Wednesday, November 3, 2010

Cola Drinking Frequency Associated with Risk of Metabolic Syndrome

ResearchBlogging.orgMetabolic Syndrome (MetS) is a condition we hear about increasingly that relates usually to pre-diabetes (type II), obesity and other factors that create a perfect storm of mainly lifestyle-oriented disease.

A recent report that looked at a survey of near 18000 people in Norway shows a pretty strong correlation between something as simple as cola consumption and MetS.

The simple take away is: drinking more than one glass of cola a day, coupled with ANY of the risk factors associated with MetS means the likelihood of getting MetS goes up significantly. The post discusses the study and concludes with a few possible strategies & resources.

The abstract of the study follows:
Appl Physiol Nutr Metab. 2010 Oct;35(5):635-42.
The Oslo Health Study: Soft drink intake is associated with the metabolic syndrome.

Høstmark AT.
Section of Preventive Medicine and Epidemiology, University of Oslo, Box 1130, Blindern, 0318 Oslo, Norway (e-mail:
It has been reported that the frequency of cola intake (COLA) is positively associated with serum triglycerides and negatively associated with high-density-lioprotein (HDL) cholesterol, both components of the metabolic syndrome (MetS). The question now is whether noncola soft drink intake (NCOLA) is associated with MetS. Among the 18 770 participants in the Oslo Health Study, 5373 men and 6181 women had data on COLA and NCOLA and risk factors for MetS (except fasting glucose). Main MetS requirements are central obesity and 2 of the following: increased triglycerides, low HDL cholesterol, increased systolic or diastolic blood pressure, and elevated fasting blood glucose. The MetSRisk index was calculated to estimate many MetS components. Using regression analyses, the association between COLA (NCOLA) and MetS (MetSRisk) was studied. In young (aged 30 years), middle-aged (aged 40 and 45 years), and senior (aged 59 and 60 years) men and women, there was, in general, a positive correlation between COLA and MetSRisk, and between COLA and single MetS risk factors, except HDL cholesterol, which was negatively correlated. A less consistent picture was found for NCOLA. By regression analyses, after adjustment for sex, age, time since last meal, and use of sugar-sweetened soft drinks, a positive association between COLA (NCOLA) and MetSRisk (MetS) was still found. However, when also controlling for cheese, fatty fish, coffee, alcohol, smoking, physical activity, education, and birthplace, only the association with COLA remained significant, irrespective of the presence or absence of sugar. In conclusion, the self-reported intake frequency of soft drinks can be positively associated with MetS.

What does this result mean? The authors looked at two measures of Metabolic Syndrome. First, they used the MetSRisk requirements whicn = obesity + any 2 of the following: increased triglycerides (fatty acids ), low HDL cholesterol (usually refered to as the good stuff cholesterol - but really it's ratios of high and low that are important), increased blood pressure, high fasting blood glucose (this latter as i understand it can happen when insulin (a hormone) is out of whack trying to its job to get the glucose from consumed carbs shoved into the cells for use as energy, and it's not working very well).

The authors note that they could not measure fasting glucose rates in the study, so they suggest that the strength of the association they see may well be UNDERestimated, based on reality.

What does Frequency Mean?
Here's how the study measured frequency of intake by creating three main groups:
For beverages, there were 5 levels: 1, rarely–never; 2, 1 to 6 glasses per week; 3, 1 glass per day; 4, 2 to 3 glasses per day; and 5, 4 or more glasses per day. For the intake frequency of colas and noncolas, the midpoint in each frequency interval was used to calculate a rough approximation of intake per week. To obtain a reasonable number of subjects, the population was divided into 3 intake groups: never–rarely (1999 men; 3302 women); 1 to 6 glasses per week (2302 men; 2086 women); and ≥1 glass per day (1072 men; 793 women).
Results on Risk Matching
The authors show that "the frequency of cola intake in model 1 was significantly (p < 0.001 for most) associated with all of the single MetS-related risk factors, with the compound risk estimate of MetSRisk, and with the complete MetS." Right - but how much does that risk go up?

The authors find that the differences bewteen group 1 (rarely/never) and group three (more than 1 glass of cola a day) go up a lot, across all ages and genders:
going from group 1 (intake never–rarely) to group 3 (intake ≥1 glass per day), there was a mean increase in SumRisk points of 16.5% in young men (p < 0.001, 1-way ANOVA, with Bonferroni correction), 11.9% in middle-aged men (p < 0.001), and 11.1% in senior men (p = 0.006). Corresponding percentage increases in the 3 age groups of women were 11.1% (p < 0.001), 12.2% (p < 0.001), and 10.8% (p < 0.001).
Also, intriguingly, the study makes clear that whether or not the cola had real sugar or not didn't make a difference. Diet cola in other words doesn't change the association. 

Fig. 1. Relationship between the frequency of cola intake and MetSRisk. Group 1, intake never–rarely; group 2, intake of 1 to 6 glasses per week; group 3, intake of ≥1 glass per day. Number of subjects in cola intake groups 1, 2, and 3, respectively, was, for young (30 y) men, 368, 836, and 433; for middle-aged (40 + 45 y) men, 884, 1009, and 465; and for senior men (59–60 y), 747, 457, and 174. Corresponding numbers in women were 770, 814, and 314 (30 y); 1511, 959, and 370 (40 + 45 y); and 1021, 313, and 109 (59–60 y); mean values, with SE, are indicated. Note the broken axes and the variation in range for the MetSRisk score between age groups.

Waist Circumference and Cola. The authors also actually saw that waist circumference is more strongly associated with cola than BMI. This finding is a rather nice one since so many of us rather question the whole BMI measure. Waist circumference seems a much clearer one to assess.

Take Away
The authors make clear that what they have seen is evidence of an association between cola frequency and MetSRisk. That doesn't show (yet) that there is a causal relationship. That is, they're not saying that someone who kicks back a can of coke daily will be at risk of MetS. What it does suggest however is that the presence of a daily cola intake greater than a glass, along with any of the other MetSRisk factors is a pretty good indicator of trouble ahead. As the authors put it in their discussion of results:
It seems reasonable to assume that the complete MetS takes a long time to develop, presumably several years. Accordingly, preceding the appearance of the complete MetS, metabolic disturbances, reflected in the level of 1 or more MetS-related factors, such as waist circumference, body mass index, serum lipids, and blood pressure, are likely. In keeping with this assumption, the results of this study show a direct relationship between cola intake and many single MetS-related risk factors, as well as the compound variable MetSRisk.
What may also be deducible is that, if at risk of MetS, to un-cola oneself may be a great start at backing away from MetS. How do this? how about one really tiny super guaranteed not to fail one step at a time? 

The 4-day Win: Change the Way You Think About Food and Your Body in Just 4 DaysPractice: Awhile ago i proposed mc's change one thing sure fire diet based on the z-health sustenance course work.

In the diet, the approach is to change one thing, one step at a time and an example is to start with one less cola a week, to get to one less a day and so on, building on success. This approach is also inspired by Martha Beck's 4 day win: create strategies that someone feels are so easy they can't fail.

It seems that for folks struggling with weight loss and feeling like they're doing good things for themselves, thinking about reducing that cola intake may be a great path towards health success.

Readers of b2d know that for those a little more interested in nutrition knowledge and practice, i've found precision nutrition another great place to learn and to build one better habit at a time. Here's a free 45 page overview.

Best with your practice. If you're looking for a coach to help with this process, please shout. Qualifications are over in the about box.


Høstmark, A. (2010). The Oslo Health Study: Soft drink intake is associated with the metabolic syndrome Applied Physiology, Nutrition, and Metabolism, 35 (5), 635-642 DOI: 10.1139/H10-059

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