Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes: Methodologic concern about a recent epidemiological study

摘要

In a recent issue of the Journal, Fagherazzi et al (1) revived the controversy about the safety of intense sweeteners. It has been repeatedly proven that increased sugar intake leads to weight gain (2) and that consumption of sugar-sweetened beverages (SSBs) is significantly associated with an increased risk of type 2 diabetes (T2D; reviews in reference 3). From the data on the E3N French cohort of 66,118 menopausal women, monitored between 1994 and 2007, Fagherazzi et al extend this risk to the consumption of artificially sweetened beverages (ASBs). However, several methodologic weaknesses cast doubt on the validity of their conclusions. First, it is unlikely that a single diet-history questionnaire from 1993 on eating and drinking habits during the previous year was sufficiently precise to quantify the amount of different beverages consumed during the following 14 y of medical consultations. The reference the authors provided to justify their survey methodology (4) shows a limited reproducibility of the data provided by such a questionnaire, as indicated by low correlation of coefficients between data of 2 diet-history questionnaires recorded at 1-y intervals. This reference also indicates a very poor relative validity because of the systematic differences between data provided by the questionnaires and the data of 12 repeated 24-h recalls. In addition, in the E3N questionnaire, the beverage recording was only partial because consumption at the traditional 2 main meals in France, lunch and dinner, was not taken into consideration.