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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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

Basic Research
The Effects of Exercise and Restriction of Sugar-Sweetened Beverages on Muscle Function and Autophagy Regulation in High-Fat High-Sucrose-Fed Obesity Mice: Didi Zhang, Ji Hyun Lee, Hyung Eun Shin, Seong Eun Kwak, Jun Hyun Bae, Liang Tang, Wook Song; Diabetes Metab J. 2021;45(5):773-786. Published online March 25, 2021; DOI: https://doi.org/10.4093/dmj.2020.0157

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296 Download
7 Web of Science
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Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
Autophagy maintains muscle mass and healthy skeletal muscles. Several recent studies have associated sugar-sweetened beverage (SSB) consumption with diseases. We investigated whether muscle dysfunction due to obesity could be restored by SSB restriction (SR) alone or in combination with exercise (EX) training.
Methods
Obese mice were subjected to SR combined with treadmill EX. Intraperitoneal glucose tolerance test, grip strength test, hanging time test, and body composition analysis were performed. Triglyceride (TG) and total cholesterol (TC) serum concentrations and TG concentrations in quadriceps muscles were analyzed. Western blot and reverse transcription-quantitative polymerase chain reaction helped analyze autophagy-related protein and mRNA expression, respectively.
Results
SR alone had no significant effect on fasting blood glucose levels, glucose tolerance, and muscle function. However, it had effect on serum TC, serum TG, and BCL2 interacting protein 3 expression. SR+EX improved glucose tolerance and muscle function and increased serum TC utilization than SR alone. SR+EX reduced P62 levels, increased glucose transporter type 4 and peroxisome proliferator-activated receptor γ coactivator-1α protein expression, and improved grip strength relative to the high-fat and high-sucrose liquid (HFHS) group, and this was not observed in the HFHS+EX group.
Conclusion
SR induced mitophagy-related protein expression in quadriceps, without affecting muscle function. And, the combination of SR and EX activated mitophagy-related proteins and improved muscle function.

Citations

Citations to this article as recorded by

Electroacupuncture Ameliorates Premature Ovarian Insufficiency by Inhibiting METTL3‐Mediated m6A Methylation of Beclin 1 mRNA in Granulosa Cells
Lele Ling, Sining He, Xue Zhao, Yaran Sheng, Mengying Hong, Long Yuan, Peng Liu, Boliang Ke, Bingrong Li, Bimeng Zhang
Food Science & Nutrition.2026;[Epub] CrossRef
Mitochondrial Dysfunction, Oxidative Stress, and Inter-Organ Miscommunications in T2D Progression
Rajakrishnan Veluthakal, Diana Esparza, Joseph M. Hoolachan, Rekha Balakrishnan, Miwon Ahn, Eunjin Oh, Chathurani S. Jayasena, Debbie C. Thurmond
International Journal of Molecular Sciences.2024; 25(3): 1504. CrossRef
The association between healthy beverage index and sarcopenia in Iranian older adults: a case-control study
Marzieh Mahmoodi, Zainab Shateri, Mehran Nouri, Mohebat Vali, Nasrin Nasimi, Zahra Sohrabi, Mohammad Hossein Dabbaghmanesh, Maede Makhtoomi
BMC Geriatrics.2024;[Epub] CrossRef
Interplay of skeletal muscle and adipose tissue: sarcopenic obesity
Min Jeong Park, Kyung Mook Choi
Metabolism.2023; 144: 155577. CrossRef
Association between sugar-sweetened beverage consumption frequency and muscle strength: results from a sample of Chinese adolescents
Yunjie Zhang, Pan Xu, Yongjing Song, Nan Ma, Jinkui Lu
BMC Public Health.2023;[Epub] CrossRef
Muscle strength and prediabetes progression and regression in middle‐aged and older adults: a prospective cohort study
Shanhu Qiu, Xue Cai, Yang Yuan, Bo Xie, Zilin Sun, Duolao Wang, Tongzhi Wu
Journal of Cachexia, Sarcopenia and Muscle.2022; 13(2): 909. CrossRef
INTENSITY OF FREE RADICAL PROCESSES IN RAT SKELETAL MUSCLES UNDER THE CONDITIONS OF DIFFERENT DIETARY SUPPLY WITH NUTRIENTS
O.M. Voloshchuk, Н.P. Kopylchuk
Fiziolohichnyĭ zhurnal.2022; 68(4): 48. CrossRef

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