Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study.
Level 3 - non-randomized controlled study
Prospective observational cohort study
PubMed 35324894 · doi:10.1371/journal.pmed.1003950
What was done
Researchers tracked 102,865 adults in the French prospective NutriNet-Santé cohort (2009–2021) over a median follow-up of 7.8 years. Dietary exposure to total artificial sweeteners and specific compounds (aspartame, acesulfame-K, sucralose) was measured using repeated 24-hour dietary records including commercial brand names. Cox proportional hazards models adjusted for age, sex, education, physical activity, smoking, BMI, weight change, family history of cancer, diabetes, and multiple baseline dietary quality variables were used to estimate hazard ratios for cancer incidence.
What was found
Across 3,358 total incident cancer cases, higher consumers of total artificial sweeteners had an increased risk of overall cancer compared to non-consumers (HR = 1.13, 95% CI 1.03 to 1.25, P-trend = 0.002). Increased overall cancer risk was specifically observed for 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). Higher aspartame intake was associated with breast cancer (979 cases, HR = 1.22, 95% CI 1.01 to 1.48, P = 0.036). Obesity-related cancers (2,023 cases) were increased with total sweetener intake (HR = 1.13, 95% CI 1.00 to 1.28, P = 0.036) and aspartame (HR = 1.15, 95% CI 1.01 to 1.32, P = 0.026).
Why it matters
This study provides large-scale, brand-specific epidemiological data suggesting that common artificial sweeteners may not be inert sugar substitutes regarding long-term cancer risk, directly informing safety evaluations by regulatory agencies.
Limits
The observational design cannot establish causality. Dietary intake was self-reported and subject to measurement error. The volunteer cohort may carry selection bias, and residual confounding or reverse causality remains possible despite multivariable adjustment.
Cited by
- contradicts In the French NutriNet-Santé cohort, low-to-moderate aspartame consumers showed a roughly 15% increased relative risk of cancer, whereas high consumers showed no statistically significant increase in risk.