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Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort
The BMJ ( IF 105.7 ) Pub Date : 2022-09-07 , DOI: 10.1136/bmj-2022-071204
Charlotte Debras 1, 2 , Eloi Chazelas 1, 2 , Laury Sellem 1, 2 , Raphaël Porcher 3, 4 , Nathalie Druesne-Pecollo 1, 2 , Younes Esseddik 1 , Fabien Szabo de Edelenyi 1 , Cédric Agaësse 1 , Alexandre De Sa 1 , Rebecca Lutchia 1 , Léopold K Fezeu 1, 2 , Chantal Julia 1, 5 , Emmanuelle Kesse-Guyot 1, 2 , Benjamin Allès 1 , Pilar Galan 1, 2 , Serge Hercberg 1, 2, 5 , Mélanie Deschasaux-Tanguy 1, 2 , Inge Huybrechts 2, 6 , Bernard Srour 1, 2 , Mathilde Touvier 1, 2
Affiliation  

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 103 388 participants of the web based NutriNet-Santé cohort (mean age 42.2±14.4, 79.8% female, 904 206 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 100 000 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 100 000 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 100 000 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. Trial registration ClinicalTrials.gov [NCT03335644][1] Researchers from public institutions can submit a collaboration request including information on the institution and a brief description of the project to collaboration@etude-nutrinet-sante.fr. All requests will be reviewed by the steering committee of the NutriNet-Santé study. If the collaboration is accepted, a data access agreement will be necessary and appropriate authorisations from the competent administrative authorities might be needed. In accordance with existing regulations, no personal data will be accessible. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03335644&atom=%2Fbmj%2F378%2Fbmj-2022-071204.atom

中文翻译:

人造甜味剂和心血管疾病的风险:来自前瞻性 NutriNet-Santé 队列的结果

目的 研究所有饮食来源(饮料、餐桌甜味剂、乳制品等)的人造甜味剂、整体和分分子(阿斯巴甜、乙酰磺胺酸钾和三氯蔗糖)与心血管疾病风险(总体、冠状动脉疾病)之间的关联心脑血管疾病)。设计基于人群的前瞻性队列研究 (2009-21)。设置法国,初级预防研究。参与者 103 388 名基于网络的 NutriNet-Santé 队列参与者(平均年龄 42.2±14.4,79.8% 为女性,904 206 人年)。人工甜味剂的膳食摄入量和消耗量通过重复的 24 小时膳食记录进行评估,包括工业产品的品牌名称。主要结果衡量甜味剂(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 风险模型评估。结果 总人造甜味剂摄入量与心血管疾病风险增加相关(1502 起事件,风险比 1.09,95% 置信区间 1.01 至 1.18,P=0.03);高级消费者(高于特定性别的中位数)和非消费者的绝对发病率分别为每 10 万人年 346 人和 314 人。人造甜味剂与脑血管疾病风险的相关性更高(777 起事件,1.18、1.06 至 1.31,P=0.002;高等消费人群和非消费人群的发病率分别为每 10 万人年 195 起和 150 起)。阿斯巴甜摄入量与脑血管事件风险增加相关(1.17,1.03 至 1.33,P = 0.02;高消费人群和非消费人群的发病率分别为每 100 000 人年 186 和 151 起),和乙酰磺胺酸钾和三氯蔗糖与冠心病风险增加相关(730 起事件;乙酰磺胺酸钾:1.40,1.06 至 1.84,P=0.02;发病率 167 和 164;三氯蔗糖:1.31,1.00 至 1.71,P=0.05;发病率271 和 161)。结论 这项大规模前瞻性队列研究的结果表明,较高的人造甜味剂消耗量(尤其是阿斯巴甜、乙酰磺胺酸钾和三氯蔗糖)与心血管疾病风险增加之间存在潜在的直接关联。人造甜味剂存在于全球数以千计的食品和饮料品牌中,但它们仍然是一个有争议的话题,目前欧洲食品安全局、世界卫生组织和其他卫生机构正在重新评估。试验注册临床试验。gov [NCT03335644][1] 公共机构的研究人员可以向 collaboration@etude-nutrinet-sante.fr 提交包括机构信息和项目简要说明在内的合作请求。所有请求都将由 NutriNet-Santé 研究的指导委员会审查。如果合作被接受,数据访问协议将是必要的,并且可能需要主管行政当局的适当授权。根据现行规定,将无法访问任何个人数据。[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03335644&atom=%2Fbmj%2F378%2Fbmj-2022-071204.atom 所有请求都将由 NutriNet-Santé 研究的指导委员会审查。如果合作被接受,数据访问协议将是必要的,并且可能需要主管行政当局的适当授权。根据现行规定,将无法访问任何个人数据。[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03335644&atom=%2Fbmj%2F378%2Fbmj-2022-071204.atom 所有请求都将由 NutriNet-Santé 研究的指导委员会审查。如果合作被接受,数据访问协议将是必要的,并且可能需要主管行政当局的适当授权。根据现行规定,将无法访问任何个人数据。[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03335644&atom=%2Fbmj%2F378%2Fbmj-2022-071204.atom
更新日期:2022-09-08
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