The intake of sugar-sweetened beverages (SSBs) has been associated with weight gain [4, 5], type-2 diabetes [6], and coronary heart disease [6,7,8]. Moreover, animal studies found that high SSBs intake can induce hypertension [9, 10], and prospective studies support the hypothesis of a positive association between SSBs intake and high blood pressure and hypertension [11,12,13,14,15,16]. Two main mechanisms have been proposed to explain the association between soft drink intake and blood pressure. First, the potential role of high-fructose corn syrup since a high intake of fructose has been associated with increases in blood pressure, adipogenesis, and oxidative stress. Also, fructose favors fat accumulation and induces vascular damage [17, 18], and animal studies indicate that high fructose intake seems to alter the hemodynamic system [19]. The second mechanism is the potential increase in blood pressure by soft drinks through weight gain due to the low to null caloric compensation induced by liquid calories, low satiety, and high added sugar content [20, 21].
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Our study has certain limitations that have to be acknowledged. First, given the observational nature of our study, we cannot rule out residual confounding, especially for time-variant variables, such as changes in types of hypertensive medications used. Second, we used an SFFQ to estimate soft drink intake. Some potential sources for error for intake data collected by SFFQ are the portion size estimation and the frequency report. The SFFQ may not capture as much detail about the type of food and beverages compared to other dietary methods. However, we would expect that the potential misclassifications were not differential. Third, our study focused on soft drinks instead of sugar-sweetened beverages. The SFFQ includes other sweetened beverages (e.g., flavored waters and juices) but not for all the waves since they were added to the instrument over time. Moreover, the SFFQ does not include separate items to differentiate industrialized from homemade beverages. Therefore, it is unknown if natural or artificial sweetener was added to homemade beverages. Given the uncertainty of knowing the nutrient composition of these beverages, we decided to focus our study on carbonated drinks. Moreover, soft drinks are the sugar-sweetened beverages more consumed in Mexico [45]. Fourth, changes in soft drinks intake might be explained by modifications in the SFFQ. However, it is unlikely this can explain, at least partially, the findings of our study since the way to ask for these beverages did not change in the three waves. Therefore, we assume that the changes in carbonated drinks observed in this study are due to changes in consumption. Fifth, the FFQ used in our study was only validated in Mexican women. Therefore, the instrument may not be adequate to estimate the dietary intake among men, which represent around 20% of the study sample. Six, the wide confidence intervals observe when we analyzed hypertension status at baseline as a potential modifier suggests that the sample was insufficient to conduct models with triple interactions. Future cohort studies with larger samples will be needed to evaluate whether hypertension status modifies the association between soft drink intake and blood pressure. Last, the distribution of Social Security Institute in Mexico workers for 2014 (data not available for previous years) was 60% women and 40% men [46]. This distribution remained constant until 2020 [47]. If we assume that the same distribution was for 2004 (the first wave of our study), perhaps our sample does not represent the distribution from which it was obtained. The latter may be because either more female health workers or female relatives participated in this study. However, representativeness is not a concern in our study. The overall goal is to add to the evidence about the association between soft drinks and blood pressure by using econometric models that remove time-invariant confounders, including sex.
Emphysematous pyelonephritis is a particularly debilitating necrotizing infection of the kidney characterized by gas within the renal parenchyma or perinephric space. It is typically diagnosed on a CT scan. The vast majority of patients with the condition are diabetic (95%), and it is six times more common in women than in men. It is also associated with renal failure, obstruction, polycystic kidneys, and an immunocompromised state.[166][167] Poor prognostic factors include azotemia, thrombocytopenia, shock, hyponatremia, confusion, and hypoalbuminemia.[168] Treatment includes renal drainage, blood sugar control, and parenteral antibiotics, typically for 3 to 4 weeks. Emergency nephrectomy is being recommended less often than previously as early surgery generally has a negative effect on outcomes. Surgery is now generally recommended if there are multiple risk factors in a non-functioning kidney or the patient is not responding to conservative measures.[168][169]
If you have diabetes, you can protect your heart and health by managing your blood glucose, also called blood sugar. You can also protect yourself by controlling your high blood pressure and high cholesterol. If you smoke, get help to stop.
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