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Study Suggests Association Between Artificial Sweeteners and Cancer Risk

Many food products and beverages containing artificial sweeteners, which reduce added sugar content and corresponding calories while maintaining sweetness, are consumed by millions of people daily. However, the safety of these additives has been a subject of debate.

To evaluate the potential carcinogenicity of artificial sweeteners, researchers analyzed data from 102,865 French adults participating in the NutriNet-Santé study. The NutriNet-Santé study is an ongoing web-based cohort initiated in 2009 by the Nutritional Epidemiology Research Team, a nutrition research collaborative based in the Paris area. Participants enroll voluntarily and self-report medical history, sociodemographic, diet, lifestyle, and health data.

Researchers gathered data concerning artificial sweetener intake from 24-hour dietary records. After collecting cancer diagnosis information during follow-up, the researchers conducted statistical analyses to investigate the associations between artificial sweetener intakes and cancer risk. They also adjusted for a range of variables including age, sex, education, physical activity, smoking, BMI, height, weight gain during follow-up, diabetes, family history of cancer, and baseline intakes of calories, alcohol, sodium, saturated fatty acids, fiber, sugar, whole grain foods, and dairy products.

The researchers found that enrollees consuming larger quantities of artificial sweeteners, particularly aspartame and acesulfame-K, had a higher risk of overall cancer compared with nonconsumers (hazard ratio 1.13; 95% confidence interval 1.03 to 1.25). Higher risks were observed for breast cancer and obesity-related cancers. The results are published in PLOS Medicine.

The study had several important limitations; firstly, dietary intakes are self-reported. Because participants volunteer, selection bias also may have been a factor. Participants were more likely to be women, to have higher education levels, and to exhibit health-conscious behaviors. Moreover, the observational nature of the study means that residual confounding (the presence of unapparent factors that could affect the results) is possible and reverse causality can’t be ruled out. Additional research is needed to confirm the findings and clarify the underlying mechanisms.

According to the authors, "Our findings do not support the use of artificial sweeteners as safe alternatives for sugar in foods or beverages and provide important and novel information to address the controversies about their potential adverse health effects. While these results need to be replicated in other large-scale cohorts and underlying mechanisms clarified by experimental studies, they provide important and novel insights for the ongoing reevaluation of food additive sweeteners by the European Food Safety Authority and other health agencies globally."

Charlotte Debras, a Master of Evolutionary Biology student at the Institute of Evolutionary Sciences of Montpellier in Montpellier, France, and lead author of the study, adds, "Results from the NutriNet-Santé cohort (n=102,865) suggest that artificial sweeteners found in many food and beverage brands worldwide may be associated with increased cancer risk, in line with several experimental in vivo/in vitro studies. These findings provide novel information for the reevaluation of these food additives by health agencies."