The harmful effects of added sugars have been long established for multiple chronic diseases, leading food companies to use artificial sweeteners instead in a range of food and drinks consumed daily by millions of people worldwide.
However, researchers have linked these to an increased risk of heart disease, saying they “should not be considered a healthy and safe alternative to sugar”.
Their use has come under increased scrutiny in recent years, although study findings have been divided about their part in various diseases.
Their role in cardiovascular disease has previously been suggested in experimental studies, but data from human studies were limited, and previous observational studies focused solely on artificially sweetened drinks used as a proxy.
Now the findings from a large-scale prospective cohort study suggest a potential direct association between higher consumption of artificial sweetener and an increased risk of cardiovascular disease, reports The Guardian.
“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,” the researchers wrote in The BMJ.
In the study, of 103 000 French adults, artificial sweeteners were associated with increased risk of cardiovascular, cerebrovascular and coronary heart diseases. “The results suggest artificial sweeteners might represent a modifiable risk factor for cardiovascular disease prevention,” they wrote.
The research, led by experts from the Sorbonne Paris Nord University, examined intake of sweeteners from all dietary sources, including drinks, tabletop sweeteners and dairy products, and compared it with their risk of heart or circulatory diseases. Participants had an average age of 42, and four in five were women. Sweetener intake was tracked using diet records.
The participants noted everything they ate, including which brand, for 24 hours, with their diet diary repeated three times at six-month intervals – twice on weekdays and once on a weekend day. Some 37% of them consumed artificial sweeteners.
During an average follow-up period of about a decade, 1 502 cardiovascular events were recorded, including heart attacks, strokes, mini strokes and angina.
Artificial sweetener consumption was linked to a 9% higher risk of cardiovascular disease, The BMJ reported. When researchers looked at specific types of illness, they found artificial sweetener consumption was linked to an 18% higher risk of cerebrovascular disease – conditions that affect the blood flow to the brain.
A specific type of sweetener, aspartame, was associated with a 17% increased risk of cerebrovascular events, while acesulfame potassium and sucralose were linked to increased risk of coronary heart disease.
The study was observational, so cannot establish cause, nor rule out the possibility that other unknown factors may have affected the results.
Nevertheless, the researchers said, it was a large study that assessed artificial sweetener intake using precise, high-quality dietary data, and the findings were in line with other studies linking artificial sweeteners with markers of poor health. Further studies were needed, they said.
Study details
Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort
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, Mathilde Touvier.
Published in The BMJ on 7 September 2022
Abstract
Objectives
To study the associations between artificial sweeteners from all dietary sources (beverages, but also table top sweeteners, dairy products, etc), overall and by molecule (aspartame, acesulfame potassium, and sucralose), and risk of cardiovascular diseases (overall, coronary heart disease, and cerebrovascular disease).
Design
Population based prospective cohort study (2009-21).
Participants
103 388 participants of the web based NutriNet-Santé cohort (mean age 42.2±14.4, 79.8% female, 904 206 person years). Dietary intakes and consumption of artificial sweeteners were assessed by repeated 24 h dietary records, including brand names of industrial products.
Main outcomes measures
Associations between sweeteners (coded as a continuous variable, log10 transformed) and cardiovascular disease risk, assessed by multivariable adjusted Cox hazard models.
Results
Total artificial sweetener intake was associated with increased risk of cardiovascular diseases (1502 events, hazard ratio 1.09, 95% confidence interval 1.01 to 1.18, P=0.03); absolute incidence rate in higher consumers (above the sex specific median) and non-consumers was 346 and 314 per 100 000 person years, respectively. Artificial sweeteners were more particularly associated with cerebrovascular disease risk (777 events, 1.18, 1.06 to 1.31, P=0.002; incidence rates 195 and 150 per 100 000 person years in higher and non-consumers, respectively). Aspartame intake was associated with increased risk of cerebrovascular events (1.17, 1.03 to 1.33, P=0.02; incidence rates 186 and 151 per 100 000 person years in higher and non-consumers, respectively), and acesulfame potassium and sucralose were associated with increased coronary heart disease risk (730 events; acesulfame potassium: 1.40, 1.06 to 1.84, P=0.02; incidence rates 167 and 164; sucralose: 1.31, 1.00 to 1.71, P=0.05; incidence rates 271 and 161).
Conclusions
The findings from this large scale prospective cohort study suggest a potential direct association between higher artificial sweetener consumption (especially aspartame, acesulfame potassium, and sucralose) and increased cardiovascular disease risk. Artificial sweeteners are present in thousands of food and beverage brands worldwide, however they remain a controversial topic and are currently being re-evaluated by the European Food Safety Authority, the World Health Organization, and other health agencies.
See more from MedicalBrief archives:
Artificial sweeteners and increased cancer risk – French cohort study
Artificial sweeteners found to be toxic to gut microbes
Artificial sweeteners may leave a bitter aftertaste