The longitudinal association between artificial sweetener intake and the risk of type 2 diabetes among adults aged 18 years and older: a systematic review and meta-analysis.
Artificial sweeteners are commonly used as sugar substitutes because they provide sweetness with little or no caloric content. However, the relationship between artificial sweetener consumption and type 2 diabetes (T2D) remains controversial. This meta-analysis was conducted to investigate the longitudinal association between artificial sweetener intake and T2D among adults.
Electronic databases in English and Chinese were searched for prospective studies published from inception to March 2025. Using a random-effects model, the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to investigate the longitudinal association between artificial sweetener intake and T2D among adults aged 18 years and older. Between-study heterogeneity was assessed using the I 2 statistic, while the robustness of the findings was examined using a leave-one-out sensitivity analysis. Publication bias was evaluated by inspection of funnel plots and Egger's regression test.
A total of six cohort studies including 721,003 participants were analyzed in this meta-analysis. Compared with those with low or no consumption of artificial sweeteners, participants with higher artificial sweetener intake were more likely to develop T2D (pooled HR = 1.31, 95% CI = 1.16-1.49). Substantial heterogeneity was observed across studies (I 2 = 86.02%), while the overall estimate remained stable in sensitivity analysis. No significant publication bias was observed among the studies included in this meta-analysis.
A longitudinal association was observed between artificial sweetener intake and the risk of developing T2D among adults. This study has important public health implications. The findings of this study highlight that artificial sweeteners may not be a completely risk-free alternative to sugar in dietary interventions aimed at reducing high-energy sugar intake and suggest that their potential adverse metabolic effects should be considered in public health policy-making and clinical dietary recommendations regarding artificial sweetener intake.
Electronic databases in English and Chinese were searched for prospective studies published from inception to March 2025. Using a random-effects model, the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to investigate the longitudinal association between artificial sweetener intake and T2D among adults aged 18 years and older. Between-study heterogeneity was assessed using the I 2 statistic, while the robustness of the findings was examined using a leave-one-out sensitivity analysis. Publication bias was evaluated by inspection of funnel plots and Egger's regression test.
A total of six cohort studies including 721,003 participants were analyzed in this meta-analysis. Compared with those with low or no consumption of artificial sweeteners, participants with higher artificial sweetener intake were more likely to develop T2D (pooled HR = 1.31, 95% CI = 1.16-1.49). Substantial heterogeneity was observed across studies (I 2 = 86.02%), while the overall estimate remained stable in sensitivity analysis. No significant publication bias was observed among the studies included in this meta-analysis.
A longitudinal association was observed between artificial sweetener intake and the risk of developing T2D among adults. This study has important public health implications. The findings of this study highlight that artificial sweeteners may not be a completely risk-free alternative to sugar in dietary interventions aimed at reducing high-energy sugar intake and suggest that their potential adverse metabolic effects should be considered in public health policy-making and clinical dietary recommendations regarding artificial sweetener intake.