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Title: Sugar-sweetened beverage consumption is associated with change of visceral adipose tissue over 6 years of follow-up

Author
item MA, JIANTAO - Framingham Heart Study
item MCKEOWN, NICOLA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item HWANG, SHIH-JEN - Framingham Heart Study
item HOFFMAN, UDO - Harvard University
item JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item FOX, CAROLINE - Framingham Heart Study

Submitted to: Circulation
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/16/2015
Publication Date: 1/11/2016
Citation: Ma, J., McKeown, N.M., Hwang, S., Hoffman, U., Jacques, P.F., Fox, C.S. 2016. Sugar-sweetened beverage consumption is associated with change of visceral adipose tissue over 6 years of follow-up. Circulation. 133:370-377. https://doi.org/10.1161/CIRCULATIONAHA.115.018704.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.115.018704

Interpretive Summary: Visceral adipose tissue is fat located inside the abdominal cavity between the organs. This type of fat has been linked to diabetes and cardiovascular disease. In contrast, subcutaneous abdominal tissue, or fat underneath the skin, may not be as harmful as visceral adipose tissue regarding health outcomes. It is also well established that sugar-sweetened beverages may contribute to the development of metabolic disorders such as diabetes, and previous research has shown that sugar-sweetened beverage intake is associated with greater visceral adipose tissue. However, these studies linking sugar-sweetened beverages to visceral adipose tissue have been limited by study designs that cannot establish whether the sugar-sweetened beverage intake preceded the development of visceral adipose tissue. In other words, these studies cannot conclusively indicate that the sugar-sweetened beverage consumption causes the increase in visceral adipose tissue. Thus, the goal of this study is to follow individuals over time to examine habitual intake of sugar-sweetened beverages and changes in visceral adipose tissue using computed tomography (CT) imaging over the course of 6 years. We hypothesized that habitually drinking more sugar-sweetened beverages would be associated with a greater increase in visceral adipose tissue and subcutaneous abdominal tissue and that no such association would be observed with diet soda. We examined approximately 1,000 adults in the Framingham Heart Study's Third Generation cohort for which CT scan measurements of subcutaneous abdominal tissue and visceral adipose tissue were collected at year 1 and year 6. We found that higher sugar-sweetened beverage intake was associated with greater change in the volume of visceral adipose tissue (more visceral adipose tissue) over the 6 year period. Specifically, we observed that individuals who consumed 1 or more servings of sugar-sweetened beverages per day had a 29% greater increase in visceral adipose tissue volume over 6 years compared to sugar-sweetened beverage nonconsumers. In contrast, diet soda consumption was not associated with change in visceral adipose tissue. The findings of this study further highlight the importance of working to reduce sugar-sweetened beverages intake and emphasize the importance of the current Dietary Guidelines for Americans recommendations to limit sugar-sweetened beverages consumption as much as possible to reduce the burden of cardiometabolic disease.

Technical Abstract: Background: Sugar-sweetened beverage (SSB) intake has been linked to abnormal abdominal adipose tissue. We examined the prospective association of habitual SSB intake and change in visceral adipose tissue (VAT) and subcutaneous adipose tissue. Methods and Results: The quantity (volume, cm^3) and quality (attenuation, Hounsfield Unit) of abdominal adipose tissue were measured using computed tomography in 1003 participants (mean age 45.3 years, 45.0% women) at examination 1 and 2 in the Framingham's Third Generation cohort. The 2 exams were 6 years apart. At baseline, SSB and diet soda intake were assessed using a valid food frequency questionnaire. Participants were categorized into 4 groups: none to <1 serving/mo (nonconsumers), 1 serving/mo to <1 serving/week, 1 serving/week to 1 serving/d, and >/= 1 serving/d (daily consumers) of either SSB or diet soda. After adjustment for multiple confounders including change in body weight, higher SSB intake was associated with greater change in VAT volume (P trend<0.001). VAT volume increased by 658 cm^3 (95% confidence interval [CI], 602 to 713), 649 cm^3 (95% CI, 582 to 716), 707 cm^3 (95% CI, 657 to 757), and 852 cm^3 (95% CI, 760 to 943) from nonconsumers to daily consumers. Higher SSB intake was also associated with greater decline of VAT attenuation (P trend=0.007); however, the association became nonsignificant after additional adjustment for VAT volume change. In contrast, diet soda consumption was not associated with change in abdominal adipose tissue. Conclusions: Regular SSB intake was associated with adverse change in both VAT quality and quantity, whereas we observed no such association for diet soda.