Abstract
Low-calorie sweeteners (LCS) serve to replace added sugars in beverages and foods. The present goal was to explore any potential links between LCS use and cancer risk using the nationally representative National Health and Nutrition Examination Surveys 1988–2018 linked to 2019 Public-Use Linked Mortality Files. Analyses were based on dietary intakes from 1988–1994 NHANES (n = 15,948) and 1999–2018 NHANES (n = 48,754) linked to mortality data. The 1988–1994 NHANES separated aspartame from saccharin consumption; later data did not. LCS consumers were more likely to be older, female, non-Hispanic White, and with higher education and incomes compared to nonconsumers. LCS consumers were less likely to smoke and had higher HEI-2015 scores indicating higher-quality diets. In the cross-sectional NHANES data, LCS use was associated with higher BMI and higher prevalence of obesity and diabetes. There was no indication that aspartame, saccharin, or all LCS had any impact on overall cancer mortality. By using nonconsumers as the reference group, the hazard ratio (95th confidence interval, CI) group trend for tertiles of LCS use for 1988–1994 for aspartame was 1.00 (0.89–1.12), for saccharin 0.96 (0.79–1.10), and for 1988–2018 for all LCS was 0.92 (0.88–1.101). The null group trend effects were seen for analyses stratified by age/gender. The present analyses confirm past US-based reports that LCS use was associated with higher socioeconomic status, lower prevalence of smoking, and generally higher-quality diets. No association with cancer mortality was observed.
Summary
The present large and nationally representative study of the US population based on data from the National Health and Nutrition Examination Surveys (NHANES) for the period 1988-2018 shows no association between higher intake of low/no calorie sweeteners and overall cancer mortality risk.
The study analysed dietary intake data from multiple NHANES cycles for years 1988-1994 (n=15,948) and 1999–2018 (n = 48,754) linked to 2019 Public Use Linked Mortality Files to assess cancer mortality risk. The 1988–1994 data separated aspartame from saccharin consumption while later data included all low/no calorie sweeteners. Dietary intake data from 24-h dietary recalls were used to construct Healthy Eating Index (HEI 2015) scores, which is a measure of diet quality as determined by compliance with the Dietary Guidelines for Americans, and developed by the U.S. Department of Agriculture.
There was no indication that aspartame, saccharin, or all low/no calorie sweeteners had any impact on overall cancer mortality. Results showed that confidence limits for all the hazard ratio point estimates for any level of low/no calorie sweetener consumption and for any age groups included 1.0, which means that there were no differences in cancer mortality risk between consumers and non-consumers. In fact, data analyses were even suggestive of a slight reduction in cancer mortality risk among low/no calorie sweeteners’ users within selected subgroups (19+ years all, 51+ years all and males). The authors stress that the present results stand in contrast to a recent report by Debras et al (2022) based on the French Nutrinet Santé volunteer cohort, a large but non-representative and predominantly female sample of convenience.
In addition, results confirmed previous NHANES findings that consumers of low/no calorie sweeteners followed a higher quality diet and overall, had better health behaviours; for example, they were less likely to be smokers. Consumers of low/no calorie sweeteners had higher HEI-2015 scores indicating higher-quality diets, which was largely driven by a lower consumption of added sugars. In fact, low/no calorie sweeteners’ consumers had about 6 fewer tsp of added sugars in their diets as compared to non-consumers.
In summary, results from this large and nationally representative study of the US population show that the consumption of low/no calorie sweeteners was linked to better dietary habits and overall, a healthier lifestyle, with no association with overall cancer mortality risk.
