A large study of French adults published by The BMJ today suggests a potential direct association between higher consumption of artificial sweeteners and an increased risk of cardiovascular disease, including heart attack and stroke.
The results indicate that these food additives, consumed daily by millions of people and present in thousands of foods and beverages, should not be considered a healthy and safe alternative to sugar, in line with the current position of several food safety agencies. health.
Artificial sweeteners are widely used as no-calorie or low-calorie alternatives to sugar. They make up a $7,200m (£5,900m; €7,000m) global market and are found in thousands of products worldwide, particularly ultra-processed foods such as artificially sweetened drinks, some snacks and low-calorie ready meals.
Several studies have linked the consumption of artificial sweeteners or artificially sweetened beverages (ASB) to weight gain, high blood pressure and inflammation, but the results remain mixed as to the role of artificial sweeteners in the cause. various diseases, including cardiovascular disease (CVD). Additionally, several observational studies have used BSA consumption as a proxy indicator to explore CVD risk, but none have measured the intake of artificial sweeteners in the overall diet.
To explore this question further, a team of researchers from the National Institute of Health and Medical Research (Inserm) and their colleagues relied on data from 103,388 participants (average age 42 years; 80% women) from the NutriNet-Santé online study, launched in France in 2009 to study the relationship between nutrition and health.
Dietary intakes and consumption of artificial sweeteners were assessed by repeated 24-hour food recordings and a range of potentially influential health, lifestyle and socio-demographic factors were taken into account.
Artificial sweeteners from all food sources (beverages, table-top 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 to approximately one individual sachet of table-top sweetener or 100 ml of diet soda.
Among participants who consumed artificial sweeteners, the average intakes for the lower and higher consumer categories were 7.46 and 77.62 mg/day, respectively.
Compared to non-drinkers, heavy drinkers tended to be younger, have a higher body mass index, be more likely to smoke, be less physically active, and diet. They also had lower total energy intakes 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 in drinks without added sugar. However, the researchers accounted for these differences in their analyses.
During an average follow-up period of nine years, 1,502 cardiovascular events occurred. They included heart attack, angina, angioplasty (a procedure to widen blocked or narrowed arteries to the heart), transient ischemic attack and stroke.
The researchers found that the total consumption of artificial sweeteners was associated with an increased risk of cardiovascular disease (absolute rate of 346 per 100,000 person-years in high consumers and 314 per 100,000 person-years in non-consumers ).
Artificial sweeteners were particularly associated with the risk of cerebrovascular disease (absolute rates of 195 and 150 per 100,000 person-years in high consumers and non-consumers, respectively).
Aspartame consumption was associated with an increased risk of stroke (186 and 151 per 100,000 person-years among high consumers and non-consumers, respectively), while acesulfame potassium and sucralose were associated 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 high consumers 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.
Nonetheless, this was a large study that assessed individuals’ consumption of artificial sweeteners using accurate, high-quality dietary data, and the results are consistent with other studies linking exposure to artificial sweeteners artificial to several markers of poor health.
As such, the researchers say their findings suggest no benefit to replacing artificial sweeteners with added sugar on cardiovascular disease outcomes.
Further prospective cohort studies need to confirm these findings, and experimental studies are needed to clarify biological pathways, they add.
In the meantime, they suggest that this study provides key insights into the context of the reassessment of artificial sweeteners currently being conducted by the European Food Safety Authority, the World Health Organization and other health agencies.
Debras, C. et al. (2022) Artificial sweeteners and risk of cardiovascular disease: results from the NutriNet-Santé prospective cohort. BMJ. doi.org/10.1136/bmj-2022-071204.