Is the increment of diabetes mellitus in Brazil associated with the consumption of artificially sweetened beverages? A time trend analysis with 757,386 adults from 2006 to 2020

• Published in: Public health (London) Vol. 221; pp. 66 - 72
• Main Authors: Dumith, S.C., Martins, O.P.L., Moreira, M.K.V., Paulitsch, R.G., Simões, M.O., Marmitt, L.P., Silva, P.E.A., Silva, M.P.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-08-2023
• Subjects: Adult; Artificially Sweetened Beverages; Beverages - adverse effects; Brazil - epidemiology; Cross-Sectional Studies; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diabetes Mellitus - etiology; Dietetic beverage; Humans; Non-nutritive sweeteners; Sweetening Agents; Brazil; Sweetening agents; Non-nutritive sweeteners; Dietetic beverage; Diabetes mellitus
• ISSN: 0033-3506; 1476-5616
• DOI: 10.1016/j.puhe.2023.06.004

To describe trends in the prevalence of diabetes mellitus (DM) in Brazil and to analyze its association with the consumption of artificially sweetened beverages among individuals aged 18 years or older.
This was a repeated cross-sectional study.
Annual data from VIGITEL surveys (2006–2020) were used, which included adults from all Brazilian state capitals. The outcome was the prevalence of DM (type 1 and type 2). The main exposure variable was consuming beverages like soft drinks and artificial juices, either in its ‘diet, light, or zero’ form. Covariates included sex, age, sociodemographic characteristics, smoking, alcohol consumption, physical activity, fruit consumption, and obesity. The temporal trend in the indicators and the etiological fraction (population attributable risk [PAR]) were calculated. Analyses were performed using Poisson regression. The association between DM and consumption of beverages was tested, excluding the year 2020 due to the pandemic; restricting the analysis to the final three years (2018–2020).
Overall, 757,386 subjects were included. The prevalence of DM increased from 5.5% to 8.2%, with an annual growth of 0.17 percentage points (95% CI 0.11–0.24). Among those who consumed diet/light/zero beverages, the annual percentage change of DM was four times greater. The PAR corresponding to the consumption of diet/light/zero beverages on the occurrence of DM was 17%.
An increasing prevalence of DM was observed, while diet/light/zero beverages consumption remains stable. A substantial reduction in the annual percentage change of DM could be observed if people stopped consuming diet/light soda/juice.