Allison Sylvetsky, PhD, on Low-Calorie Sweetened Beverages and Type 2 Diabetes

In a recent study, consumption of low-calorie sweetened beverages (LCSB) was linked to higher energy intakes among individuals with type 2 diabetes.

The researchers conducted a secondary, exploratory analysis of data collected from 476 children and adolescents aged 10 to 17 years from the Treatment Options for Type 2 Diabetes among Adolescents and Youth (TODAY) study. The data were organized by levels of reported LCSB intake and change in reported LCSB intake over time.

Overall, they found that individuals who consumed higher amounts of LCSB also consumed more kilocalories, fiber, carbohydrates, total fat, saturated fat, and protein. Change in LCSB intake was not shown to be associated with cardiometabolic risk factors, but individuals who decreased their consumption over the course of the study showed greater increases in sugar intake compared with those whose LCSB intake increased or remained the same.

Consultant360 reached out to study author Allison Sylvetsky, PhD, assistant professor in the Department of Exercise and Nutrition Sciences at the Milken Institute School of Public Health at The George Washington University to discuss the findings further.

Consultant360: In your study, you found that higher consumption of LCBS was associated with higher levels of energy intake, while reductions in LCSB consumption appeared to be associated with increases in sugar intake among children with type 2 diabetes. Were these results surprising? In what ways could future studies help to solidify this relationship?

Allison Sylvestsky, PhD: The positive association between LCSB intake and energy intake was not surprising, as this is consistent with findings in prior studies in adults and in children without diabetes.

The finding that reductions in LCSB intake led to greater increases in sugar intake was somewhat surprising, and suggests LCSB may successfully suppress SSB consumption in youth with type 2 diabetes. However, energy and sugar intake increased in all groups, irrespective of change in LCSB intake between baseline and 2 years, suggesting that LCSB intake may not benefit the overall diet.

Our findings highlight the importance of investigating effects of LCSB on diet and cardiometabolic health in youth with type 2 diabetes in randomized controlled trials in order to determine whether associations between LCSB intake and dietary outcomes are causal.

C360: You concentrated your research on children and adolescents aged 10 to 17 years with type 2 diabetes. How did you decide on this specific population, rather than choosing to include adults with diabetes as well?

AS: We selected this population for several reasons. First, the GW Biostatistics Center (BSC) is a coordinating center for the TODAY study, and therefore, we were able to access these data. More importantly, consumption of low-calorie sweeteners has increased markedly among children in the past two decades, yet little is known about their effects on children’s diet, weight, and health. This is particularly critical for children with type 2 diabetes, who are often advised to consume beverages with low-calorie sweeteners in an effort to reduce sugar intake and manage weight.

C360: How could your findings inform current standards of diabetes management in children, adults, or in general?

AS: Our findings support guidance put forth in a recent American Academy of Pediatrics (AAP) Position Statement, which states that “when substituted for caloric sweetened foods or beverages, NNSs [synonymous with LCS] can reduce weight gain or promote small amounts of weight loss (∼1 kg) in children (and adults); however, data are limited, and use of NNSs in isolation is unlikely to lead to substantial weight loss.”

Nonetheless, future well-designed, randomized controlled trials are needed in children, with and without diabetes, in order to inform evidence-based recommendations for or against LCSB intake in the prevention and management of obesity and cardiometabolic disease.

Reference:

Sylvetsky AC, Chandran A, Talegawkar SA, et al. Consumption of beverages containing low-calorie sweeteners, diet, and cardiometabolic health in youth with type 2 diabetes. JAND. doi: 10.1016/j.jand.2020.04.005