Low-calorie sweeteners (LCS) serve to replace added sugars in beverages and foods. The present goal was to explore any potential links between LCS use and cancer risk using the nationally representative National Health and Nutrition Examination Surveys 1988-2018 linked to 2019 Public-Use Linked Mortality Files. Analyses were based on dietary intakes from 1988-1994 NHANES (n = 15,948) and 1999-2018 NHANES (n = 48,754) linked to mortality data. The 1988-1994 NHANES separated aspartame from saccharin consumption; later data did not. LCS consumers were more likely to be older, female, non-Hispanic White, and with higher education and incomes compared to nonconsumers. LCS consumers were less likely to smoke and had higher HEI-2015 scores indicating higher-quality diets. In the cross-sectional NHANES data, LCS use was associated with higher BMI and higher prevalence of obesity and diabetes. There was no indication that aspartame, saccharin, or all LCS had any impact on overall cancer mortality. By using nonconsumers as the reference group, the hazard ratio (95th confidence interval, CI) group trend for tertiles of LCS use for 1988-1994 for aspartame was 1.00 (0.89-1.12), for saccharin 0.96 (0.79-1.10), and for 1988-2018 for all LCS was 0.92 (0.88-1.101). The null group trend effects were seen for analyses stratified by age/gender. The present analyses confirm past US-based reports that LCS use was associated with higher socioeconomic status, lower prevalence of smoking, and generally higher-quality diets. No association with cancer mortality was observed.
Keywords: HEI-2015; NHANES 1988–2018; aspartame; cancer mortality; low-calorie sweeteners (LCS); mortality files; saccharin; smoking; socioeconomic status.