Diabetes & Metabolism Journal

Original Articles

Guideline/Statement/Fact Sheet
Health Effects of Sugar-Sweetened and Artificially Sweetened Beverages: Umbrella Review and Evidence-Based Consensus Statement of the Korean Diabetes Association and the Korean Nutrition Society: Jong Han Choi, SuJin Song, Soo Kyoung Kim, Jae Won Cho, Jae Hyun Bae, Shinje Moon, Jeong Hyun Lim, YeonHee Lee, Ji-Yun Hwang, YoonJu Song, Sang Soo Kim; Diabetes Metab J. 2026;50(1):32-46. Published online January 1, 2026; DOI: https://doi.org/10.4093/dmj.2025.0848

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Background
Excess intake of added sugars contributes to obesity, type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and premature mortality. Sugar-sweetened beverages (SSBs), the main source of added sugars, are consistently linked to adverse outcomes. Artificially sweetened beverages (ASBs) have been suggested as short-term substitutes, but evidence regarding benefits and harms remains inconclusive, and guidance is lacking.
Methods
This consensus statement draws on a structured evidence review combining two approaches: an updated meta-analysis of randomized controlled trials (RCTs) assessing short- to intermediate-term effects of replacing SSBs with ASBs on weight and metabolic outcomes; and an umbrella review of systematic reviews of cohort studies evaluating long-term associations of SSBs and ASBs with major outcomes, including mortality, CVD, and T2DM.
Results
In 14 RCTs (3–76 weeks), replacing SSBs with ASBs produced modest reductions in body weight (–0.73 kg) and body fat (–0.72%), with inconsistent effects on glycemic and cardiometabolic markers. Evidence from 20 systematic reviews of cohorts (up to 34 years follow-up) showed that higher intake of both SSBs and ASBs was associated with increased risks of T2DM, CVD, and mortality, with relative risks for ASBs similar to those for SSBs.
Conclusion
ASBs may serve as a short-term substitution for individuals with high SSB intake, particularly those at elevated metabolic risk. However, regular or long-term use is not recommended due to uncertain safety and potential reinforcement of sweet preference. Public health strategies should emphasize reducing both SSBs and ASBs, prioritizing water and unsweetened beverages as the ultimate goal.

Citations

Citations to this article as recorded by

Do Not Replace Your Sugar, Simply Eat Less!
Jeehyun Lee, Sunghwan Suh
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Mohammad R. Monjur
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Shaojuan Zhao, Leyao Tang, Ni Xiong, Liping Liang, Xin Yin Wu, Chuanning Yu, Xueling Wei, Xuanzhen Wu, Wenjie Dai
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Roselinde L. van Nee, Ellen van Kleef, Hans C.M. van Trijp
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Metabolic Risk/Epidemiology
Effect of Sarcopenia and Body Shape on Cardiovascular Disease According to Obesity Phenotypes: Hyun-Woong Cho, Wankyo Chung, Shinje Moon, Ohk-Hyun Ryu, Min Kyung Kim, Jun Goo Kang; Diabetes Metab J. 2021;45(2):209-218. Published online July 10, 2020; DOI: https://doi.org/10.4093/dmj.2019.0223

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Background

This study aimed to assess the effects of sarcopenia and A Body Shape Index (ABSI) on cardiovascular disease (CVD) risk according to obesity phenotypes.

Methods

We used data from the National Health and Nutrition Examination Survey 1999 to 2012. A total of 25,270 adults were included and classified into the following groups: metabolically healthy normal weight (MHNW), metabolically healthy overweight/obese (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy overweight/obese (MUO). Sarcopenia was defined as the appendicular skeletal mass index <7 kg/m² in men and <5.5kg/m² in women. A multivariate logistic regression analysis was performed to evaluate the odds ratio (OR) of sarcopenia and ABSI for CVD events according to the obesity phenotype.

Results

The MHNW participants with sarcopenia had higher risk for CVD than those without sarcopenia (OR, 2.69; 95% confidence interval [CI], 1.56 to 4.64). In the analysis with MHNW participants without sarcopenia as a reference, the participants with sarcopenia showed a higher OR for CVD than those without sarcopenia in both MHO (OR in participants without sarcopenia, 3.31; 95% CI, 1.94 to 5.64) (OR in participants with sarcopenia, 8.59; 95% CI, 2.63 to 28.04) and MUO participants (OR in participants without sarcopenia, 5.11; 95% CI, 3.21 to 8.15) (OR in participants with sarcopenia, 8.12; 95% CI, 4.04 to 16.32). Participants within the second and third tertiles of ABSI had higher ORs for CVDs than the counterpart of obesity phenotypes within the first tertile.

Conclusion

These results suggest that clinical approaches that consider muscle and body shape are required.

Citations

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Obesity and Metabolic Syndrome
The Association between Z-Score of Log-Transformed A Body Shape Index and Cardiovascular Disease in Korea: Wankyo Chung, Jung Hwan Park, Hye Soo Chung, Jae Myung Yu, Shinje Moon, Dong Sun Kim; Diabetes Metab J. 2019;43(5):675-682. Published online April 26, 2019; DOI: https://doi.org/10.4093/dmj.2018.0169

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Background

In order to overcome the limitations of body mass index (BMI) and waist circumference (WC), the z-score of the log-transformed A Body Shape Index (LBSIZ) has recently been introduced. In this study, we analyzed the relationship between the LBSIZ and cardiovascular disease (CVD) in a Korean representative sample.

Methods

Data were collected from the Korea National Health and Nutrition Examination VI to V. The association between CVD and obesity indices was analyzed using a receiver operating characteristic curve. The cut-off value for the LBSIZ was estimated using the Youden index, and the odds ratio (OR) for CVD was determined via multivariate logistic regression analysis. ORs according to the LBSIZ value were analyzed using restricted cubic spline regression plots.

Results

A total of 31,227 Korean healthy adults were analyzed. Area under the curve (AUC) of LBSIZ against CVD was 0.686 (95% confidence interval [CI], 0.671 to 0.702), which was significantly higher than the AUC of BMI (0.583; 95% CI, 0.567 to 0.599) or WC (0.646; 95% CI, 0.631 to 0.661) (P<0.001). Similar results were observed for stroke and coronary artery diseases. The cut-off value for the LBSIZ was 0.35 (sensitivity, 64.5%; specificity, 64%; OR, 1.29, 95% CI, 1.12 to 1.49). Under restricted cubic spline regression, LBSIZ demonstrated that OR started to increase past the median value.

Conclusion

The findings of this study suggest that the LBSIZ might be more strongly associated with CVD risks compared to BMI or WC. These outcomes would be helpful for CVD risk assessment in clinical settings, especially the cut-off value of the LBSIZ suggested in this study.

Citations

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Predictive value of the triglyceride glucose index-a body shape index (TyG-ABSI) for cardiovascular disease and its comparison with other TyG-related obesity indices: a study based on the China health and retirement longitudinal study (CHARLS) cohort
Xinying Liu, Shuo Yang, Qiang Fu, Yichen Sun, Shiwen Jing, Mingze Liu, Li Liu, Xiaokun Yang
Cardiovascular Diabetology.2026;[Epub] CrossRef
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Yiseul Lee, Nam-Kyoo Lim, Hyun-Young Park
BMC Public Health.2025;[Epub] CrossRef
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Thung-Lip Lee, Fang-Ju Lin, Chih-Fan Yeh, Yu-Chung Hsiao, Kai-Chien Yang, Chin-Feng Hsuan, Chau-Chung Wu
BMC Public Health.2025;[Epub] CrossRef
Associations of longitudinal trajectories of triglyceride-glucose index combined with classical and novel obesity indices and cardiovascular disease: evidence from a nationwide prospective cohort study in China
Chao Wang, Shiming He, Guobo Xie, Shuhua Zhang, Zhiyu Xiong, Hengcheng Lu, Qun Wang, Lin Xie, Wei Wang, Yang Zou, Xue Li
Cardiovascular Diabetology.2025;[Epub] CrossRef
Comparison of the TyG index, TyG-traditional obesity indices, and TyG-novel obesity indices: does increased complexity help in predicting cardiometabolic multimorbidity?
Fanzhi Zhang, Bin Zhang, Xinfang Huang, Zhenyu Wang, Juan Wang, Houhui Lan, Guobo Xie, Wei Wang, Yang Zou, Chao Wang
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Association between body shape index and risk of mortality in the United States
Heysoo Lee, Hye Soo Chung, Yoon Jung Kim, Min Kyu Choi, Yong Kyun Roh, Wankyo Chung, Jae Myung Yu, Chang-Myung Oh, Shinje Moon
Scientific Reports.2022;[Epub] CrossRef
Utility of the Z-score of log-transformed A Body Shape Index (LBSIZ) in the assessment for sarcopenic obesity and cardiovascular disease risk in the United States
Wankyo Chung, Jung Hwan Park, Hye Soo Chung, Jae Myung Yu, Dong Sun Kim, Shinje Moon
Scientific Reports.2019;[Epub] CrossRef

Clinical Diabetes & Therapeutics
Association between Serum Selenium Level and the Presence of Diabetes Mellitus: A Meta-Analysis of Observational Studies: Juno Kim, Hye Soo Chung, Min-Kyu Choi, Yong Kyun Roh, Hyung Joon Yoo, Jung Hwan Park, Dong Sun Kim, Jae Myung Yu, Shinje Moon; Diabetes Metab J. 2019;43(4):447-460. Published online January 2, 2019; DOI: https://doi.org/10.4093/dmj.2018.0123

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Background

Epidemiological studies have suggested an association between selenium (Se) and diabetes mellitus (DM). However, different studies have reported conflicting results. Therefore, we performed a comprehensive meta-analysis to clarify the impact of Se on DM.

Methods

We searched the PubMed database for studies on the association between Se and DM from inception to June 2018.

Results

Twenty articles evaluating 47,930 participants were included in the analysis. The meta-analysis found that high levels of Se were significantly associated with the presence of DM (pooled odds ratios [ORs], 1.88; 95% confidence interval [CI], 1.44 to 2.45). However, significant heterogeneity was found (I²=82%). Subgroup analyses were performed based on the Se measurement methods used in each study. A significant association was found between high Se levels and the presence of DM in the studies that used blood (OR, 2.17; 95% CI, 1.60 to 2.93; I²=77%), diet (OR, 1.61; 95% CI, 1.10 to 2.36; I²=0%), and urine (OR, 1.49; 95% CI, 1.02 to 2.17; I²=0%) as samples to estimate Se levels, but not in studies on nails (OR, 1.24; 95% CI, 0.52 to 2.98; I²=91%). Because of significant heterogeneity in the studies with blood, we conducted a sensitivity analysis and tested the publication bias. The results were consistent after adjustment based on the sensitivity analysis as well as the trim and fill analysis for publication bias.

Conclusion

This meta-analysis demonstrates that high levels of Se are associated with the presence of DM. Further prospective and randomized controlled trials are warranted to elucidate the link better.

Citations

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