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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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Adjusted Odds Ratios (aORs) comparing albuminuria among consumers of 2+ vs. 0–1 sugary soft drinks per day, according to interaction with body mass index (BMI).Adjusted for diet soda consumption, age, race, ethnicity, poverty status, BMI, and BMI-squared.
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pone-0003431-g003: Adjusted Odds Ratios (aORs) comparing albuminuria among consumers of 2+ vs. 0–1 sugary soft drinks per day, according to interaction with body mass index (BMI).Adjusted for diet soda consumption, age, race, ethnicity, poverty status, BMI, and BMI-squared.

Mentions: The finding of negative interaction between obesity and sugary soda consumption was unexpected, warranting further investigated of the relationship between BMI, soda consumption, and albuminuria. We conducted a stratified analysis, fitting Model 1 within categories of underweight, optimal weight, overweight, and obesity. Because the relationship between sugary soda consumption and albuminuria appears to be modified in a quadratic manner (Figure 2), we added to the variables in Model 1 the following: BMI, BMI-squared, and interaction terms between soda consumption and continuous BMI and BMI-squared (respective p-values for interaction: 0.04 and 0.10). Due to the interaction terms, there is no true main effect for sugary soda consumption in this model. The results are reported in Figure 3, which shows that the strongest association between sugary soda consumption and albuminuria was at the low end of BMI: at 18.7 kg/m2 (the midpoint of the lowest decile of BMI), the odds ratio was 2.48 (95% CI: 1.39, 4.42), while at a BMI of 40.2 (the midpoint of the highest decile), the OR was 0.97 (95% CI: 0.62, 1.50). We conclude that sugary sodas are most strongly associated with albuminuria at the low end of body weight.


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)

Adjusted Odds Ratios (aORs) comparing albuminuria among consumers of 2+ vs. 0–1 sugary soft drinks per day, according to interaction with body mass index (BMI).Adjusted for diet soda consumption, age, race, ethnicity, poverty status, BMI, and BMI-squared.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0003431-g003: Adjusted Odds Ratios (aORs) comparing albuminuria among consumers of 2+ vs. 0–1 sugary soft drinks per day, according to interaction with body mass index (BMI).Adjusted for diet soda consumption, age, race, ethnicity, poverty status, BMI, and BMI-squared.
Mentions: The finding of negative interaction between obesity and sugary soda consumption was unexpected, warranting further investigated of the relationship between BMI, soda consumption, and albuminuria. We conducted a stratified analysis, fitting Model 1 within categories of underweight, optimal weight, overweight, and obesity. Because the relationship between sugary soda consumption and albuminuria appears to be modified in a quadratic manner (Figure 2), we added to the variables in Model 1 the following: BMI, BMI-squared, and interaction terms between soda consumption and continuous BMI and BMI-squared (respective p-values for interaction: 0.04 and 0.10). Due to the interaction terms, there is no true main effect for sugary soda consumption in this model. The results are reported in Figure 3, which shows that the strongest association between sugary soda consumption and albuminuria was at the low end of BMI: at 18.7 kg/m2 (the midpoint of the lowest decile of BMI), the odds ratio was 2.48 (95% CI: 1.39, 4.42), while at a BMI of 40.2 (the midpoint of the highest decile), the OR was 0.97 (95% CI: 0.62, 1.50). We conclude that sugary sodas are most strongly associated with albuminuria at the low end of body weight.

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