{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:37:02Z","timestamp":1786466222497,"version":"build-2736575974"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"\n Background<\/jats:title>\n Artificial sweeteners are commonly used as sugar substitutes because they provide sweetness with little or no caloric content. However, the relationship between artificial sweetener consumption and type 2 diabetes (T2D) remains controversial. This meta-analysis was conducted to investigate the longitudinal association between artificial sweetener intake and T2D among adults.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Electronic databases in English and Chinese were searched for prospective studies published from inception to March 2025. Using a random-effects model, the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to investigate the longitudinal association between artificial sweetener intake and T2D among adults aged 18\u202fyears and older. Between-study heterogeneity was assessed using the\n I<\/jats:italic>\n 2<\/jats:sup>\n statistic, while the robustness of the findings was examined using a leave-one-out sensitivity analysis. Publication bias was evaluated by inspection of funnel plots and Egger\u2019s regression test.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of six cohort studies including 721,003 participants were analyzed in this meta-analysis. Compared with those with low or no consumption of artificial sweeteners, participants with higher artificial sweetener intake were more likely to develop T2D (pooled HR\u202f=\u202f1.31, 95% CI\u202f=\u202f1.16\u20131.49). Substantial heterogeneity was observed across studies (\n I<\/jats:italic>\n 2<\/jats:sup>\n \u202f=\u202f86.02%), while the overall estimate remained stable in sensitivity analysis. No significant publication bias was observed among the studies included in this meta-analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n A longitudinal association was observed between artificial sweetener intake and the risk of developing T2D among adults. This study has important public health implications. The findings of this study highlight that artificial sweeteners may not be a completely risk-free alternative to sugar in dietary interventions aimed at reducing high-energy sugar intake and suggest that their potential adverse metabolic effects should be considered in public health policy-making and clinical dietary recommendations regarding artificial sweetener intake.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fnut.2026.1886458","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T15:38:40Z","timestamp":1786462720000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The longitudinal association between artificial sweetener intake and the risk of type 2 diabetes among adults aged 18\u202fyears and older: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Siyuan","family":"Lu","sequence":"first","affiliation":[{"name":"School of Management, Xuzhou Medical University","place":["Xuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Lu","sequence":"additional","affiliation":[{"name":"First Clinical Medical College, Xuzhou Medical University","place":["Xuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Xu","sequence":"additional","affiliation":[{"name":"School of Management, Xuzhou Medical University","place":["Xuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenfeng","family":"Hou","sequence":"additional","affiliation":[{"name":"School of Public Health, Xuzhou Medical University","place":["Xuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Xu","sequence":"additional","affiliation":[{"name":"Dept. of Endocrinology, Geriatric Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Tang","sequence":"additional","affiliation":[{"name":"Dept. of Endocrinology, Geriatric Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the global burden of disease study 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