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Artificial sweeteners in place of real sugar may not be such a healthy alternative, a French cohort study suggested.

Over a median follow-up of 7.8 years, adults deemed "high consumers" of artificial sweeteners faced a higher risk of developing cancer compared with non-consumers (HR 1.13, 95% CI 1.03-1.25), reported Charlotte Debras, a PhD candidate at the Sorbonne Paris Nord University in France, and colleagues in .

When looking at specific types of artificial sweeteners, aspartame and acesulfame potassium were the two culprits that seemed to drive this overall cancer risk:

• Aspartame: HR 1.15 (95% CI 1.03-1.28)
• Acesulfame potassium: HR 1.13 (95% CI 1.01-1.26)

Artificial sweeteners in general were linked with a 13% increased risk for developing obesity-related cancers, including colorectal, stomach, liver, mouth, pharynx, larynx, esophageal, breast (with opposite associations pre- and post-menopause), ovarian, endometrial, and prostate cancers (HR 1.13, 95% CI 1.00-1.28). Aspartame alone was linked with a 15% higher risk for obesity-related cancers (HR 1.15, 95% CI 1.01-1.32), and a 22% higher risk for developing breast cancer (HR 1.22, 95% CI 1.01-1.48).

In fully adjusted models, even low consumption of these artificial sweeteners -- including both aspartame and acesulfame potassium individually -- was tied to a significantly higher risk for all cancers (HR 1.14, 95% CI 1.05-1.25).

However, sucralose consumption at any level wasn't linked to cancer risk, including for site-specific cancers, the researchers noted.

"Findings from this study are very original since, to our knowledge, no previous cohort study had directly investigated the association between quantitative artificial sweetener intakes per se -- distinguishing the different types of sweeteners and cancer risk," Debras and co-author Mathilde Touvier, PhD, also of Sorbonne Paris Nord University, jointly told MedPage Today.

"But these results are in line with our initial hypothesis and with previous scientific literature," they added. "Indeed, some observational studies have investigated the associations between cancer risk and the consumption of artificially sweetened beverages (used as a proxy) and found increased risk of cancer, suggesting that artificial sweeteners present in these types of beverages might play a role in the development of cancer."

The implications of these findings are far reaching, since artificial sweeteners are prevalent in foods and beverages consumed by millions daily, they pointed out.

While the findings need to be replicated in other larger-scale studies, they "provide important and novel information to address the controversies about the potential adverse health effects of these additives, in the context of the ongoing re-evaluation of food-additive sweeteners by the and other health agencies globally," Debras and Touvier noted.

"In line with official recommendations from several public health agencies, these findings do not support the use of artificial sweeteners as safe alternatives for sugar in foods or beverages," they added.

Drawing on the population-based , the researchers assessed dietary intake data from French adults (mean age 42), including 24-hour dietary records that were collected every 6 months. Incident cancer cases during follow-up were also self-reported every 6 months.

A total of 3,358 incident cancer cases were diagnosed during follow-up. Mean age at diagnosis was 59.5, and the most common cancer types were obesity-related (2,023 cases), breast (982 cases), and prostate (403 cases).

Overall, artificial sweeteners were consumed by 36.9% of the cohort -- with aspartame the most common (58% of all consumption), followed by acesulfame potassium (29%), and sucralose (10%). The most popular foods that drove up artificial sweetener consumption were soft drinks with no added sugars, table-top sweeteners, yogurt, and cottage cheese.

The cutoffs between "high consumers" and "low consumers" were sex-specific: 17.44 mg/day in men and 19.00 mg/day in women for total artificial sweeteners, 14.45 mg/day in men and 15.39 mg/day in women for aspartame, 5.06 mg/day in men and 5.50 mg/day in women for acesulfame potassium and 3.46 mg/day in men and 3.43 mg/day in women for sucralose.

People who consumed artificial sweeteners tended to be women, younger, smokers, less physically active, more educated, and more likely to have prevalent diabetes compared with those who avoided artificial sweeteners.

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