Abstract
Although the 2015 Dietary Guidelines Advisory Committee concluded that there was moderate evidence that substituting sugar-containing sweeteners with low-calorie sweeteners (LCS) reduces calorie intake and weight, dietary recommendations encourage substituting only water for sugar-sweetened beverages during weight management. This cross-sectional study evaluated the relation of water and no- and low-calorie sweetened beverage (LCSB) intake with nutrient intakes and prediabetes criteria using data from the National Health and Nutrition Examination Survey (NHANES) 2001–2012 in 25,817 adults that were free of diabetes. Although linear trends were observed with both beverages, higher LCSB intake was associated with significantly lower consumption of carbohydrates (?9.1 g/day vs. ?1.4 g/day), total sugars (?10.9 g/day vs. ?2.2 g/day), and added sugars (?2.0 tsp eq vs. ?0.8 tsp eq) than those associated with higher water intake. Higher intake of both beverages was significantly associated with lower insulin levels (p < 0.01); however, higher intake of LCSB was also associated with lower hemoglobin A1c (HbA1c) and lower homeostatic model assessment of insulin resistance (HOMA-IR) (p < 0.01). We observed lower odds ratios for elevated HbA1c (adjusted odds ratio [OR] 0.79, 95% CI 0.64–0.98), HOMA-IR (0.68, 0.53–0.87), and insulin levels (0.63, 0.49–0.80) in LCSB among the higher (2+ servings) intake group compared to the lowest (<1 serving) intake group. Contrary to conventional wisdom, LCSB consumption was associated with equal, if not better, dietary intake and glycemic response than water consumption. Although observational in nature, these results contribute to the growing body of evidence from human studies suggesting that in addition to water, LCSBs can also be sensible choices for reducing sugars and carbohydrate intake, with no adverse associations to measures of glycemic response.
Summary
This observational study by Leahy et al found that higher consumption of low calorie sweetened beverages was associated with lower odds ratios for elevated levels of several prediabetes markers including insulin resistance indexes. Furthermore, it was found that higher consumption of low calorie sweetened beverages was associated with significantly lower intake of carbohydrates and total and added sugar.
Although cross-sectional in nature, results of this observational study by Leahy et al contribute to the growing body of evidence from clinical studies that do not support the hypothesis that consumption of low calorie sweeteners is associated with greater intakes of sweets and total energy, and further builds on the findings of intervention studies showing that low calorie sweetened product intake does not affect insulin resistance and type 2 diabetes risk, while on the contrary low calorie sweeteners can be a significant aid to people with prediabetes or diabetes.
Overall, these findings suggest that diet drinks, in addition to water, may also be sensible beverage choices to help moderate sugar and carbohydrate intake.