Beverage Intake and Metabolic Syndrome Risk Over 14 Years: The Study of Women's Health Across the Nation

Published:December 06, 2016DOI:



      Alcohol and energy-dense beverages consumption have been implicated in cardiometabolic disease, albeit inconsistently.


      This study tested prospective associations between intakes of alcohol, energy-dense beverages, and low-calorie beverages and cardiometabolic risk in midlife women.


      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 (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.


      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.


      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.


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      B. M. Appelhans is an associate professor, Departments of Preventive Medicine and Behavioral Sciences, Rush University Medical Center, Chicago, IL.


      A. Baylin is an associate professor, Departments of Epidemiology and Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor.


      M.-H. Huang is a researcher, Division of Geriatrics, UCLA David Geffen School of Medicine, Los Angeles, CA.


      H. Li is an associate professor, Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, and an associate professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston.


      I. Janssen is an associate professor, Department of Preventive Medicine, Rush University Medical Center, Chicago, IL.


      E. F. Avery is a supervising statistician, Department of Preventive Medicine, Rush University Medical Center, Chicago, IL.


      R. Kazlauskaite is an associate professor, Departments of Preventive Medicine and Internal Medicine, Rush University Medical Center, Chicago, IL.


      H. M. Kravitz is a professor, Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, IL.