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

  1. Jennifer A. Nettleton, PhD (jennifer.a.nettleton{at},
  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. From the 1Division of Epidemiology, University of Texas Health Sciences Center, Houston, TX, the
  2. 2Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
  3. 3Center for Human Nutrition, Department of International Health and
  4. 4Division of Cardiology, Johns Hopkins University, Baltimore, MD; the
  5. 5Department of Nutrition, University of Oslo, Oslo, Norway


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

    Research Design & Methods: Diet soda consumption was assessed by food frequency questionnaire at baseline (2000-02). Incident type 2 diabetes was identified at three follow-up exams (2002-03, 2004-05, 2005-07) as fasting glucose >126 mg/dL, self-reported type 2 diabetes, or use of diabetes medication. MetSyn (and components) were defined by National Cholesterol Education Program Adult Treatment Panel 3 criteria. Hazard ratios (HR with [95% CI]) for type 2 diabetes, Met Syn, and MetSyn 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 MetSyn and a 67% greater relative risk of incident type 2 diabetes compared to non-consumption (1.36 [1.11, 1.66] for MetSyn; 1.67 [1.27, 2.20] for type 2 diabetes). Of MetSyn components, only high waist circumference (men: ≥102 cm; 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 MetSyn 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 MetSyn components and type 2 diabetes.


      • Received October 1, 2008.
      • Accepted December 30, 2008.

    This Article

    1. Diabetes Care
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