Consumption of artificial sweeteners and association with cardiovascular disease risk

1. In a large cohort of French adults, the consumption of artificial sweeteners was associated with an increased risk of cardiovascular disease

2. Aspartame consumption was associated with an increased incidence of cerebrovascular disease, while acesulfame potassium and sucralose were associated with an increased incidence of coronary heart disease.

Level of evidence assessment: 2 (good)

Artificial sweeteners exist as an alternative to added sugar, which is found in many foods around the world, including drinks, snacks, and low-calorie meals. Over 23,000 products worldwide contain artificial sweeteners Several studies have investigated the effects of artificial sweeteners, with most suggesting adverse effects. This study examined the association between artificial sweeteners and the risk of cardiovascular disease (CVD). 103,388 French adults aged 18 and over took part in the study. Each participant first completed online questionnaires on diet, health, anthropometric data, lifestyle, socio-demographic data and physical activity. A dietary assessment comprising three nonconsecutive days of 24-hour food recordings was randomly assigned over a 2-week period for baseline, then every 7 months, food additives, including artificial sweeteners, were assessed using the food recording tool. To determine cardiovascular health, biannual health questionnaires and a personal health interface allowed participants to report health events. Each time a cardiovascular event was declared, a physician at the time contacted the participant. Participants with two valid dietary records within the first two years were included, patients with prevalent cardiovascular disease and pre-existing diabetes were excluded, and patients diagnosed with cardiovascular disease within the first two years of follow-up to limit reverse causation. The median duration of follow-up was 9 years. During the follow-up period, 1502 cardiovascular events occurred. Total consumption of artificial sweeteners was associated with an increased risk of CVD (relative risk 1.09, 95% confidence interval 1.01 to 1.18, P = 0.03) and was particularly associated with cerebrovascular disease (1.18, 1.06 to 1.31, P = 0.002; incidence rate 195 and 150). Looking at artificial sweetener subtypes, aspartame was associated with an increased risk of cerebrovascular events (1.17, 1.03 to 1.33, P=0.02; incidence rate 186 and 151), and acesulfame potassium and sucralose were associated with an increased risk of coronary heart disease (acesulfame potassium: 1.40, 1.06 to 1.84, P = 0.02; incidence rate 167 and 164; sucralose: 1.31, 1.00 to 1.71, P = 0.05; incidence rate 271 and 161). The strengths of this study include the large sample size. Limitations include that the 24-hour food recording days were decided in advance and may have influenced behavior. Although many variables have been adjusted, there may be some confusion. Additionally, study participants were mostly female, with higher levels of education, and were more likely to lead health-conscious lifestyles.

Click to read the study in BMJ

Picture: PD

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