Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)*

  1. Jennifer A. Nettleton, PHD1,
  2. Pamela L. Lutsey, PHD2,
  3. Youfa Wang, MD, PHD3,
  4. João A. Lima, PHD4,
  5. Erin D. Michos, MD4 and
  6. David R. Jacobs, Jr., PHD2,5
  1. 1Division of Epidemiology, University of Texas Health Sciences Center, Houston, Texas;
  2. 2Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota;
  3. 3Center for Human Nutrition, Department of International Health, The Johns Hopkins University, Baltimore, Maryland;
  4. 4Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland;
  5. 5Department of Nutrition, University of Oslo, Oslo, Norway.
  1. Corresponding author: Jennifer A. Nettleton, jennifer.a.nettleton{at}


OBJECTIVE We determined associations between diet soda consumption and risk of incident metabolic syndrome, its components, and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis.

RESEARCH DESIGN AND METHODS Diet soda consumption was assessed by food frequency questionnaire at baseline (2000–2002). Incident type 2 diabetes was identified at three follow-up examinations (2002–2003, 2004–2005, and 2005–2007) as fasting glucose >126 mg/dl, self-reported type 2 diabetes, or use of diabetes medication. Metabolic syndrome (and components) was defined by National Cholesterol Education Program Adult Treatment Panel III criteria. Hazard ratios (HRs) with 95% CI for type 2 diabetes, metabolic syndrome, and metabolic syndrome components were estimated, adjusting for demographic, lifestyle, and dietary confounders.

RESULTS At least daily consumption of diet soda was associated with a 36% greater relative risk of incident metabolic syndrome and a 67% greater relative risk of incident type 2 diabetes compared with nonconsumption (HR 1.36 [95% CI 1.11–1.66] for metabolic syndrome and 1.67 [1.27–2.20] for type 2 diabetes). Of metabolic syndrome components, only high waist circumference (men ≥102 cm and women ≥88 cm) and high fasting glucose (≥100 mg/dl) were prospectively associated with diet soda consumption. Associations between diet soda consumption and type 2 diabetes were independent of baseline measures of adiposity or changes in these measures, whereas associations between diet soda and metabolic syndrome were not independent of these factors.

CONCLUSIONS Although these observational data cannot establish causality, consumption of diet soda at least daily was associated with significantly greater risks of select incident metabolic syndrome components and type 2 diabetes.


  • *A full list of participating Multi-Ethnic Study of Atherosclerosis (MESA) investigators and institutions can be found at

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received October 1, 2008.
    • Accepted December 30, 2008.
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  1. Diabetes Care vol. 32 no. 4 688-694
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