Artificial Sweeteners and Risk of Type 2 Diabetes in the Prospective NutriNet-Santé Cohort
Author:
Debras Charlotte1ORCID, Deschasaux-Tanguy Mélanie1, Chazelas Eloi1, Sellem Laury1, Druesne-Pecollo Nathalie1, Esseddik Younes1, Szabo de Edelenyi Fabien1, Agaësse Cédric1, De Sa Alexandre1, Lutchia Rebecca1, Julia Chantal12, Kesse-Guyot Emmanuelle1, Allès Benjamin1, Galan Pilar1, Hercberg Serge12, Huybrechts Inge3, Cosson Emmanuel14, Tatulashvili Sopio4ORCID, Srour Bernard1ORCID, Touvier Mathilde1
Affiliation:
1. 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 2. 2Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France 3. 3International Agency for Research on Cancer, World Health Organization, Lyon, France 4. 4Diabetology, Endocrinology and Nutrition Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
Abstract
OBJECTIVETo 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 METHODSThe 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.RESULTSDuring 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).CONCLUSIONSPotential 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.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
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