Intake of artificial sweeteners among adults is associated with reduced odds of gastrointestinal luminal cancers: a meta-analysis of cohort and case-control studies

Tepler, Adam; Hoffman, Gila; Jindal, S.K.; Narula, Neeraj; Shah, Shailja C.

doi:10.1016/j.nutres.2021.07.007

Cited by 10 publications

(6 citation statements)

References 56 publications

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“…found that AS consumption was linked to a 19% decreased risk of developing luminal gastrointestinal cancer. 65 Taken together, these and our findings may suggest a beneficial effect of NSS consumption with respect to small bowel microbial populations.…”

Section: Discussionsupporting

confidence: 69%

Consuming artificial sweeteners may alter the structure and function of duodenal microbial communities

Hosseini,

Barlow,

Leite

et al. 2023

iScience

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Section: Discussionsupporting

confidence: 69%

Consuming artificial sweeteners may alter the structure and function of duodenal microbial communities

Hosseini,

Barlow,

Leite

et al. 2023

iScience

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“…Evaluating sweetener intake through ASBs might not be sufficient since many other foods are also vectors of artificial sweeteners (e.g., breakfast cereals, yogurts, ice creams, and table-top sweeteners). Several case-control studies have analysed associations between artificial sweeteners or ASBs and different cancer locations, as recently meta-analysed [44][45][46]. Although these studies bring interesting pieces of evidence, potentially strong reverse causality bias with this type of design limits the interpretability of these studies.…”

Section: Plos Medicinementioning

confidence: 99%

Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study

et al. 2022

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Background The food industry uses artificial sweeteners in a wide range of foods and beverages as alternatives to added sugars, for which deleterious effects on several chronic diseases are now well established. The safety of these food additives is debated, with conflicting findings regarding their role in the aetiology of various diseases. In particular, their carcinogenicity has been suggested by several experimental studies, but robust epidemiological evidence is lacking. Thus, our objective was to investigate the associations between artificial sweetener intakes (total from all dietary sources, and most frequently consumed ones: aspartame [E951], acesulfame-K [E950], and sucralose [E955]) and cancer risk (overall and by site). Methods and findings Overall, 102,865 adults from the French population-based cohort NutriNet-Santé (2009–2021) were included (median follow-up time = 7.8 years). Dietary intakes and consumption of sweeteners were obtained by repeated 24-hour dietary records including brand names of industrial products. Associations between sweeteners and cancer incidence were assessed by Cox proportional hazards models, adjusted for age, sex, education, physical activity, smoking, body mass index, height, weight gain during follow-up, diabetes, family history of cancer, number of 24-hour dietary records, and baseline intakes of energy, alcohol, sodium, saturated fatty acids, fibre, sugar, fruit and vegetables, whole-grain foods, and dairy products. Compared to non-consumers, higher consumers of total artificial sweeteners (i.e., above the median exposure in consumers) had higher risk of overall cancer (n = 3,358 cases, hazard ratio [HR] = 1.13 [95% CI 1.03 to 1.25], P-trend = 0.002). In particular, aspartame (HR = 1.15 [95% CI 1.03 to 1.28], P = 0.002) and acesulfame-K (HR = 1.13 [95% CI 1.01 to 1.26], P = 0.007) were associated with increased cancer risk. Higher risks were also observed for breast cancer (n = 979 cases, HR = 1.22 [95% CI 1.01 to 1.48], P = 0.036, for aspartame) and obesity-related cancers (n = 2,023 cases, HR = 1.13 [95% CI 1.00 to 1.28], P = 0.036, for total artificial sweeteners, and HR = 1.15 [95% CI 1.01 to 1.32], P = 0.026, for aspartame). Limitations of this study include potential selection bias, residual confounding, and reverse causality, though sensitivity analyses were performed to address these concerns. Conclusions In this large cohort study, artificial sweeteners (especially aspartame and acesulfame-K), which are used in many food and beverage brands worldwide, were associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of food additive sweeteners by the European Food Safety Authority and other health agencies globally. Trial registration ClinicalTrials.gov NCT03335644.

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“…A meta-analysis studied the association between the use of ASs and 1 043 496 individuals suffering from gastrointestinal (GI) cancers including pancreatic, gastric, esophageal, colorectal, and oropharyngeal cancers, and results have shown no association between AS and non-luminal GI cancer (OR = 1.04, 95% CI: 0.95-1.14), but a significant improvement effect on luminal GI cancer (OR = 0.81, 95% CI: 0.68-0.97). 32 An RCT was also performed to study the role of AS on cancer risk; this trial included 1010 patients with gastric, pancreatic, or endometrial cancers, and results showed that AS consumption (mainly saccharin and aspartame) did not associate with the risk of such cancers. 33 The results of the Melbourne Collaborative Cohort Study indicated that there was no association between the consumption of artificial sweetened soft drinks and obesity-related cancer risk.…”

Section: Discussionmentioning

confidence: 99%

The causal association between artificial sweeteners and the risk of cancer: a Mendelian randomization study

Pan,

Feng,

Zhou

et al. 2024

Food Funct.

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Intake of artificial sweeteners among adults is associated with reduced odds of gastrointestinal luminal cancers: a meta-analysis of cohort and case-control studies

Cited by 10 publications

References 56 publications

Consuming artificial sweeteners may alter the structure and function of duodenal microbial communities

Consuming artificial sweeteners may alter the structure and function of duodenal microbial communities

Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study

The causal association between artificial sweeteners and the risk of cancer: a Mendelian randomization study

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