Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France.
Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France.
Diabetes Care. 2023 Sep 1;46(9):1681-1690. doi: 10.2337/dc23-0206.
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.
The analyses included 105,588 participants from the web-based NutriNet-Santé study (France, 2009-2022; mean age 42.5 ± 14.6 years, 79.2% women). Repeated 24-h dietary records, including brands and commercial names of industrial products, merged with qualitative and quantitative food additive composition data, enabled artificial sweetener intakes to be accurately assessed from all dietary sources. Associations between artificial sweeteners (total, aspartame, acesulfame potassium [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 9.1 years (946,650 person-years, 972 incident T2D), compared with nonconsumers, higher consumers of artificial sweeteners (i.e., above the sex-specific medians of 16.4 mg/day in men and 18.5 mg/day in women) had higher risks of developing T2D (hazard ratio [HR] 1.69; 95% CI 1.45-1.97; P-trend <0.001). Positive associations were also observed for individual artificial sweeteners: aspartame (HR 1.63 [95% CI 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 reevaluation of artificial sweeteners by health authorities worldwide.
在一项大规模的前瞻性队列研究中，研究人工甜味剂（包括所有饮食来源的总和及各类型人工甜味剂）与 2 型糖尿病（T2D）风险之间的关系。
该分析纳入了来自基于网络的 NutriNet-Santé 研究的 105588 名参与者（法国，2009-2022 年；平均年龄 42.5±14.6 岁，79.2%为女性）。重复 24 小时饮食记录，包括工业产品的品牌和商品名，与定性和定量食物添加剂成分数据合并，使人工甜味剂的摄入量能够从所有饮食来源中得到准确评估。使用 Cox 比例风险模型调整潜在混杂因素（包括随访期间的体重变化），研究人工甜味剂（总和、阿斯巴甜、乙酰磺胺酸钾[K]和三氯蔗糖）与 T2D 之间的关系。
在中位随访 9.1 年（946650 人年，972 例 T2D 发病）期间，与非消费者相比，人工甜味剂摄入量较高（即男性 16.4mg/天和女性 18.5mg/天的性别特异性中位数以上）者发生 T2D 的风险更高（风险比[HR]1.69；95%CI1.45-1.97；P<0.001）。对于个别人工甜味剂也观察到了正相关关系：阿斯巴甜（HR1.63[95%CI1.38-1.93]，P<0.001）、乙酰磺胺酸钾（HR1.70[1.42-2.04]，P<0.001）和三氯蔗糖（HR1.34[1.07-1.69]，P=0.013）。
不能排除反向因果关系的可能性；然而，进行了许多敏感性分析以限制这种可能性和其他潜在偏倚。这些人工甜味剂摄入量与 T2D 风险增加之间存在正相关关系的发现，进一步证实了这些添加剂可能不是安全的糖替代品。本研究在全球卫生当局对人工甜味剂进行重新评估的背景下提供了重要的见解。
