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Grand Rounds

Is There a Link Between Artificial Sweetener Consumption and Cardiovascular Disease Risk?

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BACKGROUND AND PURPOSE:

  • Debras et al. (BMJ, 2022) investigated the associations between artificial sweeteners and risk of cardiovascular diseases (CVD)

METHODS:

  • Population-based prospective cohort study
    • NutriNet-Santé cohort (France)
  • Participants
    • General population
    • Followed from 2009 to 2021
  • Exposures
    • Dietary intakes and consumption of artificial sweeteners
  • Study design
    • Intake of artificial sweeteners was assessed by repeated 24 hour dietary records, including brand names of industrial products
    • Dietary intake of sweeteners was coded as a continuous variable
    • Risk of CVD was assessed using multivariable adjusted Cox Proportional Hazards models
  • Primary outcome
    • CVD risk (overall, coronary heart disease, and cerebrovascular disease)

RESULTS:

  • 103,388 participants
    • Mean age 42.2 years; 79.8% female
    • 904,206 person years
  • Total artificial sweetener intake was associated with increased risk of CVD
    • Consumers: Incidence rate 346 per 100,000 person years
    • Non-consumers: Incidence rate 314 per 100,000 person years
    • Hazard ratio (HR) 1.09 (95% CI, 1.01 to 1.18); P=0.03; 1502 events
  • Artificial sweeteners were particularly associated with cerebrovascular disease
    • Consumers: Incidence rate 195 per 100,000 person years
    • Non-consumers: incidence rate 150 per 100,000 person years
    • HR 1.18 (95% CI, 1.06 to 1.31); P=0.002; 777 events
  • Aspartame intake was associated with increased risk for cerebrovascular events
    • Consumers: Incidence rate 186 per 100,000 person years
    • Non-consumers: Incidence rate 151 per 100,000 person years
    • HR 1.17 (95% CI, 1.03 to 1.33); P=0.02
  • Acesulfame potassium and sucralose were associated with increased coronary heart disease risk
    • Acesulfame potassium
      • Consumers: incidence rate 167 per 100,000 person years
      • Non-consumers: Incidence rate 164 per 100,000 person years
      • HR 1.40 (95% CI, 1.06 to 1.84); P=0.02
    • Sucralose
      • Consumers: Incidence rate 271 per 100,000 person years
      • Non-consumers: incidence rate 161 per 100,000 person years
      • HR 1.31 (95% CI, 1.00 to 1.71); P=0.05

CONCLUSION:

  • Consumption of artificial sweeteners is associated with an increased risk of CVD, particularly with use of aspartame, acesulfame potassium, and sucralose
  • The authors state

Our 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 health agencies

Learn More – Primary Sources:

Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort

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Related ObG Topics:

Do Artificially Sweetened Drinks Increase Risk for Stroke?
What are the Long-term Consequences of Nonnutritive Sweeteners?
Do Foods with Fructose Sugars Contribute to Metabolic Syndrome?

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