Long-Term Artificial Sweetener Intake Linked to Risk for Obesity

Long-term aspartame, saccharin, and diet soda intake is related to an increased risk for obesity, according to study results published in the International Journal of Obesity.

Researchers conducted the Coronary Artery Risk Development in Young Adults (CARDIA) study, which included 5115 women and men who were Black and White. The study sought to determine whether greater artificial sweetener intake and diet beverages are associated with greater volumes of visceral adipose tissue (AT), intermuscular AT, and subcutaneous AT independent of demographic and lifestyle variables, including total caloric intake and the healthy eating index. Questionnaires assessed demographic characteristics, lifestyle factors, and physical activity.

A total of 3276 participants aged 18 to 30 years at baseline attended the examination over a course of 25 years. The resulting number of participants included in the study was 3088, including 869 Black women, 867 White women, 590 Black men, and 762 White men. A dietary intake follow-up was made at year 0, 7, and 20. The researchers separated aspartame and dietary intake into 5 quintiles and saccharin intake into 3 tertiles.

The researchers noted a strong correlation between increased artificial sweetener consumption and higher volumes of visceral (P_trend =.001), subcutaneous (P_trend <.001), and intermuscular AT (P <.001).

Higher aspartame intake also correlated with greater volumes of visceral AT, subcutaneous AT, and intermuscular AT in participants who consumed aspartame in the top quintile. Higher volumes of visceral AT (8.4%), subcutaneous AT (11.6%), and intermuscular AT (10.6%) were also reported in participants who consumed aspartame in the bottom quintile. The researchers noted consuming more aspartame was linked to a higher BMI, weight, and waist circumference, with these metrics increasing during the follow-up period of 25 years.

Participants in the top tertile of saccharin intake had 10.3% higher visceral AT, 14% higher subcutaneous AT, and 10% higher intermuscular AT volumes than those in the bottom tertile. Additionally, saccharin intake was positively correlated with an increase in BMI (P <.001), weight (P_trend <.001), and waist circumference (P_trend <.001). Over the follow up period an increase in overall weight (P_trend =.03), waist circumference (P_trend =.008), but not BMI (P_trend =.06) was also positively correlated to saccharin intake.

As the intake of diet beverages increased, there was significant increase in visceral AT, subcutaneous AT (P_trend ≤.001), and intermuscular AT (P_trend <.001). Participants who consumed more diet beverages, particularly those in the highest quintile, had 10.4% higher visceral AT, 14.1% higher saccharine AT, and 14.8% higher intermuscular AT volumes than those in the lowest quintile. Diet beverage intake was associated with higher BMI, weight, and waist circumference (P_trend <.001 for all) over the period of 25 years.

Sucralose intake increased across quintiles with a corresponding increase in BMI (P_trend =.004), weight (P_trend <.001), and waist circumference (P_trend =.05). However, there were no significant associations observed between sucralose intake and AT volumes or changes in anthropometry over a period of 25 years.

The researchers reported consuming artificial sweeteners, aspartame, sucralose, and diet soda increased risk for obesity (P_trend <.001), especially with greater intake. Those in higher quintiles showed a 78% greater risk for obesity for artificial sweetener, 64% for aspartame, and 57% for diet beverages compared with those in lower quintiles.

Study limitations included self-reporting bias and the risk of adipogenesis influence from an altered microbiome.

“Coupled with evidence from microbiome and experimental studies, our findings suggest that alternatives to the national recommendations to replace added sugar with ArtSw should be considered since both may have health consequences,” the researchers concluded.