Artificial sweeteners up risk of cardiovascular diseases

Higher consumption of artificial sweetener, particularly aspartame, sucralose, and acesulfame potassium, appears to increase the risk of cardiovascular disease (CVD), suggests a study.

“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 said. [BMJ 2019;364:k4718; https://www.anses.fr/fr/system/files/NUT2011sa0161Ra.pdf]

This population-based prospective cohort study was conducted in France from 2009 to 2021 and included 103,388 participants of the web-based NutriNet-Santé cohort (mean age 42.2 years, 79.8 percent female, 904,206 person-years). The researchers assessed dietary intakes and consumption of artificial sweeteners via repeated 24-h dietary records, including brand names of industrial products.

Finally, multivariable-adjusted Cox hazard models were used to examine the associations between sweeteners (coded as a continuous variable, log₁₀ transformed) and CVD risk.

Total consumption of artificial sweetener correlated with a higher risk of CVD (1,502 events; hazard ratio [HR], 1.09, 95 percent confidence interval [CI], 1.01‒1.18; p=0.03). The absolute incidence rate (IR) was 346 per 100,000 person-years in higher consumers (above the sex-specific median) and 314 per 100,000 person-years in nonconsumers. [BMJ 2022;378:e071204]

In particular, artificial sweeteners contributed to an increased cerebrovascular disease risk (777 events; HR, 1.18, 95 percent CI, 1.06‒1.31; p=0.002; IRs, 195 and 150 per 100,000 person-years in higher consumers and nonconsumers, respectively).

Aspartame intake correlated with a higher risk of cerebrovascular events (HR, 1.17, 95 percent CI, 1.03‒1.33; p=0.02; IRs, 186 and 151 per 100,000 person-years), while acesulfame potassium (HR, 1.40, 95 percent CI, 1.06‒1.84; p=0.02; IRs, 167 and 164 per 100,000 person-years) and sucralose (HR, 1.31, 95 percent CI, 1.00‒1.71; p=0.05; IRs, 271 and 161 per 100,000 person-years) contributed to increased coronary heart disease risk (730 events).

Underlying mechanisms

“In some prospective cohort studies, associations have been reported between artificially sweetened beverage consumption and increased risk of obesity or weight gain,” the researchers said. [CMAJ 2017;189:E929-39; Am J Clin Nutr 2014;100:765-177; Eur J Epidemiol 2020;35:655-671]

Earlier studies also found an association between low-calorie sweeteners from beverages, tabletop sweeteners, and foods and obesity. A cross-sectional study even reported the consumers of diet soft drinks had greater waist circumference. [Nutr Diabetes 2016;6:e202; PLoS One 2016;11:e0167241; Nutrients 2015;7:3569-3586]

Underlying mechanisms for such association could be causally involved, according to the researchers. [Physiol Behav 2015;152:450-455; Food Res Int 2021;142:110220]

Several meta-analyses revealed associations between artificially sweetened beverages and metabolic syndrome, a cardiometabolic risk factor defined by dyslipidaemia, abdominal obesity, high blood glucose, insulin resistance, and hypertension. [Int J Clin Pract 2017; doi:10.1111/ijcp.12927 pmid:28074617; Public Health Nutr 2021;24:3892-3904; Clin Cornerstone 2007;8:11-28]

“Another potential pathway could involve the interaction of artificial sweeteners with intestinal sweet taste receptors, which play a part in insulin secretion and glucose absorption,” the researchers said. [Physiol Behav 2015;152:450-455]

“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,” they noted.