Artificial sweeteners and risk of type 2 diabetes in the prospective NutriNet-Santé cohort

  

Objectives

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

105,588 participants from the web-based NutriNet-Santé study (France, 2009-2022, mean age=42.5±14.6y, 79.2% women) were included in the analyses. Repeated 24-hours dietary records including brands and commercial names of industrial products, merged with qualitative and quantitative food additive composition data enabled to assess artificial sweetener intakes accurately from all dietary sources. Associations between artificial sweeteners (total, aspartame, acesulfame-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 9.1y (946,650 person-years, 972 incident T2D), compared to non-consumers, higher-consumers of artificial sweeteners (i.e., above the sex-specific medians of 16.4 mg/d in men and 18.5 mg/d in women) had higher risks of developing T2D: HR=1.69 (1.45-1.97), P-trend<0.001. Positive associations were also observed for individual artificial sweeteners: aspartame (HR=1.63 (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 re-evaluation of artificial sweeteners by health authorities worldwide.