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Association Between Artificial Sweetener Consumption and the Risk of Type 2 Diabetes
TAKE-HOME MESSAGE
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Given the obesity and diabetes epidemic, there is a growing use of artificial sweeteners in ultra-processed foods. However, previous studies have found an association between artificial sweeteners and the risk of breast cancer, obesity-related cancers, and CVD. In the present study, the authors evaluated the associations between artificial sweeteners, more specifically aspartame, acesulfame K, and sucralose, and type 2 diabetes risk. With a robust sample of 105,588 participants, the results showed that, compared with nonconsumers, consumers of higher amounts of artificial sweeteners had a higher type 2 diabetes risk, more so with aspartame and acesulfame K than with sucralose.
- The results of this study provide a new piece of evidence that complements recent mounting scientific literature regarding the potential adverse effects associated with artificial sweeteners on chronic disease and can add a layer of discussion with patients.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
To study the relationships between artificial sweeteners, accounting for all dietary sources(total and by type of artificial sweetener) and risk of type 2 diabetes (T2D), in a large-scale prospective cohort.
RESEARCH DESIGN AND METHODS
The analyses included 105,588 participants from the web-based NutriNet-Santé study (France, 2009-2022; mean age 42.5 ± 14.6 years, 79.2% women). Repeated 24-h dietary records, including brands and commercial names of industrial products, merged with qualitative and quantitative food additive composition data, enabled artificial sweetener intakes to be accurately assessed from all dietary sources. Associations between artificial sweeteners (total, aspartame, acesulfame potassium [K], and sucralose) and T2D were investigated using Cox proportional hazard models adjusted for potential confounders, including weight variation during follow-up.
RESULTS
During a median follow-up of 9.1 years (946,650 person-years, 972 incident T2D), compared with nonconsumers, higher consumers of artificial sweeteners (i.e., above the sex-specific medians of 16.4 mg/day in men and 18.5 mg/day in women) had higher risks of developing T2D (hazard ratio [HR] 1.69; 95% CI 1.45-1.97; P-trend <0.001). Positive associations were also observed for individual artificial sweeteners: aspartame (HR 1.63 [95% CI 1.38-1.93], P-trend <0.001), acesulfame-K (HR 1.70 [1.42-2.04], P-trend <0.001), and sucralose (HR 1.34 [1.07-1.69], P-trend = 0.013).
CONCLUSIONS
Potential for reverse causality cannot be eliminated; however, many sensitivity analyses were computed to limit this and other potential biases. These findings of positive associations between artificial sweetener intakes and increased T2D risk strengthen the evidence that these additives may not be safe sugar alternatives. This study provides important insights in the context of on-going reevaluation of artificial sweeteners by health authorities worldwide.
Additional Info
Disclosure statements are available on the authors' profiles:
Artificial Sweeteners and Risk of Type 2 Diabetes in the Prospective NutriNet-Santé Cohort
Diabetes Care 2023 Jul 25;[EPub Ahead of Print], C Debras, M Deschasaux-Tanguy, E Chazelas, L Sellem, N Druesne-Pecollo, Y Esseddik, F Szabo de Edelenyi, C Agaësse, A De Sa, R Lutchia, C Julia, E Kesse-Guyot, B Allès, P Galan, S Hercberg, I Huybrechts, E Cosson, S Tatulashvili, B Srour, M TouvierFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Artificial sweeteners associated with diabetes
When a product has been associated with a variety of health concerns, consumers should be cautious.
Last month, The World Health Association stated that there is limited evidence for the carcinogenic risk of aspartame. However, cancer does not appear to be the problem in comparison with the risk of cardiovascular events, stroke,1 obesity,2 and now diabetes.
The EPIC (European Prospective Investigation into Cancer and Nutrition) study of 451,743 individuals across 10 European countries looked at the mortality rates of individuals consuming high amounts of sweetened beverages, with artificially sweetened drinks showing a higher risk.3
Mortality rates where <1 glass/month is compared to >1 glass per day.
Cerebrovascular Disease
Hazard Ratio
Artificially Sweetened Soft Drinks
1.24
Sugar-Sweetened Soft Drinks
1.10
Parkinson’s Disease
Artificially Sweetened Soft Drinks
1.50
Sugar-Sweetened Soft Drinks
1.39
Ischemic Heart Disease
Artificially Sweetened Soft Drinks
1.41
Sugar-Sweetened Soft Drinks
1.04
Total Circulatory Diseases
Artificially Sweetened Soft Drinks
1.52
Sugar-Sweetened Soft Drinks
1.11
This prospective study of the NutriNet-Santé cohort followed 105,588 individuals for a mean of 9.13 years, with three consecutive daily food inventories every 6 months. The total amount of artificial sweeteners was included, not just that in artificially sweetened beverages. For reference, there is about 130 mg of artificial sweetener in one can of diet soda.
Incidence of type 2 diabetes compared with non-consumers
Total Artificial Sweeteners
Hazard Ratio
Low Consumers (Avg 6.38 mg/day)
1.30
High Consumers (Avg 48 mg/day)
1.69
Aspartame
Low Consumers (Avg 5.32 mg/day)
1.48
High Consumers (Avg 38.8 mg/day)
1.63
Acesulfame K
Low Consumers (Avg 1.53 mg/day)
1.39
High Consumers (Avg 15 mg/day)
1.70
Sucralose
Low Consumers (Avg 1.67 mg/day)
1.09
High Consumers (Avg 7.15 mg/day)
1.34
A recent paper found that patients at high cardiovascular risk were much more likely to have a major adverse cardiac event (MACE) if they had high levels of erythritol in their blood.4 Erythritol is thought to increase thrombotic risk and is found in artificial sweeteners including Truvia and Splenda.
Our track record for manipulating nutrition with the intent to improve health is rather poor. Many of our diabetic patients take these artificial sweeteners because they believe they are healthier than sugar. In fact, there is growing evidence that they are causing more harm.
References