Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.
Admin Office, Nanjing First Hospital, Nanjing Medical University, Nanjing210006, People's Republic of China.
Br J Nutr. 2024 Oct 28;132(8):1065-1072. doi: 10.1017/S000711452400223X. Epub 2024 Oct 18.
Artificial sweeteners are generally used and recommended to alternate added sugar for health promotion. However, the health effects of artificial sweeteners remain unclear. In this study, we included 6371 participants from the National Health and Nutrition Examination Survey with artificial sweetener intake records. Logistic regression and Cox regression were applied to explore the associations between artificial sweeteners and risks of cardiometabolic disorders and mortality. Mendelian randomisation was performed to verify the causal associations. We observed that participants with higher consumption of artificial sweeteners were more likely to be female and older and have above medium socio-economic status. After multivariable adjustment, frequent consumers presented the OR (95 % CI) for hypertension (1·52 (1·29, 1·80)), hypercholesterolaemia (1·28 (1·10, 1·50)), diabetes (3·74 (3·06, 4·57)), obesity (1·52 (1·29, 1·80)), congestive heart failure (1·89 (1·35, 2·62)) and heart attack (1·51 (1·10, 2·04)). Mendelian randomisation confirmed the increased risks of hypertension and type 2 diabetes. Moreover, an increased risk of diabetic mortality was identified in participants who had artificial sweeteners ≥ 1 daily (HR = 2·62 (1·46, 4·69), = 0·001). Higher consumption of artificial sweeteners is associated with increased risks of cardiometabolic disorders and diabetic mortality. These results suggest that using artificial sweeteners as sugar substitutes may not be beneficial.
人工甜味剂通常被用于替代添加糖以促进健康。然而，人工甜味剂的健康影响仍不清楚。在这项研究中，我们纳入了来自全国健康和营养调查的 6371 名有摄入人工甜味剂记录的参与者。应用逻辑回归和 Cox 回归来探讨人工甜味剂与心血管代谢紊乱和死亡风险的关系。进行孟德尔随机化以验证因果关系。我们观察到，人工甜味剂消耗较高的参与者更可能为女性和老年人，且社会经济地位较高。在多变量调整后，频繁消费者的高血压（1.52（1.29，1.80））、高胆固醇血症（1.28（1.10，1.50））、糖尿病（3.74（3.06，4.57））、肥胖症（1.52（1.29，1.80））、充血性心力衰竭（1.89（1.35，2.62））和心脏病发作（1.51（1.10，2.04））的比值比（95 %置信区间）更高。孟德尔随机化证实了高血压和 2 型糖尿病风险增加。此外，在每天摄入人工甜味剂≥1 次的参与者中，发现糖尿病死亡率增加（HR = 2.62（1.46，4.69）， = 0.001）。人工甜味剂摄入较高与心血管代谢紊乱和糖尿病死亡风险增加有关。这些结果表明，使用人工甜味剂替代糖可能无益。
