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Sugary soda consumption and albuminuria: results from the National Health and Nutrition Examination Survey, 1999-2004.

Shoham DA, Durazo-Arvizu R, Kramer H, Luke A, Vupputuri S, Kshirsagar A, Cooper RS - PLoS ONE (2008)

Bottom Line: Adjustment for potential mediators and use of alternative definitions of albuminuria and soda consumption did not appreciably change results.Findings suggest that sugary soda consumption may be associated with kidney damage, although moderate consumption of 1 or fewer sodas does not appear to be harmful.Additional studies are needed to assess whether HFCS itself, overall excess intake of sugar, or unmeasured lifestyle and confounding factors are responsible.

View Article: PubMed Central - PubMed

Affiliation: Department of Preventive Medicine and Epidemiology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA. dshoham@lumc.edu

ABSTRACT

Background: End-stage renal disease rates rose following widespread introduction of high fructose corn syrup in the American diet, supporting speculation that fructose harms the kidney. Sugar-sweetened soda is a primary source of fructose. We therefore hypothesized that sugary soda consumption was associated with albuminuria, a sensitive marker for kidney disease.

Methodology/principal findings: Design was a cross-sectional analysis. Data were drawn from the National Health and Nutrition Examination Survey (NHANES), 1999-2004. The setting was a representative United States population sample. Participants included adults 20 years and older with no history of diabetes mellitus (n = 12,601); after exclusions for missing outcome and covariate information (n = 3,243), the analysis dataset consisted of 9,358 subjects. Exposure was consumption of two or more sugary soft drinks, based on 24-hour dietary recall. The main outcome measure was Albuminuria, defined by albumin to creatinine ratio cutpoints of >17 mg/g (males) and >25 mg/g (females). Logistic regression adjusted for confounders (diet soda, age, race-ethnicity, gender, poverty). Interactions between age, race-ethnicity, gender, and overweight-obesity were explored. Further analysis adjusted for potential mediators: energy intake, basal metabolic rate, obesity, hypertension, lipids, serum uric acid, smoking, energy expenditure, and glycohemoglobin. Alternative soda intake definitions and cola consumption were employed.

Results: Weighted albuminuria prevalence was 11%, and 17% consumed 2+ sugary soft drinks/day. The confounder-adjusted odds ratio for sugary soda was 1.40 (95% confidence interval: 1.13, 1.74). Associations were modified by gender (p = 0.008) and overweight-obesity (p = 0.014). Among women, the OR was 1.86 (95% CI: 1.37, 2.53); the OR among males was not significant. In the group with body mass under 25 kg/m(2), OR = 2.15 (95% confidence interval: 1.42, 3.25). Adjustment for potential mediators and use of alternative definitions of albuminuria and soda consumption did not appreciably change results. Diet sodas were not associated with albuminuria.

Conclusions: Findings suggest that sugary soda consumption may be associated with kidney damage, although moderate consumption of 1 or fewer sodas does not appear to be harmful. Additional studies are needed to assess whether HFCS itself, overall excess intake of sugar, or unmeasured lifestyle and confounding factors are responsible.

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Related in: MedlinePlus

Prevalence of albuminuria among NHANES 1999–2004 non-diabetics age 20 and over, unadjusted and adjusted for age, according to sugary soft drink consumption.
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pone-0003431-g001: Prevalence of albuminuria among NHANES 1999–2004 non-diabetics age 20 and over, unadjusted and adjusted for age, according to sugary soft drink consumption.

Mentions: All analyses were weighted by mobile examination clinic (MEC) weights to account for the complex survey design, and analyzed using STATA version 9.2 svy commands (STATA Corp., College Station, TX) according to NHANES analytical guidelines [24]. Soda consumption was obtained from 24 hour dietary recall (USDA Food Codes 92400000 through 92411610). Sugar-sweetened and diet sodas were separately dichotomized as 0–1 (reference) vs. 2 or more drinks per day. The choice of this cutpoint was based on preliminary analyses, which showed the association between sugary drinks and albuminuria was similar for 0 and 1 drinks per day (8.7 and 9.6%, respectively; see Figure 1). Unadjusted logistic regression was first conducted for associations with albuminuria. Next, Model 1 adjusted for diet soda consumption (2 or more, vs. 0–1 per day), age, non-Hispanic black race or Hispanic ethnicity (reference: non-Hispanic white), gender, and poverty; following Martins and colleagues, we defined poverty as falling below twice the U.S. federal poverty guidelines (for a non-elderly household of 2 in the year 2000, this was an annual household income under $23,180) [25]. Race-ethnicity was by self report, according to pre-set categories. A further analysis (Model 2) included several variables assumed to be mediators of any association, to see if any association with soda consumption persisted. Model 2 included all of the variables in Model 1, plus hypertension, glycohemoglobin A1C, total caloric consumption, smoking (current vs. former or never), obesity, total cholesterol, and a summary measure of physical activity (the sum of all reported physical activity weighted by metabolic equivalent level or MET for each activity, expressed as total MET-minutes; see http://www.cdc.gov/nchs/data/nhanes/frequency/paqiaf_doc.pdf for more detail). Hypertension was a dichotomous variable defined according to Seventh Joint National Committee guidelines as systolic blood pressure ≥140, diastolic blood pressure ≥90, self-reported history of hypertension and/or use of antihypertensive medication [26].


Sugary soda consumption and albuminuria: results from the National Health and Nutrition Examination Survey, 1999-2004.

Shoham DA, Durazo-Arvizu R, Kramer H, Luke A, Vupputuri S, Kshirsagar A, Cooper RS - PLoS ONE (2008)

Prevalence of albuminuria among NHANES 1999–2004 non-diabetics age 20 and over, unadjusted and adjusted for age, according to sugary soft drink consumption.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2562987&req=5

pone-0003431-g001: Prevalence of albuminuria among NHANES 1999–2004 non-diabetics age 20 and over, unadjusted and adjusted for age, according to sugary soft drink consumption.
Mentions: All analyses were weighted by mobile examination clinic (MEC) weights to account for the complex survey design, and analyzed using STATA version 9.2 svy commands (STATA Corp., College Station, TX) according to NHANES analytical guidelines [24]. Soda consumption was obtained from 24 hour dietary recall (USDA Food Codes 92400000 through 92411610). Sugar-sweetened and diet sodas were separately dichotomized as 0–1 (reference) vs. 2 or more drinks per day. The choice of this cutpoint was based on preliminary analyses, which showed the association between sugary drinks and albuminuria was similar for 0 and 1 drinks per day (8.7 and 9.6%, respectively; see Figure 1). Unadjusted logistic regression was first conducted for associations with albuminuria. Next, Model 1 adjusted for diet soda consumption (2 or more, vs. 0–1 per day), age, non-Hispanic black race or Hispanic ethnicity (reference: non-Hispanic white), gender, and poverty; following Martins and colleagues, we defined poverty as falling below twice the U.S. federal poverty guidelines (for a non-elderly household of 2 in the year 2000, this was an annual household income under $23,180) [25]. Race-ethnicity was by self report, according to pre-set categories. A further analysis (Model 2) included several variables assumed to be mediators of any association, to see if any association with soda consumption persisted. Model 2 included all of the variables in Model 1, plus hypertension, glycohemoglobin A1C, total caloric consumption, smoking (current vs. former or never), obesity, total cholesterol, and a summary measure of physical activity (the sum of all reported physical activity weighted by metabolic equivalent level or MET for each activity, expressed as total MET-minutes; see http://www.cdc.gov/nchs/data/nhanes/frequency/paqiaf_doc.pdf for more detail). Hypertension was a dichotomous variable defined according to Seventh Joint National Committee guidelines as systolic blood pressure ≥140, diastolic blood pressure ≥90, self-reported history of hypertension and/or use of antihypertensive medication [26].

Bottom Line: Adjustment for potential mediators and use of alternative definitions of albuminuria and soda consumption did not appreciably change results.Findings suggest that sugary soda consumption may be associated with kidney damage, although moderate consumption of 1 or fewer sodas does not appear to be harmful.Additional studies are needed to assess whether HFCS itself, overall excess intake of sugar, or unmeasured lifestyle and confounding factors are responsible.

View Article: PubMed Central - PubMed

Affiliation: Department of Preventive Medicine and Epidemiology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA. dshoham@lumc.edu

ABSTRACT

Background: End-stage renal disease rates rose following widespread introduction of high fructose corn syrup in the American diet, supporting speculation that fructose harms the kidney. Sugar-sweetened soda is a primary source of fructose. We therefore hypothesized that sugary soda consumption was associated with albuminuria, a sensitive marker for kidney disease.

Methodology/principal findings: Design was a cross-sectional analysis. Data were drawn from the National Health and Nutrition Examination Survey (NHANES), 1999-2004. The setting was a representative United States population sample. Participants included adults 20 years and older with no history of diabetes mellitus (n = 12,601); after exclusions for missing outcome and covariate information (n = 3,243), the analysis dataset consisted of 9,358 subjects. Exposure was consumption of two or more sugary soft drinks, based on 24-hour dietary recall. The main outcome measure was Albuminuria, defined by albumin to creatinine ratio cutpoints of >17 mg/g (males) and >25 mg/g (females). Logistic regression adjusted for confounders (diet soda, age, race-ethnicity, gender, poverty). Interactions between age, race-ethnicity, gender, and overweight-obesity were explored. Further analysis adjusted for potential mediators: energy intake, basal metabolic rate, obesity, hypertension, lipids, serum uric acid, smoking, energy expenditure, and glycohemoglobin. Alternative soda intake definitions and cola consumption were employed.

Results: Weighted albuminuria prevalence was 11%, and 17% consumed 2+ sugary soft drinks/day. The confounder-adjusted odds ratio for sugary soda was 1.40 (95% confidence interval: 1.13, 1.74). Associations were modified by gender (p = 0.008) and overweight-obesity (p = 0.014). Among women, the OR was 1.86 (95% CI: 1.37, 2.53); the OR among males was not significant. In the group with body mass under 25 kg/m(2), OR = 2.15 (95% confidence interval: 1.42, 3.25). Adjustment for potential mediators and use of alternative definitions of albuminuria and soda consumption did not appreciably change results. Diet sodas were not associated with albuminuria.

Conclusions: Findings suggest that sugary soda consumption may be associated with kidney damage, although moderate consumption of 1 or fewer sodas does not appear to be harmful. Additional studies are needed to assess whether HFCS itself, overall excess intake of sugar, or unmeasured lifestyle and confounding factors are responsible.

Show MeSH
Related in: MedlinePlus