BMJ: British Medical Journal: Published on September, 2022

The harmful effects of added sugars on various health outcomes including cardiometabolic disorders have been extensively studied, meta-analysed and are currently recognised as major risk factors by public health authorities. In particular, the World Health Organization recommends that less than 5% daily energy intake should come from free sugar. 

Artificial sweeteners emerged as an alternative to added sugar that enabled the sweet taste to be reproduced without using sugar and therefore reduced calorie content from free sugar

An extensive number of brands worldwide contain these food additives, especially ultra-processed foods such as artificially sweetened beverages, some snacks, and low calorie ready-to-go meals or dairy products. Artificial sweeteners are also directly used by consumers as table top sweeteners instead of sugar.

Acceptable daily intakes for each artificial sweetener have been set by the European Food Safety Authority (EFSA), the United States Food and Drug Administration, or the Joint Expert Committee on Food Additives.

The aim is to study the associations between artificial sweeteners from all dietary sources (beverages, but also table top sweeteners, dairy products, etc), overall and by molecule (aspartame, acesulfame potassium, and sucralose), and risk of cardiovascular diseases (overall, coronary heart disease, and cerebrovascular disease).

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In this prospective cohort study, the association of the intake of artificial sweeteners with cardiovascular disease was evaluated in 103,388 French adults using self-reported dietary recall.

The intake of artificial sweeteners such as aspartame, acesulfame potassium, and sucralose was associated with an increased risk of cardiovascular disease. The intake of artificial sweeteners appears to be a modifiable risk factor for cardiovascular disease.

Aspartame was associated with the highest risk of stroke, and it is absorbed and metabolized into a variety of compounds, one of which is formaldehyde. This may break down the blood–brain barrier, increasing the risk of CNS toxicity, inflammation, and stroke.

Sucralose was associated with the highest coronary heart disease risk and is only partially absorbed systemically and may have its greatest effect on the microbiome.

Study endpoints included cardiovascular diseases including heart disease, coronary artery disease, and stroke. This was a young cohort (median age, 42.2 years), revealing that the incidence of one of these events at a relatively young age is particularly worrisome.

The findings from this large scale prospective cohort study suggest a potential direct association between higher artificial sweetener consumption (especially aspartame, acesulfame potassium, and sucralose) and increased cardiovascular disease risk.

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