Search Results (12)

Childhood obesity represents a growing global public health crisis, strongly driven by the widespread consumption of sugar-sweetened beverages (SSBs) and, increasingly, artificially sweetened beverages (ASBs). SSB intake drives excessive calorie consumption, reduces satiety, and disrupts hormones, leading to metabolic dysfunction such as insulin resistance and type 2 diabetes. Despite some regional declines, global consumption of SSBs remains high, with persistent socioeconomic disparities. Concurrently, ASBs, marketed as healthier alternatives, pose emerging metabolic and behavioral risks, such as gut microbiota disruption and altered appetite regulation, raising concerns about their long-term safety. Both beverage types displace nutritionally balanced food options in children’s diets and foster enduring preferences for sweetness, exacerbating poor dietary quality. Public health interventions targeting SSB reduction have demonstrated modest success; however, rising ASB use complicates prevention strategies. Effective mitigation of childhood obesity requires comprehensive approaches that emphasize reducing all sweetened beverage consumption, promoting water and whole-food hydration, and addressing the behavioral and environmental factors underlying unhealthy beverage choices to improve lifelong health outcomes. Full article

Background: Artificially sweetened beverages (ASBs) are commonly recommended as a substitute for sugar-sweetened beverages (SSBs) in dietary counseling. Childhood obesity, associated with comorbidities like type 2 diabetes (T2D), has risen alongside increased consumption of both SSBs and ASBs. Metformin, a common treatment for pediatric T2D, affects GDF-15, a hormone involved in weight regulation. This pilot study examines the impact of ASBs on the therapeutic effects of metformin in pediatric patients with obesity and prediabetes, focusing on growth differentiation factor 15 (GDF-15) as a potential mediator. Methods: Forty-six children aged 10–21 years were randomized into two groups: one consuming non-sweetened beverages (USB) and the other consuming ASBs during a 12-week metformin intervention. Results: While the USB group showed a greater decrease in the point estimate for mean BMI (−0.55 ± 1.49 USB vs. −0.23 ± 1.60 ASB) and an increase in the point estimate for mean GDF-15 (33.40 ± 58.34 in USB vs. 19.77 ± 85.87 in ASB), these differences were not statistically significant (p = 0.6). As a hypothesis-generating exercise, change in insulin resistance was explored. While again lacking statistical power, we observed that more participants in the USB group showed improvements in insulin resistance. Conclusions: Additional studies are needed to fully elucidate the impact of non-nutritive sweeteners on metabolic health and treatment outcomes in pediatric obesity. Full article

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are fast becoming the most common chronic liver disease and are often preventable with healthy dietary habits and weight management. Sugar-sweetened beverage (SSB) consumption is associated with obesity and NAFLD. However, the impact of different types of SSBs, including artificially sweetened beverages (ASBs), is not clear after controlling for total sugar intake and total caloric intake. The aim of this study was to examine the association between the consumption of different SSBs and the risk of NAFLD and NASH in US adults. The representativeness of 3739 US adults aged ≥20 years old who had completed 24 h dietary recall interviews and measurements, including dietary, SSBs, smoking, physical activity, and liver stiffness measurements, were selected from the National Health and Nutrition Examination Survey 2017–2020 surveys. Chi-square tests, t-tests, and weighted logistic regression models were utilized for analyses. The prevalence of NASH was 20.5%, and that of NAFLD (defined without NASH) was 32.7% of US. adults. We observed a higher prevalence of NASH/NAFLD in men, Mexican-Americans, individuals with sugar intake from SSBs, light–moderate alcohol use, lower physical activity levels, higher energy intake, obesity, and medical comorbidities. Heavy sugar consumption through SSBs was significantly associated with NAFLD (aOR = 1.60, 95% CI = 1.05–2.45). In addition, the intake of ASBs only (compared to the non-SSB category) was significantly associated with NAFLD (aOR = 1.78, 95% CI = 1.04–3.05), after adjusting for demographic, risk behaviors, and body mass index. A higher sugar intake from SSBs and exclusive ASB intake are both associated with the risk of NAFLD. Full article

The impact of artificially sweetened beverages (ASBs), alternatives to sugar-sweetened beverages, on cancer incidence remains controversial. We conducted a meta-analysis of prospective studies to assess the association of daily ASB intake with cancer risk. A systematic search was performed between January 1967 and September 2022. Risk ratios (RR) or hazard ratios (HR) were extracted and pooled. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used for the assessment of the certainty of evidence. The study was registered at PROSPERO (CRD42022312171). Overall, 14 articles with 17 cohorts were included. There was no significant association between daily ASB consumption and risk of overall cancer (highest versus lowest category: n = 17, RR = 1.03, 95% CI: 0.96–1.11, p = 0.407). For site-specific cancer analysis, the risk of non-lymphoid leukemia was elevated with high ASB intake (n = 3, RR = 1.35, 95% CI: 1.03–1.77, p = 0.030), while risk of colorectal cancer was decreased (n = 3, RR = 0.78, 95% CI: 0.62–0.99, p = 0.037). Dose–response analysis indicated a positive linear association between ASB intake and the risk of leukemia (p_-linear = 0.027). The risk increased by 15% per one serving (355 mL) daily ASB intake increment (RR = 1.15, 95% CI: 1.02–1.30). In conclusion, ASB consumption might be positively associated with the risk of leukemia and negatively associated with the risk of colorectal cancer. Full article

Much remains unknown about the role of added sugar in relation to cardiovascular disease (CVD) and the relative contributions of sugar-sweetened beverages (SSB) or artificially sweetened beverages (ASB) to CVD risk. Among the 109,034 women who participated in Women’s Health Initiative, we assessed average intakes of added sugar, SSB and ASB, and conducted Cox regression to estimate the hazard ratios (HRs) and their 95% confidence intervals for CVD risk. The consistency of findings was compared to a network meta-analysis of all available cohorts. During an average of 17.4 years of follow-up, 11,597 cases of total CVD (nonfatal myocardial infarction, coronary heart disease (CHD) death, stroke, coronary revascularization, and/or incident heart failure) were confirmed. Added sugar as % energy intake daily (%EAS) at ≥15.0% was positively associated with total CVD (HR = 1.08 [1.01, 1.15]) and CHD (HR = 1.20 [1.09, 1.32]). There was also a higher risk of total CVD associated with ≥1 serving of SSB intake per day (HR = 1.29 [1.17, 1.42]), CHD (1.35 [1.16, 1.57]), and total stroke (1.30 [1.10, 1.53]). Similarly, ASB intake was associated with an increased risk of CVD (1.14 [1.03, 1.26]) and stroke (1.24 [1.04, 1.48]). According to the network meta-analysis, there was a large amount of heterogeneity across studies, showing no consistent pattern implicating added sugar, ASB, or SSB in CVD outcomes. A diet containing %EAS ≥15.0% and consuming ≥1 serving of SSB or ASB may be associated with a higher CVD incidence. The relative contribution of added sugar, SSB, and ASB to CVD risk warrants further investigation. Full article

This study examined consumption proportions and factors associated with sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and 100% fruit juice (FJ) consumption. We recruited Non-Hispanic Black (n = 136) and White (n = 192) low-income overweight or obese pregnant women aged 18 to 46 years (mean = 25.7 years) from the Special Supplemental Nutrition Program for Women, Infants, and Children clinics in Michigan, USA. Independent variables included weight status, trimester, smoking, stress, education, employment, race, and age. Dependent variables were high (consuming ≥ 1 serving/day) versus low consumptions of SSB, ASB, and 100% FJ. Multivariate logistic regression modeling was performed to examine factors associated with beverage consumption. Out of the sample, 48.2%, 6.7%, and 31.3% reported high SSB, ASB, and 100% FJ consumption, respectively. SSB consumption was associated with smoking (OR: 3.77, p < 0.001), education (OR: 0.57, p = 0.03), and race (OR: 1.69, p = 0.03). Artificially sweetened beverage consumption was not associated with any factors examined. One hundred percent FJ consumption was associated with stress (OR: 0.90, p = 0.03) and race (OR: 4.48, p < 0.001). Clinicians may advocate for reductions in SSB and 100% FJ consumption tailored to client consumption characteristics. Full article

Although studies have examined the association between habitual consumption of sugar- (SSBs) and artificially sweetened beverages (ASBs) and health outcomes, the results are inconclusive. Here, we conducted a dose-response meta-analysis of prospective cohort studies in order to summarize the relationship between SSBs and ASBs consumption and risk of type 2 diabetes (T2D), cardiovascular diseases (CVDs), and all-cause mortality. All relevant articles were systematically searched in PubMed, Embase, and Ovid databases until 20 June 2020. Thirty-four studies met the inclusion criteria and were eligible for analysis. Summary relative risks (RRs) and 95% confidence intervals (95% CI) were estimated using random effects or fixed-effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships. With each additional SSB and ASB serving per day, the risk increased by 27% (RR: 1.27, 95%CI: 1.15–1.41, I² = 80.8%) and 13% (95%CI: 1.03–1.25, I² = 78.7%) for T2D, 9% (RR: 1.09, 95%CI: 1.07–1.12, I² = 42.7%) and 8% (RR: 1.08, 95%CI: 1.04–1.11, I² = 45.5%) for CVDs, and 10% (RR: 1.10, 95%CI: 0.97–1.26, I² = 86.3%) and 7% (RR: 1.07, 95%CI: 0.91–1.25, I² = 76.9%) for all-cause mortality. Linear relationships were found for SSBs with T2D and CVDs. Non-linear relationships were found for ASBs with T2D, CVDs, and all-cause mortality and for SSBs with all-cause mortality. The findings from the current meta-analysis indicate that increased consumption of SSBs and ASBs is associated with the risk of T2D, CVDs, and all-cause mortality. Full article

The consumption of sweet beverages, including sugar-sweetened beverages (SSB), artificial-sweetened beverages (ASB) and fruit juices (FJ), is associated with the risk of different cardiometabolic diseases. It may also be linked to the development of certain types of tumors. We carried out a systematic review and meta-analysis of observational studies aimed at examining the association between sweet beverage intake and cancer risk. Suitable articles published up to June 2020 were sourced through PubMed, Web of Science and SCOPUS databases. Overall, 64 studies were identified, of which 27 were selected for the meta-analysis. This was performed by analyzing the multivariable-adjusted OR, RR or HR of the highest sweet beverage intake categories compared to the lowest one. Random effects showed significant positive association between SSB intake and breast (RR: 1.14, 95% CI: 1.01–1.30) and prostate cancer risk (RR: 1.18, 95% CI: 1.10–1.27) and also between FJs and prostate cancer risk (RR: 1.03, 95% CI: 1.01–1.05). Although the statistically significant threshold was not reached, there tended to be positive associations for the following: SSBs and colorectal and pancreatic cancer risk; FJs and breast, colorectal and pancreatic cancer risk; and ASBs and pancreatic cancer risk. This study recommends limiting sweet beverage consumption. Furthermore, we propose to establish a homogeneous classification of beverages and investigate them separately, to better understand their role in carcinogenesis. Full article

There is an association between the consumption of artificial sweeteners and Type 2 diabetes in cohort studies, but intervention studies do not show a clear elevation of blood glucose after the use of artificial sweeteners. The objective of this study was to examine whether two commonly used artificial sweeteners had an adverse effect on glucose control in normal-weight subjects, and in overweight and obese subjects when consumed for 2 weeks. In the study, 39 healthy subjects (body-mass index, kg/m²) (18–45) without Type 2 diabetes with an age of 18–75 years were randomly assigned to 0.6 L/day of an artificially sweetened soft drink containing acesulfame K (950) and aspartame (951) or 0.6 L/day of mineral water for 2 weeks each in a crossover study. There was a 4 week washout period with no drinks consumed. Glucose levels were read by a continuous glucose monitor (CGM) during each 2 week period. A 75 g oral glucose-tolerance test (OGTT) was performed at the beginning and end of each intervention period. Blood samples were collected at baseline, and 1 and 2 h for glucose and insulin. A 2 week intake of artificially sweetened beverage (ASB) did not alter concentrations of fasting glucose and fasting insulin, the area under the curve (AUC) for OGTT glucose and insulin, the incremental area under the curve (iAUC) for OGTT glucose and insulin, the homeostatic model assessment for insulin resistance (HOMA-IR), and the Matsuda index compared with the baseline and with the changes after a 2 week intake of mineral water. Continuous 2 week glucose concentrations were not significantly different after a 2 week intake of ASB compared with a 2 week intake of mineral water. This study found no harmful effect of the artificially sweetened soft drink containing acesulfame K (950) and aspartame (951) on glucose control when consumed for 2 weeks by people without Type 2 diabetes. Full article

The need to reduce sugar-sweetened beverage (SSB) consumption is widely accepted, but whether artificially sweetened beverages (ASBs) are a recommended alternative is a growing policy issue because of emerging evidence of potential health effects associated with excess consumption. This study aimed to establish the extent of the Australian population’s knowledge of the risks associated with consuming SSBs (e.g., soda) and ASBs (e.g., diet soda), which is essential for identifying which facets of knowledge to target with public health interventions. A national computer-assisted telephone survey of 3430 Australian adults was conducted in 2017. The survey included a range of measures to test associations between SSB and ASB knowledge and beliefs, demographic characteristics, and soda and diet soda consumption. Participants had an overall awareness that there were health risks associated with SSB and ASB consumption, but they lacked more detailed knowledge of health effects and nutritional composition of these drinks. These knowledge gaps are concerning given that SSBs and ASBs are consumed in large quantities in Australia. Public health interventions targeting consumers’ limited knowledge and perceptions of health risks associated with excess sugar, calorie intake and artificial sweeteners are essential in reducing the health burden of obesity. Full article

Objective: Addition of fructose to the diet of normal weight and overweight subjects can increase postprandial plasma triglyceride and uric acid concentration. We, therefore, assessed whether replacing sugar-sweetened beverages (SSB) with artificially-sweetened beverages (ASB) in the diet of overweight and obese subjects would decrease these parameters. Methods: Twenty-six participants of the REDUCS study, which assessed the effects of replacing SSB by ASB over 12 weeks on intra-hepatocellular lipid concentration, were included in this sub-analysis. All were studied after a four-week run-in period during which they consumed their usual diet and SSBs, and after a 12-week intervention in which they were randomly assigned to replace their SSBs with ASBs (ASB arm) or to continue their usual diet and SSBs (control arm, CTRL). At the end of run-in (week 4) and again at the end of intervention (week 16), they took part in an 8.5 h metabolic investigation during which their plasma glucose, insulin, glucagon, lactate, triglyceride (TG), non-esterified fatty acids (NEFA), and uric acid concentrations were measured over a 30 min fasting period (−30–0 min), then every 2 h over 480 min. with ingestion of standard breakfast at time 0 min and a standard lunch at time 240 min. Breakfast and lunch were consumed together with a 3.3 dL SSB at week 4 and with either an ASB (ASB arm) or a SSB (CTRL arm) at week 16. After analyzing the whole group, a secondary analysis was performed on 14 subjects with hepatic steatosis (seven randomized to ASB, seven to CTRL) and 12 subjects without hepatic steatosis (six randomized to ASB and six to CTRL). Results: Ingestion of meals increased plasma glucose, insulin, glucagon, lactate, and TG concentrations and decreased NEFA concentrations, but with no significant difference of integrated postprandial responses between week 4 and week 16 in both ASB and CTRL, except for a slightly decreased glucagon response in ASB. There was, however, no significant postprandial increase in uric acid concentration in both arms. In the secondary analysis, replacing SSBs with ASBs did not significantly change postprandial TG and uric acid concentrations irrespective of the presence or not of hepatic steatosis, Conclusions: In overweight, high SSB consumers, replacing SSBs with ASBs during 12 weeks did not significantly alter post-prandial TG and uric acid concentration, in spite of the lower energy and fructose content of the meals. These effects were globally the same in subjects without and with hepatic steatosis. Full article

The pediatric obesity epidemic has gathered public and political interest recently. People often choose “diet” or artificial sweetened beverages (ASB) to combat this epidemic, but the obesity incidence continues to rise. First, I review the pediatric studies on the effect of ASB consumption with subsequent food intake. Next, I present pediatric studies of chronic ASB consumption and weight change. Some epidemiologic pediatric studies have supported an association between artificial sweetener use and increased BMI but cannot prove causation. Randomized control trials have provided some evidence of weight loss with ASB ingestion among children, but study limitations may minimize these conclusions. Finally, I summarize the possible mechanisms that may drive potential effects of artificial sweeteners. Full article