TOPLINE

Higher consumption of non-sugar-sweetened beverages (NSSBs) was associated with an increased risk for type 2 diabetes (T2D) in a multiethnic population, particularly among adults with BMI ≥ 25 and individuals of non-Dutch origin. Notably, replacing sugar-sweetened beverages (SSBs) with NSSB alternatives increased the risk for T2D among younger adults and those of non-Dutch origin. 

METHODOLOGY

• Researchers analyzed data of 2612 adults (median age at baseline, 49.0 years; 59.9% women) enrolled in a large prospective multiethnic cohort study based in Amsterdam to evaluate the association between the consumption of SSBs and NSSBs, their mutual substitutions, and the risk for incident T2D.
• Participants were of Dutch, Surinamese, Turkish, and Moroccan origin and completed ethnic-specific food frequency questionnaires to assess dietary intakes at baseline between 2011 and 2015, with follow-up data obtained between 2019 and 2022.
• Beverage consumption included water, fruit juices, coffee/tea, SSBs, and NSSBs; syrup-based drinks, soft drinks, iced teas, and energy/sport drinks were classified according to whether they contained sugar or non-nutritive sweeteners.
• Beverage consumption was categorized as no servings per day, up to one serving per day, and more than one serving per day. Substitution analyses examined the effect of replacing one serving (250 mL) per day of SSBs with an equivalent amount of NSSBs and vice versa, while keeping the total beverage consumption constant.
• Incident T2D was identified during follow-up through a self-reported diagnosis by a healthcare professional, the use of T2D medications, or a fasting glucose level of at least 7.0 mmol/L among participants free of diabetes at baseline.

TAKEAWAY

• Over a median follow-up of 7.08 years, 141 participants developed incident T2D. After adjustment, the consumption of more than one serving per day of NSSBs was associated with an increased risk for T2D among overall participants (incidence rate ratio [IRR], 2.26; P for trend = .019) and participants of non-Dutch origin (IRR, 3.04; P for trend = .034).
• Among adults aged 18-49 years, consuming up to one serving per day of NSSBs was associated with a higher risk for T2D than nonconsumption (IRR, 2.25; P for trend = .003), and among those with BMI ≥ 25, the consumption of more than one serving per day of NSSBs was associated with an increased risk for T2D (IRR, 2.19; P for trend = .030).
• Substituting one serving per day of SSBs with NSSBs was associated with a higher risk for T2D among adults aged 18-49 years (IRR, 1.67) and participants of non-Dutch origin (IRR, 2.03). Conversely, replacing one daily serving of NSSBs with SSBs was associated with a lower risk for T2D among adults aged 18-49 years (IRR, 0.60) and participants of non-Dutch origin (IRR, 0.49).
• Consuming SSBs was not associated with the risk for T2D in the overall cohort; however, consuming more than one serving per day was associated with an increased risk for T2D among participants of Dutch origin (IRR, 2.80).

IN PRACTICE

“While NSSBs are often promoted as healthier alternatives to SSBs, our findings highlight the need for further interventional and mechanistic studies to better understand their long-term health effects and to inform public health recommendations,” the authors of the study wrote. 

SOURCE

This study was led by Sara Beigrezaei, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands. It was published online in the European Journal of Nutrition.

LIMITATIONS

The small sample size and few cases of T2D may have limited the study’s power to detect reliable associations between SSBs, NSSBs, their substitution, and T2D risk — especially within subgroups. The low consumption of NSSBs within the cohort may have limited statistical power. The observational study design precluded any conclusion about causality.

DISCLOSURES

This work was supported by the Swiss National Science Foundation. The prospective cohort study from which the data were drawn received support from the Amsterdam University Medical Center and the Public Health Service of Amsterdam, with additional baseline funding from the Dutch Heart Foundation, the Netherlands Organization for Health Research and Development, the European Union’s Seventh Framework Programme, and other sources. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.