Diet Soda Intake Is Associated with Long‐Term Increases in Waist Circumference in a Biethnic Cohort of Older Adults: The San Antonio Longitudinal Study of Aging

Abstract

BACKGROUND/OBJECTIVES Diet soda (DS) intake (DSI) has been associated with increased cardiometabolic risk, but its specific impact in older adults has not been addressed. Because central obesity increases cardiovascular risk, we examined the relationship between DSI and long-term waist circumference (WC) change (ΔWC) in the bi-ethnic San Antonio Longitudinal Study of Aging (SALSA). DESIGN Prospective cohort study. SETTING San Antonio, Texas, neighborhoods PARTICIPANTS SALSA examined 749 Mexican-American and European-American individuals ≥ 65 years old at baseline (BL: 1992-1996); 79.1% of survivors completed follow-up 1 (FU1) (2000-2001, n=474); 73.4%, FU2 (2001-2003, n=413); and 71.0%, FU3 (2003-2004, n=375). Participants completed a mean of 2.64 follow-up intervals, for 9.41 total follow-up years. MEASUREMENTS DSI, WC, height and weight were measured at outset and conclusion of each interval: BL-FU1, FU1-FU2, and FU2-FU3. RESULTS Adjusted for initial WC, demographics, physical activity, diabetes, and smoking, mean interval ΔWC (95% confidence interval) for all DS users was almost triple that among non-users: 2.11 (1.45-2.76) vs. 0.77 (0.29-1.23) cm, respectively (p < 0.001). For non-, occasional, and daily DS users, adjusted interval ΔWCs were 0.77 (0.29-1.23), 1.76 (0.96-2.57), and 3.04 (1.82-4.26) cm, respectively (p=0.002 for trend). This translates to ΔWCs of 0.80, 1.83, and 3.16 inches, respectively, for these groups, over the total SALSA follow-up. In sub-analyses stratified separately by key covariates, ΔWC point estimates were consistently higher among DS users. CONCLUSION In a striking dose-response relationship, increasing diet soda intake was associated with escalating abdominal obesity, a potential pathway for heightened cardiometabolic risk in this aging population.

Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies

“…From 11 774 citations, we assessed 938 full-text articles for eli gibility, and 37 studies involving a total of 406 910 individuals met our inclusion criteria: 7 RCTs 19,20,34-38 and 30 cohort studies [14][15][16][17][18][21][22][23][24] ( Figure 1). 36,37 or consumption of aspartame at the discretion of the participant.…”

“…13 Several studies involving more than 100 000 new participants and representing several new geographic settings have since been published. [14][15][16][17][18][19][20][21][22][23][24] Our objective was to synthesize evidence addressing this question: Is routine consumption of nonnutritive sweeteners by adults and adolescents associated with adverse long-term cardiometabolic effects in RCTs and prospective cohort studies?…”

“…Previous reviews 12,65 concluded that, although data from RCTs support weight-loss effects from sustained nonnutritive sweetener interventions, observational studies provide inconsistent results. Building on these findings, we included new studies [14][15][16][17][18][19][20][21][22][23][24] and found that consumption of nonnutritive sweeteners was not generally associated with weight loss among participants in RCTs, except in long-term (≥ 12 mo) trials with industry sponsorship. In addition, we found that consumption of nonnutritive sweeteners was associated with modest long-term weight gain in observational studies.…”

“…One 6-month trial reported no effect on percentage of body fat. 35 In contrast to RCTs, cohort studies with 4 to 9 years of followup showed that higher intake of nonnutritive sweeteners was associated with increasing waist circumference (MD 2.27 cm, 95% CI 0.96 to 3.58; 1 cohort; 384 participants) 18 (Table 3), higher incidence of abdominal obesity (OR 1.59, 95% CI 1.23 to 2.07; 1 cohort; 5011 participants) 60 (Table 3) and higher incidence of overweight (OR 1.84, 95% CI 1.28 to 2.66 for highest v. lowest intake quantiles; I 2 0%; 3 cohorts; 7917 participants) 22,50,59 ( Table 3 and Appendix 1, Figure S1B). …”

Diet soft drink is associated with increased odds of proliferative diabetic retinopathy

“…However, several studies including a recent systematic review and meta-analysis, 10 have linked diet soft drinks with poor cardiovascular outcomes. 3,[11][12][13][14][15][16] The population-based Multi-Ethnic Study of Atherosclerosis (MESA), for example, found that a daily consumption of diet soda was associated with 36% and 67% greater relative risks of incident metabolic syndrome and type 2 diabetes mellitus, respectively, compared with non-consumption. 12 Although plausible biological mechanisms explaining these associations are limited, it is possible that artificial sweeteners in diet soft drink increase the need for sweet, energy-dense foods or beverages 17 and disrupt an individual's ability to accurately estimate energy intake and energy needs, 18 both of which may lead to increased consumption of calories.…”