The measurement of metabolites in patients at high risk of major cardiovascular events (MACE) revealed a linear relationship between the occurrence of such events and the plasma concentration of the artificial sweetener erythritol in the 3 years before. After adjustment, the risk was almost doubled when comparing the upper quartile with the lower quartile.
Background
Although artificial sweeteners have repeatedly been suspected of causing cancer, no increased risk has been proven so far.In the current study, a possible connection between the consumption of erythritol with cardiovascular diseases has now been investigated. As a food additive, this compound bears the E number 968 and is approved in both Europe and the USA without quantitative restrictions. Although erythritol is also found in fruits and vegetables in low concentrations, it was consumed in a US study by some participants in amounts of up to 30 grams / day.
Design
The association between erythritol and cardiovascular disease was not measured directly, but instead numerous metabolites were measured in a non-targeted metabolomics study in 1157 stable patients who presented for cardiac diagnostic evaluation. In addition to compounds with known associations for the risk of major cardiovascular events (MACE), several polyols were also identified in plasma, including those derived from artificial sweeteners. These correlations were tested in 2 validation cohorts.Finally, the influence of erythritol on platelet function was also investigated at concentrations that occur, for example, after the consumption of diet sodas.
Results
- In the first metabolomics study, erythritol was among the molecules with the strongest association with MACE. The odds ratio HR was 3.22 with a 95% confidence interval of 1.91 – 5.41 and was with a P of <0.0001 is statistically highly significant.
- In a US and a European validation cohort with a total of 2982 at-risk patients (cardiovascular disease and/or risk factors such as diabetes and obesity), significantly increased plasma levels of erythritol were found in those already suffering from the disease and in those who suffered MACE in 3 subsequent years (P each <0.0001). The event rate increased with erythritol levels.
- After adjustment for cardiovascular risk factors, the comparison between the top and bottom quartile of erythritol levels in the validation cohorts resulted in HR for MACE of 1.80 and 1.80, respectively.2,21; the P-values were reduced to 0.007 and 0.010, respectively.
- In vitro experiments and animal experiments showed accelerated blood clotting when erythritol was added to whole blood. Finally, the researchers gave 30 grams of erythritol in the form of sweetened beverages to 8 volunteers and then found blood levels of the compound in all of them for 2-3 days that were beyond the concentration above which the risk of blood clots increases.
Clinical significance
People at increased risk of cardiovascular events are likely to take artificial sweeteners such as erythritol more frequently. Whether there is a causal connection behind the associations shown is unclear and cannot be answered with such studies.
Funding: National Institutes of Health, Leducq Foundation, German Research Foundation.
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Source — https://www.univadis.de/viewarticle/erh%25C3%25B6htes-kardiales-risiko-durch-s%25C3%25BC%25C3%259Fungsmittel-2023a100050j