Background: Few data are available linking intake of sugar-sweetened beverages (SSBs) with the metabolic syndrome. Furthermore, findings from these studies are inconsistent and most are from Western societies; no information is available in this regard from Middle Eastern populations. Objective: This study was conducted to assess the relationship between SSB consumption and metabolic syndrome in an Iranian adult population. Methods: In this cross-sectional study, data from 1,752 people (782 men and 970 women) that were selected with the multistage cluster random sampling method from three counties of Isfahan, Najafabad and Arak were used. A validated food frequency questionnaire was used to assess participants’ usual dietary intakes. Consumption of SSBs was calculated by summing up the consumption of ‘soft drinks’ and ‘artificially sweetened fruit juices’. To categorize participants, we used three levels of SSB consumption: <1 time/week, 1–3 times/week, and >3 times/week. Biochemical assessments were done after an overnight fasting. Metabolic syndrome was defined according to the guidelines of Adult Treatment Panel III. Results: Subjects with high consumption of SSBs (>3 times/week) were younger than those with low consumption (<1 time/week). Mean BMI was not significantly different across SSB categories. High consumption of SSBs was associated with greater intakes of energy and almost all food groups. We found a significant difference in serum triglyceride levels between men consuming SSBs 1–3 times/week and those consuming <1 time/week. However, after controlling for potential confounders, this association disappeared. In crude models, no significant associations were found between SSB intake and prevalence of the metabolic syndrome in either gender. After adjustment for potential confounders including BMI, we found that men in the top category of SSB intake were 17% more likely to have the metabolic syndrome (odds ratio (OR) 1.17; 95% confidence interval (95% CI) 0.56–2.46), while women in the highest category were 20% less likely to have the syndrome (OR 0.80; 95% CI 0.46–1.42) as compared with those in the bottom category. However, these associations were not significant in either men or women. Conclusion: Our results do not support the previous findings on the association between SSB consumption and metabolic syndrome. Prospective studies are needed to further explore for this association.

1.
Resnick H, Jones K, Ruotolo G, Jain A, Henderson J, Lu W, Howard B: Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease in nondiabetic American Indians. Diabetes Care 2003;26:861–867.
2.
McNeill A, Rosamond W, Girman C, Golden S, Schmidt M, East H, Ballantyne C, Heiss G: The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care 2005;28:385–390.
3.
Lakka H, Laaksonen D, Lakka T, Niskanen L, Kumpusalo E, Tuomilehto J, Salonen J: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002;288:2709–2716.
4.
Antonopoulos S: Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143–3421.
5.
Reaven P: Metabolic syndrome. J Insur Med 2004;36:132–142.
6.
Ford E, Giles W, Dietz W: Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287:356–359.
7.
Azizi F, Etemadi A, Salehi P, Zahedi S: Prevalence of metabolic syndrome in an urban population: Tehran Lipid and Glucose Study. TUMJ 2003;61:389–399
8.
Esmaillzadeh A, Mirmiran P, Azadbakht L, Etemadi A, Azizi F: High prevalence of the metabolic syndrome in Iranian adolescents. Obesity 2006;14:377–382.
9.
Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu F, Willett W: Fruit and vegetable intakes, C-reactive protein, and the metabolic syndrome. Am J Clin Nutr 2006;84:1489–1497.
10.
Azadbakht L, Esmaillzadeh A: Red meat intake is associated with metabolic syndrome and the plasma c-reactive protein concentration in women. J Nutr 2009;139:335–339.
11.
Oh SW, Yoon YS, Lee ES, Kim WK, Park C, Lee S, Jeong EK, Yoo T: Association between cigarette smoking and metabolic syndrome. Diabetes Care 2005;28:2064–2066.
12.
Miyatake N, Nishikawa H, Morishita A, Kunitomi M, Wada J, Suzuki H, Takahashi K, Makino H, Kira S, Fujii M: Daily walking reduces visceral adipose tissue areas and improves insulin resistance in japanese obese subjects. Diabetes Res Clin Pract 2002;58:101–107.
13.
Lutsey P, Steffen L, Stevens J: Dietary intake and the development of the metabolic syndrome: The Atherosclerosis Risk in Communities Study. Circulation 2008;117:754–761.
14.
Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi F: Dairy consumption is inversely associated with the prevalence of the metabolic syndrome in Tehranian adults. Am J Clin Nutr 2005;82:523–530.
15.
Esmaillzadeh A, Mirmiran P, Azizi F: Whole-grain consumption and the metabolic syndrome: a favorable association in Tehranian adults. Eur J Clin Nutr 2004;59:353–362.
16.
Azadbakht L, Surkan PJ, Esmaillzadeh A, Willett WC: The dietary approaches to stop hypertension eating plan affects C-reactive protein, coagulation abnormalities, and hepatic function tests among type 2 diabetic patients. J Nutr 2011;141:1083–1088.
17.
Nielsen S, Popkin B: Changes in beverage intake between 1977 and 2001. Am J Prev Med 2004;27:205–210.
18.
Vereecken C, Inchley J, Subramanian S, Hublet A, Maes L: The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe. Eur J Pub Health 2005;15:224–232.
19.
Hejazi N, Mazloom Z: Socioeconomic status, youth’s eating patterns and meals consumed away from home. Pakistan J Biol Sci 2009;12:730–733.
20.
Karimi-Shahanjarini A, Omidvar N, Bazargan M, Rashidian A, Majdzadeh R, Shojaeizadeh D: Iranian female adolescent’s views on unhealthy snacks consumption: a qualitative study. Iranian J Publ Health 2010;39:92–101
21.
James J, Thomas P, Cavan D, Kerr D: Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ 2004;328:1237–1239.
22.
Schulze M, Manson J, Ludwig D, Colditz G, Stampfer M, Willett W, Hu F: Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 2004;292:927–934.
23.
Parks E, Hellerstein M: Carbohydrate-induced hypertriacylglycerolemia: Historical perspective and review of biological mechanisms1. Am J Clin Nutr 2000;71:412–433.
24.
Drewnowski A, Bellisle F: Liquid calories, sugar, and body weight. Am J Clin Nutr 2007;85:651–661.
25.
Dhingra R, Sullivan L, Jacques P, Wang T, Fox C, Meigs J, D’Agostino R, Gaziano J, Vasan R: Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation 2007;116:480–488.
26.
Pereira MA, Jacobs Jr DR, Van Horn L, Slattery ML, Kartashov AI, Ludwig DS: Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the Cardia Study. JAMA 2002;287:2081–2089.
27.
Sarrafzadegan N, Kelishadi R, Baghaei A, Hussein Sadri G, Malekafzali H, Mohammadifard N, Rabiei K, Bahonar A, Sadeghi M, O’Laughlin J: Metabolic syndrome: an emerging public health problem in Iranian women: Isfahan Healthy Heart Program. Int J Cardiology 2008;131:90–96.
28.
Sarraf-Zadegan N, Malek Afzali H, Baghaei M, Mohamadi Fard N, Shahrokhi S: Isfahan Healthy Heart Program: a comprehensive integrated community-based program for cardiovascular disease prevention and control. Acta Cardiol 2003;58:309–320.
29.
Sarrafzadegan N, Baghaei A, Sadri G, Kelishadi R: Isfahan Healthy Heart Program: evaluation of comprehensive, community-based interventions for non-communicable disease prevention. Prevent Contr 2006;2:73–84.
30.
Friedewald WT, Levy RI, Fredrickson DS: Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499–502.
31.
Pereira M, FitzerGerald S, Gregg E, Joswiak M, Ryan W, Suminski R, Utter A, Zmuda J: A collection of physical activity questionnaires for health-related research. Med Sci Sports Exerc 1997;29(6 suppl):S1–205.
32.
Fung TT, Malik V, Rexrode KM, Manson JAE, Willett WC, Hu FB: Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr 2009;89:1037–1042.
33.
Nettleton JA, Lutsey PL, Wang Y, Lima JA, Michos ED, Jacobs DR: Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care 2009;32:688–694.
34.
Duffey KJ, Gordon-Larsen P, Steffen LM, Jacobs DR, Popkin BM: Drinking caloric beverages increases the risk of adverse cardiometabolic outcomes in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr 2010;92:954–959.
35.
Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L: Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med 2008;168:1487–1492.
36.
Forshee RA, Anderson PA, Storey ML: Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis. Am J Clin Nutr 2008;87:1662–1671.
37.
Bachman CM, Baranowski T, Nicklas TA: Is there an association between sweetened beverages and adiposity? Nutr Rev 2006;64:153–174.
38.
Forshee RA, Storey ML, Allison DB, Glinsmann WH, Hein GL, Lineback DR, Miller SA, Nicklas TA, Weaver GA, White JS: A critical examination of the evidence relating high fructose corn syrup and weight gain. Crit Rev Food Sci Nutr 2007;47:561–582.
39.
Pereira MA: The possible role of sugar-sweetened beverages in obesity etiology: a review of the evidence. Int J Obes 2006;30:S28–S36.
40.
DiMeglio DP, Mattes RD: Liquid versus solid carbohydrate: effects on food intake and body weight. Int J Obes 2000;24:794–800.
41.
Ebbeling CB, Feldman HA, Osganian SK, Chomitz VR, Ellenbogen SJ, Ludwig DS: Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: a randomized, controlled pilot study. Pediatrics 2006;117:673–680.
42.
Bray GA, Nielsen SJ, Popkin BM: Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004;79:537–543.
43.
Forshee RA, Anderson PA, Storey ML: The role of beverage consumption, physical activity, sedentary behavior, and demographics on body mass index of adolescents. Int J Food Sci Nutr 2004;55:463–478.
44.
Forshee RA, Storey ML: Total beverage consumption and beverage choices among children and adolescents. Int J Food Sci Nutr 2003;54:297–307.
45.
Hein GL, Storey ML, White JS, Lineback DR: Highs and lows of high fructose corn syrup: a report from the Center for Food and Nutrition Policy and its Ceres workshop. Nutr Today 2005;40:253–256.
46.
Paynter NP, Yeh HC, Voutilainen S, Schmidt MI, Heiss G, Folsom AR, Brancati FL, Kao WH: Coffee and sweetened beverage consumption and the risk of type 2 diabetes mellitus. Am J Epidemiol 2006;164:1075–1084.
47.
Yoo S, Nicklas T, Baranowski T, Zakeri IF, Yang SJ, Srinivasan SR, Berenson GS: Comparison of dietary intakes associated with metabolic syndrome risk factors in young adults: The Bogalusa Heart Study. Am J Clin Nutr 2004;80:841–848.
48.
Sturt J: Higher consumption of sugar-sweetened beverages is associated with increased risk of developing type 2 diabetes or metabolic syndrome. Evid Based Nurs 2011;14:35–39.
49.
Malik VS, Schulze MB, Hu FB: Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006;84:274–288.
50.
Hu FB, Malik VS: Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence. Physiol Behav 2010;100:47–54.
51.
Ko G, So W, Chow C, Wong P, Tong S, Hui S, Kwok R, Chan A, Chan C, Chan J: Risk associations of obesity with sugar-sweetened beverages and lifestyle factors in chinese: THE ‘Better Health for Better Hong Kong’ Health Promotion Campaign. Eur J Clin Nutr 2010;64:1386–1392.
52.
Malik VS, Hu FB: Sugar-sweetened beverages and health: where does the evidence stand? Am J Clin Nut 2011;94:1161–1162.
53.
Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB: Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes. Diabetes Care 2010;33:2477–2483.
54.
De Koning L, Malik VS, Rimm EB, Willett WC, Hu FB: Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am J Clin Nutr 2011;93:1321–1327.
55.
Frost G, Leeds AA, Dore CJ, Madeiros S, Brading S, Dornhorst A: Glycaemic index as a determinant of serum HDL-cholesterol concentration. Lancet 1999;353:1045–1048.
56.
Willett W, Manson JA, Liu S: Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr 2002;76:274S-280s.
57.
Janssens JP, Shapira N, Debeuf P, Michiels L, Putman R, Bruckers L, Renard D, Molenberghs G: Effects of soft drink and table beer consumption on insulin response in normal teenagers and carbohydrate drink in youngsters. Eur J Cancer Prev 1999;8:289–295.
58.
McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PWF, Jacques PF: Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 2004;27:538–546.
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