Diabetes mellitus (DM) is an increasing burden on the public health system due to the widespread and costly nature of the disease. The Center for Disease Control estimates that roughly 29.1 million people in the United States live with DM. This disease, however, is largely preventable. According to the American Diabetes Association, prevention may be as simple as avoiding excess energy intake.
In the United States, sugar-sweetened beverages (SSBs) are one of the main sources of excess sugar and energy. Their link with an increased risk of diabetes has been well documented in past studies. This is because SSB consumption is often accompanied by weight gain and obesity, both of which are known DM risk factors. As a result, artificial sweeteners have been suggested as a replacement for sugar, prompting a rise in artificially sweetened beverages (ASBs). However, there have been a limited number of studies concerning the risks and benefits of non-nutritive sweeteners; furthermore, the results of these studies have been mixed. Thankfully, a recently published study in The American Journal of Clinical Nutrition seems to provide more conclusive results.
The researchers aimed to evaluate the associations of ASB and SSB consumption with the risk of developing DM. The study also investigated the potential benefit of replacing SSBs with ASBs or water.Between 1993 and 1998, the National Women’s Health Initiative (WHI) recruited a large prospective cohort of postmenopausal women. ASB, SSB, and water consumption was measured by lifestyle and dietary intake questionnaires. Outcomes related to DM were collected up until 2010 as part of the WHI Extension Study. Of the initial 93,676 women, the current analysis comprised of 64,850 participants. Over roughly 8.4 years of follow-up, 4,675 of these women developed diabetes. ASBs and SSBs were both associated with an increased risk of DM.
The results showed a link between both ASB and SSB consumption and the development of DM. Sugar sweetened beverages were associated with a staggering 43% increased risk of developing diabetes, roughly double the risk associated with artificially sweetened beverages at 21%. The researchers conclude replacing SSBs with ASBs may help reduce the incidence of diabetes mellitus. Furthermore replacing ASBs and SSBswith water could potentially further reduce the risk.
The strength in this study is found in the large, multi-ethnic, geographically diverse population, with most known diabetes mellitus risk factors, accounted for. The long follow up period also provides relevance and statistical reliability to the study. One possible limitation of the study is the observational nature of the research which allows for a possible co-founder. For example, it is possible that those drinking artificially sweetened beverages are doing so in an effect to improve health, and that their sugar consumption may differ in other significant ways as well.
Overall, this study provides important information regarding diabetes mellitus risk factors. Clinicians and the public can be certain that artificially sweetened beverages are less likely to contribute to diabetes mellitus than sugar sweetened ones, although as always – water is the best choice!
Written by Rebecca Yu
Source: Huang, M., Quddus, A., Stinson, L., Shikany, J. M., Howard, B. V., Kutob, R. M., … & Eaton, C. B. (2017). Artificially sweetened beverages, sugar-sweetened beverages, plain water, and incident diabetes mellitus in postmenopausal women: the prospective Women’s Health Initiative observational study. The American Journal of Clinical Nutrition, ajcn145391.