The lifetime health and economic burden of obesity in five European countries: what is the potential impact of prevention?

Aim

Estimating the burden of obesity in five European countries (Germany, Greece, the Netherlands, Spain and the UK) and the potential health benefits and changes in health care costs associated with a reduction in body mass index (BMI).

Materials and Methods

A Markov model was used to estimate the long-term burden of obesity. Health states were based on the occurrence of diabetes, ischaemic heart disease and stroke. Multiple registries and literature sources were used to derive the demographic, epidemiological and cost input parameters. For the base-case analyses, the model was run for a starting cohort of healthy obese people with a BMI of 30 and 35 kg/m² aged 40 years to estimate the lifetime impact of obesity and the impact of a one-unit decrease in BMI. Different scenario and sensitivity analyses were performed.

Results

The base-case analyses showed that total lifetime health care costs (for obese people aged 40 and BMI 35 kg/m²) ranged from €75 376 in Greece to €343 354 in the Netherlands, with life expectancies ranging from 37.9 years in Germany to 39.7 years in Spain. A one-unit decrease in BMI showed gains in life expectancy ranging from 0.65 to 0.68 year and changes in total health care costs varying from −€1563 to +€4832.

Conclusions

The economic burden of obesity is substantial in the five countries. Decreasing BMI results in health gains, reductions in obesity-related health care costs, but an increase in non-obesity related health care costs, which emphasizes the relevance of including all costs in decision making on implementation of preventive interventions.     

Clinical outcomes and costs for patients with type 2 diabetes mellitus initiating insulin therapy in Greece: Two-year experience from the INSTIGATE study

AimsTo evaluate the quality of metabolic control, clinical outcomes, resource costs, and quality of life among patients with type 2 diabetes mellitus (T2DM), who initiated insulin for the first time as part of routine clinical practice.MethodsThe INSTIGATE study is a prospective, multicentric, observational study of patients initiating insulin treatment. This sub-cohort analysis focuses on Hellenic outcomes.ResultsAt baseline, 263 Greek patients were enrolled just before initiating insulin for the first time. At the 6-month visit, 237 patients (90.1%) remained and consented to an additional 18-month observation period. In these 237 extension patients, over the 24-month post-initiation period, HbA1c (mean(SD)) decreased from 9.7%(1.6%) to 7.1%(0.9%) and body weight and BMI increased (+3(6) kg and +1.1(2.2) kg/m², respectively). At each post-baseline visit approximately one in five patients reported ≥1 episodes of hypoglycaemia in the preceding 3–6 months. Median total costs fluctuated from 438€ at baseline to 538€ up to 6 months and 451€ at 24 months; mean costs were 496(383)€, 573(276)€ and 485(247)€, respectively.ConclusionsIn this cohort, insulin treatment seems to be effective with little long-term impact on cost. Findings should be interpreted in the context of an observational study.     

Sugar-Sweetened and Artificially Sweetened Beverages Consumption and Risk of Cardiovascular Health

IntroductionSugar-sweetened and artificially sweetened beverages are routinely consumed worldwide. Given their popularity, there has been much debate about the effect that these beverages have on cardiovascular health. We sought to determine the exact relationship between sugar-sweetened and artificially sweetened beverages consumption on cardiovascular health.MethodsAll studies that reported an association between sugar-sweetened/artificially sweetened beverages consumption and cardiovascular health were extracted from database inception to September 2022 using keywords from several databases. We used the DerSimonian & Laird random-effects method for the analysis.ResultsOf the total 16 prospective studies, 1,405,375 individuals were followed for a median follow-up of 14.8 years. Compared with low sugar-sweetened and artificially sweetened beverage consumption, a higher consumption of sugar-sweetened and artificially sweetened beverages was associated with greater cardiovascular outcomes (hazard ratio [HR] of 1.27, 95% confidence interval [CI] of 1.16-1.40 and risk ratios of 1.16, 95% CI of 1.02-1.33). Similarly, compared with low artificially sweetened beverages consumption, a higher consumption of artificially sweetened beverages was associated with greater cardiovascular outcomes (HR of 1.32, 95% CI of 1.12-1.57). Likewise, compared with low sugar-sweetened beverages consumption, a higher consumption of sugar-sweetened beverages was associated with greater cardiovascular outcomes (HR of 1.21, 95% CI of 1.07-1.37 and risk ratios of 1.22, 95% CI of 1.09-1.35).ConclusionsIncreasing consumption of sugar-sweetened and artificially sweetened beverages may be correlated with an increased risk of developing cardiovascular/vascular complications and mortality, albeit without causality of cardiovascular/vascular morbidity.     

Econometric and comparative risk assessment scenario modelling of the proposed UK sugary drink tax on health

BackgroundIn March, 2016, the UK Chancellor of the Exchequer announced a two-tier industry levy on sugar-sweetened beverages (SSBs). Both the response from soft drink companies and the details of the legislation are uncertain. For example, companies might react by reformulating products, passing on the price change to consumers, or introducing new products and changing marketing strategy. We aimed to estimate the effect of possible industry responses on incidence of diabetes, obesity, and dental caries to inform design and implementation of the legislation.MethodsWe modelled the effects of an SSB price change, product reformulation, and a change in market share between high-sugar, mid-sugar, and low-sugar drinks. Routine data were identified on SSB consumption, expenditure, and waste, population height and weight, diabetes incidence, and dental caries. UK-specific own and cross-price elasticity data were estimated to model the effect of the tax on SSB purchases. A comparative risk assessment model was developed using published estimates of the association between SSB consumption and disease in adults and children.FindingsAn SSB price change resulting from the tax could result in 82 000 (95% CI 4000 to 183 000) fewer obese adults and children, 11 000 (4000 to 19 000) fewer cases of diabetes per year, and 149 000 (45 000 to 262 000) fewer decayed, missing, or filled teeth annually. Reformulation could result in 144 000 (5 000 to 307 000) fewer obese individuals, a fall in 19 000 (7 000 to 33 000) cases of diabetes, and 269 000 (82 000 to 471 000) fewer decayed, missing, or filled teeth. Change in market share between SSBs and diet soft drinks could lead to a 122 000 (5000 to 276 000) fall in the obese population, 16 000 (6000 to 29 000) fewer cases of diabetes, and 224 000 (65 000 to 412 000) fewer decayed, missing, or filled teeth. The greatest benefit for obesity and oral health would be among individuals under 18 years old, with people over 65 years old experiencing the largest decreases in incidence of diabetes.InterpretationHow the soft drink industry implements the SSB levy could have substantial impacts on the health benefits of the policy. These data could be used to help inform the Government's consultation and maximise health impact.FundingADMB is funded by the Wellcome Trust (grant number 102730/Z/13/Z). OTM is supported by a Wellcome Trust clinical doctoral fellowship. PS is funded by the British Heart Foundation (grant number FS/15/34/31656).     

Cardiovascular risk and dietary sugar intake: is the link so sweet?

Soft drinks and sugar-sweetened beverages have been targeted as one of the primary culprits in the escalating rates of obesity and diabetes and reduction of added sugars is considered between the goals to achieve in order to promote cardiovascular health and to reduce deaths from cardiovascular causes. Many reliable mechanisms, such as dislypidemia, inflammation and enhanced oxidative stress, have been proposed to support a causal link between sugar sweetened beverages intake and cardiovascular risk, but the ultimate underlying pathways remain to be determined in adequately designed studies. Furthermore, while epidemiological evidence strongly supports an association between sugar sweetened beverages consumption and obesity, type 2 diabetes mellitus or cardiovascular risk, incongruous findings yielded by clinical trials, or formal meta-analyses make difficult to draw firm conclusions in this regard. Further and rigorous studies are needed to better understand the role of sugar sweetened beverages in the etiology of cardiovascular diseases and to better address the warnings and decisions of regulatory authorities on public health worldwide.     

Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct

Aims/hypothesis

Consumption of sugar-sweetened beverages has been shown, largely in American populations, to increase type 2 diabetes incidence. We aimed to evaluate the association of consumption of sweet beverages (juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks) with type 2 diabetes incidence in European adults.

Methods

We established a case–cohort study including 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants selected from eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. After exclusions, the final sample size included 11,684 incident cases and a subcohort of 15,374 participants. Cox proportional hazards regression models (modified for the case–cohort design) and random-effects meta-analyses were used to estimate the association between sweet beverage consumption (obtained from validated dietary questionnaires) and type 2 diabetes incidence.

Results

In adjusted models, one 336 g (12 oz) daily increment in sugar-sweetened and artificially sweetened soft drink consumption was associated with HRs for type 2 diabetes of 1.22 (95% CI 1.09, 1.38) and 1.52 (95% CI 1.26, 1.83), respectively. After further adjustment for energy intake and BMI, the association of sugar-sweetened soft drinks with type 2 diabetes persisted (HR 1.18, 95% CI 1.06, 1.32), but the association of artificially sweetened soft drinks became statistically not significant (HR 1.11, 95% CI 0.95, 1.31). Juice and nectar consumption was not associated with type 2 diabetes incidence.

Conclusions/interpretation

This study corroborates the association between increased incidence of type 2 diabetes and high consumption of sugar-sweetened soft drinks in European adults.     

Os custos da insuficiência cardíaca em Portugal e a sua evolução previsível com o envelhecimento da população

Introduction and ObjectivesHeart failure (HF) is a growing public health problem. This study estimates the current and future costs of HF in mainland Portugal.MethodsCosts were estimated based on prevalence and from a societal perspective. The annual costs of HF included direct costs (resource consumption) and indirect costs (productivity losses). Estimates were mostly based on data from the Diagnosis‐Related Groups database, real‐world data from primary care, and the opinions of an expert panel. Costs were estimated for 2014 and, taking population aging into account, changes were forecast up to 2036.ResultsDirect costs in 2014 were €299 million (39% for hospitalizations, 24% for medicines, 17% for exams and tests, 16% for consultations, and the rest for other needs, including emergencies and long‐term care). Indirect costs were €106 million (16% for absenteeism and 84% for reduced employment). Between 2014 and 2036, due to demographic dynamics, total costs will increase from €405 to €503 million. Per capita costs are estimated to rise by 34%, which is higher than the increase in total costs (+24%), due to the expected reduction in the resident population.ConclusionsHF currently has a significant economic impact, representing around 2.6% of total public health expenditure, and this is expected to increase in the future. This should be taken into account by health policy makers, alerting them to the need for resource management in order to mitigate the impact of this disease.     

Knowledge,attitudes and practices with regard to sugar sweetened beverages and taxation among people with type 2 diabetes mellitus in the Caribbean island of Barbados – A cross sectional survey in primary care

AimsBarbados implemented a 10% tax on sugar sweetened beverages (SSBs) in 2015. We aimed to determine knowledge, attitudes and practices towards SSB consumption and taxation among people with type 2 diabetes (T2D) attending public sector primary care clinics in Barbados.MethodsPeople with T2D attending public sector clinics completed a survey including the Beverage Intake Questionnaire (BEVQ-15). Waist circumference was measured.ResultsOf 384 participants (34.6% male, median age 67 years, interquartile range 60–74 years, African descent 97.6%) 45.9% had diabetes diagnosed for >10 years, 30.7% used insulin, 31.8% had not seen a dietician since diabetes diagnosis, and 62.2% had abdominal obesity. Most (91.1%) thought that consuming SSB was unhealthy and 91% felt that reducing intake would be easy. Only 44.7% favoured the current 10% tax and 29.7% favoured a 20% tax. The median daily SSB consumption was 26.6 ml (IQR 3.0–53.2). Responses did not differ by age, gender or abdominal obesity status (p > 0.5). Weight loss was being attempted by 45.6% and 21.1% with and without abdominal obesity respectively (p < 0.0001).ConclusionsWhile most felt SSB consumption is harmful and the median reported consumption contributes few calories to the diet, a minority supported the current tax.     

Sugar sweetened beverages and increasing prevalence of type 2 diabetes in the Indigenous community of Australia

AimsThe aim of this viewpoint was to discuss a profound health gap in type 2 diabetes that exists between Indigenous and non-Indigenous Australians.Data synthesisIn Australia, type 2 diabetes is ranked as the fastest growing chronic condition, with the rates of type 2 diabetes higher among Indigenous than non-Indigenous Australians. Improvements to diet could aid in reducing overweight and obesity in the Indigenous community, with sugar sweetened beverages (SSBs) examples of discretionary foods that contain a high amount of sugar. The marked increase in type 2 diabetes, obesity and consumption of SSBs in the Indigenous community may suggest that type 2 diabetes may result from weight gain caused by SSB consumption. Recent evidence suggests that higher consumption of SSBs was associated with greater incidence of type 2 diabetes independent of adiposity. Some determinants influencing increased SSBs consumption in the Indigenous population include advertising, marketing, availability and affordability.ConclusionsThe prevalence rates of type 2 diabetes continue to be higher among Indigenous than non-Indigenous Australians and overall, a link between SSBs and risk of type 2 diabetes is reported. Three solutions to high SSBs consumption in Indigenous communities include increased availability, affordability, and accessibility of healthy food and drink, engagement of Indigenous people in offering solutions including discussion of a sugar tax on SSBs framed with Indigenous input, and the provision of clean community water supply and water bubblers.     

Fructose and Risk of Cardiometabolic Disease

Fructose and glucose in soft drinks and fruit drinks account for just under 50?% of added sugars. Soft drinks intake has risen five-fold between 1950 and 2000, and this increase in intake of simple sugars has raised health concerns. The risks of cardiovascular disease, obesity and the metabolic syndrome have all been related to consumption of sugar-sweetened beverages in several, but not all meta-analyses. Fructose and sugar-sweetened beverages have also been related to the risk of gout in men, and to non-alcoholic fatty liver disease. Studies show that the calories in sugar-sweetened beverages do not produce an adequate reduction in the intake of other foods, leading to increased caloric intake. Plasma triglycerides are increased by sugar-sweetened beverages, and this increase appears to be due to fructose, rather than to glucose in sugar. Several 10-week to 26-week randomized trials of sugar-containing soft drinks show increases in triglycerides, body weight, and visceral adipose tissue; there were also increases in muscle fat and liver fat, which might lead to non-alcoholic-fatty liver disease.     

Direct and indirect costs of heart failure in relation to diabetes status - A nationwide study

Background and aimHeart failure (HF) and diabetes mellitus (DM) are burdensome chronic diseases with high lifetime risks and numerous studies indicate associations between HF and DM. The objective of this study was to investigate the direct and indirect costs of HF patients with and without DM.Methods and resultsPatients with a first-time diagnosis of HF from 1998 to 2016 were identified through nationwide Danish registries and stratified according to DM status into HF with or without DM. The economic healthcare cost analysis was based on both direct costs, including hospitalization, procedures, medication and indirect costs including social welfare and lost productivity. The economic burden was investigated prior to, at, and following diagnosis of HF. Patients with concomitant HF and DM were younger (median age 74 vs. 77), had more comorbidities and fewer were female as compared to patients with HF but without DM. The socioeconomic burden of concomitant HF and DM compared to HF alone was substantially higher; 45% in direct costs (€16,237 vs. €11,184), 35% in home care costs (€3123 vs. €2320), 8% in social transfer income (€17,257 vs. €15,994) and they had 27% lower income (€10,136 vs. €13,845). The economic burden peaked at year of diagnosis, but the difference became increasingly pronounced in the years following the HF diagnosis.ConclusionPatients with concomitant HF and DM had a significantly higher economic burden compared to patients with HF but without DM.     

Direct and indirect costs for systemic lupus erythematosus in Sweden. A nationwide health economic study based on five defined cohorts

ObjectivesThe main objectives of this study were to calculate total costs of illness and cost-driving disease features among patients with systemic lupus erythematosus (SLE) in Sweden.MethodsFive cohorts of well-defined SLE patients, located in different parts of the country were merged. Incident and prevalent cases from 2003 through 2010 were included. The American College of Rheumatology (ACR) classification criteria was used. From the local cohorts, data on demographics, disease activity (SLEDAI 2K), and organ damage (SDI) were collected. Costs for inpatient care, specialist outpatient care and drugs were retrieved from national registries at the National Board of Health and Welfare. Indirect costs were calculated based on sickness leave and disability pensions from the Swedish Social Insurance Agency.ResultsIn total, 1029 SLE patients, 88% females, were included, and approximately 75% were below 65 years at the end of follow-up, and thus in working age. The mean number of annual specialist physician visits varied from six to seven; mean annual inpatient days were 3.1–3.6, and mean annual sick leave was 123–148 days, all per patient. The total annual cost was 208,555 SEK ($33,369 = 22,941€), of which direct cost was 63,672kr ($10,188 = 7004€) and the indirect cost was 144,883 SEK ($23,181 = 15,937€), all per patient. The costs for patients with short disease duration were higher. Higher disease activity as measured by a SLEDAI 2K score > 3 was associated with approximately 50% increase in both indirect and direct costs. Damage in the neuropsychiatric and musculoskeletal domains were also linked to higher direct and indirect costs, while organ damage in the renal and ocular systems increased direct costs.ConclusionBased on this study and an estimate of slightly more than 6000 SLE patients in Sweden, the total annual cost for SLE in the country is estimated at $188 million (=129.5 million €). Both direct (30%) and indirect costs (70%) are substantial. Medication accounts for less than 10% of the total cost. The tax paid national systems for health care and social security in Sweden ensure equal access to health care, sick leave reimbursements, and disability pensions nationwide. Our extrapolated annual costs for SLE in Sweden are therefore the best supported estimations thus far, and they clearly underline the importance of improved management, especially to reduce the indirect costs.     

Sugar-sweetened and artificially sweetened beverage consumption and adiposity changes: a national longitudinal study

BackgroundIn response to increasing policy action and public concern about the negative health effects of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs) are increasingly being promoted. These beverages have been linked with obesity and diabetes in recent experimental work. This study examined associations between SSB and ASB consumption and changes in adiposity in a nationally representative sample of UK children.MethodsWe conducted a longitudinal study of 13 170 children aged 7–11 years from the UK Millennium Cohort Study. Data were collected between Jan 1, 2008, and Feb 28, 2009, and between Jan 1 and Dec 31, 2012. Logistic regression was used to assess sociodemographic and behavioural correlates of SSB and ASB consumption at least once per week at age 11 years. Linear regression examined associations between consumption of SSB and ASB and changes in adiposity measures between ages 7 and 11 years. Analyses were adjusted for characteristics and behaviours previously associated with adiposity: age, sex, ethnic group, household income, country of residence, portions of fruit consumed per day, breakfast consumption, days per week of sport or exercise, hours spent watching television per weekday, and mode of transport to school.FindingsAt age 11 years, boys were more likely than girls to consume SSBs at least once per week (4061 [62·3%] of 6519 vs 3936 [59·1%] of 6651). South Asian children were more likely than white children to consume SSBs at least once per week (8603 [78·8%] of 10 918 vs 738 [58·4%] of 1264) but less likely to consume ASBs (51·7% vs 66·3%). Daily SSB consumption was associated with increases in body-mass index (BMI) between ages 7 and 11 (+0·22 kg/m², 95% CI 0·11–0·34). Daily ASB consumption was associated with increased percentage body fat at age 11 years (+1·18%, 0·81–1·54) and further increases between ages 7 and 11 (+0·35%, 0·09–0·61).InterpretationResults of this study show that consumption of SSBs and ASBs is associated with increases in BMI and percentage body fat in UK children. Emerging policy responses to address health concerns about SSBs should consider encouraging drinking water as a substitute rather than ASBs.FundingNone.     

Coste económico del paciente asmático en Espa?a (estudio AsmaCost)

ObjectiveThis analysis of the cost of asthma in Spain includes both direct health care costs and indirect costs arising from illness.Patients and MethodsProspective, 12-month observational cohort study of adult patients with asthma diagnosed according to the guidelines of the Global Initiative for Asthma (GINA) and the adapted Spanish criteria (GEMA). We recorded information on health care resources utilized (medications, medical visits, emergency care, hospital admissions, and tests) and indirect costs (patient travel or transfer costs and workdays lost).ResultsA total of 627 patients throughout Spain were studied. Of these, 21.2% had intermittent asthma, 24.6% mild asthma, 27.6% moderate asthma, and 26.6% severe asthma. The total societal cost of asthma (including indirect costs) was €1726 (95% confidence interval [CI], €1314–€2154) per patient annually. Indirect costs accounted for 11.2% of the total. The cost to the National Health Service was €1533 (95% CI, €1133–€1946) per patient annually. The cost of asthma was higher for patients older than 65 years (€2079) and for those with more severe disease (€959 for intermittent asthma; €1598, mild asthma; €1553, moderate asthma; and €2635 severe asthma). Based on these findings, the total annual cost of asthma in Spain is estimated to be €1480 million (95% CI, €382–€2565 million) for patients with demonstrated bronchial hyperreactivity and €3022 million (95% CI, €2472–€3535 million) for patients diagnosed based on symptoms alone.ConclusionsThe average annual cost of asthma in adults in Spain comes to €1726 per patient, considering both direct and indirect costs. The average annual cost per patient to the National Health Service is €1533.     

Increasing BMI and waist circumference and prevalence of obesity among adults with Type 2 diabetes: the National Health and Nutrition Examination Surveys

ObjectiveObesity remains one of the most important modifiable risk factors for the prevention of Type 2 diabetes and its related comorbid conditions. The aim of this study was to examine trends in average body mass index (BMI), waist circumference, and obesity prevalence among adults with and without Type 2 diabetes.MethodsInformation on BMI and waist circumference among 4162 adults with and 40,376 adults without Type 2 diabetes was obtained from the National Health and Examination Surveys completed during years 1976–2006. Mean BMI, waist circumference and prevalence of total obesity (BMI ≥30 kg/m²) and obesity stage III (BMI ≥40 kg/m²) were determined by survey periods after adjustment for the survey period weights and age standardization to the US 2000 Census. Means and proportions between first and last survey periods were compared using Z scores.ResultsDuring this 20-year period, mean BMI increased from 29.2 kg/m² to 34.2 kg/m² among adults with Type 2 diabetes and from 25.2 kg/m² to 28.1 kg/m² among adults without diabetes (P<.0001 for both comparisons). Mean waist circumference increased substantially in all groups. Among adults with and without Type 2 diabetes, total obesity increased by 58% and 136%, respectively, while Class III obesity increased by 141% and 345%, respectively (P<.0001 for all comparisons).ConclusionsObesity prevalence is rising rapidly among adults with and without Type 2 diabetes. This has important implications for the likely growth of the population with Type 2 diabetes and diabetes related comorbid conditions.     

Family history of diabetes identifies a group at increased risk for the metabolic consequences of obesity and physical inactivity in EPIC-Norfolk: a population-based study. The European Prospective Investigation into Cancer

OBJECTIVE: To investigate the interaction of a family history of diabetes with obesity and physical inactivity on diabetes prevalence in middle-aged and elderly men and women. DESIGN: A cross-sectional population-based study. SUBJECTS: 2,912 men and 3,561 women, aged 45-74y. MEASUREMENTS: Body mass index (BMI), HbA1C, self-administered questionnaire including questions on occupational physical activity and personal and family history of diabetes as part of the Norfolk arm of the European Prospective Investigation into Cancer (EPIC-Norfolk). RESULTS: The prevalence of diabetes increased in a dose-response relationship with increasing BMI. There was an interaction between family history and obesity on diabetes risk in subjects with a BMI of greater than 27.5kg/m2 (P= 0.049). Crude prevalence in individuals without a family history and BMI of 22.5-24.9 kg/m2 was 2.2% compared to 33.3% in those with a family history and BMI over 35 kg/m2. Thirty-eight percent of the excess risk of diabetes in people with a family history could be avoided if their BMI did not exceed 30 kg/m2. Individuals who reported sedentary occupations were at greater risk of diabetes compared to those reporting more active occupations. There was a synergistic effect of family history and self-reported occupational physical activity on diabetes risk. CONCLUSION: Individuals with a family history of diabetes are at increased risk for the metabolic consequences of obesity and form an easily identifiable group who may benefit from targeted intervention to prevent the development of obesity through increased physical activity.     

Healthcare outcomes for patients with type 2 diabetes with and without comorbid obesity

AimsExamine the burden of comorbid obesity associated with type 2 diabetes (T2D).MethodsThe IBM® MarketScan® Explorys Claims Electronic Medical Records Data were used to identify adults with T2D, two recorded body mass index (BMI) values, and continuous insurance coverage from 1 year prior through 1 year post index date. Patients with index BMI ≥18 kg/m² and <30 kg/m² (normal/overweight) were matched to patients with index BMI ≥ 30 kg/m² (obese) using propensity score matching (PSM). Using the PSM cohort, multivariable analyses examined the association between obesity and patient comorbidities, healthcare costs, and resource utilization.ResultsIn the matched cohort (16,006 normal/overweight; 16,006 obese), multivariable analyses showed that obesity, compared to normal/overweight, was associated with increased odds of a diabetes-related comorbidity (Odds Ratio [OR] = 1.29; 95% Confidence Interval [CI] 1.21–1.38) and an obesity-related comorbidity (OR = 1.42; 95% CI 1.29–1.56). Obesity was also associated with significantly higher annual diabetes-related and all-cause total costs and resource utilization.ConclusionsThis research increases the knowledge of how patients with T2D and obesity should be of greater concern for healthcare providers compared to T2D patients without comorbid obesity, given their worse comorbidity profile, increased resource utilization, and higher healthcare costs.     

Sugar- and artificially-sweetened soda consumption and subclinical atherosclerosis among Mexican women

Background and aimsSugar-sweetened soda consumption is associated with most cardiometabolic risk factors. The role of artificially-sweetened beverages in cardiovascular disease (CVD) is inconclusive, but their consumption correlates with health impairment. Little is known about the contribution of soda consumption in subclinical stages of atherosclerosis. Therefore, we evaluated the relation between sugar- and artificially-sweetened soda consumption and carotid intima-media thickness (IMT) among Mexican women.Methods and resultsWe cross-sectionally evaluated 1093 women enrolled in the Mexican Teachers’ Cohort who were free of CVD, diabetes or cancer. Sugar- and artificially-sweetened soda consumption was estimated from a validated 140-item food frequency questionnaire in 2008 and all women underwent a carotid ultrasound assessment three years later. Participants were categorized into tertiles of soda consumption in servings/week. Subclinical atherosclerosis was defined as a mean left and/or right IMT ≥0.8 mm or the presence of plaque on either common carotid artery. In multivariable regression models, women in the highest tertile of sugar-sweetened soda consumption had 2.6% (95%CI: 0.8, 4.5) mean increased IMT, and had 2-fold the risk of carotid atherosclerosis (PR: 2.0, 95%CI: 1.3, 3.2) compared to those in the lowest tertile. In stratified analyses, older and postmenopausal women who consumed sugar-sweetened soda had an increased IMT and atherosclerosis risk. Artificially-sweetened soda consumption was not associated with IMT or carotid atherosclerosis.ConclusionsSugar-sweetened soda consumption was associated with subclinical atherosclerosis among disease-free Mexican women. Public health strategies to decrease CVD should consider the impact of sugar-sweetened soda consumption, particularly in older women.     

Association between sugar‐sweetened beverages and type 2 diabetes: A meta‐analysis

Aims/Introduction

Many studies have been carried out to examine the association between sugar-sweetened beverages and the incident of type 2 diabetes, but results are mixed. The aim of the present study was to estimate the association between sugar-sweetened beverage intake and the risk of type 2 diabetes.

Materials and Methods

PubMed, Springer Link and Elsevier databases were searched up to July 2014. Prospective studies published on the association between sugar-sweetened beverage intake and the risk of type 2 diabetes were included. The pooled relative risks (RRs) and 95% confidence intervals (CIs) for highest versus lowest category of sugar-sweetened beverages were estimated using a random-effects model.

Results

The pooled effect estimate of sugar-sweetened beverage intake was 1.30 (95% confidence interval [CI] 1.21–1.39) for type 2 diabetes; stratified by geographic region of the studies, the pooled effect estimates were 1.34 (95% CI 0.74–2.43), 1.30 (95% CI 1.20–1.40), 1.29 (95% CI 1.09–1.53) in Asia, the USA and Europe,respectively; the pooled effect estimates were 1.26 (95% CI 1.16–1.36) with adjusting body mass index and 1.38 (95% CI 1.23–1.56) without adjusting body mass index.

Conclusions

Our findings suggested that sugar-sweetened beverage intake was associated with an increased risk of type 2 diabetes, and the association was attenuated by adjustment for body mass index. Specifically, the associations were also found to be significantly positive in the USA and Europe.