A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk

doi:10.1093/ajcn/nqz094

The American Journal of Clinical Nutrition

Volume 110, Issue 1, July 2019, Pages 221-232

https://doi.org/10.1093/ajcn/nqz094 Get rights and content

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ABSTRACT

Background

Artificially sweetened beverages (ASBs) are commonly consumed and recommended for individuals at high risk for cardiometabolic diseases; however, the health effects of ASBs remain contradictory. Given that cross-sectional analyses are subject to reverse causation, prospective studies with long-term follow-up are needed to evaluate associations between ASBs and cardiometabolic health, especially among high-risk individuals.

Objective

The aim of this study was to examine associations of ASB intake and cardiometabolic health among high-risk women with prior gestational diabetes mellitus (GDM).

Methods

We included 607 women with GDM from the Danish National Birth Cohort (DNBC; 1996–2002) who completed a clinical exam 9–16 y after the DNBC pregnancy for the Diabetes & Women–s Health (DWH) Study (2012–2014). We assessed ASB intake using FFQs completed during the DNBC pregnancy and at the DWH Study clinical exam. We examined cardiometabolic outcomes at the DWH clinical exam. We estimated percentage differences in continuous cardiometabolic markers and RRs for clinical endpoints in association with ASB intake both during pregnancy and at follow-up adjusted for prepregnancy BMI, diet, and lifestyle factors. Sensitivity analyses to account for reverse causation were performed.

Results

In pregnancy and at follow-up, 30.4% and 36.4% of women regularly (≥2 servings/wk) consumed ASB, respectively. Consumption of ASBs, both during pregnancy and at follow-up, was associated with higher glycated hemoglobin (HbA1c), insulin, HOMA-IR, triglycerides, liver fat, and adiposity and with lower HDL at follow-up. After adjustment for covariates, particularly prepregnancy BMI, the majority of associations between ASB intake in pregnancy and outcomes at follow-up became null with the exception of HbA1c. ASB intake at follow-up (≥1 serving/d compared with <1 serving/mo) was associated with higher HbA1c (6.5%; 95% CI: 1.9, 11.3; P-trend = 0.007); however, associations were not upheld in sensitivity analyses for reverse causation.

Conclusions

Among Danish women with a history of GDM, ASB intake was not significantly associated with cardiometabolic profiles.

Keywords:

artificially sweetened beverages

nonnutritive sweeteners

soda

diet

obesity

diabetes

cardiometabolic health

gestational diabetes

Abbreviations used:

AHEI

Alternate Healthy Eating Index

ALT

alanine aminotransferase

ASB

artificially sweetened beverage

AST

aspartate aminotransferase

CRP

C-reactive protein

DNBC

Danish National Birth Cohort

DWH

Diabetes & Women–s Health Study

GDM

gestational diabetes mellitus

HbA1c

glycated hemoglobin

triglyceride

T2DM

type 2 diabetes mellitus.

Cited by (0)

This work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the NIH (contracts HHSN275201000020C, HHSN275201500003C, HHSN275201300026I, and HSN275201100002I), the March of Dimes Birth Defects Foundation (grants 6-FY-96-0240, 6-FY97-0553, 6-FY97-0521, and 6-FY00-407), Innovation Fund Denmark [grants 09-067124 and 11-115923, (Centre for Fetal Programming)], the Health Foundation (grant 11/263-96), the Heart Foundation (grant 96-2-4-83-22450), the European Union (grant FP7-289346-EarlyNutrition), and the Danish Diabetes Academy supported by the Novo Nordisk Foundation. YZ is supported by a career development award from the NIH Building Interdisciplinary Research Careers in Women–s Health Program (grant 5K12HD05216). SHL is supported by grant P20GM109036 from the National Institute of General Medical Sciences of the NIH.

Data sharing: The analytic code used for the analysis described in this article is available on request by contacting SNH ([email protected]). The data described in the article are not currently available for sharing; please contact CZ for more information ([email protected]).

Supplemental Figure 1 and Supplemental Tables 1–9 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/ajcn/.