SEARCHCOHORTendocrinology, nutrition

cohort·endocrinology, nutrition, epidemiology, public health, observational study·PMC10465821

Artificial Sweeteners and Risk of Type 2 Diabetes in the Prospective NutriNet-Santé Cohort

Diabetes Care · 20 authors, 4 centres

AI SUMMARY

FIDELITY 100%

POPULATION105,588 French adults (mean age 42.5 ± 14.6 years, 79.2% women)

INTERVENTIONDietary intake of artificial sweeteners (total, aspartame, acesulfame potassium, sucralose) from all sources

COMPARISONNon-consumers or lower consumers (below sex-specific medians)

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

This prospective cohort study of 105,588 French adults found that higher dietary intake of artificial sweeteners (total, aspartame, acesulfame-K, and sucralose) was associated with an increased risk of developing type 2 diabetes over a median 9.1-year follow-up.

Full summary

1,090 CHARS

This large-scale prospective cohort study from the NutriNet-Santé study (France, 2009–2022) analyzed 105,588 participants. Repeated 24-h dietary records, matched with detailed food additive composition data, were used to assess artificial sweetener intake from all dietary sources. Cox proportional hazard models, adjusted for numerous potential confounders including weight change, were employed. During a median 9.1-year follow-up (946,650 person-years), 972 incident type 2 diabetes cases occurred. Positive associations were also found for aspartame (HR 1.63), acesulfame-K (HR 1.70), and sucralose (HR 1.34). Sensitivity analyses to address reverse causality yielded similar results, except for sucralose in some subgroups. Strengths include the novel, comprehensive assessment of sweetener intake from all sources. Limitations include potential residual confounding and the cohort not being fully representative of the general population. The findings suggest artificial sweeteners may not be safe sugar alternatives, but causality cannot be established from this observational study.

PICO

PPOPULATION

105,588 French adults (mean age 42.5 ± 14.6 years, 79.2% women)

IINTERVENTION

Dietary intake of artificial sweeteners (total, aspartame, acesulfame potassium, sucralose) from all sources

OOUTCOME

Incident type 2 diabetes

STUDY TYPE

cohort

SPECIALTY

endocrinology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10465821

Artificial Sweeteners and Risk of Type 2 Diabetes in the Prospective NutriNet-Santé Cohort

Diabetes Care

READ THE FULL PAPER

ABSTRACT

Abstract OBJECTIVE 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.

CITATION EXPORT

Charlotte Debras, Mélanie Deschasaux-Tanguy, Eloi Chazelas et al.. Artificial Sweeteners and Risk of Type 2 Diabetes in the Prospective NutriNet-Santé Cohort. Diabetes Care. (2023). https://doi.org/10.2337/dc23-0206

AUTHORS

20 · 4 CENTRES

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

1Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
2Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
3International Agency for Research on Cancer, World Health Organization, Lyon, France
4Diabetology, Endocrinology and Nutrition Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France