Abstract
Background
Low-calorie sweetened beverages (LCSBs) are commonly used as a lower-calorie alternative
to sugar-sweetened beverages (SSBs) by individuals with type 2 diabetes. However,
little is known about how intake of LCSBs is related to dietary intake and cardiometabolic
health, particularly among youth.
Objective
To test the hypothesis that having higher baseline LCSB intake and increasing LCSB
intake over 2 years of follow-up are associated with poorer dietary intake and higher
cardiometabolic risk factors among youth enrolled in the Treatment Option for Type
2 Diabetes in Adolescents and Youth (TODAY) study.
Design
Secondary, exploratory, analysis of baseline and longitudinal data from the TODAY
study, which was a randomized, multisite trial conducted from 2004 to 2012, to compare
effects of 3 interventions (metformin alone, metformin + rosiglitazone, and metformin +
intensive lifestyle intervention) on glycemic control in youth with type 2 diabetes.
Participants/setting
The study included 476 children and adolescents (10-17 years, mean body mass index
34.9 ± 7.8 kg/m2), who were participants in the multicenter (n = 15) TODAY study.
Main outcome measures
Diet was assessed using a food frequency questionnaire. Differences in energy intake,
macronutrients, food group intakes, and cardiometabolic biomarkers were evaluated
in 3 groups of LCSB consumers at baseline (low [1-4 servings/wk], medium [5-11 servings/wk],
and high [≥12 servings/wk]), each compared with nonconsumers, and between 4 groups
of change in LCSB intake (nonconsumption at start of study and nonconsumption after
2 years, increase in consumption after 2 years, decrease in consumption after 2 years,
and high consumption at start of study and high consumption after 2 years).
Statistical analyses performed
Multivariable linear regression was performed at baseline and longitudinally over
2 years of follow-up.
Results
Energy (kilocalories), fiber, carbohydrate, total fat, saturated fat, and protein
intake (grams) were higher among high LCSB consumers compared with nonconsumers at
baseline. No associations were observed between LCSB consumption and cardiometabolic
risk factors at baseline. Change in LCSB intake between baseline and follow-up was
not associated with change in energy intake or cardiometabolic risk factors. Participants
who decreased LCSB consumption reported greater increases in sugar intake (18.4 ±
4.8 g) compared with those who increased LCSB consumption (5.7 ± 4.9 g) or remained
high LCSB consumers (5.9 ± 7.4 g), but this trend was not statistically significant
after a correction for multiple testing.
Conclusions
LCSB consumption was associated with higher energy intake in youth with type 2 diabetes,
with the highest energy intakes reported in high LCSB consumers. Those who reduced
LCSB consumption tended to report greater increases in sugar intake during follow-up,
but further studies are needed to better understand this trend.
Keywords
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Biography
A. C. Sylvetsky is an assistant professor, Department of Exercise and Nutrition Sciences, and affiliated faculty, Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, Washington, DC.
Biography
S. A. Talegawkar is an associate professor, Department of Exercise and Nutrition Sciences; Milken Institute School of Public Health, The George Washington University, Washington, DC.
Biography
A. Chandran is a research associate, Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC; and a postdoctoral fellow, Matthew Gfeller Sport-Related TBI Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill.
Biography
J. A. Welsh is an assistant professor, Department of Pediatrics, Emory University School of Medicine, Emory University, Atlanta, GA.
Biography
K. Drews is an associate research professor, George Washington University Biostatistics Center, Milken Institute School of Public Health, The George Washington University, Rockville, MD.
Biography
L. El ghormli is a data scientist, George Washington University Biostatistics Center, Milken Institute School of Public Health, The George Washington University, Rockville, MD.
Article info
Publication history
Accepted:
April 3,
2020
Received:
July 19,
2019
Footnotes
Supplementary materials: The Figure and
, 7, and 8 are available at www.jandonline.orgSTATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This work was funded by a pilot grant (principal investigator: Sylvetsky) from the Sumner M. Redstone Global Center for Prevention and Wellness at the George Washington University.
Identification
Copyright
© 2020 by the Academy of Nutrition and Dietetics.
