A Dutch cohort study suggests that swapping sugary drinks for diet alternatives may not uniformly reduce type 2 diabetes risk, particularly among non-Dutch populations and younger adults, highlighting the need for tailored dietary guidelines.
A new Dutch cohort study suggests that swapping sugary drinks for diet alternatives may not be the simple health win many consumers expect. In the Amsterdam-based analysis, higher intake of non-sugar-sweetened beverages was linked with a greater risk of type 2 diabetes, especially among people with a body mass index of 25 or above and among participants of non-Dutch origin. Researchers also found that replacing one daily serving of sugar-sweetened drinks with non-sugar-sweetened options was associated with a higher diabetes risk in younger adults and in people of non-Dutch origin.
The study, led by Sara Beigrezaei of the Julius Centre for Health Sciences and Primary Care at the University Medical Centre Utrecht and published in the European Journal of Nutrition, followed 2,612 adults in a multi-ethnic cohort drawn from Amsterdam. Participants, who were Dutch, Surinamese, Turkish and Moroccan in origin, completed ethnicity-specific food questionnaires between 2011 and 2015 and were followed until 2019 to 2022. Over a median 7.08 years, 141 people developed type 2 diabetes.
After adjustment, drinking more than one serving a day of non-sugar-sweetened beverages was associated with a higher diabetes risk across the full group, with the strongest signal in participants of non-Dutch origin. Among adults aged 18 to 49, even up to one serving a day was linked with increased risk, while the association was also stronger in those with overweight or obesity. By contrast, sugar-sweetened drinks were not tied to diabetes risk overall, although higher intake was associated with more risk among Dutch participants.
Those findings sit uneasily beside a broader evidence base that has consistently pointed in the opposite direction for sugary drinks. Reviews for the 2025 Dietary Guidelines Advisory Committee and the National Institutes of Health both concluded that higher sugar-sweetened beverage intake is associated with a higher risk of type 2 diabetes, with evidence graded as moderate. Earlier meta-analyses have reported similar links, and researchers have pointed to weight gain, insulin resistance and inflammation as likely pathways. The Amsterdam study does not overturn that literature, but it adds a complication: diet drinks may not be a straightforward substitute in every group.
The authors cautioned that the study’s size was modest and that the number of diabetes cases was relatively small, limiting statistical power, particularly in subgroups. As an observational study, it also cannot prove cause and effect. Still, the researchers said the results underline the need for more interventional and mechanistic research before non-sugar-sweetened beverages are widely promoted as universally healthier replacements for sugary drinks.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
