Frisdranken, bewegen en insulineresistentie*
Zowel frisdranken en dranken met extra suiker als meer bewegen hebben duidelijk invloed op de insulineresistentie. Bij insulineresistentie is er een relatief tekort aan insuline en daardoor een groot risico voor het krijgen van diabetes type-2. Het regelmatig drinken van gesuikerde dranken doet de insulineresistentie duidelijk verhogen. Ook het cholesterol, de triglyceriden, de bloeddruk en de buikomtrek werden daardoor duidelijk hoger. Het regelmatig bewegen doet al die zaken juist verminderen. Het regelmatig bewegen en nauwelijks of geen gesuikerde dranken
drinken geeft de beste resultaten voor de insulineresistentie. Dit alles blijkt uit een studie onder bijna 7.000
tieners met een gemiddelde leeftijd van 15 jaar.
Sugar-Sweetened Beverages, Physical Activity Independently Linked to Insulin Resistance
Sugar-sweetened beverage intake and physical activity levels are each independently liked to insulin resistance in adolescents, according to the results of a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data, collected by the National Center for Health Statistics, reported in the April issue of the Archives of Pediatrics & Adolescent Medicine.
"Two lifestyle behaviors associated with obesity, insulin resistance, and metabolic syndrome are (1) high levels of sugar-sweetened beverage...intake and (2) low levels of physical activity," write Andrew A. Bremer, MD, PhD, from the University of California Davis School of Medicine in Sacramento, and colleagues.
"Dietary modifications and consistent exercise are thus 2 recommendations typically given by pediatricians to children and adolescents either at risk for or currently diagnosed with these disorders. Experimental studies support the hypothesis that [sugar-sweetened beverages] may increase energy intake and induce weight gain via their reduced satiety response, the promotion of a positive energy balance by liquid calories relative to isoenergetic solid calories, and their dysregulation of energy homeostasis."
The goal of this study was to examine the association between insulin resistance–associated metabolic parameters and anthropometric measurements with sugar-sweetened beverage intake and physical activity levels, using a nationally representative sample of 6967 US adolescents participating in NHANES during the years 1999 to 2004. Age range was 12 to 19 years.
Sugar-sweetened beverages were defined as caloric soft drinks, colas, sugar-sweetened fruit drinks, and any other sugar-sweetened drinks.
The exposure of interest was sugar-sweetened beverage consumption and physical activity levels, and the main endpoints were glucose and insulin concentrations; a homeostasis model assessment of insulin resistance (HOMA-IR); total, high-density lipoprotein, and low-density lipoprotein cholesterol concentrations; triglyceride concentrations; systolic and diastolic blood pressure; waist circumference; and body mass index percentile for age and sex. Body mass index was calculated as weight in kilograms divided by height in meters squared.
Increased sugar-sweetened beverage intake was independently associated with increased HOMA-IR, systolic blood pressure, waist circumference, and body mass index percentile for age and sex and decreased high-density lipoprotein cholesterol concentrations, based on multivariate linear regression analyses. Increased physical activity levels were independently associated with reduced HOMA-IR, low-density lipoprotein cholesterol concentrations, and triglyceride concentrations and increased high-density lipoprotein cholesterol concentrations.
"Low sugar-sweetened beverage intake and high physical activity levels appear to modify each others' effects of decreasing HOMA-IR and triglyceride concentrations and increasing high-density lipoprotein cholesterol concentrations," the study authors write. "Sugar-sweetened beverage intake and physical activity levels are each independently associated with insulin resistance–associated metabolic parameters and anthropometric measurements in adolescents."
Limitations of this study include cross-sectional design precluding determination of causality, inability to adjust for the subjects' degree of sexual maturation, and use of questionnaire data with inherent limitations.
"Although prospective studies are needed to directly test the effects of dietary modification and consistent exercise on the development of obesity, insulin resistance, and metabolic syndrome in the pediatric population, pediatricians should continue promoting these lifestyle modifications in efforts to improve overall health," the study authors conclude.
The National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research supported this study. The authors have disclosed no relevant financial relationships.
Arch Pediatr Adolesc Med. 2009;163:328–335.
Clinical Context
Sugar-sweetened beverages may promote weight gain through a lowered satiety response compared with solid food with similar caloric content. In addition, these drinks can disturb energy homeostasis. In a previous study by Ludwig and colleagues of 548 children with an average age of 11.7 years, each additional daily serving of a sugar-sweetened beverage increased body mass index by a mean of 0.24 kg/m2. The results, which were published in the February 17, 2001, issue of The Lancet, also demonstrated that this incremental increase in beverage consumption increased the risk for obesity by 60%.
The current study examines variables that should have a contradictory effect on metabolic outcomes — consumption of sugar-sweetened beverages and physical activity — among adolescents. Specifically, researchers focused on measures of insulin resistance and serum lipid values.
Study Highlights
· The study used data from NHANES conducted in 1999 to 2000, 2001 to 2002, and 2003 to 2004. The current study focuses on respondents between the ages of 12 and 19 years.
· Adolescents who were pregnant or who were using metabolically active medications were excluded from study analysis.
· All participants underwent a comprehensive health and diet survey and provided blood and urine samples.
· Diet information was obtained through 24-hour recall information. Sugar-sweetened beverages were defined as caloric soft drinks, colas, sugar-sweetened fruit drinks, and any other sugar-sweetened drinks.
· Physical activity was measured as the number of times an individual was active per day multiplied by the duration of the activity.
· The main study outcomes were the relationships between consumption of sugar-sweetened beverages, physical activity, and physical and metabolic parameters. These parameters included body mass index, waist circumference, blood pressure, serum lipid levels, and measurements of insulin resistance.
· 6967 adolescents provided data for study analysis. The mean age of participants was 15.5 years, and approximately half of the participants were girls. There was some heterogeneity to the study cohort with regard to racial/ethnic background.
· Participants in the lowest quintile of sugar-sweetened beverage consumption an average of 0.01 servings per day, while those in the high-intake quintile consumed a mean of 7.4 beverages per day.
· Each additional daily serving of a sugar-sweetened beverage was associated with a 5% increase in the homeostasis model of insulin resistance, a 0.16 mm Hg increase in systolic blood pressure, a 0.47-cm increase in waist circumference, a 0.90 kg/m2 increase in the body mass index for age, and a 0.48 mg/dL decrease in high-density lipoprotein cholesterol.
· 14.4% of participants in the lowest quintile of physical activity reported engaging in at least 1 moderate physical activity in the last month, while 96.9% of adolescents in the highest quintile for physical activity had engaged in vigorous activity.
· Higher physical activity was associated with improved insulin resistance, reductions in low-density lipoprotein cholesterol and triglyceride levels, and an increase in high-density lipoprotein cholesterol levels.
· The combination of higher physical activity and lower consumption of sugar-sweetened beverages was synergistic in improving insulin resistance and concentrations of high-density lipoprotein cholesterol and triglycerides. However, there was no effect modification for blood pressure or anthropometric outcomes.
· Female adolescents were more sensitive than males to the deleterious metabolic effects of a higher consumption of sugar-sweetened beverages. Conversely, adolescent boys derived more benefit from physical activity compared with girls.
· Another subgroup analysis revealed that the combination of lower consumption of sugar-sweetened beverages and higher physical activity was synergistic only among adolescent boys. (Mei
2009)
