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Paul Franks

Paul Franks

Principal investigator

Paul Franks

Estimated Substitution of Tea or Coffee for Sugar-Sweetened Beverages Was Associated with Lower Type 2 Diabetes Incidence in Case-Cohort Analysis across 8 European Countries in the EPIC-InterAct Study


  • Fumiaki Imamura
  • Matthias B. Schulze
  • Stephen J. Sharp
  • Marcela Guevara
  • Dora Romaguera
  • Benedetta Bendinelli
  • Elena Salamanca-Fernández
  • Eva Ardanaz
  • Larraitz Arriola
  • Dagfinn Aune
  • Heiner Boeing
  • Courtney Dow
  • Guy Fagherazzi
  • Paul W. Franks
  • Heinz Freisling
  • Paula Jakszyn
  • Rudolf Kaaks
  • Kay Tee Khaw
  • Tilman Kühn
  • Francesca R. Mancini
  • Giovanna Masala
  • Maria Dolores Chirlaque
  • Peter M. Nilsson
  • Kim Overvad
  • Valeria M. Pala
  • Salvatore Panico
  • Aurora Perez-Cornago
  • Jose R. Quirós
  • Fulvio Ricceri
  • Miguel Rodríguez-Barranco
  • Olov Rolandsson
  • Ivonne Sluijs
  • Magdalena Stepien
  • Annemieke M.W. Spijkerman
  • Anne Tjønneland
  • Tammy Y.N. Tong
  • Rosario Tumino
  • Linda E.T. Vissers
  • Heather A. Ward
  • Claudia Langenberg
  • Elio Riboli
  • Nita G. Forouhi
  • Nick J. Wareham

Summary, in English

Introduction: Beverage consumption is a modifiable risk factor for type 2 diabetes (T2D), but there is insufficient evidence to inform the suitability of substituting 1 type of beverage for another. Objective: The aim of this study was to estimate the risk of T2D when consumption of sugar-sweetened beverages (SSBs) was replaced with consumption of fruit juice, milk, coffee, or tea. Methods: In the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study of 8 European countries (n = 27,662, with 12,333 cases of incident T2D, 1992-2007), beverage consumption was estimated at baseline by dietary questionnaires. Using Prentice-weighted Cox regression adjusting for other beverages and potential confounders, we estimated associations of substituting 1 type of beverage for another on incident T2D. Results: Mean ± SD of estimated consumption of SSB was 55 ± 105 g/d. Means ± SDs for the other beverages were as follows: fruit juice, 59 ± 101 g/d; milk, 209 ± 203 g/d; coffee, 381 ± 372 g/d; and tea, 152 ± 282 g/d. Substituting coffee for SSBs by 250 g/d was associated with a 21% lower incidence of T2D (95% CI: 12%, 29%). The rate difference was-12.0 (95% CI:-20.0,-5.0) per 10,000 person-years among adults consuming SSBs ≥250 g/d (absolute rate = 48.3/10,000). Substituting tea for SSBs was estimated to lower T2D incidence by 22% (95% CI: 15%, 28%) or-11.0 (95% CI:-20.0,-2.6) per 10,000 person-years, whereas substituting fruit juice or milk was estimated not to alter T2D risk significantly. Conclusions: These findings indicate a potential benefit of substituting coffee or tea for SSBs for the primary prevention of T2D and may help formulate public health recommendations on beverage consumption in different populations.


  • Genetic and Molecular Epidemiology
  • EpiHealth: Epidemiology for Health
  • EXODIAB: Excellence in Diabetes Research in Sweden
  • Internal Medicine - Epidemiology

Publishing year







Journal of Nutrition





Document type

Journal article


Oxford University Press


  • Endocrinology and Diabetes
  • Nutrition and Dietetics


  • beverages
  • diabetes
  • dietary guidelines
  • epidemiology
  • sugar-sweetened beverages



Research group

  • Genetic and Molecular Epidemiology
  • Internal Medicine - Epidemiology


  • ISSN: 0022-3166