Heart risks associated with artificial sweeteners

In a recently published study in the British Medical JouralThe researchers examined the association between artificial sweetener intake and the risk of all cardiovascular diseases (CVDs), including cardiometabolic disorders.

Researchers looked at artificial sweeteners from all food sources, such as: B. sweetened beverages, table sweeteners and dairy products. They also examined their molecular composition, ie aspartame, acesulfame potassium and sucralose.

Study: Artificial Sweeteners and the Risk of Cardiovascular Disease: Results of the NutriNet-Santé Prospective Cohort. Photo credit: Monika Wisniewska/Shutterstock

background

Artificial sweeteners are an alternative to sugar but are much lower in calories than free sugar. With a current global market of $7.2 billion and growing at 5% annually, artificial sweeteners are expected to reach $9.7 billion by 2028. They are present in several food and beverage brands worldwide. However, there is insufficient data to suggest the acceptable daily intake of each artificial sweetener. Nevertheless, they are currently under re-evaluation by several health authorities, including the European Food Safety Authority (EFSA) and the US Food and Drug Administration (FDA).

About the study

In the present study, researchers enrolled 103,388 participants in the NutriNet-Santé cohort in France to assess their dietary intake and consumption of artificial sweeteners. They repeatedly recorded their interactive web-based 24-hour diet records, including brand names of manufactured products.

In addition, the team used multivariable fitted Cox hazard models to assess a correlation between sweeteners and the risk of developing CVDs. They calculated each type of cerebrovascular or coronary disease event separately, including myocardial infarction, angioplasty, angina pectoris, stroke, acute coronary syndrome, and transient ischemic event. In addition, they examined associations between CVD risk and artificial sweeteners in beverages and solid foods. They used both self-reported and medical-administrative data to identify CVD outcomes.

For the statistical calculation of continuous models, the researchers logarithmically transformed the intake of artificial sweeteners (log10 of sweetener consumption in mg/g+1). They then used the continuous model as the primary analysis to obtain hazard ratios (HRs) and 95% confidence intervals (CIs). Finally, the team performed a sensitivity analysis on the subset of participants with at least four diet records, doubling the minimum number of 24-hour diet records.

study results

In the NutriNet Santé cohort, 37.1% of participants consumed artificial sweeteners. The mean intake of all participants and consumers was 15.76 mg/day and 42.46 mg/day, respectively. Aspartame, acesulfame potassium and sucralose accounted for 58%, 29% and 10% of the total intake of artificial sweeteners, respectively. Soft drinks, tabletop sweeteners, and flavored dairy products accounted for 53%, 30%, and 8% of artificial sweetener intakes, respectively.

The authors identified 1,502 cardiovascular events during a median follow-up of nine years. Of these, 730 events involved coronary artery disease and 777 events associated with cerebrovascular disease. In addition, they observed a correlation between total intake of artificial sweeteners and an increased risk of CVD with a HR of 1.09, 95% CI. Of note, replacing artificial sweeteners with added sugars did not reduce CVD risk or improve CVD outcomes.

The NutriNet-Santé study collected comprehensive information about the food and beverage brands. In addition, the date-to-date reconciliation between the 24-hour diet records and ingredient lists allowed researchers to identify the full composition of industrial products, enabling their potential reformulations.

Most of the participants in the NutriNet-Santé study were women with a health-conscious lifestyle and good eating habits. All observations made in the study were consistent with previous epidemiological literature on sweetener intake proxies and mechanistic insights from experimental studies. However, this does not mean that these results can be generalized to the French population.

The cohort users had a daily mean intake of aspartame and acesulfame potassium of 0.49 and 0.22 mg/kg body weight, respectively. The general French population had mean daily intakes of 1.29 and 0.73 mg/kg body weight of aspartame and acesulfame potassium, respectively. These results indicate an underestimation of the correlations between artificial sweetener consumption and CVD risk observed in the current study. However, this assessment was still more accurate than that made in a previous study for the French population. The latter only used three-day nutritional records of the participants and overlooked the brand-specific composition of artificial sweeteners. Remarkably, the results remained similar across all sensitivity analyses.

Conclusions

The current prospective cohort study showed a possible direct correlation between a high consumption of artificial sweeteners and an increased overall cardiovascular risk. While aspartame intake increased the risk of cerebrovascular events, acesulfame potassium and sucralose increased the risk of coronary artery disease. The study results are alarming considering that more than 23,000 products worldwide contain artificial sweeteners.