This is actually a solid study, despite what the current top comment might suggest. It's frustrating how frequently shallow, dismissive takes that don't engage with the substance of a paper rise to the top on HN. I genuinely don't understand what drives such upvotes. That's not how science works, folks.
If you're going to criticize a study, the least you can do is read it carefully and refer to specific sections and quote specific excerpts where you believe the authors went wrong. Anything less is just noise.
One important note (also mentioned in the study) is that this may be a reverse causality.
Their study also indicates an association between high Artificially Sweetened Beverage ("ASB" in the study) consumption and high total calorie intake/obesity. The link may therefore that obesity was the cause of all diabetes incidents and that obese individuals tend to want to reduce weight by drinking diet soda (and are less likely to have preference for foods and drinks traditionally considered healthy like plain water or tea), without the diet soda consumption itself being a contributing factor.
(There will be many correlations like this - e.g., if you look at statistics for knee problems you might find a large overlap between people with diabetes and with knee problems, because obesity causes both more load on the knees and a higher risk of diabetes.)
Quote:
> The mechanisms linking high habitual consumption of ASBs and the risk of type 2 diabetes are not fully understood. It is suggested that reverse causality between obesity and ASB intake may partly explain the observed association, where individuals with relatively high BMI at baseline might be using ASB to try to reduce weight and follow a healthy lifestyle [35,37]. Our results, showing the attenuation of the association of ASB with type 2 diabetes after adjustment for body size measures, were consistent with supportive of obesity being a confounder of the association.
I don't believe they claim causality either... unless I overlooked something. Their conclusion advocating for public health measures feels over the top!
The paper does explore the possibility of a linkage and attempts to justify why the observed relationship may be more than just a simple association. They even go a step further by presenting arguments against the likelihood of reverse causality. That they need to consider reverse causality and prepare a defense against it is sort of admitting that they are far from proving causality.
Here are some excerpts from the paper that illustrate this:
A sensitivity analysis excluding cases at the first follow-up was conducted to examine whether the observed association reflects a possible reverse causality."
Our results, showing the attenuation of the association of ASB with type 2 diabetes after adjustment for body size measures, were consistent with obesity being a confounder of the association."
In addition, to rule out the likelihood of reverse causality, we interpreted appropriate models and conducted sensitivity analyses, which strengthen the robustness of our findings."
The authors also include three pages of data, though I neither have the time nor the statistical expertise to evaluate it in depth.
What's frustrating is that the paper never explicitly states that causality is NOT established. While they argue against reverse causality, the absence of reverse causality does not, in itself, imply causality. It may still be a case of correlation. So your point is completely valid.
This is actually a solid study, despite what the current top comment might suggest. It's frustrating how frequently shallow, dismissive takes that don't engage with the substance of a paper rise to the top on HN. I genuinely don't understand what drives such upvotes. That's not how science works, folks.
If you're going to criticize a study, the least you can do is read it carefully and refer to specific sections and quote specific excerpts where you believe the authors went wrong. Anything less is just noise.