Artificially Sweetened Beverage Consumption Is Positively Associated with Newly Diagnosed Diabetes in Normal-Weight but Not in Overweight or Obese Brazilian Adults

J Nutr. 2016 Feb;146(2):290-7. doi: 10.3945/jn.115.220194. Epub 2015 Dec 9.


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.

Keywords: BMI; artificially sweetened beverage consumption; glucose intolerance; type 2 diabetes; β-cell function.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Beverages / adverse effects*
  • Blood Glucose / metabolism*
  • Body Mass Index*
  • Brazil
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / etiology*
  • Diet
  • Feeding Behavior*
  • Female
  • Glucose Tolerance Test
  • Glycated Hemoglobin / metabolism
  • Humans
  • Insulin Resistance
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Obesity / blood
  • Obesity / complications*
  • Overweight
  • Reference Values
  • Sweetening Agents / adverse effects*
  • Weight Gain


  • Blood Glucose
  • Glycated Hemoglobin A
  • Sweetening Agents