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 study was to examine associations of ASB
intake and cardiometabolic health among high-risk women with 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.
- Artificially sweetened beverages
- Cardiometabolic health
- Gestational diabetes
- Nonnutritive sweeteners