These food additives “should not be considered a healthy and safe alternative to sugar,” say the researchers.
A potential direct association between higher consumption of artificial sweeteners and an increased risk of cardiovascular disease, including heart attacks and strokes, was discovered by a large study of French adults published on September 7 by The BMJ.
These food additives are consumed daily by millions of people and are present in thousands of foods and beverages. The results indicate that these artificial sweeteners 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 no-calorie or low-calorie alternatives to sugar. They represent a $7.2 billion (£5.9 billion; €7.0 billion) global market and are found in thousands of products worldwide. They are especially common in ultra-processed foods such as artificially sweetened drinks, some snacks, and low-calorie ready meals.
Several studies have already linked the consumption of artificial sweeteners or artificially sweetened beverages (ASB) to weight gain, high blood pressure and inflammation. However, the results remain mixed on the role of artificial sweeteners in the cause of 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 ) of the NutriNet-Santé online study. . Launched in France in 2009, this ongoing study is studying the relationship between nutrition and health.
Dietary intakes and consumption of artificial sweeteners were assessed by repeated food recordings over 24 hours. A wide range of potentially influencing health, lifestyle and socio-demographic factors were taken into account.
Artificial sweeteners from all food sources (beverages, dairy, table-top sweeteners, etc.) and by type (aspartame, sucralose, and acesulfame potassium) were included in the analysis.
A total of 37% of participants consumed artificial sweeteners, with an average intake of 42.46 mg/day. This corresponds to approximately one individual sachet of table-top sweetener or 100 ml (3.4 ounces) 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, less physically active, have a higher body mass index (BMI), smoke, and diet. They also had lower total energy intakes and lower intakes of alcohol, carbohydrates, saturated and polyunsaturated fats, fiber, fruits and vegetables, and higher intakes of sodium, red and processed meat, dairy products and unsweetened beverages. However, the investigators took these differences into account in their analyses.
During an average follow-up period of nine years, 1,502 cardiovascular events occurred. They included heart attack, angioplasty (a procedure to widen blocked or narrowed arteries to the heart), angina pectoris, transient ischemic attack and stroke.
Scientists found that total consumption 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 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 cerebrovascular events (186 and 151 per 100,000 person-years among heavy 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).
As this is an observational study, it cannot establish cause. Additionally, the researchers cannot 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. Additionally, the findings are consistent with other studies linking exposure to artificial sweeteners to several markers of poor health.
Therefore, the researchers say their findings suggest there is 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 (WHO) and other health agencies. .
Reference: “Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort” by Charlotte Debras, Eloi Chazelas, Laury Sellem, Raphaël Porcher, Nathalie Druesne-Pecollo, Younes Esseddik, Fabien Szabo de Edelenyi, Cédric Agaësse, Alexandre De Sa, Rebecca Lutchia, Léopold K Fezeu, Chantal Julia, Emmanuelle Kesse-Guyot, Benjamin Allès, Pilar Galan, Serge Hercberg, Mélanie Deschasaux-Tanguy, Inge Huybrechts, Bernard Srour and Mathilde Touvier, 7 September 2022, The BMJ.
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