“Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men” is an analysis of a prospective cohort study that compares the effect of sugar-sweetened beverages and artificial sweetened beverages on type 2 diabetes. The study found that sugar-sweetened beverages do increase the risk of type 2 diabetes but artificial sweeteners do not show such an effect. When it comes to risk of type 2 diabetes, artificial sweeteners should be used over sugar-sweeteners to avoid increasing the risk of type 2 diabetes (1).
As state before, this paper was an analysis of a prospective cohort study from the Health Professionals Follow-Up Study. 51,529 men aged 40-75 years were recruited for this study. After adjusting for preexisting conditions and implausible energy intake 40,389 participants were left. Average consumption of sugar-sweetened and artificially-sweetened beverages were determined from food-frequency questionnaires. After that, other possible confounding factors were adjusted for (such as smoking, obesity, family history, healthy eating, and triglyceride levels). It was found that the mean intake of sugar sweetened beverages was 2.5 servings/wk and was mostly cola. The mean consumption of artificially sweetened beverages was 3.4 servings/wk. It was found that those who consumed sugar sweetened beverages were more likely to have unhealthy lifestyles (smokers, unhealthy diets, low amounts of physical activity, and have a family history of type 2 diabetes). Those who consumed artificially sweetened beverages showed the opposite lifestyles of those that consumed sugar sweetened. After adjusting for these factors it was found that sugar sweetened beverages were significantly associated with risk of type 2 diabetes (P=<0.01) and artificially sweetened beverages were not (P=0.13).
This article did a very good job adjusting for possible confounders but did not pick subjects that could make this study generalizable to the whole population. For example, the final results were adjusted based on smoking habits, diet, physical activity, and family history of type 2 diabetes. All of these factors are things that can influence the risk of type 2 diabetes and adjusting based on such factors helped decrease confounding factors. Also, people that had type 2 diabetes within the first two years of the study were excluded from the final data to avoid recall bias. However, this study was solely done on men ages 40-75 and therefore cannot be generalized to the whole male population and especially cannot be generalized to women. This study did a very good job ruling out confounding factors but it would have been stronger had it included a more diverse population.
Other studies that have been done on similar subjects have shown the same results. Artificial sweeteners do not contribute to weight gain like sugar-sweeteners do and therefore do not contribute to type 2 diabetes (2,3). The main mechanism by which sugar causes type 2 diabetes is insulin resistance caused by extra adipose tissue (weight gain). Multiple studies have shown that artificial sweeteners do not contribute to weight gain and therefore do not contribute to the risk of type 2 diabetes (2,3). However, studies have shown that artificial sweeteners may not have the same effect on satiety as sugar. This may cause overconsumption of other foods to gain satiety and in a roundabout way contribute to type 2 diabetes (4).
Overall, this study did a good job in ruling out confounding factors but would have been much stronger if a larger more randomized population was used. Consumers should be confident in the information given in this article and should realize that artificial sweeteners are a better choice when it comes to type 2 diabetes but such sweeteners may have other adverse affects not included/studied in this paper.
http://ajcn.nutrition.org/content/93/6/1321.full.pdf+html.
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References
1.) Koning LD, Malik VS, Rimm EB, Willet WC, and Hu FB. Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am J Clin Nutr. 2011;93(6):1321-1327. Available at: http://ajcn.nutrition.org/content/93/6/1321.full.pdf+html. Accessed January 14, 2014.
2.) Raben A, Vasilaras TH, Moller AC, Astrup A. Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. Am J Clinc Nutr. 2002;76(4):721-729. Available at: http://ajcn.nutrition.org/content/76/4/721.short. Accessed February 19, 2014
3.) Stellman SD, Garfinkel L. Artificial sweetener use and one-year weight change among women. Elsevier. 1986;15(2):195-202. Available at: http://www.sciencedirect.com/science/article/pii/0091743586900897. Accessed February 19, 2014.
4.) Steinert RE, Frey F, Topfer A, Drewe J, Beglinger C. Effects of carbohydrate sugars and artificial sweeteners on appetite and the secretion of gastrointestinal satiety peptides. Brit J of Nutr. 2011;105:1320-1328. Available at doi:10.1017/S000711451000512X. Accessed February 19, 2014.
Reviewed by Viktoriya Wolff
