Cardiovascular diseases are the leading cause of death worldwide. Identifying the risk factors associated with these diseases in order to better prevent them represents a real public health challenge. A group of researchers from Inserm, INRAE, Cnam and Université Sorbonne Paris Nord within the Nutritional epidemiology research team (Eren) studied the health impacts of artificial sweetener consumption. They analyzed the health data of 103,388 adults participating in the French NutriNet-Santé cohort study in terms of their overall consumption of this type of food additive. The results of these statistical analyses, published in the British Medical Journal, suggest an association between total sweetener intake and an increased risk of cardiovascular diseases.
The harmful effects of added sugars for various chronic diseases have been established, leading the food industries to use artificial sweeteners as alternatives in a wide range of foods and beverages. However, the safety of artificial sweeteners is debated and data remain divided as to their role in the development of various diseases. A recent publication had, for example, observed a link between the consumption of sweeteners and an increase in cancer risk.
Based on the same methodology that involved a vast population study, the team wanted to examine the links between sweetener intake and the risk of cardiovascular diseases (coronary heart diseases and cerebrovascular diseases). While several epidemiological studies had suggested an increased risk of cardiovascular diseases associated with the consumption of artificially sweetened beverages, none had until now gone beyond that category of products to look at total artificial sweetener intake. For example, artificial sweeteners are also found in some dairy products and a multitude of reduced-calorie foods.
The scientists used the data reported by 103,388 French adults participating in the NutriNet-Santé study (see box below). The volunteers reported, via specific questionnaires, their medical history, sociodemographic data and levels of physical activity, as well as information on their lifestyle and health. They also gave details of their food consumption by sending the scientists full records of what they had consumed over several 24-hour periods, including the names and brands of the products. This made it possible to accurately evaluate their exposure to additives, particularly sweeteners.
After collecting information on the diagnosis of cardiovascular diseases over the follow-up period (2009-2021), the researchers conducted statistical analyses to study the links between the participants’ artificial sweetener intake and risk of cardiovascular diseases. They took into account many potentially confounding factors such as age, sex, physical activity, smoking, family cardiovascular disease history, as well as intakes of energy, alcohol, sodium, saturated fatty acids, polyunsaturated fatty acids, fiber, sugar, fruit and vegetables, and red and processed meat.
The scientists found that the total sweetener intake was associated with an increased risk of cardiovascular diseases, and more specifically cerebrovascular diseases.
Concerning the types of sweeteners, aspartame was more closely associated with the risk of cerebrovascular diseases and acesulfame K and sucralose with that of coronary heart diseases.
“In accordance with several other epidemiological studies on artificially sweetened drinks, this large-scale study suggests that artificial sweeteners, which are additives used in many foods and beverages, may represent an increased risk factor for cardiovascular diseases,” explains Charlotte Debras, PhD student and lead author of the study. Further research in other large-scale cohorts will be needed in order to replicate and confirm these findings.
“These findings, in agreement with the latest WHO report published this year, do not support the use of sweeteners as safe alternatives to sugar and provide new information in response to the scientific debates on their potential health effects. They also provide important data for their current re-evaluation by the European Food Safety Authority (EFSA) and other public health agencies worldwide,” concludes Dr. Mathilde Touvier, Inserm research director and study coordinator.
NutriNet-Santé is a public health study coordinated by the Nutritional epidemiology research team (Eren, Inserm/INRAE/Cnam/Université Sorbonne Paris Nord) which, thanks to the commitment and loyalty of over 170,000 participants (known as Nutrinautes), advances research into the links between nutrition (diet, physical activity, nutritional status) and health. Launched in 2009, the study has already given rise to over 250 international scientific publications. In France, a drive to recruit new participants is still ongoing in order to continue to further research into the relationship between nutrition and health.
By devoting a few minutes per month to answering questionnaires on diet, physical activity and health through the secure online platform etude-nutrinet-sante.fr, participants in France contribute to furthering knowledge of the links between diet and health.
 Debras C, Chazelas E, Srour B, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, et al. (2022) Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study. PLoS Med 19(3): e1003950. https://doi.org/10.1371/journal.pmed.1003950
 Diseases affecting the arteries that supply blood to the heart (coronary arteries).
 Cerebrovascular diseases are caused by brain lesions that occur following insufficient blood circulation or a brain hemorrhage.