Artificial sweetener use may increase risk of type 2 diabetes, reveals study

"The findings of positive associations between intake of artificial sweetener and increased risk of type 2 diabetes strengthen the evidence that these additives may not be safe sugar alternatives," the researchers wrote. "The study provides important insights in the context of ongoing worldwide reevaluation of artificial sweeteners by health authorities."

Artificial sweeteners provide sweetness to beverages and food like coffee and tea, without the addition of significant calories. Also, they are ingredients widely used in pre-packed food. Hence, they have become a popular choice, particularly among those who are trying to burn calories or lose weight.

Charlotte Debras, the University of Paris Cité (CRESS), Bobigny, France, and collages aimed to investigate the relationships between artificial sweeteners, accounting for all dietary sources (total and by type of artificial sweetener) and type 2 diabetes (T2D) risk, in a large-scale prospective cohort.

The analyses included 105,588 participants from the web-based NutriNet-Santé study. Accurate assessment of artificial sweetener intakes from all dietary sources was done through repeated 24-h dietary records, including commercial names and brands of industrial products, merged with quantitative and qualitative food additive composition data.

Cox proportional hazard models were used to investigate associations between artificial sweeteners (total, aspartame, acesulfame potassium [K], and sucralose) and type 2 diabetes after adjusting for potential confounders, including weight variation during follow-up.

The authors reported the following findings:

• During a median follow-up of 9.1 years (946,650 person-years, 972 incident type 2 diabetes), 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), compared with nonconsumers.
• Positive associations were also observed for individual artificial sweeteners: aspartame (HR 1.63), acesulfame-K (HR 1.70), and sucralose (HR 1.34).

The researchers wrote, "We cannot eliminate the potential for reverse causality; however, many sensitivity analyses were computed to limit this and other potential biases. These findings of positive associations between intake of artificial sweetener and increased T2D risk strengthen the evidence that these additives may not be safe sugar alternatives."

"This study provides important and novel information in the context of ongoing reevaluation of artificial sweeteners by health authorities worldwide," they concluded.

Reference:

Charlotte Debras, Mélanie Deschasaux-Tanguy, Eloi Chazelas, Laury Sellem, Nathalie Druesne-Pecollo, Younes Esseddik, Fabien Szabo de Edelenyi, Cédric Agaësse, Alexandre De Sa, Rebecca Lutchia, Chantal Julia, Emmanuelle Kesse-Guyot, Benjamin Allès, Pilar Galan, Serge Hercberg, Inge Huybrechts, Emmanuel Cosson, Sopio Tatulashvili, Bernard Srour, Mathilde Touvier; Artificial Sweeteners and Risk of Type 2 Diabetes in the Prospective NutriNet-Santé Cohort. Diabetes Care 2023; dc230206. https://doi.org/10.2337/dc23-0206