A large study of French adults published by The BMJ suggests a possible direct association between higher consumption of artificial sweeteners and an increased risk of cardiovascular diseases, including heart attacks and strokes.
The findings indicate that these food additives, consumed daily by millions of people and present in thousands of foods and drinks, should not be considered a healthy and safe alternative to sugar, in line with the current position of several health agencies.
Artificial sweeteners are widely used as low or no-calorie alternatives to sugar. They represent a $7.2 billion (£5.9 billion; €7 billion) global market and are found in thousands of products around the world, particularly ultra-processed foods such as artificially sweetened drinks, some snacks and low-calorie ready meals.
Several studies have linked consumption of artificial sweeteners or artificially sweetened beverages (ASBs) to weight gain, high blood pressure, and inflammation, but findings remain unclear about the role of artificial sweeteners in the cause of several diseases, including cardiovascular disease (CVD). Furthermore, several observational studies have used ASB consumption as an indicator to explore CVD risk, but none have measured overall dietary intake of artificial sweeteners.
To investigate this further, a team of researchers from the French National Institute for Health and Medical Research (Inserm) and their colleagues drew on data from 103,388 participants (average age 42 years; 80% women) from the NutriNet-study. Web-based Santé, launched in France in 2009 to investigate the relationships between nutrition and health.
Dietary intake and consumption of artificial sweeteners were assessed using repeated 24-hour dietary records, taking into account a variety of potentially influential sociodemographic, health, and lifestyle factors.
Artificial sweeteners from all dietary sources (beverages, tabletop sweeteners, dairy products, etc.) and by type (aspartame, acesulfame potassium, and sucralose) were included in the analysis.
A total of 37% of participants consumed artificial sweeteners, with an average intake of 42.46 mg/day, which corresponds approximately to a single packet of tabletop sweetener or 100 ml of diet soda.
Among participants who consumed artificial sweeteners, the mean intake for the highest and lowest consumer categories was 7.46 and 77.62 mg/day, respectively.
Compared to non-users, older users tended to be younger, have a higher body mass index, were more likely to smoke, be less physically active, and be on a weight-loss diet. They also had lower total energy intake, and lower intakes of alcohol, saturated and polyunsaturated fats, fiber, carbohydrates, fruits and vegetables, and higher intakes of sodium, red and processed meat, dairy products, and sugar-free beverages. added. However, the researchers took these differences into account in their analyses.
During an average follow-up period of nine years , 1502 cardiovascular events occurred. They included heart attack, angina, angioplasty, transient ischemic attack and stroke.
The researchers found that total intake of artificial sweeteners was associated with an increased risk of cardiovascular disease (absolute rate of 346 per 100,000 person-years in heavy consumers and 314 per 100,000 person-years in non-consumers).
Artificial sweeteners were most particularly associated with the risk of cerebrovascular disease (absolute rates of 195 and 150 per 100,000 person-years in older consumers and non-consumers, respectively).
Aspartame intake was associated with an increased risk of cerebrovascular events (186 and 151 per 100,000 person-years in high and non-consumers, respectively), while acesulfame potassium and sucralose were associated with an increased risk of coronary heart disease (acesulfame potassium: 167 and 164 per 100,000 person years; sucralose: 271 and 161 per 100,000 person years in elderly and non-consumers, respectively).
This is an observational study , so it cannot establish cause, nor can the researchers rule out the possibility that other unknown (confounding) factors may have affected their results.
However, this was a large study that assessed people’s artificial sweetener intake using high-quality, accurate dietary data, and the findings are in line with other studies linking exposure to artificial sweeteners with several markers of poor health. .
As such, the researchers say their results do not suggest any benefit from substituting artificial sweeteners for added sugar on CVD outcomes.
More prospective cohort studies are needed to confirm these results and experimental studies are needed to clarify the biological pathways, they add.
Meanwhile, they suggest that this study provides key information about the context of the re-evaluation of artificial sweeteners currently being carried out by the European Food Safety Authority, the World Health Organization and other health agencies.
Conclusions Findings from this large-scale prospective cohort study suggest a possible direct association between increased consumption of artificial sweeteners (especially aspartame, acesulfame potassium, and sucralose) and increased risk of cardiovascular disease. Artificial sweeteners are present in thousands of food and drink brands around the world, however, they remain a controversial issue and are currently being re-evaluated by the European Food Safety Authority, the World Health Organization and other health agencies. . |
