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Daily consumption of diet soda linked to metabolic syndrome...

Medscape Medical News

Daily Consumption of Diet Soda Linked to Metabolic Syndrome, Type 2 Diabetes

Laurie Barclay, MD
February 11, 2009
February 11, 2009 — Drinking diet soda at least daily is associated with significantly greater risks for select incident components of the metabolic syndrome (MetSyn) and type 2 diabetes,according to the results of an observational study reported in the January 16, 2009 Online First issue of Diabetes Care.
"Two longitudinal cohort studies have shown positive associations between diet soda consumption and incident MetSyn independent of baseline measures of adiposity," write Jennifer A. Nettleton, PhD, from the University of Texas Health Sciences Center in Houston, and colleagues. "Replication of previously observed diet soda-MetSyn associations in a distinct cohort would bolster their credibility and provide further insight into the nature of the relationship. Previous studies have not addressed associations between diet soda and individual MetSyn components or risk of type 2 diabetes nor have they fully addressed potential longitudinal mediators of these relationships, i.e., changes in adiposity status."
The goal of this study was to evaluate associations between diet soda consumption and the risk for incident MetSyn, its components, and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA).
Initial evaluation was performed from 2000 to 2002, at which time baseline food frequency questionnaires measured diet soda consumption. Three follow-up evaluations were performed from 2002 to 2003, 2004 to 2005, and 2005 to 2007. Incident type 2 diabetes was defined as fasting glucose levels of more than 126 mg/dL, self-reported type 2 diabetes, or use of diabetes medication. National Cholesterol Education Program Adult Treatment Panel 3 criteria were used to define MetSyn and its components. After adjustment for demographic, lifestyle, and dietary confounders, hazard ratios (HRs) were estimated for type 2 diabetes, MetSyn, and MetSyn components.
Compared with participants who did not drink diet soda, those who drank diet soda at least daily had a 36% greater relative risk for incident MetSyn (HR, 1.36; 95% confidence interval [CI], 1.11 - 1.66) and a 67% greater relative risk for incident type 2 diabetes (HR, 1.67; 95% CI, 1.27 - 2.20).
Of the individual components of MetSyn, only high waist circumference (men: ≥ 102 cm; women: ≥ 88 cm) and high fasting glucose levels (≥ 100 mg/dL) were prospectively associated with consumption of diet soda. Associations between diet soda intake and type 2 diabetes were independent of baseline measures of adiposity or changes in these measures. In contrast, associations between diet soda and MetSyn were not independent of these factors.
"Although these observational data cannot establish causality, consumption of diet soda at least daily was associated with significantly greater risks of select incident MetSyn components and type 2 diabetes," the study authors write.
Limitations of this study include observational design, precluding determination of causality; possible confounding by other dietary and lifestyle/behavioral factors; and difficulties in estimating intake of diet soda or artificial sweetener.
"These results corroborate findings from the ARIC [Atherosclerosis Risk in Communities] and Framingham studies and show stronger adverse associations exist between diet soda and type 2 diabetes," the study authors conclude. "Diet soda consumption, either independently or in conjunction with other dietary and lifestyle behaviors, may lead to weight gain, impaired glucose control, and eventual diabetes."
The National Heart, Lung, and Blood Institute supported this study. The study authors have disclosed no relevant financial relationships.
Diabetes Care. Published online January 16, 2009.

Daily quaffing of diet soda heightens vascular-event risk in cohort study

Allison Gandey
February 10, 2011
Los Angeles, CA - Artificially sweetened "diet" soda may not be the healthier alternative many had hoped: an observational study suggests the popular drinks may increase the risk of stroke, MI, and vascular death [1].
Dr Hannah Gardener
"People who had diet soda every day experienced a 61% higher risk of vascular events than those who reported drinking no soda," lead investigator Dr Hannah Gardener(University of Miami, FL) told reporters attending a news conference here at the International Stroke Conference 2011 sponsored by the American Stroke Associati on (ASA).
Previous studies have suggested a link between diet-soda consumption and the risk of metabolic syndrome and diabetes. But the current analysis from the Northern Manhattan Study is the first study to show such an association between diet soft drink consumption and hard vascular-disease end points, according to ASA national spokesperson Dr Larry Goldstein (Duke University Stroke Center, Durham, NC). 
"This is an observational study and not a prospective randomized trial," he pointed out. "This is an association and not yet a proven causal relationship."
Still, Goldstein said, "I think that it's always good to do things in moderation. People should look at this information and consider it in the context of their other risk factors."
More than 2500 people from the multiethnic cohort study were asked to report how much and what kind of soda they drank. Over an average follow-up of 9.3 years, there were 559 vascular events, including both ischemic and hemorrhagic strokes. 
The researchers also observed a marginally significant increased risk of vascular events among those who consumed diet soda daily and regular soda once or more a month (adjusted relative risk 1.74; 95% CI 0.96-3.16).
After researchers controlled for metabolic syndrome, peripheral vascular disease, and cardiac disease history, daily consumption of diet soda posed a 1.48 (95% CI 1.03-2.12) relative risk of vascular events compared with no soda intake.
The potential mechanisms for any association between diet soda and vascular events remain unknown, according to the investigators, who acknowledge that additional studies are needed.

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