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Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH

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Visceral Adiposity: Yet Another Reason to Cut Back on Sugary Drinks!

Posted in
Eat better

Monday, May 16, 2016

One of the major points of emphasis in the 2015-2020 Dietary Guidelines for Americans includes limiting intake of added sugars to less than 10% of total daily calorie intake.  The majority of our added sugar intake comes in the form of sugar-sweetened beverages (SSB) such as non-diet soda, sports drinks, energy drinks, and imitation fruit drinks (fruit punch, lemonade, etc). While excess SSB intake has been associated with an increased risk of cardiovascular disease and type 2 diabetes, there is very limited data on habitual SSB intake and the change in the quantity of abdominal adipose tissue over time. You may recall from a previous blog  that there are two depots of fat in the abdominal region. Subcutaneous adipose tissue lies immediately under the skin and is relatively benign when compared to visceral adipose tissue (VAT), which lies deep among the internal organs. VAT produces substances that promote inflammation, blood clotting, blood vessel constriction, and insulin resistance. Thus, high levels of VAT are strongly linked to increased health risks such as cardiovascular disease and type 2 diabetes.

In a recent issue of Circulation, Ma et al. (2016) studied a group of 1003 adult men and women with an average age of 45 years who were enrolled in the Framingham Heart Study. At baseline, all subjects completed a previously validated Food Frequency Questionnaire, which included detailed questions regarding SSB and other beverage intake. Baseline VAT volume was also assessed by using a CT scan. Subjects were divided into 4 groups according to baseline SSB intake:

Group 1: none to <1 serving per month (317 individuals)                                                                                            
Group 2: 1 serving a month to <1 serving per week (196 individuals)                                                                           
Group 3: 1 serving a week to 1 serving per day (356 individuals)                                                                           
Group 4: >1 serving per day (134 individuals)

The CT scan was repeated an average of 6 years following the baseline exam. After taking into consideration other factors that might ‘muddy the water’ such as age, gender, and physical activity level, the group examined changes in VAT in the 4 Groups. As shown in Figure 1 below, Groups 1 and 2 had very similar gains in VAT volume over the 6 year period (658 and 649 cm3 gains respectively).  Group 3 experienced a gain of 707 cm3, while Group 4 gained 852 cm3 of VAT. Thus, higher baseline levels of SSB intake were significantly associated with greater gains in VAT over time.


Some individuals among the non-scientist population vigorously claim that diet soda is ‘just as bad’ as SSB in terms of causing obesity. This study also examined diet soda intake separately, and in the same manner as they examined SSB intake. There was no association between diet soda intake and changes in VAT when comparing the 4 Groups. This is not surprising, given that diet soda does not contain any calories!

In conclusion, this study found a dose:response relationship between SSB intake and increases in VAT over time. The results strongly reinforce the current dietary recommendation to limit added sugars. Consumption of SSB’s should be an occasional treat rather than an everyday occurrence!

To learn more about nutrition, physical activity, healthy eating, and risk of chronic disease, take our Nutrition for Health and Fitness, Personal Training Education, and/or Weight Loss Strategies courses. The first two of these courses are available live and online. You need not be a health and fitness professional to take these courses; the general public is always welcome!

Reference
Ma, J., McKeown, N.M., Hwang, S.J., 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(4), 370-377.