Meta-analysisindependent cross-checkabstract checked I-UPF-116 standard review

Diet drinks and heart disease

Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages and Risk of Cardiovascular Disease: A Meta-Analysis and Systematic Review.

Overview

Yin J et al.. Adv Nutr 2021 · PMID 32696948 · DOI 10.1093/advances/nmaa084

Each daily diet drink was linked to 7% more cardiovascular disease across cohort studies; the authors warn this may reflect who drinks them.

Does the study support the specific claim? Partly · Methodological quality: moderate

Study explained simply

What did the researchers want to find out?: To link sweetened drinks with heart disease.
How was the study done?: Meta-analysis of cohorts.
How many people, animals or samples were studied?: 8 articles on diet drinks.
What was actually found?: Diet and sugary drinks both linked to more CVD.
How large was the observed effect?: RR 1.07 per serving.
What do the results mean in everyday life?: Water is the safest choice.
What are the study's limitations?: Reverse causation.
What does it say about Elawady's specific claim?: Supports the association in C-UPF-07.
Do the results apply to Germany and Europe?: Applicable.
What can explicitly not be concluded from this study?: Cannot prove sweeteners cause CVD.

Authors: Yin J et al.
Journal: Adv Nutr
Year: 2021
Identifier: PMID 32696948 DOI 10.1093/advances/nmaa084 · PMC7850046
Verification: verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: No COI statement in PubMed record; funding listed: NIMHD NIH HHS

Are sugar-sweetened (SSB) and low-calorie sweetened beverages (LCSB) associated with CVD?

Study design: Meta-analysis – Meta-analysis of prospective cohort studies
Population: Adults in cohorts
Country: Multinational
Period: Search to 1 December 2019
Sample size: 8 articles on LCSB (18,077 incident CVD cases, 14,114 CVD deaths); 11 on SSB
Inclusion and exclusion criteria: Prospective cohorts

Results: LCSB: +1 serving/day CVD incidence RR 1.07 (1.05-1.10; I2 0%); CVD mortality association non-linear, significant above 2 servings/day. SSB: CVD incidence RR 1.08 (1.02-1.14); CVD mortality 1.08 (1.04-1.13).
Absolute risks: not reported in abstract
Authors' conclusion: LCSB were associated with higher CVD risk, but interpretation may be complicated by reverse causation and residual confounding.

Upper CI rounding asymmetry minor.

Shows the CVD link for sweetened (diet) drinks is replicated across cohorts, beyond NutriNet-Sante.

Reverse causation acknowledged by authors.

Applicable.

Supports 'linked to CVD' as an association.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	moderate
Risk of bias	some concerns
Precision of results	high
Directness	indirect
Reproducibility	replicated
Consistency with the overall evidence	consistent
Regional transferability	high
Adequacy of the interpretation (by the archive)	not applicable

Causality.