A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk

Stefanie N. Hinkle*, Shristi Rawal, Anne Ahrendt Bjerregaard, Thor I. Halldorsson, Mengying Li, Sylvia H. Ley, Jing Wu, Yeyi Zhu, Liwei Chen, Aiyi Liu, Louise Groth Grunnet, Mohammad L. Rahman, Freja Bach Kampmann, James L. Mills, Sjurdur F. Olsen, Cuilin Zhang

*Corresponding author for this work

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Abstract

Background: Artificially sweetened beverages (ASBs) are commonly consumed and recommended for individuals at high risk for cardiometabolic diseases; however, the health effects of ASBs remain contradictory. Given that cross-sectional analyses are subject to reverse causation, prospective studies with long-term follow-up are needed to evaluate associations between ASBs and cardiometabolic health, especially among high-risk individuals. Objective: The aim of this studywas to examine associations of ASB intake and cardiometabolic health among high-riskwomenwith prior gestational diabetes mellitus (GDM). Methods: We included 607 women with GDM from the Danish National Birth Cohort (DNBC; 1996-2002) who completed a clinical exam 9-16 y after the DNBC pregnancy for the Diabetes & Women's Health (DWH) Study (2012-2014). We assessed ASB intake using FFQs completed during the DNBC pregnancy and at the DWH Study clinical exam. We examined cardiometabolic outcomes at the DWH clinical exam. We estimated percentage differences in continuous cardiometabolic markers and RRs for clinical endpoints in association with ASB intake both during pregnancy and at follow-up adjusted for prepregnancy BMI, diet, and lifestyle factors. Sensitivity analyses to account for reverse causation were performed. Results: In pregnancy and at follow-up, 30.4% and 36.4% of women regularly (≥2 servings/wk) consumed ASB, respectively. Consumption of ASBs, both during pregnancy and at follow-up, was associated with higher glycated hemoglobin (HbA1c), insulin, HOMA-IR, triglycerides, liver fat, and adiposity and with lower HDL at follow-up. After adjustment for covariates, particularly prepregnancy BMI, the majority of associations between ASB intake in pregnancy and outcomes at follow-up became null with the exception of HbA1c. ASB intake at follow-up (≥1 serving/d compared with <1 serving/mo) was associated with higher HbA1c (6.5%; 95% CI: 1.9, 11.3; P-trend = 0.007); however, associations were not upheld in sensitivity analyses for reverse causation. Conclusions: Among Danish women with a history of GDM, ASB intake was not significantly associated with cardiometabolic profiles.

Original languageEnglish
Article numbernzq094
JournalThe American Journal of Clinical Nutrition
Volume110
Issue number1
Pages (from-to)221-232
ISSN0002-9165
DOIs
Publication statusPublished - 2019

Keywords

  • Artificially sweetened beverages
  • Cardiometabolic health
  • Diabetes
  • Diet
  • Gestational diabetes
  • Nonnutritive sweeteners
  • Obesity
  • Soda

Cite this

Hinkle, S. N., Rawal, S., Bjerregaard, A. A., Halldorsson, T. I., Li, M., Ley, S. H., ... Zhang, C. (2019). A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk. The American Journal of Clinical Nutrition, 110(1), 221-232. [nzq094]. https://doi.org/10.1093/ajcn/nqz094
Hinkle, Stefanie N. ; Rawal, Shristi ; Bjerregaard, Anne Ahrendt ; Halldorsson, Thor I. ; Li, Mengying ; Ley, Sylvia H. ; Wu, Jing ; Zhu, Yeyi ; Chen, Liwei ; Liu, Aiyi ; Grunnet, Louise Groth ; Rahman, Mohammad L. ; Kampmann, Freja Bach ; Mills, James L. ; Olsen, Sjurdur F. ; Zhang, Cuilin. / A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk. In: The American Journal of Clinical Nutrition. 2019 ; Vol. 110, No. 1. pp. 221-232.
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title = "A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk",
abstract = "Background: Artificially sweetened beverages (ASBs) are commonly consumed and recommended for individuals at high risk for cardiometabolic diseases; however, the health effects of ASBs remain contradictory. Given that cross-sectional analyses are subject to reverse causation, prospective studies with long-term follow-up are needed to evaluate associations between ASBs and cardiometabolic health, especially among high-risk individuals. Objective: The aim of this studywas to examine associations of ASB intake and cardiometabolic health among high-riskwomenwith prior gestational diabetes mellitus (GDM). Methods: We included 607 women with GDM from the Danish National Birth Cohort (DNBC; 1996-2002) who completed a clinical exam 9-16 y after the DNBC pregnancy for the Diabetes & Women's Health (DWH) Study (2012-2014). We assessed ASB intake using FFQs completed during the DNBC pregnancy and at the DWH Study clinical exam. We examined cardiometabolic outcomes at the DWH clinical exam. We estimated percentage differences in continuous cardiometabolic markers and RRs for clinical endpoints in association with ASB intake both during pregnancy and at follow-up adjusted for prepregnancy BMI, diet, and lifestyle factors. Sensitivity analyses to account for reverse causation were performed. Results: In pregnancy and at follow-up, 30.4{\%} and 36.4{\%} of women regularly (≥2 servings/wk) consumed ASB, respectively. Consumption of ASBs, both during pregnancy and at follow-up, was associated with higher glycated hemoglobin (HbA1c), insulin, HOMA-IR, triglycerides, liver fat, and adiposity and with lower HDL at follow-up. After adjustment for covariates, particularly prepregnancy BMI, the majority of associations between ASB intake in pregnancy and outcomes at follow-up became null with the exception of HbA1c. ASB intake at follow-up (≥1 serving/d compared with <1 serving/mo) was associated with higher HbA1c (6.5{\%}; 95{\%} CI: 1.9, 11.3; P-trend = 0.007); however, associations were not upheld in sensitivity analyses for reverse causation. Conclusions: Among Danish women with a history of GDM, ASB intake was not significantly associated with cardiometabolic profiles.",
keywords = "Artificially sweetened beverages, Cardiometabolic health, Diabetes, Diet, Gestational diabetes, Nonnutritive sweeteners, Obesity, Soda",
author = "Hinkle, {Stefanie N.} and Shristi Rawal and Bjerregaard, {Anne Ahrendt} and Halldorsson, {Thor I.} and Mengying Li and Ley, {Sylvia H.} and Jing Wu and Yeyi Zhu and Liwei Chen and Aiyi Liu and Grunnet, {Louise Groth} and Rahman, {Mohammad L.} and Kampmann, {Freja Bach} and Mills, {James L.} and Olsen, {Sjurdur F.} and Cuilin Zhang",
year = "2019",
doi = "10.1093/ajcn/nqz094",
language = "English",
volume = "110",
pages = "221--232",
journal = "American Journal of Clinical Nutrition",
issn = "0002-9165",
publisher = "American Society for Nutrition",
number = "1",

}

Hinkle, SN, Rawal, S, Bjerregaard, AA, Halldorsson, TI, Li, M, Ley, SH, Wu, J, Zhu, Y, Chen, L, Liu, A, Grunnet, LG, Rahman, ML, Kampmann, FB, Mills, JL, Olsen, SF & Zhang, C 2019, 'A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk', The American Journal of Clinical Nutrition, vol. 110, no. 1, nzq094, pp. 221-232. https://doi.org/10.1093/ajcn/nqz094

A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk. / Hinkle, Stefanie N.; Rawal, Shristi; Bjerregaard, Anne Ahrendt; Halldorsson, Thor I.; Li, Mengying; Ley, Sylvia H.; Wu, Jing; Zhu, Yeyi; Chen, Liwei; Liu, Aiyi; Grunnet, Louise Groth; Rahman, Mohammad L.; Kampmann, Freja Bach; Mills, James L.; Olsen, Sjurdur F.; Zhang, Cuilin.

In: The American Journal of Clinical Nutrition, Vol. 110, No. 1, nzq094, 2019, p. 221-232.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk

AU - Hinkle, Stefanie N.

AU - Rawal, Shristi

AU - Bjerregaard, Anne Ahrendt

AU - Halldorsson, Thor I.

AU - Li, Mengying

AU - Ley, Sylvia H.

AU - Wu, Jing

AU - Zhu, Yeyi

AU - Chen, Liwei

AU - Liu, Aiyi

AU - Grunnet, Louise Groth

AU - Rahman, Mohammad L.

AU - Kampmann, Freja Bach

AU - Mills, James L.

AU - Olsen, Sjurdur F.

AU - Zhang, Cuilin

PY - 2019

Y1 - 2019

N2 - Background: Artificially sweetened beverages (ASBs) are commonly consumed and recommended for individuals at high risk for cardiometabolic diseases; however, the health effects of ASBs remain contradictory. Given that cross-sectional analyses are subject to reverse causation, prospective studies with long-term follow-up are needed to evaluate associations between ASBs and cardiometabolic health, especially among high-risk individuals. Objective: The aim of this studywas to examine associations of ASB intake and cardiometabolic health among high-riskwomenwith prior gestational diabetes mellitus (GDM). Methods: We included 607 women with GDM from the Danish National Birth Cohort (DNBC; 1996-2002) who completed a clinical exam 9-16 y after the DNBC pregnancy for the Diabetes & Women's Health (DWH) Study (2012-2014). We assessed ASB intake using FFQs completed during the DNBC pregnancy and at the DWH Study clinical exam. We examined cardiometabolic outcomes at the DWH clinical exam. We estimated percentage differences in continuous cardiometabolic markers and RRs for clinical endpoints in association with ASB intake both during pregnancy and at follow-up adjusted for prepregnancy BMI, diet, and lifestyle factors. Sensitivity analyses to account for reverse causation were performed. Results: In pregnancy and at follow-up, 30.4% and 36.4% of women regularly (≥2 servings/wk) consumed ASB, respectively. Consumption of ASBs, both during pregnancy and at follow-up, was associated with higher glycated hemoglobin (HbA1c), insulin, HOMA-IR, triglycerides, liver fat, and adiposity and with lower HDL at follow-up. After adjustment for covariates, particularly prepregnancy BMI, the majority of associations between ASB intake in pregnancy and outcomes at follow-up became null with the exception of HbA1c. ASB intake at follow-up (≥1 serving/d compared with <1 serving/mo) was associated with higher HbA1c (6.5%; 95% CI: 1.9, 11.3; P-trend = 0.007); however, associations were not upheld in sensitivity analyses for reverse causation. Conclusions: Among Danish women with a history of GDM, ASB intake was not significantly associated with cardiometabolic profiles.

AB - Background: Artificially sweetened beverages (ASBs) are commonly consumed and recommended for individuals at high risk for cardiometabolic diseases; however, the health effects of ASBs remain contradictory. Given that cross-sectional analyses are subject to reverse causation, prospective studies with long-term follow-up are needed to evaluate associations between ASBs and cardiometabolic health, especially among high-risk individuals. Objective: The aim of this studywas to examine associations of ASB intake and cardiometabolic health among high-riskwomenwith prior gestational diabetes mellitus (GDM). Methods: We included 607 women with GDM from the Danish National Birth Cohort (DNBC; 1996-2002) who completed a clinical exam 9-16 y after the DNBC pregnancy for the Diabetes & Women's Health (DWH) Study (2012-2014). We assessed ASB intake using FFQs completed during the DNBC pregnancy and at the DWH Study clinical exam. We examined cardiometabolic outcomes at the DWH clinical exam. We estimated percentage differences in continuous cardiometabolic markers and RRs for clinical endpoints in association with ASB intake both during pregnancy and at follow-up adjusted for prepregnancy BMI, diet, and lifestyle factors. Sensitivity analyses to account for reverse causation were performed. Results: In pregnancy and at follow-up, 30.4% and 36.4% of women regularly (≥2 servings/wk) consumed ASB, respectively. Consumption of ASBs, both during pregnancy and at follow-up, was associated with higher glycated hemoglobin (HbA1c), insulin, HOMA-IR, triglycerides, liver fat, and adiposity and with lower HDL at follow-up. After adjustment for covariates, particularly prepregnancy BMI, the majority of associations between ASB intake in pregnancy and outcomes at follow-up became null with the exception of HbA1c. ASB intake at follow-up (≥1 serving/d compared with <1 serving/mo) was associated with higher HbA1c (6.5%; 95% CI: 1.9, 11.3; P-trend = 0.007); however, associations were not upheld in sensitivity analyses for reverse causation. Conclusions: Among Danish women with a history of GDM, ASB intake was not significantly associated with cardiometabolic profiles.

KW - Artificially sweetened beverages

KW - Cardiometabolic health

KW - Diabetes

KW - Diet

KW - Gestational diabetes

KW - Nonnutritive sweeteners

KW - Obesity

KW - Soda

U2 - 10.1093/ajcn/nqz094

DO - 10.1093/ajcn/nqz094

M3 - Journal article

VL - 110

SP - 221

EP - 232

JO - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

SN - 0002-9165

IS - 1

M1 - nzq094

ER -