(P17-035-25) Association of Artificial Sweetener Intake With Cardiometabolic Outcomes: A Systematic Review and Meta-Analysis

Objectives: Artificial sweeteners are widely consumed as sugar substitutes to reduce sugar intake and mitigate related health risks. However, their impact on cardiometabolic health remains controversial. This systematic review and meta-analysis aimed to assess the association between artificial sweetener intake and the risk of cardiometabolic outcomes and mortality.

Methods: Relevant studies were identified by searching PubMed and Embase databases until December 2024. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) comparing highest versus lowest categories of artificial sweetener consumption were calculated using a random-effects model. Heterogeneity was defined as I² statistic >50%. The endpoints of this study included all-cause mortality, cardiovascular death, coronary artery disease, stroke, heart failure, hypertension, atrial fibrillation, and type 2 diabetes.

Results: A total of 3,625,613 participants from 37 studies were included. Higher artificial sweetener intake was significantly associated with an increased risk of all-cause mortality (HR 1.09; 95% CI 1.01–1.17), cardiovascular death (HR 1.18; 95% CI 1.03–1.35), coronary artery disease (HR 1.11; 95% CI 1.00–1.23), stroke (HR 1.12; 95% CI 1.05–1.19), heart failure (HR 1.26; 95% CI 1.14–1.39), hypertension (HR 1.13; 95% CI 1.09–1.18), and type 2 diabetes (HR 1.26; 95% CI 1.14–1.40). A non-significant association was observed for atrial fibrillation (HR 1.13; 95% CI 0.94–1.37). Significant heterogeneity was observed for all endpoints, except for stroke and heart failure.

Conclusions: This meta-analysis demonstrated a significant association between higher artificial sweetener intake and an increased risk of adverse cardiometabolic outcomes. These results underscore the need for cautious consumption of artificial sweeteners and highlight the importance of further research to better understand their long-term effects on cardiometabolic health.

Funding Sources: The authors declare that no funding was received to support this study.