Consumption of artificial sweetener has been linked to a possible increased risk of cardiovascular disease risk, including heart attack and stroke, researchers report today.
A French study, involving more than 100,000 participants, concludes the additives should not be considered a healthy and safe alternative to sugar.
While previous studies have linked consumption of artificial sweeteners or artificially sweetened drinks (ASB) to weight gain, high blood pressure, and inflammation, there have been mixed results when examining artificial sweeteners’ role in the cause of various diseases.
Researchers at the French National Institute for Health and Medical Research (Inserm) examined data for 103,388 participants involved in the web-based NutriNet-Santé study, which was launched in France in 2009 to investigate relations between nutrition and health.
The average age of participants was 42 years and 80% were female.
Dietary intakes and consumption of artificial sweeteners were assessed by repeated 24-hour dietary records and a range of potentially influential health, lifestyle, and sociodemographic factors were taken into account.
Artificial sweeteners from all dietary sources and by type, such as aspartame, acesulfame potassium, and sucralose, were included in the analysis, and they found 37% of participants consumed artificial sweeteners, with an average intake of 42.46 mg/day. This corresponds to about one individual packet of table top sweetener or 100 ml of diet soda.
Among participants who consumed artificial sweeteners, mean intakes for lower and higher consumer categories were 7.46 and 77.62 mg/ day, respectively.
Writing in *The BMJ*, the researchers say that compared with non-consumers, higher consumers tended to be younger, have a higher body mass index, were more likely to smoke, be less physically active, and to follow a weight loss diet.
They also had lower total energy intake, and lower alcohol, saturated and polyunsaturated fats, fibre, carbohydrate, fruit and vegetable intakes, and higher intakes of sodium, red and processed meat, dairy products, and beverages with no added sugar.
During an average follow-up period of nine years, there were 1,502 cardiovascular events, including heart attack, angina, angioplasty, transient ischemic attack and stroke.
Total artificial sweetener intake was associated with an increased risk of cardiovascular disease, with an absolute rate 346 per 100,000 person years in higher consumers and 314 per 100,000 person years in non-consumers.
Artificial sweeteners were associated with cerebrovascular disease risk, with absolute rates 195 and 150 per 100,000 person years in higher and non-consumers, respectively, while aspartame intake was associated with increased risk of cerebrovascular events at 186 and 151 per 100,000 person years in higher and non-consumers, respectively.
Acesulfame potassium and sucralose were associated with increased coronary heart disease risk, with the former’s absolute rates being 167 and 164 per 100,000 person years and the latter 271 and 161 per 100,000 person years in higher and non-consumers, respectively.
This is an observational study, but the team says it was a large study that assessed individuals’ artificial sweetener intake using precise, high quality dietary data. The findings are in line with other studies linking exposure to artificial sweeteners with several markers of poor health.
They call for further prospective cohort studies to confirm these results.
Debras C, Chazelas E, Sellem L et al. Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort. *BMJ* 8 September 2022; doi: 10.1136/bmj-2022-071204
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