法国巴黎大学Charlotte Debras团队研究了人工甜味剂与心血管疾病风险的相关性。2022年9月7日出版的《英国医学杂志》发表了这项成果。
为了研究所有膳食来源、整体或按分子（阿斯巴甜、安赛蜜钾和三氯蔗糖）的人工甜味剂（饮料，但也包括桌面甜味剂、乳制品等）与心血管疾病风险（总体冠心病和脑血管病）之间的关系，研究组在法国初级保健机构进行了一项基于人群的前瞻性队列研究（2009-2021）。
基于网络的NutriNet Santé队列共涉及103388名参与者（平均年龄42.2±14.4岁，79.8%为女性，共904206人-年）。通过重复的24小时膳食记录（包括工业产品的品牌名称）来评估人工甜味剂的膳食摄入量和消费量。主要结局为甜味剂（编码为连续变量，log10转换）与心血管疾病风险之间的关联，通过多变量调整Cox风险模型进行评估。
人工甜味剂总摄入量与心血管疾病风险增加相关（1502次事件，风险比为1.09）；高消费者和非消费者的绝对发病率分别为346和314/100 000人-年。人工甜味剂与脑血管病风险更为相关（777个事件，1.18；较高消费者和非消费者发病率分别为195和150/100000人-年）。
阿斯巴甜摄入与脑血管事件风险增加相关（1.17；较高消费者和非消费者中发病率分别为186和151/100000人-年），安赛蜜钾和三氯蔗糖与冠心病风险增加相关（730例事件；安赛蜜钾风险比为1.40；发病率分别为167和164/100000人-年；三氯蔗糖风险比为1.31；发病率分别为271和161/100000人-年）。
这项大规模前瞻性队列研究的结果表明，较高的人工甜味剂消费量（尤其是阿斯巴甜、安赛蜜钾和三氯蔗糖）与心血管疾病风险增加之间存在潜在直接关联。人工甜味剂存在于全球数千个食品和饮料品牌中，但它们仍然是一个有争议的话题，目前正在由欧洲食品安全局、世界卫生组织和其他卫生机构重新评估。
附：英文原文
Title: Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort
Author: Charlotte Debras, Eloi Chazelas, Laury Sellem, Raphal Porcher, Nathalie Druesne-Pecollo, Younes Esseddik, Fabien Szabo de Edelenyi, Cédric Agasse, Alexandre De Sa, Rebecca Lutchia, Léopold K Fezeu, Chantal Julia, Emmanuelle Kesse-Guyot, Benjamin Allès, Pilar Galan, Serge Hercberg, Mélanie Deschasaux-Tanguy, Inge Huybrechts, Bernard Srour, Mathilde Touvier
Issue&Volume: 2022/09/07
Abstract:
Objectives To study the associations between artificial sweeteners from all dietary sources (beverages, but also table top sweeteners, dairy products, etc), overall and by molecule (aspartame, acesulfame potassium, and sucralose), and risk of cardiovascular diseases (overall, coronary heart disease, and cerebrovascular disease).
Design Population based prospective cohort study (2009-21).
Setting France, primary prevention research.
Participants 103388 participants of the web based NutriNet-Santé cohort (mean age 42.2±14.4, 79.8% female, 904206 person years). Dietary intakes and consumption of artificial sweeteners were assessed by repeated 24 h dietary records, including brand names of industrial products.
Main outcomes measures Associations between sweeteners (coded as a continuous variable, log10 transformed) and cardiovascular disease risk, assessed by multivariable adjusted Cox hazard models.
Results Total artificial sweetener intake was associated with increased risk of cardiovascular diseases (1502 events, hazard ratio 1.09, 95% confidence interval 1.01 to 1.18, P=0.03); absolute incidence rate in higher consumers (above the sex specific median) and non-consumers was 346 and 314 per 100000 person years, respectively. Artificial sweeteners were more particularly associated with cerebrovascular disease risk (777 events, 1.18, 1.06 to 1.31, P=0.002; incidence rates 195 and 150 per 100000 person years in higher and non-consumers, respectively). Aspartame intake was associated with increased risk of cerebrovascular events (1.17, 1.03 to 1.33, P=0.02; incidence rates 186 and 151 per 100000 person years in higher and non-consumers, respectively), and acesulfame potassium and sucralose were associated with increased coronary heart disease risk (730 events; acesulfame potassium: 1.40, 1.06 to 1.84, P=0.02; incidence rates 167 and 164; sucralose: 1.31, 1.00 to 1.71, P=0.05; incidence rates 271 and 161).
Conclusions The findings from this large scale prospective cohort study suggest a potential direct association between higher artificial sweetener consumption (especially aspartame, acesulfame potassium, and sucralose) and increased cardiovascular disease risk. Artificial sweeteners are present in thousands of food and beverage brands worldwide, however they remain a controversial topic and are currently being re-evaluated by the European Food Safety Authority, the World Health Organization, and other health agencies.
DOI: 10.1136/bmj-2022-071204
Source: https://www.bmj.com/content/378/bmj-2022-071204
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
