title: 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: OBJECTIVE
  To examine the relationship between diet soda (DS) intake (DSI) and long-term waist circumference (WC) change (ΔWC) in the biethnic San Antonio Longitudinal Study of Aging (SALSA).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  San Antonio, Texas, neighborhoods.
  
  
  METHODS
  SALSA examined 749 Mexican-American and European-American individuals aged 65 and older at baseline (baseline, 1992-96); 474 (79.1%) survivors completed follow-up 1 (FU1, 2000-01), 413 (73.4%) completed FU2 (2001-03), and 375 (71.0%) completed FU3 (2003-04). Participants completed a mean of 2.64 follow-up intervals, for 9.4 total follow-up years.
  
  
  METHODS
  DSI, WC, height, and weight were measured at outset and at the conclusion of each interval: baseline, FU1, FU2, and FU3.
  
  
  RESULTS
  Adjusted for initial WC, demographic characteristics, physical activity, diabetes mellitus, and smoking, mean interval ΔWC of DS users (2.11 cm, 95% confidence interval (CI) = 1.45-2.76 cm) was almost triple that of nonusers (0.77 cm, 95% CI = 0.29-1.23 cm) (P < .001). Adjusted interval ΔWCs were 0.77 cm (95% CI = 0.29-1.23 cm) for nonusers, 1.76 cm (95% CI = 0.96-2.57 cm) for occasional users, and 3.04 cm (95% CI = 1.82-4.26 cm) for daily users (P = .002 for trend). This translates to ΔWCs of 0.80 inches for nonusers, 1.83 inches for occasional users, and 3.16 for daily users over the total SALSA follow-up. In subanalyses stratified for selected covariates, ΔWC point estimates were consistently higher in DS users.
  
  
  CONCLUSIONS
  In a striking dose-response relationship, increasing DSI was associated with escalating abdominal obesity, a potential pathway for cardiometabolic risk in this aging population.
authors.affiliation: Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Sharon P G
authors.initials: SP
authors.lastname: Fowler
authors.forename: Ken
authors.initials: K
authors.lastname: Williams
authors.forename: Helen P
authors.initials: HP
authors.lastname: Hazuda
mesh_terms: D000368:Aged; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D002253:Carbonated Beverages; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017058:Mexican Americans; D056128:Obesity, Abdominal / Q000209:etiology; D011446:Prospective Studies; D013781:Texas; D055105:Waist Circumference
keywords: abdominal obesity; artificial sweeteners; diet soda; nonnutritive sweeteners; waist circumference