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A small, long-term study of almost 500 children in Massachusetts has found that regularly drinking sugary drinks and 100% fruit juices during childhood and adolescence may be linked to a higher risk of developing Type 2 diabetes among boys than girls, according to preliminary research to be presented at the American Heart Association’s Epidemiology and Prevention│Lifestyle and Cardiometabolic Scientific Sessions 2024, March 18- 21, in Chicago. The meeting offers the latest science on population-based health and wellness and implications for lifestyle.

“While these findings are preliminary, they support the existing evidence about the potential relationship between beverages with added sugar and long-term risk of Type 2 diabetes in children,” said lead investigator Soren Harnois-Leblanc, Ph.D., a registered dietitian and postdoctoral researcher in the department of population medicine at Harvard Pilgrim Health Care Institute and Harvard Medical School, both in Boston. “Pediatricians and other health care professionals should caution young patients and their parents about sugary drinks and fruit juices when discussing healthy eating habits.”

According to a 2022 American Heart Association fact sheet about sugary drinks, nearly two-thirds of children and adolescents in the U.S. consume at least one sugary drink, such as soda, lemonade or an energy drink, each day. It also notes that in addition to weight gain, eating too many foods with added sugars, especially from sugary drinks, raises the risk of developing heart disease, high blood pressure, Type 2 diabetes and tooth decay.

Using data from Project Viva, an ongoing long-term study of women and their children in eastern Massachusetts that began in 1999, researchers explored whether drinking sugary drinks, 100% fruit juices and eating fresh fruits were associated with markers for developing Type 2 diabetes. Researchers calculated the average consumption of sugary drinks, 100% fruit juices, and fresh fruits over childhood and adolescence based on dietary records and assessed their potential associations to three markers of Type 2 diabetes: insulin resistance, fasting blood glucose level and HbA1c levels. These markers were measured by a single blood test while fasting in late adolescence (approximately age 17).

The analysis found:

• Each daily serving of sugary drinks (approx. 8 ounces) during childhood and adolescence among boys was associated with a 34% increase in insulin resistance; a 5.6 milligrams per deciliter (mg/dl) increase in fasting glucose levels; and a 0.12% increase in HbA1c levels in late adolescence.
• Drinking 100% fruit juice throughout childhood and adolescence was linked to a 0.07% increase in HbA1c levels in late adolescence per daily serving of 100% fruit juice among the boys in the study, with only a slight increase in girls of 0.02%.
• Eating fresh fruit during childhood and adolescence did not appear to have a positive or negative effect on the risk of developing Type 2 diabetes among the boys or girls in the study, according to Harnois-Leblanc.

The associations between regularly drinking sugar-sweetened beverage and insulin resistance, fasting blood glucose levels and elevated HbA1c levels among boys persisted when other health, family and social factors were considered. These factors included socioeconomic status; child’s and mother’s body mass index; mother’s age at time of child’s birth; maternal and paternal history of Type 1 or Type 2 diabetes; overall diet quality and other lifestyle behaviors.

“Although several aspects of biology and behaviors differ between boys and girls, I would have expected to also find an association between sugar-sweetened beverages and fruit juice intake and the increases in insulin resistance, glycemia and HbA1c levels in late-adolescent girls. I was also surprised that eating whole fruits did not reduce the levels of these markers of Type 2 diabetes,” Harnois-Leblanc said.

“The next steps are to use more advanced statistical tools to enable us to better understand the potential causal role of sugary drinks and fruit juices, and to examine whether the relationships may also differ among children by race and/or ethnicity.”

Study background and details:

• Researchers analyzed data of children of the 2,128 pregnant women who had children while enrolled in Project Viva. 972 of the children met criteria for inclusion in this study (parent-completed questionnaires at the child’s age-3 examination and no personal or parental history of Type 1 or Type 2 diabetes, assessed separately from parental history of Type 2 diabetes). Of the 972 children, 455 had a fasting blood sample collected at a research visit in late adolescence, Harnois-Leblanc noted.
• 240 of the children in the study were girls and 215 were boys.
• Project Viva is a long-term study of women and their children in eastern Massachusetts that began enrollment in 1999. The study is focused on improving maternal and child health by examining the potential impact of various life and health factors during and after pregnancy on the mother’s health and their children’s health, including a review of diet and nutrition. Children were followed from birth to late adolescence, up to age 20 at most recent follow-up.
• Researchers evaluated the frequency of drinking sugary drinks, fruit juices and eating fresh fruit (based on standard serving sizes) from questionnaires completed by the parent at the child’s age of approximately 3, 8 and 13 years old; and measured fasting blood glucose, insulin and HbA1c levels in late adolescence (average age of 17.4 years).

The study had several limitations. Although it found an association between regularly drinking sugary drinks and fruit juices and the development of markers for Type 2 diabetes, it could not prove that the drinks caused Type 2 diabetes. Additionally, the relatively small number of study participants may have affected the strength of the association found between sugary drinks and fruit juices and the increased risk of developing Type 2 diabetes.

“Diet and cardiometabolic health are complex, with many factors varying over time and interacting in different ways, and this study represents one small piece of this puzzle,” Harnois-Leblanc said.

American Heart Association nutrition committee member Penny M. Kris-Etherton, Ph.D., R.D., FAHA, said, “This study has shown that greater sugar sweetened beverage intake, including fruit juice, throughout childhood and adolescents is associated with higher markers of diabetes risk in late adolescents in boys but not girls. It is striking that many measures of Type 2 diabetes risk were increased in boys at such an early age.”

Kris-Etherton, an emeritus professor of nutritional sciences at Penn State University, was also a co-author of the Association’s 2018 science advisory on low-calorie sweetened beverages and cardiometabolic health.

“Importantly, although fruit intake did not appear to be protective, it nonetheless was not associated with increased Type 2 diabetes risk,” she said. “These findings support the current dietary recommendations of the Association, and many organizations, to limit or eliminate drinking sugar sweetened beverages and instead consume whole fruits, which are high in so many nutrients especially the shortfall nutrients in the average American diet.” (Shortfall nutrients are the vitamins and nutrients that people are missing each day from the foods they eat; long-term deficiencies in some vitamins and nutrients have been linked to adverse health outcomes.)

The health care resource called Know Diabetes by Heart, developed by the American Heart Association and the American Diabetes Association, provides information about preventing heart disease and stroke while living with Type 2 diabetes. The initiative aims to raise awareness and understanding of the link between Type 2 diabetes and cardiovascular disease, provide resources and support to help people better manage their risk for heart disease and stroke, support health care professionals by sharing the latest clinical guidelines and science and engage health systems to improve quality of care for people with Type 2 diabetes.

Although women have breastfed since the beginning of time, there is very little scientific research on how exercise affects breast milk.

Online forums for pregnant women and new mothers are full of questions about this exact issue:

Can exercise cause breast milk to go sour? What happens to breast milk if you do high-intensity interval training? Will strenuous exercise affect your milk supply?

“There are so many myths about exercise and breast milk. We simply need more knowledge,” says researcher Trine Moholdt at the Norwegian University of Science and Technology (NTNU).

She heads several international research projects on how exercise can prevent and treat lifestyle diseases.

Limiting overweight in children

Last year, Moholdt received NOK 23.5 million from the EU and NTNU to find out if breast milk is extra healthy for babies if mothers exercise.

“The primary aim of our research is to find out if we can limit the development of overweight in children,” says Moholdt.

In 2020, the World Health Organization estimated that 39 million children under the age of five were overweight or obese. They also found that the incidence of overweight and obesity among children and adolescents aged 5–19 rose from four per cent in 1975 to 18 per cent in 2018.

Research shows that one possible contributing factor in the rapid rise in obesity in children is that nutrition during the early phase of life partially determines your health later in life.

“In fact, the period from conception to two years of age is considered the most critical period for possible development of obesity later in life,” says Moholdt.

Important hormone

Twenty new mothers have given 240 samples of breast milk. The samples were taken before and at specific times after two exercise sessions, and then compared with the corresponding times after the participants had been more sedentary.

The first piece of the puzzle has been identified, and it concerns a hormone called adiponectin.

This hormone regulates the body’s metabolism to ensure a supply of energy and substances that the body needs to function.

It is probable that this hormone is absorbed through the intestines of breastfeeding babies, thus changing how their metabolism functions.

Having low levels of this hormone is associated with insulin resistance and type 2 diabetes.

Good for the child

Moholdt’s study shows that mothers who did high-intensity interval training had higher levels of this hormone in their breast milk after their exercise session.

It is the first time that someone has investigated the effect exercise has on this hormone in breast milk.

“The hormone is secreted from fatty tissue and enters the bloodstream, and much of what is in the blood goes into the milk. We were not that surprised by the findings, but now we know for certain,” says Moholdt.

Intense exercise gives the best effect

The study shows that moderately intense exercise did not have the same effect on this particular hormone.

“Intense exercise led to a higher response. In my opinion, new mothers don’t have to worry about lactic acid in their breast milk. There is no research suggesting that this is unfortunate, and lactic acid is energy-rich,” says Moholdt.

One of the reasons why the WHO recommends breastfeeding during the first six months of life is that breast-fed children are less likely to be overweight and obese than formula-fed children. However, new research shows that the composition of breast milk varies between mothers who have high and low body mass indexes, and that differences in breast milk composition can play a role in the transfer of obesity from mother to child.

“We now have the first result of all the work we are doing, and many more results are on the way. It will be very exciting going forward,” says Moholdt.

Reference:

Mads Holmen, Guro F. Giskeødegård, Trine Moholdt, High-intensity exercise increases breast milk adiponectin concentrations: a randomised cross-over study, Frontiers in Nutrition, https://doi.org/10.3389/fnut.2023.1275508

The findings, presented at the AHA’s Epidemiology, Prevention, Lifestyle, and Cardiometabolic Health Scientific Sessions in Chicago, IL, do not support the long-term use of 16:8 time-restricted eating for preventing cardiovascular death.

The analysis from the National Health and Nutrition Examination Survey (NHANES) showed that eating during an 8-hour or smaller window throughout the day was tied to a 91% higher risk of death from cardiovascular causes; greater risks were observed in those with cancer or cardiovascular disease (CVD).

Time-restricted eating has gained popularity as a dietary intervention that limits daily food intake to a 4- to 12-hour window. Most short-term randomized controlled trials (RCTs) reported that TRE improved cardiometabolic risk profiles. However, there is no knowledge of whether TRE is associated with long-term hard endpoints.

Against the above background, Meng Chen, Sch of Public Health, Shanghai Jiao Tong Univ Sch of Med, Shanghai, China, and colleagues assessed the hypothesis that TRE is linked with a reduced risk of cause-specific and all-cause mortality.

For this purpose, the researchers included participants aged at least 20 years who completed two valid 24-hour dietary recalls and reported usual intake in both recalls from the NHANES in 2003-2018. Mortality status as of December 2019 was obtained through linkage to the National Death Index.

An eating occasion needs consumption of more than 5 kcal of beverages or foods. For each day, the eating duration between the last and first eating occasion was calculated. The average duration of two recall days defined typical eating duration which was then divided as <8, 8-<10, 10-<12, 12-16 (reference group; mean duration in US adults), and >16 hours.

Multivariable Cox proportional hazard models were employed to estimate the association of eating duration with cause-specific and all-cause mortality in the overall sample and among adults with cancer or CVD.

Among 20,078 adults included, the weighted mean age was 48.5 years, 50.0% were men, and 73.3% were non-Hispanic White.

The study led to the following findings:

• During a median follow-up of 8.0 years, 2797 all-cause deaths occurred, including 840 cardiovascular deaths and 643 cancer deaths.
• Compared with eating 12-16 hours, eating duration <8 hours was significantly associated with an increased risk of cardiovascular mortality (HR, 1.96); this association was also observed in adults with cardiovascular disease (HR, 2.06) and adults with cancer (HR, 2.72).
• Other eating durations were not associated with cardiovascular mortality, except for eating duration of 8-<10 hours in people with cardiovascular disease (HR, 1.64).
• No significant associations were found between eating duration and all-cause or cancer mortality in the overall sample and diseased subsamples, except that eating duration >16 hours was associated with a lower risk of cancer mortality in people with cancer (HR, 0.46).

In conclusion, among US adults, TRE with eating duration <8 hours was significantly associated with a higher risk of cardiovascular mortality in the general population and people with cancer or CVD. These findings do not support the long-term use of 16:8 TRE for preventing cardiovascular death.

However, the authors acknowledged that the study findings need replication and warned that no specific dietary advice around restricted eating/intermittent fasting should be given based on their study alone.

Reference:

Chen M, Zhong VW. Association between time-restricted eating and all-cause and cause-specific mortality. Presented at: Epidemiology, Prevention, Lifestyle, and Cardiometabolic Health Scientific Sessions. Chicago, IL. March 18, 2024.