(P17-031-25) Association Between Artificial Sweetener Consumption and Risk of Incident Diabetes: The CARDIA study

Objectives: The prevalence of diabetes has risen sharply over the past decades. Artificial sweeteners (ArtSw) are widely used as sugar substitutes which have been linked to adverse health outcomes. This study examined the association between ArtSw intake and incident diabetes risk. We hypothesize that higher ArtSw intake increases incident diabetes risk.

Methods: This analysis included 4,654 adults (54.4% female, 50.1% white) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study who were mean age 24.9 years at baseline in 1985-86. Dietary intake was assessed by the CARDIA diet history at year 0 (Y0), Y7, and Y20 cumulative average intakes of ArtSw, diet beverage, aspartame, and sucralose were calculated. Diabetes was defined as fasting glucose greater than or equal to 126 mg/dl, OGTT 2-hour glucose greater than or equal to 200 mg/dl, hemoglobin A1C greater than or equal to 6.5%, or use of diabetes medications at follow-up visits. Time-dependent multivariable cox proportional hazard regression models were used to assess associations of incident diabetes across quintiles of ArtSw, diet beverages, aspartame, or sucralose intakes through year 30. Models were adjusted for age, sex, race, field center, education, energy intake, physical activity, smoking status, alcohol drinking, diet quality, and family history of diabetes.

Results: Over a median follow-up of 30 years (691 incident diabetes events), participants in quintile 5 of diet beverage intake had significantly higher risk of developing diabetes compared to those in quintile 1 (hazard ratio [HR]: 2.29; 95% CI: 1.66–3.18; p<sub>trend < 0.001). Positive associations were also observed for intakes of saccharin (HR: 2.10; 95% CI: 1.37–3.21; p<sub>trend=0.013). Adjusting for waist circumference attenuated the associations slightly. Associations were not significant for total ArtSw, sucralose, or aspartame intake with incidence of diabetes.

Conclusions: Higher intakes of diet beverage and saccharin were associated with an increased risk of incident diabetes. These findings highlight the need to evaluate the long-term metabolic effect of ArtSw on glucose metabolism.

Funding Sources: CARDIA is supported by the National Heart, Lung, and Blood Institute.