Effects of Low-Calorie Sweetener Restriction on Glycemic Variability and Cardiometabolic Health in Children with Type 1 Diabetes: Findings of a Pilot and Feasibility Study

Allison C Sylvetsky; Hailey R Moore; Xinyu Zhu; Jasmine H Kaidbey; Leyi Kang; Abbas Saeed; Shazmeena Khattak; Mariana F Grilo; Natalie Vallone; Janae Kuttamperoor; Fran R Cogen; Angelo Elmi; Peter J Walter; Hongyi Cai; Loretta DiPietro; Michael I Goran; Randi Streisand

doi:10.3390/nu15183867

Effects of Low-Calorie Sweetener Restriction on Glycemic Variability and Cardiometabolic Health in Children with Type 1 Diabetes: Findings of a Pilot and Feasibility Study

Nutrients. 2023 Sep 5;15(18):3867. doi: 10.3390/nu15183867.

Authors

Allison C Sylvetsky¹, Hailey R Moore², Xinyu Zhu³, Jasmine H Kaidbey¹, Leyi Kang², Abbas Saeed¹, Shazmeena Khattak¹, Mariana F Grilo¹, Natalie Vallone¹, Janae Kuttamperoor¹, Fran R Cogen^{4

5}, Angelo Elmi⁶, Peter J Walter⁷, Hongyi Cai⁷, Loretta DiPietro¹, Michael I Goran⁸, Randi Streisand^{2

5}

Affiliations

¹ Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Suite 200, Washington, DC 20052, USA.
² Division of Psychology & Behavioral Health, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA.
³ Nutrition and Health Sciences Program, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA.
⁴ Division of Endocrinology, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA.
⁵ School of Medicine and Health Sciences, The George Washington University, 2300 I St. NW, Washington, DC 20052, USA.
⁶ Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Suite 200, Washington, DC 20052, USA.
⁷ Clinical Mass Spectrometry Lab, National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, MD 20892, USA.
⁸ Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.

Abstract

Low-calorie sweeteners (LCS) are commonly consumed by children with type 1 diabetes (T1D), yet their role in cardiometabolic health is unclear. This study examined the feasibility, acceptability, and preliminary effects of 12 weeks of LCS restriction among children with T1D. Children (n = 31) with T1D completed a two-week run-in (n = 28) and were randomly assigned to avoid LCS (LCS restriction, n = 15) or continue their usual LCS intake (n = 13). Feasibility was assessed using recruitment, retention, and adherence rates percentages. Acceptability was assessed through parents completing a qualitative interview (subset, n = 15) and a satisfaction survey at follow-up. Preliminary outcomes were between-group differences in change in average daily time-in-range (TIR) over 12 weeks (primary), and other measures of glycemic variability, lipids, inflammatory biomarkers, visceral adiposity, and dietary intake (secondary). Linear regression, unadjusted and adjusted for age, sex, race, and change in BMI, was used to compare mean changes in all outcomes between groups. LCS restriction was feasible and acceptable. No between-group differences in change in TIR or other measures of glycemic variability were observed. However, significant decreases in TNF-alpha (-0.23 ± 0.08 pg/mL) and improvements in cholesterol (-0.31 ± 0.18 mmol/L) and LDL (-0.60 ± 0.39 mmol/L) were observed with usual LCS intake, compared with LCS restriction. Those randomized to LCS restriction did not report increases in total or added sugar intake, and lower energy intake was reported in both groups (-190.8 ± 106.40 kcal LCS restriction, -245.3 ± 112.90 kcal usual LCS intake group). Decreases in percent energy from carbohydrates (-8.5 ± 2.61) and increases in percent energy from protein (3.2 ± 1.16) and fat (5.2 ± 2.02) were reported with usual LCS intake compared with LCS restriction. Twelve weeks of LCS restriction did not compromise glycemic variability or cardiometabolic outcomes in this small sample of youth with T1D. Further examination of LCS restriction among children with T1D is warranted.

Keywords: artificial sweetener; beverages; diet soda; glycemic control; metabolism; sugar; sugar substitutes.

Grants and funding

R21DK12234501A1/DK/NIDDK NIH HHS/United States