Ditch the Diet… Drinks

From ginger beer to cola, many people enjoy a refreshing soft drink. Obesity and tooth decay are well-known as potential risks of consuming sugary beverages, but what about their artificially-sweetened, lower-calorie cousins? Evidence is building around the theory that such drinks may not circumvent all potential health issues. And now, a team from the Singapore Eye Research Institute and Centre for Eye Research Australia has found that consumption of diet drinks may be linked with diabetic retinopathy (DR) (1). In a cohort of 609 patients with diabetes, high levels of diet soft drink consumption (over four cans per week) was independently associated with an increased likelihood of having proliferative DR (odds ratio, 2.51; 95% CI, 1.05–5.98) when compared with no consumption. Ecosse Lamoureux, senior author of the study, tells us more.

The results seem somewhat surprising...

The association of diet soft drink consumption with DR was certainly unexpected, and prospective studies are needed to confirm this cross-sectional phenomenon. We were also surprised by the differential impact that diet and regular soft drinks had on DR risk. However, as few individuals with diabetes in our sample consumed regular soft drinks, the lack of an association could be due to inadequate statistical power; this caveat was noted in our manuscript and caution is needed when interpreting our results.

What impact could your findings have?

Our findings indicate that daily consumption of low-calorie soft drinks may be associated with DR in people with diabetes. And although more research is needed, doctors could advise patients with diabetes to reduce or eliminate the consumption of diet soft drinks. Such advice could be important for individuals with existing DR to prevent disease progression to vision-threatening stages. More importantly, our results may inform future dietary management plans for individuals with no or existing DR.

Next steps?

Given the cross-sectional nature of our study, we are unable to determine causality. Therefore, we are planning to undertake a longitudinal study, using prospectively collected dietary data to determine whether diet soft drinks are indeed unhealthy substitutes for regular soft drinks in patients with diabetes, so as best to inform the clinical management guidelines for DR.