Dose-response association between sugar- and artificially sweetened beverage consumption and the risk of metabolic syndrome: a meta-analysis of population-based epidemiological studies

Objective: The associations between sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) consumption and the risk of metabolic syndrome (MetS) remain controversial. A quantitative assessment of dose-response associations has not been reported. This study aims to assess the associations between the risk of MetS and SSB, ASB, and total sweetened beverage (TSB, the combination of SSB and ASB) consumption by reviewing population-based epidemiological studies. Design: Meta-analysis. Setting: We searched PubMed, Embase and Web of Science databases prior to 4 November 2019, for relevant studies investigating the SSB-MetS and ASB-MetS associations. A random effects model was used to estimate pooled relative risks (RR) and 95 % CI. Dose-response association was assessed using a restricted cubic splines model. Participants: We identified seventeen articles (twenty-four studies, including 93 095 participants and 20 749 MetS patients). Results: The pooled RR for the risk of MetS were 1 center dot 51 (95 % CI 1 center dot 34, 1 center dot 69), 1 center dot 56 (1 center dot 32, 1 center dot 83) and 1 center dot 44 (1 center dot 19, 1 center dot 75) in high consumption group of TSB, SSB and ASB, respectively; and 1 center dot 20 (1 center dot 13, 1 center dot 28), 1 center dot 19 (1 center dot 11, 1 center dot 28) and 1 center dot 31 (1 center dot 05, 1 center dot 65) per 250 ml/d increase in TSB, SSB and ASB consumption, respectively. Additionally, we found evidence of non-linear, TSB-MetS and SSB-MetS dose-response associations and a linear ASB-MetS dose-response association. Conclusions: TSB, SSB and ASB consumption was associated with the risk of MetS. The present findings provide evidence that supports reducing intake of these beverages to lower the TSB-, SSB- and ASB-related risk of MetS.