每天一罐无糖汽水会使缺血性卒中和阿尔茨海默病痴呆的风险增至近三倍。
原始表述
تبيَّن أن مَن يشرب علبة دايت واحدة يومياً يرتفع لديه خطر السكتة الدماغية الإقفارية إلى ما يقرب من ثلاثة أضعاف (HR=2.96)، وخطر ألزهايمر أيضاً نحو ثلاثة أضعاف (HR=2.89).
按来源为原话. 译文由本项目提供；以阿拉伯语原文为准。
译文
每天一罐无糖汽水会使缺血性卒中和阿尔茨海默病痴呆的风险增至近三倍。
出处
- 来源状态
- 档案网站编辑
- 归属
- Archive editors (study selection and narrative are the archive's, not necessarily Elawady's)
- 出处
- https://eltayebat.com/rule/soda/
- 归属的不确定性
- The archive homepage states that the forbidden-food section is supported by research 'independently of Dr. Diaa's words'. No evidence was found that Elawady himself cited these studies.
- 所声称的机制
Artificial sweeteners (partly via gut microbiome, according to the archive).
- 所声称的健康影响
Ischaemic stroke, Alzheimer's dementia.
- 涉及人群
Adults >45/ >60 years
- Elawady 设定的地域限制
none found
科学评估
基本错误 – 该说法的主要部分没有证据支持，或被严重夸大。
证据确定性: 低 – 进一步研究很可能大幅改变该评估。
1. 说法是什么？
Daily diet soda roughly triples stroke and dementia risk.
2. 哪些内容可证实是正确的？
Pase 2017 (A-SOD-02) did report HR 2.96 (1.26-6.97) for ischaemic stroke and 2.89 (1.18-7.07) for Alzheimer's disease for daily cumulative intake vs none. Some larger studies also found positive, but much smaller, associations: WHI ischaemic stroke HR 1.31 for >=2/day (I-SOD-06); pooled Alzheimer RR 1.42 (I-SOD-105).
3. 哪些内容是错误或夸大的？
The 'triple' magnitude rests on few events and very wide CIs, and is not reproduced in larger studies: a multicohort analysis with about 23 times the statistical weight found no dementia association (I-SOD-104), and the stroke association in WHI was far smaller. In Pase 2017 itself, the dementia association was no longer significant after adjustment for cardiometabolic factors (all-cause dementia HR 1.70, 0.80-3.61; Alzheimer's HR 2.03, 0.83-4.97), daily diet-soda drinkers had about three times the diabetes prevalence, and many comparisons were uncorrected. The archive's 'more than 4,000 adults' is inaccurate (2,888 for stroke, 1,484 for dementia). The link to the 2014 microbiome paper is the archive's speculation. Reverse causation (people with obesity or diabetes switch to diet drinks) is a recognised problem.
4. 哪些内容仍不明确？
Whether artificially sweetened beverages have any causal effect on stroke or dementia.
5. 哪些研究支持该说法？
6. 哪些研究与该说法相矛盾？
I-SOD-104 (no dementia association in six cohorts), I-SOD-101 (stroke evidence weak), I-SOD-06 (much smaller stroke effect), I-SOD-105 (Alzheimer RR 1.42, not ~3); I-SOD-08 notes confounding in NSS evidence.
7. 对德国和欧洲而言情况如何？
EFSA and JECFA consider approved sweeteners safe within ADIs; no regulatory body has concluded that diet drinks cause stroke or dementia.
8. 关于埃及的已知情况是什么？
No Egypt-specific data.
9. 合理的实际结论是什么？
没有充分理由为了健康而喝无糖汽水，但“每天一罐会使卒中或痴呆风险增至三倍”的说法缺乏支持。
评估详情
- 证据确定性的依据
The 'nearly triple' estimates come from one small cohort (82 ischaemic strokes, 63 Alzheimer cases; very wide CIs). Larger datasets do not reproduce them: a six-cohort study of 10,974 older adults (I-SOD-104) found no association of diet drinks with dementia (HR 1.00, 0.83-1.21), a meta-analysis found a much smaller Alzheimer association (RR 1.42, I-SOD-105), WHI found ischaemic stroke HR 1.31 at >=2/day (I-SOD-06), and an umbrella review graded the stroke evidence as weak (I-SOD-101). Certainty is low because all data are observational and reverse causation is likely.
- 来源质量
Numbers reported correctly, but the archive presents an imprecise association from one small cohort as a near-tripling of risk and links it causally to the microbiome without evidence.
- 地区可推广性
Moderate.
- 个体例外情况
Not applicable.
- 说法的地域范围
- 普遍性（生物学/医学）
- 最近审核
- 2026年10月26日 初步
科学证据详解
过度解读 – 确有真实的发现，但该说法从中引申出的结论超出了数据所能支持的范围（例如把关联当作因果、把动物数据套用到人身上、把小效应说成大效应）。
研究问题: Does one diet soda per day nearly triple the risk of ischaemic stroke and Alzheimer's dementia?
研究问题详解 (PECO)
- 人群
- Adults
- 干预或暴露
- Artificially sweetened beverages >=1/day
- 对照
- None or low
- 地域范围
- universal
- 结局指标
- Ischaemic stroke
- Dementia/Alzheimer's disease
研究结果按作者报告呈现。我们的评估见下文。
哪些证据支持该说法？
Diet soda, stroke and dementia in Framingham
Pase 2017 (Framingham Offspring): daily cumulative ASB intake HR 2.96 for ischaemic stroke and 2.89 for Alzheimer's disease.
- 实际结果
- HR 2.96 (1.26-6.97); 2.89 (1.18-7.07).
- 方法学质量
- moderate (small cohort, high bias)
- 相关性
- direct
- 局限
- 82 and 63 events; dementia association not significant after full adjustment.
Possible modest link between sweetened drinks and Alzheimer's
Jouni N et al.. Aging Ment Health 2025 · PMID 40511662 · DOI 10.1080/13607863.2025.2512215 Meta分析已核查摘要新增Meta-analysis: ASB associated with Alzheimer's disease (RR 1.42).
- 实际结果
- RR 1.42 (1.14-1.78).
- 方法学质量
- moderate
- 相关性
- direct
- 局限
- Few studies; includes Pase.
哪些证据不支持该说法？
No dementia link for diet drinks in older adults
Chen H et al.. JAMA Psychiatry 2025 · PMID 40531522 · DOI 10.1001/jamapsychiatry.2025.1230 队列研究已核查摘要新增Six US cohorts (10,974 older adults, 2445 dementia cases): no association of ASB with dementia.
- 实际结果
- ASB >=1/day HR 1.00 (0.83-1.21).
- 方法学质量
- high
- 相关性
- direct
- 局限
- Late-life exposure.
Diet drinks and stroke in 81,000 women
WHI (81,714 women): ischaemic stroke HR 1.31 at >=2 ASB/day.
- 实际结果
- HR 1.31 (1.06-1.63).
- 方法学质量
- high
- 相关性
- direct
- 局限
- Observational.
Diet drinks linked to several diseases in observational data
Umbrella review: evidence for ASB and stroke graded weak.
- 实际结果
- Stroke: weak credibility.
- 方法学质量
- moderate
- 相关性
- direct
- 局限
- Observational.
总体证据说明了什么？
基于上述研究的编辑评估——其本身并非研究结果。
哪种观点有更好的证据支持？
Larger and more precise studies do not reproduce a tripling: stroke associations are about 1.3 at higher intakes, Alzheimer associations about 1.4 in a small meta-analysis, and a large multicohort study found no dementia association.
为什么有些研究权重更大
Estimates with 20-fold greater statistical weight (Chen 2025) and larger cohorts (WHI) outweigh one small cohort.
因果关系是否已确立？ 尚未确立 Reverse causation (people with obesity/diabetes choose diet drinks) likely.
仍存在的不确定性
Whether any modest causal effect exists.
合理的结论
The 'nearly triple' figure is not reliable.
为什么研究结果看起来互相矛盾？
Pase (AD) vs Chen (all-cause dementia): different outcomes, ages and adjustment; Chen includes the Framingham offspring cohort. The difference between Pase's AD estimate and Chen's estimate is statistically significant (ratio 2.89, p=0.023).
这是否取决于国家？
- 一般生物学效应
- Universal.
- 法律规则
- Sweeteners authorised in the EU with ADIs.
足以改变结论的地区差异没有可靠数据支持。
统计复核
- Precision and comparison with larger studies – Pase AD SE(log) 0.457 vs Chen 0.096 (Chen ~23 times the weight); ratio Pase/Chen 2.89 (p=0.023); Pase/WHI stroke 2.26 (p=0.07) 已重新计算
总体证据的确定性（GRADE，简化版）
- 主要结局
- Stroke and dementia with ASB
- 起始等级
- 低（观察性研究）
- 降级理由
- imprecision
- risk of bias (reverse causation)
- inconsistency
- 结果
- 低
由单名审查者参照 GRADE 方法进行的简化评估；并非正式的 GRADE 专家组评估。GRADE 评价的是针对某一结局的整体证据，而非单项研究。
已核查的临床指南和官方声明
- WHO: Use of non-sugar sweeteners: WHO guideline (2023), publication page (I-SOD-08) (2023) · 原始文献
Guidance on NSS use to reduce unhealthy weight gain and NCD risk; not based on toxicological safety assessment and not intended to replace JECFA acceptable daily intakes; accompanying news release: recommends against NSS for weight control (conditional).
检索策略
本次审查的文献检索记录（检索式采用原数据库语法）。
| 数据库 | 日期 | 检索式 | 检索目标 | 命中数 | 纳入数 |
|---|---|---|---|---|---|
| Europe PMC | 2026年10月26日 | ("artificially sweetened" OR "diet soda" OR "diet soft drink" OR "low-calorie sweetened" OR "non-sugar sweetener") AND (dementia OR "Alzheimer") AND (cohort OR "meta-analysis") | 双向 | 176 | |
| Europe PMC | 2026年10月26日 | ("artificially sweetened beverages" OR "diet soda") AND TITLE:(stroke) AND (cohort OR meta-analysis) | 双向 | 27 | |
| Europe PMC | 2026年10月26日 | (TITLE:"non-sugar sweeteners" OR TITLE:"artificially sweetened beverages" OR TITLE:"artificial sweeteners") AND (mortality OR cardiovascular OR stroke OR dementia) AND (meta-analysis) AND PUB_YEAR:[2019 TO 2026] | 双向 | 63 |
待解决的问题
Midlife ASB intake and Alzheimer-specific outcomes.
核查深度如何？
6 项相关研究：2 项核查了全文（其中 1 项进行了结构化偏倚风险评估），4 项基于摘要核查，0 项仅核查了文献信息。 尚未进行由两名独立审查者完成的正式评估，也尚未进行独立的人类专家审核。
最近一次科学审核: 2026年10月26日
评定结论的变更历史
- 2026年10月25日 · 第 1 阶段 · 初始评估: 可能错误 (极低)
- 2026年10月26日 · 第 4 阶段（系统证据审查） · 评定结论已更改: 可能错误 (极低) → 基本错误 (低)
Changed because the evidence base changed: a large multicohort study (I-SOD-104) found no dementia association and the meta-analysis (I-SOD-105) found a much smaller Alzheimer association; together with WHI they make the 'nearly triple' magnitude unlikely with low (no longer very low) certainty.
新来源: I-SOD-101 I-SOD-104 I-SOD-105
通俗解释
一项不足3,000人的美国研究发现，每天喝无糖汽水的人发生卒中和阿尔茨海默病的次数约为三倍。但病例数很少，不确定性非常大。规模大得多的研究发现，与卒中的关联要小得多；而在约11,000名老年人中，与痴呆则完全没有关联。有体重或糖尿病问题的人常常改喝无糖饮料，这可能会产生此类关联，而饮料本身并不是原因。
与该说法相关的研究
支持该说法的研究 (0)
该组中没有研究。
与该说法相矛盾或限制该说法的研究 (4)
-
Diet drinks and stroke in 81,000 women
Mossavar-Rahmani Y et al.. Stroke 2019 · PMID 30802187 · DOI 10.1161/STROKEAHA.118.023100队列研究独立交叉核查已核查摘要Women drinking two or more diet drinks daily had 31% more ischaemic strokes; far less than the 'triple' figure.
该研究是否支持这一具体说法？ 部分支持 · 方法学质量: 高 · 证据确定性：见该说法的总体评估
研究通俗解读
- 研究人员想了解什么？
Is ASB intake associated with stroke, CHD and mortality?
- 研究是如何开展的？
Prospective cohort (WHI Observational Study).
- 研究了多少人、动物或样本？
81,714; Postmenopausal women 50-79
- 实际发现了什么？
>=2 ASB/day vs <1/week: all stroke HR 1.23 (1.02-1.47); ischaemic stroke 1.31 (1.06-1.63); CHD 1.29 (1.11-1.51); all-cause mortality 1.16 (1.07-1.26); small-artery occlusion stroke 2.44 in women without CVD/diabetes.
- 观察到的效应有多大？
HR 1.31 (1.06-1.63) ischaemic stroke
- 研究结果对日常生活意味着什么？
A modest association, possibly confounded.
- 该研究有哪些局限？
Reverse causation; Single population; Observational design; residual confounding possible; Self-reported dietary intake
- 它对 Elawady 的具体说法说明了什么？
Mixed/limiting for C-SOD-06 (direction supported, magnitude much smaller).
- 研究结果是否适用于德国和欧洲？
Moderate.
- 从该研究中明确不能得出什么结论？
Causation.
-
WHO on non-sugar sweeteners
World Health Organization. WHO news release 2023指南 / 立场声明独立交叉核查已核查全文★ 关键研究WHO advises not to use sweeteners for weight control, because no long-term benefit was shown; possible harms may be confounded.
该研究是否支持这一具体说法？ 部分支持 · 方法学质量: 高 · 证据确定性：见该说法的总体评估
研究通俗解读
- 研究人员想了解什么？
Should NSS be used for weight control/NCD risk reduction?
- 研究是如何开展的？
International guideline (news release read in full).
- 研究了多少人、动物或样本？
Not applicable; All people except those with pre-existing diabetes
- 实际发现了什么？
Recommends against NSS to control weight or reduce NCD risk; NSS confer no long-term benefit for body fat; potential undesirable effects (T2D, CVD, mortality) from long-term use; recommendation conditional because observed links might be confounded by baseline characteristics and complicated patterns of NSS use.
- 观察到的效应有多大？
Not applicable
- 研究结果对日常生活意味着什么？
Water or unsweetened drinks are preferable.
- 该研究有哪些局限？
Conditional; observational evidence for harms
- 它对 Elawady 的具体说法说明了什么？
- 研究结果是否适用于德国和欧洲？
Applies globally.
- 从该研究中明确不能得出什么结论？
That sweeteners cause disease.
-
Diet drinks linked to several diseases in observational data
Diaz C et al.. Adv Nutr 2023 · PMID 37187453 · DOI 10.1016/j.advnut.2023.05.010系统综述独立交叉核查已核查摘要★ 关键研究Across many studies, regular diet-drink consumers had more obesity, diabetes, hypertension, heart disease and deaths; stroke and heart-death links were weak.
Stroke evidence graded weak.
该研究是否支持这一具体说法？ 部分支持 · 方法学质量: 中 · 证据确定性：见该说法的总体评估
研究通俗解读
- 研究人员想了解什么？
Grade the credibility of links between diet drinks and health.
- 研究是如何开展的？
Umbrella review of meta-analyses.
- 研究了多少人、动物或样本？
55 underlying studies.
- 实际发现了什么？
Several associations highly suggestive; stroke and cardiovascular mortality weak.
- 观察到的效应有多大？
Credibility classes, not single effect sizes.
- 研究结果对日常生活意味着什么？
Diet drinks are not proven healthy; causation unclear.
- 该研究有哪些局限？
Observational; reverse causation likely.
- 它对 Elawady 的具体说法说明了什么？
Partly supports 'diet soda is not a safe alternative'; does not support strong stroke effects.
- 研究结果是否适用于德国和欧洲？
Applicable.
- 从该研究中明确不能得出什么结论？
Cannot show that sweeteners cause these diseases.
-
No dementia link for diet drinks in older adults
Chen H et al.. JAMA Psychiatry 2025 · PMID 40531522 · DOI 10.1001/jamapsychiatry.2025.1230队列研究独立交叉核查已核查摘要★ 关键研究Across six US cohorts with about 11,000 older adults, diet drinks were not linked to dementia (HR 1.00).
No association of ASB with dementia (HR 1.00, 0.83-1.21).
该研究是否支持这一具体说法？ 否 · 方法学质量: 高 · 证据确定性：见该说法的总体评估
研究通俗解读
- 研究人员想了解什么？
Test whether sweetened drinks predict dementia in older adults.
- 研究是如何开展的？
Pooled six long-term cohorts.
- 研究了多少人、动物或样本？
10,974 adults aged 65+; 2445 dementia cases.
- 实际发现了什么？
No association for sugary or diet drinks.
- 观察到的效应有多大？
ASB >=1/day HR 1.00 (0.83-1.21).
- 研究结果对日常生活意味着什么？
Fear of tripled dementia risk from diet soda is not supported.
- 该研究有哪些局限？
Late-life intake only.
- 它对 Elawady 的具体说法说明了什么？
Contradicts the claim.
- 研究结果是否适用于德国和欧洲？
Applicable.
- 从该研究中明确不能得出什么结论？
Cannot exclude effects of drinking diet soda in midlife.
该组中没有被标记为关键研究的研究。
结果不一或不明确的研究 (2)
-
Diet soda, stroke and dementia in Framingham
Pase MP et al.. Stroke 2017 · PMID 28428346 · DOI 10.1161/STROKEAHA.116.016027队列研究被 Tayebat 档案网站引用全文，含结构化偏倚风险评估★ 关键研究Daily diet-soda drinkers had about three times more ischaemic strokes and Alzheimer's disease, but with very few cases and wide uncertainty.
该研究是否支持这一具体说法？ 部分支持 · 方法学质量: 中 · 证据确定性：见该说法的总体评估
研究通俗解读
- 研究人员想了解什么？
Are sugar- or artificially sweetened beverages associated with incident stroke or dementia?
- 研究是如何开展的？
Prospective cohort (Framingham Offspring); FFQ at exams 5-7; 10-year surveillance; Cox models.
- 研究了多少人、动物或样本？
2,888 (stroke; 97 strokes, 82 ischaemic); 1,484 (dementia; 81 cases, 63 Alzheimer); Framingham Offspring participants >45 y (stroke) and >60 y (dementia)
- 实际发现了什么？
Daily cumulative ASB vs 0/week: ischaemic stroke HR 2.96 (1.26-6.97); Alzheimer's disease HR 2.89 (1.18-7.07). SSB not associated with stroke or dementia.
- 观察到的效应有多大？
HR 2.96 (1.26-6.97); HR 2.89 (1.18-7.07)
- 研究结果对日常生活意味着什么？
A worrying signal, but too imprecise to state a tripled risk.
- 该研究有哪些局限？
Few events; wide CIs; diabetes far more common in diet-soda drinkers; dementia result not robust to full adjustment; many comparisons
- 它对 Elawady 的具体说法说明了什么？
Only direct evidence for C-SOD-06.
- 研究结果是否适用于德国和欧洲？
Moderate.
- 从该研究中明确不能得出什么结论？
That diet soda causes stroke or dementia.
-
Possible modest link between sweetened drinks and Alzheimer's
Jouni N et al.. Aging Ment Health 2025 · PMID 40511662 · DOI 10.1080/13607863.2025.2512215Meta分析独立交叉核查已核查摘要Pooling seven cohort studies, diet drinks were linked to 42% higher Alzheimer's risk, far less than a tripling.
ASB-AD RR 1.42, not ~3.
该研究是否支持这一具体说法？ 部分支持 · 方法学质量: 中 · 证据确定性：见该说法的总体评估
研究通俗解读
- 研究人员想了解什么？
Pool cohort studies on sweetened drinks and Alzheimer's.
- 研究是如何开展的？
Meta-analysis of prospective cohorts.
- 研究了多少人、动物或样本？
Seven studies in the pooled analysis.
- 实际发现了什么？
Sugary and diet drinks were both linked to higher Alzheimer's risk.
- 观察到的效应有多大？
ASB RR 1.42 (1.14-1.78).
- 研究结果对日常生活意味着什么？
A possible modest link; not proof.
- 该研究有哪些局限？
Few studies; includes the archive's study.
- 它对 Elawady 的具体说法说明了什么？
Supports direction, not the size, of the claim.
- 研究结果是否适用于德国和欧洲？
Applicable.
- 从该研究中明确不能得出什么结论？
Cannot prove causation.
该组中没有被标记为关键研究的研究。
地区背景
德国 / 欧盟
EFSA and JECFA consider approved sweeteners safe within ADIs; no regulatory body has concluded that diet drinks cause stroke or dementia.
埃及
No Egypt-specific data.
在我的国家适用什么？
一般科学评估
基本错误 基本错误：“风险增至三倍”这一数字来自一项小型研究，并未在更大规模的研究中得到重复，这些研究最多只显示出小幅关联。
以下食品安全领域与该说法相关：
- 添加剂与加工
- 监管、进口、召回、标签
蜂蜜、糖、甜食
选择一个国家，查看针对该国已核查的信息。
局限：法律规则描述的是允许什么，而不是每一种食品实际含有什么。检测数据来自样本，只有结合其方法细节才有意义。
参考文献
- Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women's Health Initiative.. Mossavar-Rahmani Y et al.. Stroke 2019 · PMID 30802187 · DOI 10.1161/STROKEAHA.118.023100
- WHO advises not to use non-sugar sweeteners for weight control in newly released guideline (Use of non-sugar sweeteners: WHO guideline, 2023) — news release. World Health Organization. WHO news release 2023
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