1. In a large French adult cohort, artificial sweetener intake was associated with increased risk of cardiovascular disease

2. Aspartame consumption was associated with increased cerebrovascular disease incidence whereas acesulfame potassium and sucralose were associated with increased coronary heart disease incidence

Evidence Rating Level: 2 (Good)

Artificial sweeteners exist as an alternative to added sugar, contained in many foods worldwide including beverage, snacks, and low-calorie meals. More than 23000 products worldwide contain artificial sweeteners Several studies have investigated the effects of artificial sweeteners, with most suggesting adverse effects. This stud examined the association between artificial sweeteners and risk of cardiovascular disease (CVD). 103 388 French adults aged 18 and over were involved in the study. Each participant initially completed online questionaries about diet, health, anthropometric data, lifestyle, sociodemographic data and physical activity. A dietary assessment including three non-consecutive days of 24 hour dietary records were assigned randomly over a 2 week period for baseline, and then every 7 months, Food additives including artificial sweeteners were assessed through the dietary record tool. To determine cardiovascular health, biannual health questionnaires and a personal health interface allowed participants to report health events. At every declaration of a CVD event, a physician on the time contacted the participant. Participants with two valid dietary records during the first two years were included, patients with prevalent CVD and pre-existing diabetes were excluded, along with patients diagnosed with CVD during the first two years of follow-up to limit reverse causality. The median follow-up duration was 9 years. Over the time of follow-up, 1502 CVD events occurred. Total artificial sweetener intake was associated with an increased risk of CVD (hazard ratio 1.09, 95% confidence interval 1.01 to 1.18, P=0.03) and were more particularly associated with cerebrovascular disease (1.18, 1.06 to 1.31, P=0.002; incidence rates 195 and 150). When looking at subtypes of artificial sweeteners, aspartame was associated with increased risk of cerebrovascular events (1.17, 1.03 to 1.33, P=0.02; incidence rates 186 and 151), and acesulfame potassium and sucralose were associated with increased coronary heart disease risk (acesulfame potassium: 1.40, 1.06 to 1.84, P=0.02; incidence rates 167 and 164; sucralose: 1.31, 1.00 to 1.71, P=0.05; incidence rates 271 and 161). Strengths of this study include the large sample size. Limitations include the fact that the 24-hour dietary record days were decide in advance and could have influenced behaviour. Although many variables were adjusted for, there may be some confounding. Additionally, participants in the study were mostly female, with higher educational status and were more likely to have a health-conscious lifestyle.

Click to read the study in BMJ

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