Associations between the consumption of sweeteners and weight status in the NutriNet-Santé study

Abstract Background and objectives Reducing sugar intake to prevent chronic diseases is recommended by the WHO. As an alternative, the use of artificial sweeteners has increased. Yet, the long-term impact of using artificial sweeteners on weight status or health is still debated, with experimental and epidemiological results showing adverse outcomes. Our objective was therefore to investigate associations between the consumption of artificial sweeteners and weight status. Methods Our analyses included 101,182 adults from the French NutriNet-Santé prospective cohort study recruited between 2009 and 2023 (median follow-up: 6.5 years). Repeated 24-hour dietary records, including brands for industrial products, linked with data on qualitative and quantitative content in food additives, were used to assess intakes of artificial sweeteners from all dietary sources. Weight and height were collected every 6 months through a validated online questionnaire. Associations between intake of artificial sweeteners (total and most consumed: aspartame, acesulfame K, sucralose), BMI gain and risk of overweight and obesity were studied using multi-adjusted mixed and Cox models, respectively. Results Compared with non-consumption, a higher intake of artificial sweeteners (> sex-specific median) was associated with higher BMI gain (β higher consumers x time = 0.02, P < 0.001) and a higher risk of overweight (9641/367,549 person-years; HR = 1.30 [1.23-1.37], P-trend<0.001) and obesity (4062/531,650 person-years; HR = 1.40 [1.30-1.51], P-trend<0.001). Similar results were found for aspartame and acesulfame K, as well as in sensitivity analyses challenging reverse causality. Conclusions In this study, a higher consumption of intense sweeteners was associated with a higher risk of weight gain, overweight and obesity. These results suggest potential long-term adverse effects of intense sweeteners at doses below the admissible daily intake, and therefore provide important data for safety assessment. Key messages • Artificial sweeteners (total, aspartame, acesulfame K) are associated with gain weight and a higher risk of incidence of overweight and obesity. • If corroborated by further studies, our study underscores the necessity for stricter regulations on artificial sweeteners.