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Study on Diet Soft Drink during Pregnancy and Childhood Asthma Risk has Limitations

ATLANTA (March 13, 2013) — In the study, “Consumption of Artificially-Sweetened Soft Drinks in Pregnancy and Risk of Child Asthma and Allergic Rhinitis” published by Maslova et al in the American Journal of Clinical Nutrition, the study authors examined the relationship between intake of low-calorie sweetened (LCS) beverages during pregnancy with child asthma and allergic rhinitis at 18 months and 7 years in over 60,000 women in the Danish National Birth Cohort1. They found that at 18 months, mothers who consumed more LCS non-carbonated soft drinks were 1.23 (95% CI: 1.13, 1.33) times more likely to report a child asthma diagnosis compared to non-consumers. The authors concluded, “consumption of artificially-sweetened soft drinks during pregnancy may play a role in offspring allergic disease development.”

The Calorie Control Council cites the following as serious limitations of the study:
  • Their findings were inconsistent. If low-calorie sweeteners are truly responsible for asthma or allergic rhinitis, then these findings should be observed across all LCS products. The investigators concluded that mothers who consumed more than one serving per day of LCS non-carbonated soft drinks were more likely to report a child diagnosis with asthma at 18thmonth compared to non-users. However, carbonated low-calorie soft drinks were not associated with any risk of asthma at 18 months.
  • The early life outcomes at 18 months were associated with non-carbonated LCS soft drinks while registry outcomes were more strongly associated with intake of carbonated LCS soft drinks. These results suggest that there may be other confounding factors present for some of the associations observed. The authors themselves noted this stating that, “…. [they] may have failed to identify all relevant confounders and thus [their] findings may be due to residual confounding by unmeasured or unidentified covariates.”
  • The reported risk factor for asthma and allergic rhinitis are not dose dependent and do not correspond to categories of intakes of LCS soft drinks. This may relate to the difficulty to accurately quantify the amount of individual sweeteners consumed from soft drinks, which the authors acknowledged, and ultimately calls into question the validity of the intake assessment of low-calorie sweeteners in the beverages.
  • Since this was an observational study, a causal relationship between consumption of LCS products and asthma or allergic rhinitis cannot be established.
  • The food frequency questionnaire used to assess dietary intake was administered during the 25th week of pregnancy, which introduces recall bias into the study.
  • Finally, other studies have noted that the suggested mechanism for low-calorie sweeteners, such as aspartame, to physiologically cause asthma and allergic rhinitis or any type of allergic reaction is highly unlikely2.
References
  1. 1. Maslova E, Strøm M, Olsen SF, Halldorsson TI. 2013 Consumption of artificially-sweetened soft drinks in pregnancy and risk of child asthma and allergic rhinitis. PLoS One. 2013;8(2):e57261. doi: 10.1371/journal.pone.0057261.
  2. Abegaz EG and Bursey, R.G. 2009. Formaldehyde, aspartame, migraine: A Possible connection. Dermatitis 20(3): 176.
faq2Do you have questions about low-calorie sweeteners? Want to learn more about maintaining a healthy lifestyle? You asked and we listened. Our resident Registered Dietitians answered the most popular questions about low-calorie sweeteners.

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