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Am J Clin Nutr. 2019 Jun 7. pii: nqz094. doi: 10.1093/ajcn/nqz094. [Epub ahead of print]

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

Author information

Epidemiology Branch, Bethesda, MD.
Department of Nutritional Sciences, School of Health Professions, Rutgers University, Newark, NJ.
Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
Glotech, Rockville, MD.
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA.
Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Department of Endocrinology, Diabetes and Bone-Metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark.
The Danish Diabetes Academy, Odense, Denmark.
Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark.



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.


The aim of this study was to examine associations of ASB intake and cardiometabolic health among high-risk women with prior gestational diabetes mellitus (GDM).


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.


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.


Among Danish women with a history of GDM, ASB intake was not significantly associated with cardiometabolic profiles.


artificially sweetened beverages; cardiometabolic health; diabetes; diet; gestational diabetes; nonnutritive sweeteners; obesity; soda

[Available on 2020-07-01]

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