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

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posted on 2023-07-25, 19:30 authored by 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



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.


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).

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.


The NutriNet-Santé study was supported by the following public institutions: Ministère de la Santé, Santé Publique France, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut national de recherche pour l’agriculture, l’alimentation et l’environnement (INRAE), Conservatoire National des Arts et Métiers (CNAM) and Université Sorbonne Paris Nord. CD was supported by a grant from the French National Cancer Institute (INCa, grant #2019-158). EC was supported by a Doctoral Fellowship from Université Sorbonne Paris Nord to Galilée Doctoral School. This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (Consolidator Grant agreement No 864219), the French National Cancer Institute (INCa_14059), the French Ministry of Health (arrêté 29.11.19), the IdEx Université de Paris Cité (ANR-18-IDEX-0001), and a Bettencourt-Schueller Foundation Research Prize 2021. This project was awarded the NACRe (French network for Nutrition And Cancer Research) Partnership Label. Researchers were independent from funders. Funders had no role in the study design, the collection, analysis, and interpretation of data, the writing of the report, and the decision to submit the article for publication.


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