Low-calorie sweetener does not seem to increase cancer risk in US adults

By Dr. Sanchari Sinha Dutta, Ph.D.Nov 23 2022Reviewed by Aimee Molineux

A recent study published in the journal Nutrients claims that intake of low-calorie sweeteners does not increase the risk of cancer-related death. However, it may increase the risk of obesity and diabetes.

Background

Low-calorie sweetener (LCS) replaces added sugar in beverages and foods. It helps reduce calories from sugar while maintaining palatability. It has been estimated that about 42% of US adults consume LCS.

Relatively higher consumption of LCS has been observed among women and obese individuals.

Regarding possible health effects, studies have shown that LCS may increase the risk of obesity, diabetes, and metabolic syndrome by increasing response to sweet taste, impairing satiety and metabolism, or altering gut microbiota composition. Studies investigating the association between LCS use and cancer risk have demonstrated contrasting results.    

In the current study, scientists have explored the relationship between LCS use and overall cancer risk in US adults.

Study design

The study analysis was based on multiple cycles of the nationally-representative cross-sectional National Health and Nutrition Examination Survey (NHANES) for 1988– 1994 and 1999–2018. The dietary intake data obtained from the survey was linked with 2019 Public-Use Linked Mortality Files to explore the association between LCS use and cancer risk.

The dietary intake information was obtained from 15,948 US adults participating in the 1988–1994 NHANES and 47,854 US adults participating in the 1999–2018 NHANES. The dietary intake information of two LCS (aspartame and saccharine) was separately analyzed in 1988–1994 NHANES but not in 1999–2018 NHANES. 

Important observations

The survey population included both male and female individuals aged above 19 years. The mean age of the participants was 46 years. About 70% of participants were non-Hispanic White. About 22% were smokers, 32% were obese, and 9% were diabetic.

The proportion of LCS consumers was higher among females, non-Hispanic White individuals, non-smokers, and individuals with higher income and educational backgrounds. An association was observed between LCS consumption, higher body mass index (BMI), and higher prevalence of obesity and diabetes.

The likelihood of consuming a high-quality diet was higher among LCS consumers. Specifically, LCS consumers were more likely to consume vegetables, fruits, beans, whole grains, and dairy products and less likely to consume saturated fat and sodium. Compared to non-consumers, LCS consumers had significantly lower intakes of added sugar and alcohol and higher intakes of dietary fiber.

Impact of LCS use on cancer risk

The cancer mortality risk analysis revealed that the intake of aspartame or saccharine does not increase the risk of cancer-related death in adults, irrespective of age, sex, race/ethnicity, education, current smoking status, alcohol consumption, physical activity level, and BMI. 

Further analysis revealed that saccharine intake might reduce cancer mortality risk in males aged 19 – 50 years. Moreover, a higher intake of LCS may reduce cancer risk in adults aged 19 – 50 years and above 51 years.

Overall, cancer mortality was found to positively correlate with age and current smoking status and negatively correlate with moderate or vigorous physical activity.

Study significance   

The study uses nationally representative surveys of the US population to demonstrate that intake of LCS does not increase cancer mortality risk. Furthermore, the study establishes a link between LCS intake and a higher prevalence of obesity and diabetes.

As mentioned by the scientists, the dietary intake data used in the study is based on one or two 24-hour dietary recalls. Thus, the data is not an ideal representative of habitual consumption, making it difficult to categorize LCS consumers and non-consumers accurately.

Moreover, the mortality files used in the study provide only the overall cancer mortality rate. Thus, the study could not analyze the mortality risk of specific cancers, such as breast or obesity-related cancers.