Guy Fagherazzi, Alice Vilier, Daniela Saes Sartorelli, Martin Lajous, Beverley Balkau, and Franc¸oise Clavel-Chapelon
Background: It has been extensively shown, mainly in US populations,
that sugar-sweetened beverages (SSBs) are associated with
increased risk of type 2 diabetes (T2D), but less is known about the
effects of artificially sweetened beverages (ASBs).
Objective: We evaluated the association between self-reported
SSB, ASB, and 100% fruit juice consumption and T2D risk over
14 y of follow-up in the French prospective Etude Epide´miologique
aupre`s des femmes de la Mutuelle Ge´ne´rale de l’Education
Nationale–European Prospective Investigation into Cancer and Nutrition
Design: A total of 66,118 women were followed from 1993, and
1369 incident cases of T2D were diagnosed during the follow-up.
Cox regression models were used to estimate HRs and 95% CIs for
Results: The average consumption of sweetened beverages in consumers
was 328 and 568 mL/wk for SSBs and ASBs, respectively.
Compared with nonconsumers, women in the highest quartiles of
SSB and ASB consumers were at increased risk of T2D with HRs
(95% CIs) of 1.34 (1.05, 1.71) and 2.21 (1.56, 3.14) for women who
consumed .359 and .603 mL/wk of SSBs and ASBs, respectively.
Strong positive trends in T2D risk were also observed across quartiles
of consumption for both types of beverage (P = 0.0088 and
P , 0.0001, respectively). In sensitivity analyses, associations were
partly mediated by BMI, although there was still a strong significant
independent effect. No association was observed for 100% fruit
Conclusions: Both SSB consumption and ASB consumption were
associated with increased T2D risk. We cannot rule out that factors
other than ASB consumption that we did not control for are responsible
for the association with diabetes, and randomized trials
are required to prove a causal link between ASB consumption and