Guideline / position statementindependent cross-checkabstract checked I-SOD-102 standard review
Diet drinks: short-term substitute, not a long-term goal
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.
Overview
Choi JH et al.. Diabetes Metab J 2026 · PMID 41531289 · DOI 10.4093/dmj.2025.0848
Korean experts found that swapping sugary drinks for diet drinks lowered weight slightly in trials, but long-term observational links to disease mean water is the better goal.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Give evidence-based advice on sugary and diet drinks.
- How was the study done?
Meta-analysis of trials plus review of cohort reviews.
- How many people, animals or samples were studied?
14 trials and 20 reviews.
- What was actually found?
Swapping lowered weight by 0.73 kg; long-term cohort links for both drink types.
- How large was the observed effect?
-0.73 kg body weight.
- What do the results mean in everyday life?
Diet drinks can help people cut sugary drinks, but water is best.
- What are the study's limitations?
Consensus; abstract reviewed.
- What does it say about Elawady's specific claim?
Partly supports 'diet soda is not a safe alternative'.
- Do the results apply to Germany and Europe?
Applicable in principle.
- What can explicitly not be concluded from this study?
Cannot settle whether sweeteners cause disease.
Scientific in-depth review
1. Full reference
- Authors
- Choi JH et al.
- Journal
- Diabetes Metab J
- Year
- 2026
- Identifier
- PMID 41531289 DOI 10.4093/dmj.2025.0848
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Not stated in abstract record
2. Research question
What are the benefits and harms of SSB and ASB, and should ASB replace SSB?
3. Study design and population
- Study design
- Guideline / position statement – Consensus statement based on an updated RCT meta-analysis (14 RCTs) and an umbrella review of 20 systematic reviews of cohorts
- Population
Adults
- Country
Korea (international evidence)
- Period
2025-2026
- Sample size
14 RCTs (3-76 weeks); 20 systematic reviews of cohorts
- Inclusion and exclusion criteria
RCTs replacing SSB with ASB; cohort reviews of long-term outcomes
4. Methods and endpoints
- Exposure / intervention
ASB replacing SSB; habitual SSB and ASB
- Comparator
SSB; low intake
- Endpoints
Body weight, body fat, glycaemic/cardiometabolic markers; T2D, CVD, mortality
- Statistical methods
Meta-analysis of RCTs; umbrella review
5. Actual results
- Results
Replacing SSB with ASB reduced body weight (-0.73 kg) and body fat (-0.72%), with inconsistent effects on glycaemic and cardiometabolic markers. Cohort reviews (up to 34 years) showed higher SSB and ASB intakes associated with increased T2D, CVD and mortality risk, with relative risks for ASB similar to SSB.
- Absolute risks
not reported
- Authors' conclusion
ASB may serve as a short-term substitute for people with high SSB intake; regular or long-term use not recommended; water and unsweetened beverages should be the goal.
6. Strengths
- Combines RCT and cohort evidence
- Professional-society consensus
- Recent (2026)
7. Weaknesses
- Consensus process; abstract only reviewed
- Korean focus of recommendations
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Consensus statement; methods not appraised in detail.
9. Assessment of the statistical interpretation
RCT benefit is short- to intermediate-term; cohort ASB risks may reflect confounding.
10. Relevance to the specific claim
Mixed for C-SOD-10: agrees that diet soda is not a long-term health solution, but shows short-term benefit when replacing sugary soda.
11. Independent contrary findings
McGlynn 2022 (I-SOD-103).
12. Transferability to Germany and Europe
Evidence international; recommendations national.
13. Overall methodological judgement
Balanced recent position consistent with WHO 2023 and ADA 2026.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | not assessable |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Long-term RCTs.
15. Linked fact checks
- Diet soda is not a safe alternative to sugary soda: artificially sweetened drinks are linked to higher mortality, especially circulatory deaths. – Studies with mixed or unclear results