The association of sweetened beverage intake with risk of type 2 diabetes in an Australian population: A longitudinal study - 21/06/25

Doi : 10.1016/j.diabet.2025.101665

Robel Hussen Kabthymer ^a , Tongzhi Wu ^b , Sara Beigrezaei ^c , Oscar H Franco ^c , Allison M Hodge ^d,^e,^{^{1
Equal senior authors.}} , Barbora de Courten ^a,^f,^{^{1
Equal senior authors.},}^⁎
^a Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
^b Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, SA 5000, Australia
^c Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Centre (UMC) Utrecht, Utrecht, the Netherlands
^d Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC 3004, Australia
^e Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
^f School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3085, Australia

^⁎Corresponding author at: Health & Biomedical Sciences, STEM College, RMIT University, 124 La Trobe St Building 12, Level 7, Room 16A, Melbourne, VIC 3000, Australia.Health & Biomedical SciencesSTEM CollegeRMIT University124 La Trobe St Building 12, Level 7, Room 16AMelbourneVIC 3000Australia

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Highlights

•	Both sugar and artificially sweetened beverage intake has been linked with type 2 diabetes risk.
•	We found both sugar-sweetened and artificially sweetened beverage intakes are associated with increased risk of type 2 diabetes in an Australian population. Sensitivity analysis to rule out reverse causality also confirmed the findings.
•	The findings of this study highlight the need for a firm policy intended to curb the adverse health effects of sugar and artificially sweetened beverages in Australia.

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Abstract

Aim

Globally, sugar intake from sugar-sweetened beverages (SSBs) exceeds the daily recommended limits for intake levels of free sugar. Artificially sweetened beverages (ASBs), widely used to replace SSBs, are increasingly linked to adverse health outcomes. Hence, we assessed the association of sweetened beverage intake (SSBs and ASBs) with the risk of type 2 diabetes (T2DM).

Methods

Data from the Melbourne Collaborative Cohort Study (MCCS) on 36,608 individuals aged 40 to 69 years were used. Self-reported data on diabetes were collected. The frequency of SSBs and ASBs consumption was categorized as: never or < 1 time/month; 1–3 per month; 1–6 times per week; ≥1 time / day. The association of sweetened beverage intake with the incidence of T2DM was assessed using modified Poisson regression, adjusted for lifestyle, obesity, socioeconomic, and other confounders.

Results

Intakes of SSBs and ASBs were associated with an increased risk of T2DM. A high intake (≥ 1 time/day) compared to a low intake (never or < 1 time / month) was associated with increased risk of T2DM for SSB intake (incidence risk ratio (IRR) = 1.23; 95 % CI: 1.05–1.45; P for trend = 0.006) and for ASB intake (IRR = 1.38; 95 % CI: 1.18–1.61; P for trend < 0.001). Further adjustment for body mass index (BMI) and waist-to hip ratio (WHR) eliminated the association for SSBs, but not ASBs intake.

Conclusions

Both sugar and artificially sweetened beverages were linked to an increased risk of T2DM. The findings highlight the need for public health measures to control the intake of sweetened beverages.

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Keywords : Artificially sweetened beverages, Carbonated beverages, Cohort studies, Non-nutritive sweeteners, Sugar-sweetened beverages, Type 2 diabetes