Non-Sugar-Sweetened Beverages May Not Necessarily Provide Expected Diabetes-Protection Benefit: Study
Netherlands: Higher consumption of non-sugar-sweetened beverages (NSSBs) was associated with an increased risk of type 2 diabetes (T2D) in a multiethnic population. The association was particularly strong among adults with BMI ≥25 and those of non-Dutch origin.
Notably, replacing sugar-sweetened beverages (SSBs) with NSSBs was also linked to a higher T2D risk among younger adults and non-Dutch individuals, suggesting that NSSBs may not necessarily provide the expected diabetes-protection benefit.
The findings were published in the European Journal of Nutrition by Sara Beigrezaei, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands, and colleagues.
NSSBs, including beverages sweetened with low- or no-calorie sweeteners, are often considered alternatives to SSBs because they contain little or no added sugar. However, evidence regarding their long-term relationship with T2D remains inconsistent. The researchers therefore examined whether consumption of SSBs and NSSBs, as well as replacing one beverage with the other, was associated with diabetes risk.
The study used data from the Healthy Life in an Urban Setting (HELIUS) cohort and included adults aged 18 to 70 years who had available dietary information. Beverage intake was assessed using food-frequency questionnaires tailored to different ethnic groups. Researchers estimated the incidence of T2D according to beverage consumption and examined the potential effect of replacing one 250-mL serving of SSB with NSSB each day.
A total of 2,612 participants were included, among whom 141 developed T2D during follow-up.
Key findings included:
- Participants with higher NSSB consumption had more than twice the risk of T2D compared with those reporting lower intake (IRR, 2.26).
- The association was stronger among participants of non-Dutch ethnicity, with an IRR of 3.04.
- Overall SSB consumption was not significantly associated with T2D risk, although a positive association was observed among Dutch participants.
- Replacing one serving of SSB with NSSB daily was associated with increased T2D risk among younger participants (IRR, 1.67).
- Similar unfavorable associations with NSSB substitution were observed in some subgroups, including individuals with overweight or obesity and those of non-Dutch background.
The researchers cautioned that the observational design cannot establish causality. The small sample, limited T2D cases, single dietary assessment, and potential measurement error, selection bias, and residual confounding may have affected the findings. Reverse causation is also possible, as people at higher metabolic risk may choose NSSBs to reduce sugar intake or control weight.
Overall, replacing SSBs with NSSBs did not lower T2D risk and was associated with a higher risk in some subgroups. Further prospective and mechanistic studies are needed to clarify these associations.
Reference:
Beigrezaei, S., Hernández Vargas, J.A., Raeisi-Dehkordi, H. et al. Consumption of sugar-sweetened beverages, non-sugar sweetened beverages, and their substitution and risk of type 2 diabetes: the HELIUS study. Eur J Nutr 65, 192 (2026). https://doi.org/10.1007/s00394-026-04043-2
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