Can Artificial Sweeteners Increase the Risk of Cancer Incidence and Mortality: Evidence from Prospective Studies

Association between erythritol and lung cancer: a two-sample Mendelian randomization study

BACKGROUND

Sweeteners have been widely added to food and beverages due to their low-calorie and sweetening properties. However, the role of sweeteners in cancer risk has been a subject of extensive debate over the past few decades.

OBJECTIVE

We aimed to elucidate the causation between the commonly used natural sweetener erythritol and the risk of lung cancer (LC) using Mendelian randomization (MR).

METHODS

Data on erythritol and its metabolites were obtained from publicly available genome-wide association studies data. Summary data on LC and its subtypes were obtained from a large-scale genetic study conducted by the Transdisciplinary Research of Cancer in Lung of the International Lung Cancer Consortium and the Lung Cancer Cohort Consortium. We conducted independent two-sample MR analyses to assess the causation between erythritol and LC and its subtypes.

RESULTS

The inverse variance weighted method of MR analysis showed no evidence supporting causation between erythritol and LC or its histological subtypes. Sensitivity analysis further supported the results.

CONCLUSION

Our study findings do not support genetic association between erythritol and LC or its subtypes.

Biosynthesis and metabolic engineering of natural sweeteners

Natural sweeteners have attracted widespread attention because they are eco-friendly, healthy, low in calories, and tasty. The demand for natural sweeteners is increasing together with the popularity of green, low-carbon, sustainable development. With the development of synthetic biology, microbial cell factories have emerged as an effective method to produce large amounts of natural sweeteners. This technology has significantly progressed in recent years. This review summarizes the pathways and the enzymes related to the biosynthesis of natural sweeteners, such as mogrosides, steviol glycosides, glycyrrhizin, glycyrrhetinic acid, phlorizin, trilobatin, erythritol, sorbitol, mannitol, thaumatin, monellin, and brazzein. Moreover, it focuses on the research about the microbial production of these natural sweeteners using synthetic biology methods, aiming to provide a reference for future research on the production of natural sweeteners.

Sensory-emotion relationships in white chocolate of modified color and sweetener among Polish and Brazilian consumers

The objective of this study was to examine the influence of chocolate formulation (sweetener and color) on consumer sensory acceptance and emotional response across two consumer populations, Brazilian and Polish. White chocolate samples (n = 10) were formulated with differences in sweetener (sucrose, rebaudioside A) and color (red, blue, yellow, green). Along with a trained panel, consumers in Brazil (n = 120) and Poland (n = 120) evaluated chocolate samples for liking and associated emotions. Color was not found to influence sweetness or flavor perception, indicating the absence of cross-modal influence. However, the yellow-colored chocolate was liked less than the blue, green, or red chocolate. Emotions were a stronger driver of product liking in the Brazilian population compared to the Polish consumers. This research shows the influence of color on consumers perception, with implications of using natural colors in chocolate production and "yellowing" in white chocolate. PRACTICAL APPLICATIONS: The recipe may be used in chocolate manufacturing to produce free-sugar chocolate targeted to consumers with health conditions, such as diabetes. Our research also gives the solution for practical application of natural dyes to white chocolate to cover the problematic "yellowing," which is considered defect of this product and results in the low consumer acceptance. The dyes that are suggested to add are of red, green, or blue color due to high acceptability of consumers from different countries.

Towards healthier low-sugar and low-fat beverages: Design, production, and characterization

Many consumers are adopting low-sugar and low-fat beverages to avoid excessive calories and the negative impact of high trans- and/or saturated fat on health and wellbeing. This article reviews strategies to reduce sugar, fat, and high trans- and/or saturated fat content in beverages while maintaining their desirable physicochemical and sensory attributes. It assesses the impact of various sugar and fat replacers on the aroma, taste, texture, appearance, and nutritional profile of beverages. Combinations of natural sugar replacers and protein or polysaccharide-based fat replacers have shown partial success in mimicking the qualities of sucrose and fat. Future strategies for designing low-sugar and low-fat beverages include developing novel replacers and using odorants to enhance sensory profiles. The article also highlights methods for flavor detection and oral tribology methods, emphasizing their role in development of low-sugar and low-fat beverages. The information presented in this review article is intended to stimulate research into the design of healthier low-sugar and low-fat beverages in the future.

Association of unsweetened and sweetened cereal consumption with all-cause and cause-specific mortality: a large prospective population-based cohort study

Background & aims: Although previous observational studies have suggested an association between whole grain consumption (including breakfast cereals) and a reduced risk of death, no study has explored in detail the association between consumption of cereal with or without added sweeteners and death. We therefore aimed to evaluate the association between unsweetened, sugar-sweetened, and artificially sweetened cereals and all-cause and cause-specific mortality. Methods: We conducted a prospective cohort study of 186 419 UK Biobank participants who met the inclusion criteria for this study. Participants with baseline demographic, lifestyle, dietary, and clinical data were recruited from 2006 to 2010 and followed up until 2023. The intake of unsweetened, sugar-sweetened, or artificially sweetened cereals was estimated through repeated 24 hour dietary recalls. The non-linear relationships between daily dosage of cereal and all-cause, cancer-specific, and cardiovascular disease (CVD)-specific mortality were calculated using a restricted cubic spline curve. Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality were calculated using Cox regression models. Results: During a median follow-up of 13.6 years, 11 351 all-cause deaths were recorded, including 6176 cancer deaths and 2126 CVD deaths. Cox regression models with restricted cubic splines showed a non-linear association between unsweetened cereals and all-cause and cancer-specific mortality. Compared with non-consumers, consumers of different amounts of unsweetened cereals (0 to 0.5, 0.5 to 1.5, and >1.5 bowls per day) had lower risks of all-cause mortality in the multivariate Cox models, with respective HRs of 0.89 (95%CI: 0.84-0.95), 0.90 (95%CI: 0.86-0.94), and 0.89 (95%CI: 0.82-0.97). However, no association was observed between consumption of sugar or artificially sweetened cereals and the risk of mortality. When cereals were divided into those with or without dried fruit, the findings were consistent with our primary results. Conclusions: Moderate consumption of unsweetened cereals was associated with a reduced risk of all-cause mortality, suggesting caution in consuming cereals with added sugar or artificial sweeteners.

The key to intestinal health: a review and perspective on food additives

In this review, we explore the effects of food additives on intestinal health. Food additives, such as preservatives, antioxidants and colorants, are widely used to improve food quality and extend shelf life. However, their effects on intestinal microecology May pose health risks. Starting from the basic functions of food additives and the importance of intestinal microecology, we analyze in detail how additives affect the diversity of intestinal flora, oxidative stress and immune responses. Additionally, we examine the association between food additives and intestinal disorders, including inflammatory bowel disease and irritable bowel syndrome, and how the timing, dosage, and individual differences affect the body's response to additives. We also assess the safety and regulatory policies of food additives and explore the potential of natural additives. Finally, we propose future research directions, emphasizing the refinement of risk assessment methods and the creation of safer, innovative additives.

Could Insulin Be a Better Regulator of Appetite/Satiety Balance and Body Weight Maintenance in Response to Glucose Exposure Compared to Sucrose Substitutes? Unraveling Current Knowledge and Searching for More Appropriate Choices

BACKGROUND

Insulin exerts a crucial impact on glucose control, cellular growing, function, and metabolism. It is partially modulated by nutrients, especially as a response to the intake of foods, including carbohydrates. Moreover, insulin can exert an anorexigenic effect when inserted into the hypothalamus of the brain, in which a complex network of an appetite/hunger control system occurs. The current literature review aims at thoroughly summarizing and scrutinizing whether insulin release in response to glucose exposure may be a better choice to control body weight gain and related diseases compared to the use of sucrose substitutes (SSs) in combination with a long-term, well-balanced diet.

METHODS

This is a comprehensive literature review, which was performed through searching in-depth for the most accurate scientific databases and applying effective and relevant keywords.

RESULTS

The insulin action can be inserted into the hypothalamic orexigenic/anorexigenic complex system, activating several anorexigenic peptides, increasing the hedonic aspect of food intake, and effectively controlling the human body weight. In contrast, SSs appear not to affect the orexigenic/anorexigenic complex system, resulting in more cases of uncontrolled body weight maintenance while also increasing the risk of developing related diseases.

CONCLUSIONS

Most evidence, mainly derived from in vitro and in vivo animal studies, has reinforced the insulin anorexigenic action in the hypothalamus of the brain. Simultaneously, most available clinical studies showed that SSs during a well-balanced diet either maintain or even increase body weight, which may indirectly be ascribed to the fact that they cannot cover the hedonic aspect of food intake. However, there is a strong demand for long-term longitudinal surveys to effectively specify the impact of SSs on human metabolic health.

Linking artificial sweetener intake with kidney function: insights from NHANES 2003-2006 and findings from Mendelian randomization research

Background

The current investigation examines the association between artificial sweetener (AS) consumption and the likelihood of developing chronic kidney disease (CKD), along with its impact on kidney function.

Methods

We utilized data from the National Health and Nutrition Examination Survey from 2003-2006 to conduct covariance analysis and weighted adjusted logistic regression, aiming to assess the association between artificial sweetener intake and CKD risk, as well as kidney function indicators. Subsequently, we employed Mendelian randomization methods to validate the causal relationship between the intake of artificial sweeteners, CKD risk, and kidney function indicators. Instrumental variable analysis using inverse-variance weighting and Robust adjusted profile score were the primary analytical methods employed.

Results

A total of 20,470 participants were included in the study, with 1,257 participants ultimately included in the analysis. In all adjusted logistic regression models, no significant association was found between the intake of artificial sweeteners and CKD risk. Similarly, the summary odds ratios (OR) for each unit change in genetically predicted CKD risk were 2.14 (95% CI: 0.83, 5.21, p = 0.092), 1.41 (95% CI: 0.54, 3.63, p = 0.482), and 1.50 (95% CI: 0.50, 4.52, p = 0.468) for the impact of artificial sweeteners added to cereals, tea, and coffee, respectively. It was only observed that adding artificial sweeteners to coffee was associated with a modest reduction in urinary albumin-to-creatinine ratio (OR = 0.94, 95% CI: -0.108, -0.022, p = 0.003), the effect appeared to be relatively small and may not directly impact the individual level.

Conclusion

Our study does not support a causal relationship between artificial sweetener intake and the risk of CKD. However, due to the limitations and potential confounding factors, these findings need to be further validated through larger sample sizes in observational studies and Mendelian randomization analyses.

The causal association between artificial sweeteners and the risk of cancer: a Mendelian randomization study

Artificial sweeteners (ASs) have been widely added to food and beverages because of their properties of low calories and sweet taste. However, whether the consumption of ASs is causally associated with cancer risk is not clear. Here, we utilized the two-sample Mendelian randomization (MR) method to study the potential causal association. Genetic variants like single-nucleotide polymorphisms (SNPs) associated with exposure (AS consumption) were extracted from a genome-wide association study (GWAS) database including 64 949 Europeans and the influence of confounding was removed. The outcome was from 98 GWAS data and included several types of cancers like lung cancer, colorectal cancer, stomach cancer, breast cancer, and so on. The exposure-outcome SNPs were harmonized and then MR analysis was performed. The inverse-variance weighted (IVW) with random effects was used as the main analytical method accompanied by four complementary methods: MR Egger, weighted median, simple mode, and weighted mode. Sensitivity analyses consisted of heterogeneity, pleiotropy, and leave-one-out analysis. Our results demonstrated that ASs added to coffee had a positive association with high-grade and low-grade serous ovarian cancer; ASs added to tea had a positive association with oral cavity and pharyngeal cancers, but a negative association with malignant neoplasm of the bronchus and lungs. No other cancers had a genetic causal association with AS consumption. Our MR study revealed that AS consumption had no genetic causal association with major cancers. Larger MR studies or RCTs are needed to investigate small effects and support this conclusion.

New Zealand household purchases of sugar-sweetened, artificially sweetened, and unsweetened beverages: 2015-2019

OBJECTIVE

To assess annual household purchases of sugar-sweetened beverages (SSBs), artificially sweetened beverages (AFSBs), and unsweetened beverages (USBs) by household composition and income, and over time.

DESIGN

Observational cohort study using beverage purchasing data linked to a supermarket database. ANOVA was used to compare total household purchase volumes (L) and the contribution of beverages purchased by category, household composition (size), household income (four categories from New Zealand (NZ) < $30 000 to > $90 000), and over time (trend from 2015 to 2019).

SETTING

Aotearoa NZ.

PARTICIPANTS

∼1800 households in the NielsenIQ Homescan® market research panel.

RESULTS

In 2019, the mean (sd) annual household purchase volume and relative contribution to total beverage volume of SSBs were 72·3 (93·0) L and 33 %, respectively. Corresponding values for AFSBs were 32·5 (79·3) L (15 %), and USBs were 112·5 (100·9) L (52 %). Larger households purchased more of all beverage types except AFSBs. Total purchases were similar by income, but households earning < $NZ 30 000 purchased fewer AFSBs and USBs (but not SSBs) than households earning > $NZ 90 000. Total and USB purchases were unchanged over time, but SSBs dropped by 5·9 L (P-trend = 0·04), and AFSBs increased by 5·3 L (P-trend = 0·00).

CONCLUSIONS

USBs contributed the most to household beverage purchases. Total purchases were higher for larger households and similar by income, including for SSBs. The reduction over time was too small for health benefits. Findings support policies and interventions to reduce SSB consumption and highlight the importance of focusing on equitable outcomes.

The Impact of Artificial Sweeteners on Human Health and Cancer Association: A Comprehensive Clinical Review

Artificial sweeteners are sugar substitutes that provide high sweetening power associated with low accompanied calories. In this study, we aim to review the data on the use, benefits, side effects, and cancer risks of artificial sweeteners. We reviewed data in the PubMed, MEDLINE, Google Scholar, Embase, and Scopus databases to search for studies about artificial sweeteners from the inception of the database to July 20, 2023, published in the English language. We discuss systematic reviews and meta-analyses, randomized clinical trials, and observational cohort studies that address the use of artificial sweeteners and their effect on health. In our review, we show that artificial sweeteners have been shown to impact various functions of the gastrointestinal system. Other studies have demonstrated an association with neurologic symptoms such as headache and taste alteration. Moreover, recent studies have established an association between artificial sweeteners and cardiovascular risk and diabetes. Importantly, the majority of research data show no link between the use of artificial sweeteners and cancer risk. Although most studies show that there is no established link between these products and cancer risk, artificial sweeteners are associated with multiple diseases. Hence, more studies are needed to better characterize the effect of artificial sweeteners on human health.

Sweeteners and the Gut Microbiome: Effects on Gastrointestinal Cancers

Worldwide, the demand for natural and synthetic sweeteners in the food industry as an alternative to refined sugar is increasing. This has prompted more research to be conducted to estimate its safety and effects on health. The gut microbiome is critical in metabolizing selected sweeteners which might affect overall health. Recently, more studies have evaluated the relationship between sweeteners and the gut microbiome. This review summarizes the current knowledge regarding the role played by the gut microbiome in metabolizing selected sweeteners. It also addresses the influence of the five selected sweeteners and their metabolites on GI cancer-related pathways. Overall, the observed positive effects of sweetener consumption on GI cancer pathways, such as apoptosis and cell cycle arrest, require further investigation in order to understand the underlying mechanism.

Is the Use of Artificial Sweeteners Beneficial for Patients with Diabetes Mellitus? The Advantages and Disadvantages of Artificial Sweeteners

Artificial sweeteners have been developed as substitutes for sugar. Sucralose, acesulfame K (ACE K), aspartame, and saccharin are artificial sweeteners. Previously, artificial sweeteners were thought to be effective in treating obesity and diabetes. Human meta-analyses have reported that artificial sweeteners have no effect on body weight or glycemic control. However, recent studies have shown that artificial sweeteners affect glucose absorption in the intestinal tract as well as insulin and incretin secretion in humans and animals. Moreover, artificial sweeteners alter the composition of the microbiota and worsen the glycemic control owing to changes in the gut microbiota. The early intake of ACE K was also shown to suppress the taste response to sugar. Furthermore, a large cohort study showed that high artificial sweetener intake was associated with all-cause mortality, cardiovascular risk, coronary artery disease risk, cerebrovascular risk, and cancer risk. The role of artificial sweeteners in the treatment of diabetes and obesity should be reconsidered, and the replacement of sugar with artificial sweeteners in patients will require the long-term tracking of not only intake but also changes in blood glucose and weight as well as future guidance based on gut bacteria data. To utilize the beneficial properties of artificial sweeteners in treatment, further studies are needed.