glucose was 19 % less in OGTT+F vs. OGTT-F ( P : < 0.05 ) . Glucose tolerance was improved by fructose in 9 subjects and worsened in 2 . All 6 subjects with the largest glucose AUC during OGTT-F had a decreased response during OGTT+F ( 31 + /- 5 % decrease ) . The insulin AUC did not differ between the 2 studies . Of the 9 subjects with improved glucose tolerance during the OGTT+F , 5 had smaller insulin AUC during the OGTT+F than the OGTT-F. Plasma glucagon concentrations declined similarly during OGTT-F and OGTT+F. The blood lactate response was about 50 % greater during the OGTT+F ( P : < 0.05 ) . Neither nonesterified fatty acid nor triglyceride concentrations differed between the two OGTT . In conclusion , low dose fructose improves the glycemic response to an oral glucose load in normal adults without significantly enhancing the insulin or triglyceride response .  Fructose appears most effective in those normal individuals who have the poorest glucose tolerance CONTEXT Fructose-rich beverages such as sugar-sweetened soda and orange juice can increase serum uric acid levels and , thus , the risk of gout , but prospect i ve data on the relationship are limited . OBJECTIVE To examine the relationship between intake of fructose-rich beverages and fructose and the risk of incident gout among women . DESIGN , SETTING , AND PARTICIPANTS In the Nurses ' Health Study , a US prospect i ve cohort study spanning 22 years ( 1984 - 2006 ) , we analyzed data from 78,906 women with no history of gout at baseline who provided information on intake of beverages and fructose through vali date d food frequency question naires . MAIN OUTCOME MEASURE Incident cases that met the American College of Rheumatology survey criteria for gout . RESULTS During 22 years of follow-up , we documented 778 confirmed incident cases of gout . Increasing intake of sugar-sweetened soda was independently associated with increasing risk of gout . Compared with consumption of less than 1 serving per month of sugar-sweetened soda , the multivariate relative risk of gout for 1 serving per day was 1.74 ( 95 % confidence interval [ CI ] , 1.19 - 2.55 ) and for 2 or more servings per day was 2.39 ( 95 % CI , 1.34 - 4.26 ) ( P<.001 for trend ) . The corresponding relative risks for orange juice were 1.41 ( 95 % CI , 1.03 - 1.93 ) and 2.42 ( 95 % CI , 1.27 - 4.63 ) ( P = .02 for trend ) . The absolute risk differences corresponding to these relative risks were 36 and 68 cases per 100,000 person-years for sugar-sweetened soda and 14 and 47 cases per 100,000 person-years for orange juice , respectively . Diet soft drinks were not associated with the risk of gout ( P = .27 for trend ) . Compared with the lowest quintile of fructose intake , the multivariate relative risk of gout in the top quintile was 1.62 ( 95 % CI , 1.20 - 2.19 ; P = .004 for trend ) ( risk difference of 28 cases per 100,000 person-years ) . CONCLUSION Among this cohort of women , consumption of fructose-rich beverages is associated with an increased risk of incident gout , although the contribution of these beverages to the risk of gout in the population is likely modest given the low incidence rate among women The long-term effects of sucrose on appetite and mood remain unclear . Normal weight subjects compensate for sucrose added blind to the diet ( Reid et al. , 2007 ) . Overweight subjects , however , may differ . In a single-blind , between-subjects design , soft drinks ( 4x25cl per day ; 1800kJ sucrose sweetened versus 67kJ aspartame sweetened ) were added to the diet of overweight women ( n=53 , BMI 25 - 30 , age 20 - 55 ) for 4 weeks . A 7-day food diary gave measures of total energy , carbohydrate , protein , fat , and micronutrients . Mood and hunger were measured by ten single Likert scales rated daily at 11.00 , 14.00 , 16.00 , and 20.00 . Activity levels were measured by diary and pedometer . Baseline energy intake did not differ between groups . During the first week of the intervention energy intake increased slightly in the sucrose group , but not in the aspartame group , then decreased again , so by the final week intake again did not differ from the aspartame group . Compensation was not large enough to produce significant changes in the composition of the voluntary diet . There were no effects on hunger or mood . It is concluded that overweight women do not respond adversely to sucrose added blind to the diet , but compensate for it by reducing voluntary energy intake . Alternative explanations for the correlation between sugary soft drink intake and weight gain are discussed Background — Sugar-sweetened beverages ( SSBs ) are consumed globally and contribute to adiposity . However , the worldwide impact of SSBs on burdens of adiposity-related cardiovascular diseases ( CVDs ) , cancers , and diabetes mellitus has not been assessed by nation , age , and sex . Methods and Results — We modeled global , regional , and national burdens of disease associated with SSB consumption by age/sex in 2010 . Data on SSB consumption levels were pooled from national dietary surveys worldwide . The effects of SSB intake on body mass index and diabetes mellitus , and of elevated body mass index on CVD , diabetes mellitus , and cancers were derived from large prospect i ve cohort pooling studies . Disease-specific mortality/morbidity data were obtained from Global Burden of Diseases , Injuries , and Risk Factors 2010 Study . We computed cause-specific population -attributable fractions for SSB consumption , which were multiplied by cause-specific mortality/morbidity to compute estimates of SSB-attributable death/disability . Analyses were done by country/age/sex ; uncertainties of all input data were propagated into final estimates . Worldwide , the model estimated 184 000 ( 95 % uncertainty interval , 161 000–208 000 ) deaths/y attributable to SSB consumption : 133 000 ( 126 000–139 000 ) from diabetes mellitus , 45 000 ( 26 000–61 000 ) from CVD , and 6450 ( 4300–8600 ) from cancers . Five percent of  SSB-related deaths occurred in low-income , 70.9 % in middle-income , and 24.1 % in high-income countries . Proportional mortality attributable to SSBs ranged from < 1 % in Japanese > 65 years if age to 30 % in Mexicans < 45 years of age . Among the 20 most populous countries , Mexico had largest absolute ( 405 deaths/million adults ) and proportional ( 12.1 % ) deaths from SSBs . A total of 8.5 ( 2.8 , 19.2 ) million disability-adjusted life years were related to SSB intake ( 4.5 % of diabetes mellitus – related disability-adjusted life years ) . Conclusions — SSBs are a single , modifiable component of diet that can impact preventable death/disability in adults in high- , middle- , and low-income countries , indicating an urgent need for strong global prevention programs BACKGROUND Through the processes of oxidation , polymerization , and hydrogenation , the cooking method of frying modifies both foods and their frying medium . However , it remains unknown whether the frequent consumption of fried foods is related to long-term cardiometabolic health . OBJECTIVE We examined fried-food consumption and risk of developing incident type 2 diabetes ( T2D ) or coronary artery disease ( CAD ) . DESIGN Fried-food consumption was assessed by using a question naire in 70,842 women from the Nurses ' Health Study ( 1984 - 2010 ) and 40,789 men from the Health Professionals Follow-Up Study ( 1986 - 2010 ) who were free of diabetes , cardiovascular disease , and cancer at baseline . Time-dependent Cox proportional hazards models were used to estimate RRs and 95 % CIs for T2D and CAD adjusted for demographic , diet , lifestyle , and other cardiometabolic risk factors . Results were pooled by using an inverse variance-weighted r and om-effects meta- analysis . RESULTS We documented 10,323 incident T2D cases and 5778 incident CAD cases .  Multivariate-adjusted RRs ( 95 % CIs ) for individuals who consumed fried foods < 1 , 1 - 3 , 4 - 6 , or ≥7 times/wk were 1.00 ( reference ) , 1.15 ( 0.97 , 1.35 ) , 1.39 ( 1.30 , 1.49 ) , and 1.55 ( 1.32 , 1.83 ) , respectively , for T2D and 1.00 ( reference ) , 1.06 ( 0.98 , 1.15 ) , 1.23 ( 1.14 , 1.33 ) , and 1.21 ( 1.06 , 1.39 ) , respectively , for CAD . Associations were largely attenuated when we further controlled for biennially up date d hypertension , hypercholesterolemia , and body mass index . CONCLUSIONS  Frequent fried-food consumption was significantly associated with risk of incident T2D and moderately with incident CAD , and these associations were largely mediated by body weight and comorbid hypertension and hypercholesterolemia
target: The highest level of evidence from systematic review s and meta-analyses of controlled trials has not shown that fructose-containing sugars behave any differently from other forms of digestible carbohydrates .
  Fructose-containing sugars can only lead to weight gain and other unintended harms on cardiometabolic risk factors insofar as the excess calories they provide .
  Prospect i ve cohort studies , which provide the strongest observational evidence , have shown an association between fructose-containing sugars and cardiometabolic risk including weight gain , cardiovascular disease outcomes and diabetes only when restricted to sugar-sweetened beverages and not for sugars from other sources .
  In fact , sugar-sweetened beverages are a marker of an unhealthy lifestyle and their drinkers consume more calories , exercise less , smoke more and have a poor dietary pattern .
background: Fructose-containing sugars are a focus of attention as a public health target for their putative role in obesity and cardiometabolic disease including diabetes .
  The fructose moiety is singled out to be the primary driver for the harms of sugars due to its unique endocrine signal and pathophysiological role .
  However , this is only supported by ecological studies , animal models of overfeeding and select human intervention studies with supraphysiological doses or lack of control for energy .