Journal Club -3. Sugary drinks and the risk of Diabetes

evidence

Once again the standard of thought & discussion in the last meeting was very high. Well done to do those that attended or couldn’t attend but still posted on either the year-12 or year-13 blog. The focus of our next meeting is to take on board the views represented by Sumner at al that were discussed last time and apply them to the following piece of research work.

It seems fairly common sense that the more sugar you consume the greater the risk of diabetes is. It’s not really newsworthy and it should be straightforward to prove this. If you get your results published in the British Medical Journal then that should be that.

First of all I would like you to read the press release that accompanied the publication of a scientific paper. The purpose of a press release is to alert journalists to a potentially newsworthy piece of research. The thing to remember about the majority of journalists is that they are wannabe Scientists (Arts graduates) who will not read the original paper but just want to be told the facts and a bit of relevance so they can cut & paste their own story.

Here is the press release.

diabetes-drinks press release

You are journalist who has just received this press release (from the BMJ) and have no intention of reading the paper. What would your headline be? If you’ve been taking the ‘healthy’ option of diet drinks and fruit juice, should you be concerned? Is this a better angle for your story?

Now read the actual article published in the BMJ (the source of the article we looked at last time that told us how unhelpful / inaccurate scientific reporting and press releases could be)

Sugar & Diabetes

What is the purpose of this research?

Who conducted it? Do you trust them?

What is the main conclusion and is it justified?

What about the claims regarding artificially sweetened drinks and fruit juices?

Does the press release accurately reflect the paper? Give examples.

Finally, follow this link to the BMJ site containing this article and read the comments section.

Is everyone happy with this research? Who do you agree with? Could there be bias in these comments?

Remember that this is just to aid discussion and frame your thoughts. You can follow all, some or none of this list. The point of this is to stimulate thought and share ideas so PLEASE POST YOUR THOUGHTS BELOW prior to our next Journal Club meeting.

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9 thoughts on “Journal Club -3. Sugary drinks and the risk of Diabetes

  1. Headline – “Sugar is the new Killer! Joining Alcohol and Tobacco..
    If you changed your diet, you should still be concerned as although it is labelled as diet or fruit juice it is still bad for you and can be directly linked to type 2 diabetes.
    This would be a better angle, as you can suggest more dramatic cases and imply that people are not doing enough to live a healthy lifestyle as even dietary options are still leading to life risks.

    What is the purpose of this research?
    The purpose of this is to calculate the likelihood between drinks which contain large amounts of sugar and type 2 diabetes.

    Who conducted it? Do you trust them?
    The medical research council as well as Cambridge university completed this research so i trust them as they have quite a lot of experience and must have a good scientific understanding to be able to be where they are.

    What is the main conclusion and is it justified?

    The main conclusion was that fruit juice and artificially sweetened are not a healthy alternative to full sugar drinks and it is justified, as it proved that it still remains that ingredients which cause diabetes are still present, just less likely to lead to diabetes,

    What about the claims regarding artificially sweetened drinks and fruit juices?

    It suggests that there is little improvement from the chance of diabetes from full fizzy drinks to the fruit juices. Its rather unlikely that drinking fruit juices will decrease the chance of diabetes as it still contains sugars which is still dangerous for leading to diabetes.

    Is everyone happy with this research? Who do you agree with? Could there be bias in these comments?

    I am happy with the research and believe that drinking fruit juice is not a completely healthier alternative compared to fizzy drinks and believe water is a lot more of a healthier option than both of the drinks that have been studied.
    I agree with Hugh Mann as he suggest how sugar is just as addictive as Tobacco, and will be a big problem in the future if the trends continue. Also he suggests, how it triggers anger and is falsely advertised to be a happy food when in reality it causes more problems than it solves.
    There could be bias as there all scientists and want to disprove a theory or support it, when companies would want to suggest there is no trend and it is all related to binging on certain drinks rather than drinking it occasionally.

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  2. Journal Club 3
    William Addison

    For this press-release my headline would exaggerate the fact that there is some correlation between sugary and artificially sweetened with Type 2 Diabetes. Also, I would mention that it is fizzy drinks that is causing Diabetes and not obesity like the press- release states that this was independent of obesity.
    The purpose was to see whether there was a correlation between fruit drinks, artificially sweetened drinks and sugary drinks and Type 2 diabetes and the consequences to how many people this could effect in the U.S. and the U.K. The research was conducted by people from around the world like: Cambridge’s Institute of Metabolic Science, The Institute of Public Health and Clinical Nutrition in Finland, Department of Healthcare Kyoto University, Department of Health for Harvard University and Department of Endocrinology Tenri Hospital Japan. Therefore, the people aren’t from places which would see benefit in the result of their research showing a specific trend. The conclusion states that artificially sweetened drinks and fruit drinks aren’t healthy alternatives to sugary drinks when stopping the development of Type 2 diabetes. This is backed by evidence that may be biased and their estimations on the consequences to the population need to be more precise so the conclusion isn’t very strong. They suggest that artificially sweetened drinks and fruit juices aren’t a healthy alternative to plain fizzy drinks and that they aid the increase in Type 2 diabetes as well. The press-release fails to mention the inaccuracy in their estimations for the effect on the population which the paper’s conclusion states that their calculations aren’t precise. The press-release also doesn’t mention the fact that their sources were possibly biased which affects the credibility of their assumptions drawn from this data.
    Some comments suggest that the paper is biased (against these drinks all together) because of the government wanting to tax sugary drinks or drinks which can lead to conditions like Type 2 diabetes so the research was made to make artificially sweetened drinks and fruit juices look bad as well as fizzy drinks for an ulterior motive. Others suggest (like last Journal Club) that there is a correlation between people who drink fizzy drinks and obesity and that they should acknowledge that some may have diabetes because of other factors which are related to the individuals lifestyle choices. I agree with this opinion that they need to be more specific on the individuals in order to see what is really causing this diabetes because it may be due to other factors like unhealthy eating which means that the blame may be wrongly put on sugar for causing diabetes which can affect the public opinion on sugar if it is later proved wrong. In the comments there may be biased to disagree with the paper since they may work for a drinks company who would want to dispute these claims and blame Type 2 Diabetes on something else to make sure that the public still want to buy their product.

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  3. Journal Club 3
    The point of the research is to inform the public that consumption of artificially sweetened drinks as appose to drinks sweetened with sugar can still lead to diabetes (Type 2). The research also plays on the fact that most members of the public will now view artificially sweetened drinks as a negative influence on their health as they will take this report and interpret it in that way. In my opinion I think the research has been completed to inform people of how this “healthy” substitute is not as healthy as first thought, not to create a panic over how it isn’t fully healthy. The search was carried out by a group from Cambridge University which does make it seem quite reliable as it is unlikely that they have been influenced by anyone with an ulterior motive. Although the results do not show definitive evidence they do show a trend that although sugar filled drinks do lead to more cases of Type 2 diabetes their artificial counterparts also lead to the condition as well. The main conclusion is that artificially sweetened drinks are healthier for you, but not by much. Drawing from the journal, sugar filled drinks linked with 38,253 cases whereas the artificially sweetened drink still linked to 31,998 cases which is still very high. I agree that artificially sweetened drinks are not a truly heathy substitute for sugar filled drinks. I believe the press release does accurately reflect the article as they both admit that artificially sweetened drinks are not much healthier than normal, sugar filled drinks.

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  4. Journal Club 3

    My headline would be Non- sugary drinks with artificial sweeteners can cause type 2 diabetes! Yes you should be concerned if you are taking the healthier option as it can still cause some health issues. Maybe not as much as sugary drinks but nonetheless, it can still cause type 2 diabetes. I think that the artificial sweeteners would be the better angle for the story because it releases newer and less obvious information, which will sell more papers because people already know that sugary drinks can cause Type 2 diabetes. The new story will sell more papers, which is the aim of the journalist.

    The purpose of the research is to examine the differences between sugary drinks and the non- sugary/artificially sweetened drinks with health issues- mainly type 2 diabetes. Also to predict the projected amount of people to get type 2 diabetes in the UK and the USA from sugary drinks.

    Multiple scientists and they got their information from PubMed, Embase and Web of knowledge for prospective studies of adults without diabetes. Personally, I trust these websites because they are trusted websites in the scientific community and the scientists haven’t just used one website for their information. They have used multiple websites to cross reference the information to make sure they don’t release some inaccurate information.

    The main conclusion is that sugar sweetened beverages was directly linked with a greater amount of type 2 diabetes compared to artificially sweetened drinks and fruit juices. Yet the there was positive associations with type 2 diabetes by artificially sweetened and juice drinks. It is justified as the have quantitative analysis to back up their conclusions and haven’t just said it, they have provided evidence for this also.

    Artificially sweetened drinks and juicy drinks aren’t as likely to cause type 2 diabetes. However these drinks aren’t actually a healthier option to sugary drinks to prevent type 2 diabetes. Therefore this shows that people shouldn’t think that alternatives to sugary drinks are a healthier option.

    I think that the press release is quite accurate in the reporting of the paper as it isn’t telling any lies as such and it has lifted information straight from the reporting in the BMJ. For example, Artificially sweetened drinks and fruit juice also showed a positive association with type 2 diabetes, but the quality of evidence was limited. None the less, the authors warn that neither artificially sweetened drinks nor fruit juice are suitable alternatives to sugar sweetened drinks for the prevention of type 2 diabetes.
    Some people aren’t happy with the paper as people think that the paper lacks sufficient evidence to back up their claims. I am unsure about the paper as I think that the claims they make sense and are understandable yet I am unsure on the actual data analysis represented as I don’t really understand it all.

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  5. It appears from this study that our observations of last week were correct as in this article, the press release was over dramatised in order to attract more attention. The press release claims that there is conclusive evidence that all three drinks are directly related to diabetes, however in the article it makes the claim that all evidence used is observational and so can not be used to make a claim.

    The article seems to be reliable based on where it comes from as Cambridge is a highly respected institution and they conclude that is likely that there is correlation between sugar sweetened drinks however, this seems to be merely logical. They also claim that there is little difference between the risk of diabetes if one drinks fruit juice or artificially sweetened beverages. They went on to recommend that you shouldn’t drink these drinks and recommended a decrease in fruit juice advertisement due to this evidence (especially for children) however there evidence was based on people who are 18 years or older. I feel like the recommendation to reduce fruit drink advertisement is a poor recommendation as they still contain the vitamins that makes them healthier – with these drinks it was not a belief that they contained no sugar but more they would contribute to the nutrients needed.

    Many of the comments are well written, however there are some that are clearly biased (as shown by their job title) and this shows within their comments and claims. Their biased makes for the most compelling arguments however the better comments do not so much refer to the results but the method as they criticise what occurred and so in my opinion are superior to the overly emotional comments.

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  6. Headline: If healthy drinks are deemed unhealthy should there be a new meaning of the word healthy?

    For people who have been “taking the healthy option” of diet drinks and fruit juice, I think they should be concerned, not just for their health but for the fact that they have been led to believe that drinking fruit juice or artificially sweetened drinks would be the “healthier option” when in fact, although there is limited evidence to say that they increase Type 2 diabetes ( but that doesn’t mean they don’t completely) there is apparently no gain from it. Therefore for those people who wanted a healthy diet and were drinking these have technically not done much for themselves as researchers have concluded that “these drinks are unlikely to be healthy alternatives to sugar sweetened drinks for preventing type 2 diabetes”. For instance, this would be an issue for those who were wanting to loose weight and chose what they thought were healthier drinks when in fact they weren’t helping as much as they thought. However it is not from the original paper so this could be inaccurate or exaggerated therefore the public could question the credibility of this and may not know what to believe so some people could change their lifestyle completely to compliment the data given or some will choose not to change anything with what they already do.

    This would be a better angle to relate to the public and how this piece of information effects them instead of having it be about the «journalists discovery» for their own publicity even though they will be receiving credit for work that isn’t theirs.

    What is the purpose of this research?

    To investigate the potential connections between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity (obesity). Also to estimate the population attributable fraction for type 2 diabetes from consumption these drinks, specifically in the United States and United Kingdom.

    What is the main conclusion and is it justified?
    “In this systematic review and meta-analysis, we have produced summary evidence that habitual consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice was prospectively associated with incident type 2 diabetes, independently of adiposity”. Therefore even if you are not obese, this research concludes that drinking these drinks can cause an increase in Type 2 diabetes. Additionally Under assumption of causality for the association of consumption of sugar sweetened beverages with incidence of type 2 diabetes, they stated that its estimated that over 10 years two million type 2 diabetes events in the USA and 80000 in the UK are related to consumption of sugar sweetened beverages. Younger adults and men would have greater numbers of type 2 diabetes events related to consumption of sugar sweetened beverages than older adults and women, respectively. This is justified through Figure 3 as it highlights how on average, young people and men drink more sweetened beverages therefore they have an increased risk in type 2 diabetes compared to the elderly and women. However, measures of these results are likely to involve errors such that residual confounding persisted in individual studies and our meta-analysis. One way in which this could have happened is because it wasnt taken into account that lifestyle factors and adiposity could change over time. The time varying in the analysis might not be random and could result in bias in an unknown direction as this objectifies the changes in lifestyles overtime especially as healthiness may have decreased in recent years due to the food an drink products produced nowadays.

    What about the claims regarding artificially sweetened drinks and fruit juices?

    Artificially sweetened beverages and fruit juice also showed positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes.

    Does the press release accurately reflect the paper? Give examples.
    Press release~ “The association between artificially sweetened drinks or fruit juice and incident type 2 diabetes was less evident. Yet, the researchers found little evidence for benefits of these beverages, and therefore concluded these drinks are unlikely to be healthy alternatives to sugar sweetened drinks for preventing type 2 diabetes.”

    The Press release suggests that there was limited evidence to suggest that artificial or fruit drinks has relevance to Type 2 diabetes however in the original paper it stated that “Higher consumption of artificially sweetened beverages by one serving per day was associated with a 25% greater incidence of type 2 diabetes”. This is quite a substantial amount of which could suggest that those drinks are More than likely to not be healthy alternatives. In the analysis of fruit juice, the influence of adjustment for adiposity was in the direction opposite to that of the analysis for sugar sweetened beverages and artificially sweetened beverages. This was not highlighted in the press release as fruit juice drinks were in a way branded as the same category as artificial sweetened drinks in the fact that it would also be an unhealthy alternative. The original paper stated that “Higher consumption of fruit juice by one serving/day was associated with a 7% greater incidence of type 2 diabetes” Therefore Fruit juice may not be as high risked for getting type 2 diabetes it is smaller that the artificially sweetened drink so it could be deemed as not just necessarily an unhealthy alternative but a Slightly better Alternative.

    In relation to how accurate the press release is, i would say that it isnt as accurate as what it could have been. This may be due to that fact that it wasn’t that detailed and didnt contain much supportive evidence to back up the case given. If the press release related more accurately to the original paper, the public’s view of it would have been different because it wouldn’t have been exaggerated or less informative so for those people associated with healthy diets wouldn’t have been as concerned as they may have been.

    Is everyone happy with this research? Who do you agree with? Could there be bias in these comments?

    Edward Archer
    Obesity theorist and computational physiologist

    He could be biased towards the credibility of the evidence due to the fact that his career involves the issues of healthiness and adiposity as he says “We (and many others) have reached this conclusion because the raw data are mere uncorroborated anecdotes…… M-BMs produce nothing but meaningless numbers, not valid scientific data.” This person is clearly going to be biased as in his line of work, there are going to be many cases related to obesity etc and as he is a “Theorist” he will be using his and other peoples opinions against the evidence produced in the paper.

    There are mixed views for this research as some people ( Joanne R McCormack and Shree T Datta) are compliant with the evidence and even give their own opinions of other aspects out side of the research given to relate to the research. However for instance- Dhastagir Sultan Sheriff – warns the public to be cautious on the topic of obesity and sugar etc especially drawing conclusion based on extracting information from existing studies and statistical analyses.

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  7. Initially after reading the press release, it appears that ‘healthy’ option drinks (artificially sweetened and fruit juice) are actually no better for you than sugar sweetened beverages, when it comes to preventing type 2 diabetes. It is obvious to people that by drinking sugar sweetened beverages, it will increase their chances of getting type 2 diabetes, however they may not realize that by trying to drink healthier, their chances may not actually decrease.
    My headline would be…
    Sugar Free, but not risk free

    The purpose of the research was to examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes.

    Many different scientists conducted this experiment, including Laura O’Connor, who completed her PhD in the area of dietary energy density and dietary quality, to name one. Therefore I think we can trust these people, as they are well educated, and clearly experienced in this field. They got their information from PubMed, Ovid and Web of knowledge for prospective studies of adults without diabetes. These are trusted scientific websites; therefore I think they are reliable. Also, they have used more than one website to ensure their information is correct.

    Their main conclusion is that regular consumption of sugar-sweetened beverages was directly linked to an increased number of cases of type 2 diabetes.

    However, artificially sweetened beverages and fruit juices also showed a positive correlation with type 2 diabetes, although they are not as likely to cause it. They admitted the results may involve bias, but they concluded that these beverages were not a healthy alternative to sugar sweetened beverages.

    I think the press release does accurately reflect the paper, as it has taken the information straight from the paper, without changing it, or making it bias. They have quoted things from the paper, for example
    “ Although more research on cause and effect needs to be carried out, this study indicates the potential health gains that may be achieved by reducing the consumption of sugar sweetened drinks”

    Not everyone is happy with the research. In particular, Edward Archer, obesity theorist and computational physiologist, believes that the evidence was low quality, as the research was simply observation studies. Therefore, he thinks that the conclusions drawn are not supported by any valid scientific evidence. It is obvious he is biased, as he works in a similar field, and even quoted his own study, which he will obviously think is more accurate and reliable, as he did it himself.

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  8. This research was carried out n order to prove/ disprove whether the risk of getting type 2 diabetes is effected by different types of drinks. These were: sugar sweetened drinks artificially sweetened drink and fruit drinks.

    Because they were conducted by Cambridge University a published by the BMJ, I find the results to be accurate and trustworthy, as both are highly regarded and false evidence would cripple both of them, therefore I find it safe to say we can trust them and the evidence provided.

    The main conclusion is that all 3 drinks can cause type 2 diabetes or was at least associated, not just sugar sweetened ones. Having said this, the evidence was not large enough to conclude whether the artificial and fruit drinks did cause type 2 diabetes. Furthermore, the evidence does not state whether participants were already obese e.c.t, which could leave people to question the whole experiment. There is a lot of evidence to suggest this, however, more tests are needed to prove this.

    The article claims that artificial drinks and fruit juices, and states that neither are a healthy alternative in the example of diabetes influence diabetes. However, fruit juice is the healthiest out of the 3.

    I think the press reflects the paper properly demonstrates the findings because it provides information on how the experiment still needs work. However, perhaps it exaggerates the figures a little and it doesn’t include enough results to be a journal.

    Most people seem to find the journal to be correct. There does seem to be a couple of biases but overall, the comments are positive. I agree with Joanne R McCromack as I believe the results are promising.

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