Consumption of sugar-sweetened beverages, non-sugar sweetened beverages, and their substitution and risk of type 2 diabetes: the HELIUS study

Purpose The association between non-sugar-sweetened beverages (NSSB), as a suitable alternative for sugar-sweetened beverages (SSB), and the risk of type 2 diabetes (T2D) remains unclear. This study aimed to investigate the association between the intake of SSB and NSSB, their substitutions with each other, and T2D risk. Methods We used a sub-sample of adults aged 18–70 years from the Healthy Life in an Urban Setting (HELIUS) study. Dietary data was assessed using ethnic-specific food frequency questionnaires. Multivariable-adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for T2D risk for SSB and NSSB and their substitutions of one serving (250 ml)/day were estimated using Poisson models. Results Among the 2612 participants included, 141 incident cases of T2D were identified. After multivariable adjustment, higher NSSB intake was associated with an increased risk of T2D in the overall population (IRR high vs low : 2.26; 95% CI: 1.14, 4.46) and among participants with non-Dutch ethnicity (IRR high vs low : 3.04; 95% CI: 1.59, 5.81). No overall association was observed between SSB intake and T2D risk, although a positive association was found among Dutch participants. In substitution analyses, replacing one serving/day of SSB with NSSB was associated with a higher T2D risk among younger participants (IRR model 3 : 1.67; 95% CI: 1.01, 2.75), although this association was not observed in the overall population. Conclusion These findings suggest that replacing SSBs with NSSBs may not confer a metabolic benefit and may be associated with a higher risk of T2D in specific subgroups. Further research is needed to clarify the mechanisms and subgroup-specific factors underlying these associations.