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Original Article
- 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
- 9,385 View
- 278 Download
- 4 Web of Science
- 8 Crossref
-
Abstract
PDF
Supplementary Material
PubReader 
ePub - 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
Diabetes & Metabolism Journal.2026; 50(1): 30. CrossRef - Diabetes in Bangladesh: The Role of Sugar-Sweetened Beverages
Mohammad R. Monjur
Bangladesh Journal of Endocrinology and Metabolism.2026;[Epub] CrossRef - Associations of lifestyle behaviors with overweight and obesity: a cross-sectional study in Shenzhen, China
Shaojuan Zhao, Leyao Tang, Ni Xiong, Liping Liang, Xin Yin Wu, Chuanning Yu, Xueling Wei, Xuanzhen Wu, Wenjie Dai
Frontiers in Nutrition.2026;[Epub] CrossRef - Differential associations of beverage consumption with diabetic retinopathy: a systematic review and dose-response meta-analysis of observational studies
Siyan Liu, Xuan Wang, Guojun Chao, Wei Lu, Qi Wu, Yuxin Lv, Shuangshuang Yi, Zhengzheng Wu, Jing Yan
Frontiers in Medicine.2026;[Epub] CrossRef - Sugar rationing in the first 1000 days of life and risk of frailty: evidence from a natural experiment
Rui Zhang, Yuelan Gao, Hong Li, Yuhan Wei, Wanyang Zhong, Kai Tong, Zhibo Sun
The Journal of nutrition, health and aging.2026; 30(7): 100883. CrossRef - Influencing adolescents' beverage choices: An experimental study on the role of autonomy support and the availability of healthier options
Roselinde L. van Nee, Ellen van Kleef, Hans C.M. van Trijp
Appetite.2026; 226: 108618. CrossRef - Factors Influencing Water and Sweet Beverage Purchasing Decisions and Behaviours Among Low-Income Households in Four Peri-Urban Communities in Accra: An Exploratory Study
Christopher Delali Amegah, Gloria Adobea Odei Obeng-Amoako, Shu Wen Ng, Monica Lambon-Quayefio, Seth Adu-Afarwuah
International Journal of Environmental Research and Public Health.2026; 23(6): 799. CrossRef - Ten-year trends in sugar-sweetened beverages consumption among Koreans, 2014–2023
HyunJi Son, Khongorzul Ganbat, SuJin Song
Nutrition Research and Practice.2026; 20(4): 683. CrossRef
- Do Not Replace Your Sugar, Simply Eat Less!
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