Diet Sugar-Free Carbonated Soda Beverage, Non-Caloric Flavors Consumption, and Diabetic Retinopathy: Any Linkage

Abstract

Purpose: Assessing diabetic retinopathy (DR) risk factors and daily nutrition habits are vital for prevention. This study aims to evaluate the relationship between diet soda cans, nonnutritive sweetener consumption, and diabetic retinopathy. Patients and Methods: A cross-sectional study was conducted among 200 patients attending a diabetes center in Tabuk City, Saudi Arabia, from September 2019 to July 2020. A structured questionnaire was used to collect patients' demographic factors, and DR risk factors including the use of diet soda, non-nutritive sweeteners, and exercise habits. Dilated fundus eye examination was done to detect any diabetic retinopathy. A blood sample was taken for measuring glycated hemoglobin to assess the degree of glycemic control. Results: The participant's age was 50.74 ±13.51 years, and the duration since the diagnosis of diabetes was 9.99 ±6.97 years, body mass index was 27.28 ±4.68, and HbA1c %, 8.50 ±1.61), the patients used to consume 1.31 ±1.57 diet soda cans/week, and 1.06±1.39 artificial sweeteners/sachet/day. DR was found in 33%. Diet sugar-free carbonated soda beverage was associated with poor glycemic control and retinopathy, while non-caloric flavor consumption was associated with obesity (P-value<0.05). No association was evident regarding other factors (P-value>0.05). Conclusion: Diet sugar-free carbonated soda beverage was associated with higher HbA1c and retinopathy, while non-caloric flavor consumption was associated with obesity. No association was evident regarding other factors. Further larger multicenter studies are needed.

Artificially Sweetened Beverages Beyond the Metabolic Risks: A Systematic Review of the Literature

“…Of the latter, 57 were removed by exclusion criteria. Therefore, 21 papers were included in the systematic review; these comprised 14 cohort studies [19][20][21][22][23][24][25][26][27][28][29][30][31], five cross-sectional studies [32][33][34][35][36], a crossover study [37], a case-control study [38], and a randomized controlled trial [39].…”

Dietary Intake and Diabetic Retinopathy: A Systematic Review of the Literature

“…Mirghani and colleagues, using a cross-sectional study design, found that diet soda (sugar-free carbonated beverage) consumption was associated with a higher risk of DR ( p = 0.043) [ 22 ]. Another cross-sectional study by Fenwick and associates also found a positive association of diet drink (>4 cans [1.5 L]/week) consumption with proliferative DR (OR: 2.62, 95%CI: 1.14–6.06, p = 0.024) [ 23 ].…”

“…Another proposed theory is that the overconsumption of other food or beverages might occur due to subjects overestimating the calories saved by substituting diet beverages for sugar-sweetened drinks [ 23 ]. However, further longitudinal studies are required due to a small sample size of 200 participants [ 22 ], as well as a lack of an account of changes in diet drink, i.e. from regular soft drink to diet soft drink for lifestyle modification upon diagnosis of diabetes, which could overestimate the relationship between diet soda and DR in the study [ 23 ].…”

“…Nevertheless, very few systematic reviews comprehensively assessed the entire spectrum of dietary components but are not very recent [ 15 , 16 ]. Several recent introductions of new dietary factors, i.e., selenium [ 17 ], vitamin B6 [ 18 ], vitamin B2 [ 17 ], choline [ 19 ], rice [ 20 ], cheese, wholemeal bread [ 21 ] and diet soda [ 22 , 23 ], with their influence on DR, are not included in previous comprehensive systematic reviews. For instance, two recent observational studies have highlighted diet soda as a risk factor for DR [ 22 , 23 ].…”

“…Several recent introductions of new dietary factors, i.e., selenium [ 17 ], vitamin B6 [ 18 ], vitamin B2 [ 17 ], choline [ 19 ], rice [ 20 ], cheese, wholemeal bread [ 21 ] and diet soda [ 22 , 23 ], with their influence on DR, are not included in previous comprehensive systematic reviews. For instance, two recent observational studies have highlighted diet soda as a risk factor for DR [ 22 , 23 ]. Additionally, more studies sharing information on the effect of already known dietary factors on DR are also available, thus adding more valuable knowledge to the nutritional impact on DR. For example, newly added observational studies showing the protective effect of tea [ 24 ] and Mediterranean food [ 25 ] on DR support a similar finding in a previous systematic review [ 15 ].…”