(OR37-04-24) Associations Between Non-nutritive Sweetener Consumption, Metabolic Risk Factors, and Inflammatory Biomarkers Among U.S. Adults

Objectives: Non-nutritive sweeteners (NNS) are used to replace added sugars, yet their role in chronic disease prevention is debated. The objective of this study was to examine associations between NNS consumption, metabolic risk factors, and inflammatory biomarkers.

Methods: This cross-sectional analysis included 624 adults in the American Cancer Society’s Cancer Prevention Study-3 Diet Assessment Sub-study (DAS). Intake of NNS including aspartame, saccharin, sucralose, and acesulfame-potassium was estimated using the mean quantities (mg) reported in six 24-hour dietary recalls completed over one year. Multivariable linear regression was used to examine associations between NNS intake and metabolic risk factors including body mass index (BMI), waist circumference (WC), insulin, C-peptide, hemoglobin A1c (HbA1c), leptin, adiponectin, and inflammatory biomarkers including C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and IL-10. NNS intake was modeled continuously and using tertiles. Base models were adjusted for age, sex, race, education, smoking, and physical activity; full models were further adjusted for BMI (except where BMI was the outcome) and energy intake.

Results: Over half (55%) of DAS participants reported consuming NNS (mean intake of 45 mg per day, and 7 mg, 35 mg, and 205 mg per day among low, medium, and high NNS consumers, respectively). NNS intake was positively associated with BMI in fully adjusted models (p-trend < 0.05). NNS intake was also positively associated with WC, leptin, and CRP prior to adjustment for BMI and energy intake (all p-trend < 0.05), but associations were attenuated in fully adjusted models. A similar trend was observed for TNF-α and IL-6 but was not statistically significant (p-trend < 0.1). No associations between NNS intake and insulin, C-peptide, HbA1c, adiponectin, or IL-10 were observed.

Conclusions: NNS intake was associated with higher WC and concentrations of inflammatory biomarkers, but associations were attenuated after adjustment for energy intake and BMI. Given that energy intake and BMI may be mediators in the causal pathway, these findings emphasize the need to further investigate physiological mechanisms through which NNS consumption may exacerbate metabolic risk factors in experimental studies.

Funding Sources: This work was funded by the American Cancer Society.