Fueling the Obesity Epidemic? Artificially Sweetened Beverage Use and Long‐term Weight Gain

Abstract

articles epidemiologyWe summed AS soda, coffee, and tea intakes to estimate AS beverage (ASB) consumption, and-among consumers-identified ASB consumption quartiles. Participants using AS sweeteners and/or cereals-but not ASBs-were included in ASB consumption quartile 1. Participants reporting no AS use were categorized "nonusers. "Dieting status and exercise frequency (2) were recorded at baseline and follow-up. In cohort 1 only, baseline 24-h dietary recalls were performed (2). In cohort 2 only, follow-up AS use (present or absent) was ascertained.Physical measurements and demographic data Standard anthropometric measurements were performed (2). A BMI <25 kg/m 2 was categorized normal weight (NW); ≥ 25 and <30 kg/m 2 , overweight (OW); and ≥ 30 kg/m 2 , obese (OB). The latter categories were combined as OW/OB (BMI ≥ 25 kg/m 2 ). Baseline education and occupation were recorded, and occupation-based Duncan socioeconomic index scores (range: 0-96) assigned. Of 3,682 follow-up participants, 3371 (91.6%) had complete data for all variables reported. statistical analysesIncidence of OW/OB (OW/OB inc ) was defined as the percent of baseline NW participants who had become OW/OB by follow-up. Incidence of obesity (OB inc ) was defined as the percent of baseline NWor-OW participants (BMI < 30 kg/m 2 ) who had become OB by follow-up. Change in BMI (ΔBMI) was calculated as BMI at follow-up minus BMI at baseline. Change in exercise frequency (Δexercise) was calculated as the number of exercise sessions per week at follow-up minus the number of sessions per week at baseline. Participants with Δexercise ≥1/week were categorized as "exercising more"; those ≤−1/ week, as "exercising less"; and all others, as "exercising same. " Excess BMI gains in AS users ("users") were calculated as ΔBMI among users minus ΔBMI among nonusers, divided by ΔBMI among nonusers.Means of continuous variables and percentages of categorical variables are presented by baseline AS consumption status. We used logistic regression to adjust odds ratios (ORs) for baseline BMI, as well as gender and ethnicity; baseline age, education, socioeconomic index, exercise frequency, and smoking status; interim change in exercise level; and interim smoking cessation ("demographic/behavioral covariates"), with ordinal categories of AS doses/day as a predictor variable. Analysis of covariance was used to assess associations between ASB consumption category and ΔBMI. In logistic regression and analysis of covariance models, linear trend was assessed by models using the ordinal category of ASB doses/ day as a continuous measure. All statistical calculations were performed using SAS version 9.1 (SAS Institute, Cary, NC).Analyses of ΔBMI-with adjustment for baseline BMI and demographic/behavioral covariates-were performed for the entire sample. Within cohort 2, they were repeated separately by baseline AS use status (present or absent), with additional adjustment for follow-up AS status. Within cohort 2, these analyses were also repeated among participants whose AS use st...

Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct

“…Explanation (2) could be supported by previous observational studies suggesting an association between non-caloric sweeteners and consumption of artificially sweetened beverages and weight gain [25,26], although recent randomised trials conducted in children and adolescents do not support this hypothesis [27,28].…”

Diet Drink Consumption and the Risk of Cardiovascular Events: A Report from the Women’s Health Initiative

“…Adjusted cardiac event models were stratified on hypertension, and high cholesterol and adjusted mortality models were stratified on hypertension and the history of diabetes because these variables did not meet the proportional hazards assumption ∥ The majority of loss of patients in model 4 was secondary to missing data for salt intake and calibrated energy HR hazard ratio, CI confidence interval *Model IV: Adjusted for age, race, education, income, smoking status, BMI, diabetes, hypertension, hyperlipidemia, alcohol intake, log calibrated energy intake, physical activity, sugar-sweetened beverage intake, salt intake, and hormone therapy † Model IV; Included women without a history of diabetes, hypertension, and high cholesterol ‡ Adjusted for Model IV excluding salt intake and calibrated energy intake § Adjusted for Model IV including Healthy Eating Index-2005 scores and excluding salt intake and calibrated energy intake increase in BMI with increasing intake of artificially sweetened beverages, with an apparent dose response relationship between the amount of artificially sweetened beverages consumed and weight gain. 7 As both metabolic syndrome and obesity are important risk factors for CVD, this may contribute in part to the higher incidence of CVD events in this population.…”

“…6 Several population-based studies have demonstrated a positive association between diet drinks and the metabolic syndrome, which in turn is associated with increased risk for CVD. 2,[7][8][9] However, data are limited as to whether there is an increased CVD risk associated with diet drink consumption. Given the large population directly affected by such an association, this study was performed to evaluate the effect of diet drink consumption on CVD outcomes in the Women's Health Initiative Observational Study (WHI OS) cohort.…”

Satiety scores and satiety hormone response after sucrose-sweetened soft drink compared with isocaloric semi-skimmed milk and with non-caloric soft drink: a controlled trial

“…Therefore, the effect of ASSD on appetite and energy intake has been discussed intensively (Rolls, 1991;Rogers and Blundell, 1993). Even though some results showed body weight reducing effects of ASSD compared with SSSD (Raben et al, 2002), increased consumption of ASSD has not had the expected moderating impact on the obesity epidemic (Fowler et al, 2008). Previous studies have suggested that ASSD may lead to increased hunger sensation due to the sweet taste unaccompanied by calories (Mattes and Popkin, 2009).…”