TABLE 5.
Consumption of artificially sweetened beverages during the past year and adjusted associations with cardiometabolic outcomes among women with a history of gestational diabetes1
| Habitual artificially sweetened beverage intake at follow-up (2012–2014) | ||||||
|---|---|---|---|---|---|---|
| n | <1 serving/mo | 1–4 servings/mo | 2–6 servings/wk | ≥1 servings/d | P-trend | |
| Continuous outcomes (2012–2014)2 | ||||||
| HbA1c | 603 | 0.0 (Reference) | −0.7 (−3.3, 1.9) | 3.0 (0.6, 5.5)* | 6.5 (1.9, 11.3)* | 0.007* |
| Fasting glucose | 603 | 0.0 (Reference) | 0.6 (−3.1, 4.4) | 4.5 (0.2, 9.1)* | 7.0 (−0.4, 14.9) | 0.11 |
| Fasting insulin | 600 | 0.0 (Reference) | 6.8 (−6.9, 22.5) | −3.0 (−14.4, 9.9) | −7.8 (−26.0, 14.9) | 0.39 |
| C-peptide | 601 | 0.0 (Reference) | 4.1 (−5.2, 14.4) | −2.9 (−10.7, 5.7) | −7.5 (−19.2, 5.9) | 0.20 |
| HOMA-IR | 599 | 0.0 (Reference) | 7.4 (−7.5, 24.8) | 2.4 (−10.4, 17.0) | −1.1 (−20.5, 22.9) | 0.74 |
| HOMA-B | 599 | 0.0 (Reference) | 4.3 (−9.3, 19.9) | −13.7 (−24.8, −1.0)* | −18.9 (−38.6, 7.1) | 0.17 |
| Triglycerides | 601 | 0.0 (Reference) | −2.2 (−11.3, 7.9) | 4.2 (−4.7, 14.0) | 5.8 (−8.1, 21.9) | 0.44 |
| HDL | 601 | 0.0 (Reference) | 2.7 (−2.9, 8.6) | 1.3 (−3.6, 6.4) | 1.1 (−6.0, 8.7) | 0.97 |
| LDL | 592 | 0.0 (Reference) | −5.6 (−12.2, 1.5) | −4.1 (−9.7, 1.8) | −1.8 (−9.8, 6.8) | 0.89 |
| BMI | 606 | 0.0 (Reference) | 3.0 (−0.2, 6.2) | 0.8 (−2.2, 4.0) | 2.5 (−2.8, 8.2) | 0.52 |
| Waist circumference | 606 | 0.0 (Reference) | 2.9 (0.3, 5.6)* | 0.3 (−1.7, 2.4) | 1.1 (−1.8, 4.2) | 0.79 |
| Visceral adipose tissue | 192 | 0.0 (Reference) | 10.4 (−21.7, 55.7) | 4.4 (−22.6, 40.8) | −7.4 (−37.5, 37.4) | 0.55 |
| Mean arterial pressure | 607 | 0.0 (Reference) | 0.3 (−2.6, 3.2) | −0.4 (−2.6, 1.9) | 2.6 (−0.9, 6.1) | 0.11 |
| CRP | 600 | 0.0 (Reference) | −5.8 (−29.3, 25.5) | −6.4 (−25.4, 17.4) | −9.8 (−33.7, 22.7) | 0.61 |
| ALT3 | 284 | 0.0 (Reference) | 2.6 (−12.7, 20.5) | 8.2 (−4.8, 22.9) | 2.4 (−12.4, 19.8) | 0.94 |
| AST3 | 283 | 0.0 (Reference) | −10.8 (−21.3, 1.2) | −2.1 (−10.8, 7.5) | −3.9 (−14.9, 8.5) | 0.90 |
| AST:ALT ratio3 | 283 | 0.0 (Reference) | −13.2 (−22.7, −2.5)* | −9.2 (−17.0, −0.6)* | −6.4 (−16.3, 4.8) | 0.92 |
| Liver fat %3,4 | 280 | 0.0 (Reference) | −6.4 (−26.3, 18.7) | 10.7 (−8.8, 34.3) | −1.0 (−23.5, 28.1) | 0.84 |
| GGT3 | 286 | 0.0 (Reference) | 8.9 (−18.5, 45.7) | −4.5 (−20.4, 14.6) | 4.7 (−16.4, 31.2) | 0.69 |
| Bilirubin3 | 285 | 0.0 (Reference) | 7.0 (−11.2, 29.0) | 5.2 (−8.7, 21.2) | −4.0 (−18.4, 13.0) | 0.31 |
| Binary outcomes (2012–2014)5 | ||||||
| Hyperglycemia | 603 | 1.00 (Reference) | 1.12 (0.47, 2.69) | 1.80 (0.95, 3.42) | 1.69 (0.74, 3.83) | 0.41 |
| Type 2 diabetes | 607 | 1.00 (Reference) | 1.03 (0.65, 1.65) | 1.34 (0.95, 1.91) | 1.13 (0.75, 1.71) | 0.94 |
| Hypertriglyceridemia | 601 | 1.00 (Reference) | 0.66 (0.21, 2.05) | 1.33 (0.67, 2.62) | 1.31 (0.57, 3.01) | 0.50 |
| Obesity | 606 | 1.00 (Reference) | 1.25 (0.91, 1.70) | 1.21 (0.93, 1.57) | 1.29 (0.95, 1.74) | 0.26 |
| Elevated ALT3 | 284 | 1.00 (Reference) | 0.87 (0.59, 1.30) | 1.17 (0.89, 1.53) | 1.05 (0.77, 1.45) | 0.83 |
| Elevated AST:ALT ratio3 | 284 | 1.00 (Reference) | 0.29 (0.07, 1.15) | 0.51 (0.24, 1.08) | 0.74 (0.29, 1.89) | 0.86 |
| Elevated liver fat score3,6 | 280 | 1.00 (Reference) | 1.11 (0.69, 1.78) | 1.39 (0.96, 2.00) | 1.29 (0.87, 1.93) | 0.43 |
Analyses adjusted for current characteristics, including maternal age, parity, education, smoking, moderate/vigorous physical activity, Alternative Healthy Eating Index–2010, intake of tea, intake of coffee, and prepregnancy chronic diseases at the index pregnancy. Multiple imputation with 20 replicates was used for missing exposure and covariate data. *Statistical significance, P < 0.05. ALT, alanine aminotransferase; AST, aspartate aminotransferase; fs, fasting serum; GGT, γ-glutamyltransferase; HOMA-B, homeostatic model assessment for β-cell function; T2DM, type 2 diabetes mellitus.
Continuous outcomes were log-transformed. Results are presented as the percentage difference (95% CI) calculated as the exponentiated β coefficient from the adjusted model, subtracting 1 and multiplying by 100.
Outcomes related to liver function exclude women with habitual alcohol intake >24 g/d, approximately equivalent to 2 standard drinks/d.
Calculated liver fat % = 10(−0.805 + 0.282 × metabolic syndrome (yes = 1; no = 0) + 0.078 × T2DM (yes = 2; no = 0) + 0.525 × log(fs-insulin [mU/L]) + 0.521 × log(fs-AST [U/L]) – 0.454 × log(AST/ALT)).
Binary outcomes are presented as RR (95% CI). The following definitions were used for the binary outcomes: elevated ALT, ≥19.0 U/L; elevated AST:ALT ratio, ratio ≥2; liver fat score, > −0.640; hypertriglyceridemia, triglycerides ≥200 mg/dL; hyperglycemia, fasting glucose ≥7.0 mmol/L; type 2 diabetes, HbA1C ≥6.5%, fasting glucose ≥7.0 mmol/L, or 2-h oral glucose tolerance test glucose ≥11.1 mmol/L or self-report of physician diagnosis; obesity, BMI ≥30.0.
Liver fat score = −2.89 + 1.18 × metabolic syndrome (yes = 1/no = 0) + 0.45 × T2DM (yes = 2/no = 0) + insulin (mU/L) + 0.04 × AST (U/L) – 0.94 × AST/ALT.