Daily Use of Caloric and Artificial Sweeteners Among Hungarian Adults with Diabetes: Socioeconomic and Dietary Associations.

Abstract

Background/Objectives: Dietary sweetener use is common among individuals with diabetes, yet little is known about the socioeconomic and dietary factors that influence the choice between caloric and artificial sweeteners in Central and Eastern Europe. This study examined the determinants of caloric and artificial sweetener use among adults with diabetes mellitus (DM) in Hungary. Methods: We conducted a cross-sectional analysis using frequency-based self-reported dietary measures of 542 adults with self-reported DM from the 2019 European Health Interview Survey (EHIS). Weighted descriptive statistics and multivariable logistic regression models were used to evaluate associations between sweetener use and sociodemographic, lifestyle, and dietary characteristics. Results: Overall, 28.0% of participants reported daily use of caloric sweeteners, and 45.2% reported daily use of artificial sweeteners. Higher educational attainment and healthier dietary patterns, including greater fruit and vegetable consumption, were associated with lower odds of caloric sweetener use. Individuals with lower fruit and vegetable intake, less frequent fruit juice consumption, and poor adherence to diabetic diet recommendations were more likely to use caloric sweeteners. In contrast, artificial sweetener use was strongly associated with daily fruit consumption, lower intake of fruit juice, and adherence to a diabetic diet. Vegetable intake showed a positive association with artificial sweetener use, which may reflect compensatory patterns in dietary self-management. Conclusions: Caloric and artificial sweetener use were associated with distinct socioeconomic and dietary profiles. Caloric sweetener use was linked to less healthy dietary behaviors, whereas artificial sweetener use appeared to be consistent with sugar-reduction strategies. These findings highlight the need for tailored dietary counseling that addresses both sweetener use and broader dietary patterns among individuals with diabete