Artificial sweeteners reduce added sugar content and corresponding calories while maintaining sweetness. A study published on March 24 in OLP Medicine by Charlotte Debras and Mathilde Touvier of the French National Institute of Health and Medical Research (Inserm) and Sorbonne University Paris Nord, France and colleagues suggest that certain artificial sweeteners are associated with an increased risk of cancer.
Many food and beverage products containing artificial sweeteners are consumed daily by millions of people. However, the safety of these additives has been the subject of debate. To assess the potential carcinogenicity of artificial sweeteners, the researchers analyzed data from 102,865 French adults participating in the NutriNet-Santé study. The NutriNet-Santé study is an online cohort initiated in 2009 by the Nutritional Epidemiology Research Team (EREN). Participants register voluntarily and self-declare their medical history, socio-demographics, diet, lifestyle and health. The researchers collected data regarding the consumption of artificial sweeteners from 24-hour food records. After collecting information about cancer diagnosis during follow-up, the researchers performed statistical analyzes to investigate associations between artificial sweetener intakes and cancer risk. They also adjusted for a range of variables, including age, sex, education, physical activity, smoking, body mass index, height, weight gain during follow-up, diabetes, family history of cancer, as well as baseline energy intake, alcohol, sodium, saturated fatty acids, fiber, sugar, whole grain foods and dairy products.
Researchers found that enrollees consuming higher amounts of artificial sweeteners, particularly aspartame and acesulfame-K, had a higher overall cancer risk than non-consumers (relative risk 1.13, 95% confidence interval 1.03 to 1.25). Higher risks were observed for breast cancer and obesity-related cancers.
The study had several important limitations; food intakes are self-reported. Selection bias may also have been a factor, as participants were more likely to be female, have higher levels of education, and display health-conscious behaviors. The observational nature of the study also means that residual confounding is possible and reverse causation cannot be ruled out. Further research will be needed to confirm the findings and clarify the underlying mechanisms.
According to the authors, “Our results do not support the use of artificial sweeteners as safe alternatives to sugar in foods or beverages and provide important and novel information to address controversies regarding their potential adverse health effects. Although these results need to be replicated in other large-scale cohorts and underlying mechanisms clarified by experimental studies, they provide important and new information for the ongoing re-evaluation of food additive sweeteners by the European Food Safety Authority and other health agencies around the world.
Debras adds, “Results from the NutriNet-Santé cohort (n=102,865) suggest that artificial sweeteners found in many food and beverage brands around the world may be associated with an increased risk of cancer, consistent with several in vivo / in vitro experimental studies. These results provide new information for the re-evaluation of these food additives by health agencies.”
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