No Association between Low-Calorie Sweetener (LCS) Use and Overall Cancer Risk in the Nationally Representative Database in the US: Analyses of NHANES 1988–2018 Data and 2019 Public-Use Linked Mortality Files

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.

Estimated pulse wave velocity is associated with all-cause mortality and cardiovascular mortality among adults with diabetes

“…Publicly accessible death data were adopted from the start of follow-up to December 31, 2019 (the last update date of NDI database). Mortality outcomes were determined according the International Statistical Classification of Diseases, 10th Revision (ICD-10) ( 31 ). In ICD-10, cardiovascular death is defined as a death caused by a disease or condition related to the circulatory system.…”

WHO guideline on the use of non-sugar sweeteners: a need for reconsideration

“…It also implied that the diet quality of those who replace free sugars with NSS might may be unaffected. In fact, recent research suggests that NSS users have higher-quality diets and smoke less, but may have a higher prevalence of obesity and type 2 diabetes [38], indicating that NSS consumption may be a response to high disease risk, not a cause of harm [18,[20][21][22][23].…”

Persiste la controversia en la relación entre la ingesta de edulcorantes artificiales y el riesgo de cáncer

“…No es posible descartar por completo el sesgo de confusión residual, aunque la amplia gama de factores de ajuste que fueron tenidas en cuenta en los modelos de análisis principal y de sensibilidad limitó este riesgo. Un estudio publicado recientemente 4 buscó explorar cualquier vínculo potencial entre el uso de edulcorantes y el riesgo de cáncer utilizando las Encuestas Nacionales de Examen de Salud y Nutrición de los EE.UU. (conocidas por sus siglas en inglés, NHANES), que son representativas a nivel nacional.…”

“…EVIDENCIA -Actualización en la Práctica Ambulatoria -Oct-Dic -Disponible en internet: www.evidencia.org.ar volumen 25 nro 4. …”