Rapid Review Quiz: Artificial Sweeteners

Romesh Khardori, MD, PhD

Disclosures

November 14, 2022

A large-scale, prospective study with 103,388 French adult participants from the NutriNet-Santé cohort found that total artificial sweetener intake from all sources (food and drinks) was associated with increased risk for cardiovascular and cerebrovascular disease. The researchers mainly assessed aspartame, acesulfame potassium, and sucralose, with about 3% of sweeteners in an "other" category, including saccharin and cyclamates.

Throughout an average follow-up of 9 years, artificial sweetener intake was associated with a 9% increased risk for cardiovascular or cerebrovascular events, including acute coronary syndrome, angina, angioplasty, myocardial infarction, stroke, or transient ischemic attack. Average artificial sweetener intake among the participants was 42.46 mg/day, which is about 100 mL of diet soda or one individual packet of standard tabletop sweetener.

The researchers observed a dose-effect association, with a higher risk for cardiovascular events associated with higher consumption. In this study, this was a mean of 77 mg/day artificial sweetener, which is a little less than a standard can of soda. Higher consumers had an absolute incidence rate of cardiovascular or cerebrovascular events of 346 per 100,000 person years vs 314 per 100,000 person years in nonconsumers.

The researchers also found a particular association between aspartame intake and increased risk for cerebrovascular events and a similar association between acesulfame potassium and sucralose and increased coronary heart disease risk.

The team mentioned that some artificial sweeteners may be safer, especially those that do not increase insulin much or at all, such as stevia root, yacon root or syrup, or erythritol, but they were not part of the analysis.

Learn more about cardiovascular risk.

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