title: Artificially Sweetened Beverage Consumption Is Positively Associated with Newly Diagnosed Diabetes in Normal-Weight but Not in Overweight or Obese Brazilian Adults.
abstract: BACKGROUND
  Recent animal studies suggest that artificially sweetened beverage (ASB) consumption increases diabetes risk.
  
  
  OBJECTIVE
  We examined the relation of ASB intake with newly diagnosed diabetes and measures of glucose homeostasis in a large Brazilian cohort of adults.
  
  
  METHODS
  We used cross-sectional data from 12,884 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ASB use was assessed by questionnaire and newly diagnosed diabetes by a 2-h 75-g oral glucose tolerance test and/or glycated hemoglobin. Logistic and linear regression analyses were performed to examine the association of ASB consumption with diabetes and continuous measures of glucose homeostasis, respectively.
  
  
  RESULTS
  Although ASB consumption was not associated with diabetes in logistic regression analyses after adjustment for body mass index (BMI; in kg/m(2)) overall, the association varied across BMI categories (P-interaction = 0.04). Among those with a BMI <25, we found a 15% increase in the adjusted odds of diabetes for each increase in the frequency of ASB consumption per day (P = 0.001); compared with nonusers, ASB users presented monotonic increases in the adjusted ORs (95% CIs) of diabetes with increased frequency of consumption: 1.03 (0.60, 1.77), 1.43 (0.93, 2.20), 1.62 (1.08, 2.44), and 2.51 (1.40, 4.50) for infrequent, 1-2, 3-4, and >4 times/d, respectively. In linear regression analyses, among normal-weight individuals, greater ASB consumption was also associated with increased fasting glucose concentrations (P = 0.01) and poorer β-cell function (P = 0.009). No such associations were seen for those with BMI ≥25. In fact, in overweight or obese participants, greater ASB consumption was significantly associated with improved indexes of insulin resistance and 2-h postload glucose.
  
  
  CONCLUSIONS
  Normal-weight, but not excess-weight, individuals with greater ASB consumption presented diabetes more frequently and had higher fasting glucose and poorer β-cell function.
authors.affiliation: Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil;
authors.forename: James
authors.initials: J
authors.lastname: Yarmolinsky
authors.affiliation: Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Epidemiology, and bbduncan@ufrgs.br.
authors.forename: Bruce B
authors.identifier: http://orcid.org/0000-0002-7491-2630
authors.initials: BB
authors.lastname: Duncan
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill, NC;
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Chambless
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil; and.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Bensenor
authors.affiliation: Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Sandhi M
authors.initials: SM
authors.lastname: Barreto
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil; and.
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Goulart
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil; and.
authors.forename: Itamar S
authors.initials: IS
authors.lastname: Santos
authors.affiliation: Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Maria de Fátima Sander
authors.initials: Mde F
authors.lastname: Diniz
authors.affiliation: Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Epidemiology, and.
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D001628:Beverages / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D001938:Brazil; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000209:etiology*; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications*; D050177:Overweight; D012016:Reference Values; D013549:Sweetening Agents / Q000009:adverse effects*; D015430:Weight Gain
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D013549:Sweetening Agents
keywords: BMI; artificially sweetened beverage consumption; glucose intolerance; type 2 diabetes; β-cell function