Abstract
BACKGROUND: Alcohol and energy-dense beverages consumption have been implicated in cardiometabolic disease, albeit inconsistently. OBJECTIVE: This study tested prospective associations between intakes of alcohol, energy-dense beverages, and low-calorie beverages and cardiometabolic risk in midlife women. DESIGN: The Study of Women's Health Across the Nation is a 14-year, multisite prospective cohort study (1996-2011). Beverage intake and cardiometabolic risk factors that define the metabolic syndrome (hypertension, abdominal obesity, impaired fasting glucose, low high-density lipoprotein cholesterol level, and hypertriglyceridemia) were assessed throughout follow-up. PARTICIPANTS/SETTING: Participants (N=1,448) were African American, Chinese, Japanese, and non-Hispanic white midlife women from six US cities. MAIN OUTCOME MEASURES: The primary outcomes were incident metabolic syndrome and the individual metabolic syndrome components. STATISTICAL ANALYSES PERFORMED: Generalized linear mixed models tested associations between intakes within each beverage category and odds of meeting criteria for metabolic syndrome and each of the metabolic syndrome components. RESULTS: Energy-dense beverage consumption was highest among African-American women and lowest among women with college degrees. Non-Hispanic white women consumed the largest quantities of alcohol. Independent of energy intake and potential confounders, each additional 355 mL energy-dense beverages consumed per day was associated with higher odds of developing metabolic syndrome in each successive year of follow-up (odds ratio [OR] 1.05, 95% CI 1.02 to 1.08). Greater energy-dense beverage intake was associated with more rapidly increasing odds of developing hypertension (OR 1.06, 95% CI 1.02 to 1.11) and abdominal obesity (OR 1.10, 95% CI 1.03 to 1.16) over time, but not with the other metabolic syndrome components. Intakes of alcohol and low-calorie coffees, teas, and diet cola were not associated with metabolic syndrome risk. CONCLUSIONS: Over 14 years of follow-up, energy-dense nonalcoholic beverage consumption was associated with incident metabolic syndrome in midlife women. The observed differences in intakes by ethnicity/race and education suggest that consumption of these beverages may contribute to disparities in risk factors for diabetes and cardiovascular disease.