Consumption of non-nutritive sweeteners and prevalence of systemic arterial hypertension in adults and older adults from a capital city in northeast Brazil

Lavôr, Layanne Cristina de Carvalho; Crisóstomo, Jany de Moura; Nascimento, Larisse Monteles; Rodrigues, Bruna Grazielle Mendes; Campos, Felipe da Costa; Frota, Karoline de Macêdo Gonçalves

doi:10.1590/1678-9865202437e230223

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ORIGINAL | Collective Health • Rev Nutr 37 • 2024 • https://doi.org/10.1590/1678-9865202437e230223 copy

Consumption of non-nutritive sweeteners and prevalence of systemic arterial hypertension in adults and older adults from a capital city in northeast Brazil

Consumo de adoçantes não nutritivos e prevalência de hipertensão arterial sistêmica em adultos e idosos de uma capital do Nordeste brasileiro

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To characterize the consumption of Non-nutritive sweeteners and to verify the association between the intake of these additives and the prevalence of Systemic Arterial Hypertension in adults and the elderly in a Brazilian capital.

Methods

This was a cross-sectional household and population-based study carried out with 489 individuals aged 20 years and older residents of Teresina, Piauí, Brazil. Complex probabilistic cluster sampling was used. Sociodemographic, economic, lifestyle and diseases diagnosis, such as SAH diagnosis, data were obtained by self-report. Weight, height, waist circumference and blood pressure were measured. Data on food consumption and Non-nutritive sweeteners consumption were obtained using 24-hour dietary recall. The association between the consumption of Non-nutritive sweeteners and the prevalence of Systemic Arterial Hypertension was verified using Poisson regression.

Results

The most commonly consumed types of Non-nutritive sweeteners were cyclamate and saccharin and the main source of consumption was tabletop sweeteners. The consumption of Non-nutritive sweeteners was well below the Acceptable Daily Intake. Mean systolic blood pressure and diastolic blood pressure were higher in women and men who consumed Non-nutritive sweeteners (p=0.04), respectively. Individuals who consumed Non-nutritive sweeteners had a 36% higher prevalence of Systemic Arterial Hypertension compared to non-consumers (p=0.04), after adjustments. Female consumers of Non-nutritive sweeteners had a 31% higher prevalence of Systemic Arterial Hypertension (No-BreakpNo-Break=0.04).

Conclusion

The consumption of Non-nutritive sweeteners was positively associated with the prevalence of Systemic Arterial Hypertension. It is therefore important to continue studies investigating the possible health consequences of consuming these substances.

Keywords
Blood Pressure; Hypertension; Non-nutritive sweeteners; Saccharin; Stevia

Variables		Total n (%)	Non-consumers of NNS n (%)	Consumers of NNS n (%)	p-value
Age (mean±sd)		46.5±17.2	45.8±17.1	52.8±16.9	0.004^* ***** Mann-Whitney U-test.
Sex
	Female	327 (66.9)	289 (65.8)	38 (76.0)	0.10^* * Pearson's Chi-square test;
	Male	162 (33.1)	150 (34.2)	12 (24.0)
Skin color
	White	56 (11.4)	52 (11.9)	4 (8.0)	0.32^ Fisher's exact test;
	Black	83 (17.0)	73 (16.6)	10 (20.0)
	Brown	305 (62.4)	277 (63.1)	28 (56.0)
	Others¹ 1 Yellow, indigenous and others;	45 (9.2)	37 (8.4)	8 (16.0)
Education
	Illiterate	29 (5.9)	26 (5.9)	3 (6.0)
	Elementary School	149 (30.5)	133 (30.3)	16 (32.0)	0.95^ Fisher's exact test;
	High School	200 (40.9)	181 (41.3)	19 (38.0)
	Higher Education	111 (22.7)	99 (22.5)	12 (24.0)
Total Family Income
	Less than 2 MW	374 (76.5)	337 (76.8)	37 (74.0)	0.64^* * Pearson's Chi-square test;
	Greater than or equal to 2 MW	115 (23.5)	102 (23.2)	13 (26.0)
Alcohol consumption
	No	293 (59.9)	257 (58.5)	36 (72.0)	0.07^* * Pearson's Chi-square test;
	Yes	196 (40.1)	182 (41.5)	14 (28.0)
Smoking
	No	382 (78.1)	345 (78.6)	37 (74.0)	0.50^ Fisher's exact test;
	Ex-smoker	71 (14.5)	61 (13.9)	10 (20.0)
	Smoker	36 (7.4)	33 (7.5)	3 (6.0)
Physical activity
	Insufficiently active	96 (19.6)	82 (18.7)	14 (28.0)	0.13^* * Pearson's Chi-square test;
	Active² 2 At least 150 minutes of light to moderate physical activity and/or 75 minutes of vigorous physical activity per week.	393 (80.4)	357 (81.3)	36 (72.0)
Diabetes Mellitus diagnosis
	No	442 (90.4)	411 (93.6)	31 (62.0)	0.0001^* * Pearson's Chi-square test;
	Yes	47 (9.6)	28 (6.4)	19 (38.0)
Systemic Arterial Hypertension diagnosis
	No	276 (56.4)	259 (59.0)	17 (34.0)	0.005^* * Pearson's Chi-square test;
	Yes	213 (43.6)	180 (41.0)	33 (66.0)
Variables		Mean±Standard error	Mean±Standard error	Mean±Standard error	p-value
BMI^† † BMI: Body Mass Index; (kg/m²)		27.3±0.2	27.2±0.3	28.7±0.8	0.03^* ***** Mann-Whitney U-test.
WC^†† †† WC: Waist circumference; (m)		89.3±0.6	88.8±0.6	95.7±1.7	0.005^* ***** Mann-Whitney U-test.
	Women WC (cm)	87.0±0.7	86.3±0.7	92.4±1.8	0.002^* ***** Mann-Whitney U-test.
	Men WC (cm)	94.0±1.0	93.7±1.0	98.2±3.9	0.27^* ***** Mann-Whitney U-test.
SBP^# # SBP: Systolic Blood Pressure; (mmHg)		125.3±0.9	124.9±1.0	128.8±2.6	0.08^* ***** Mann-Whitney U-test.
	Women SBP (mmHg)	122.2±1.0	121.5±1.1	127.5±3.2	0.04^* ***** Mann-Whitney U-test.
	Men SBP (mmHg)	132.0±1.7	131.9±1.8	133.1±4.6	0.53^* ***** Mann-Whitney U-test.
DBP^## ## DBP: Diastolic Blood Pressure; (mmHg)		80.4±0.6	80.4±0.6	80.4±2.2	0.81^* ***** Mann-Whitney U-test.
	Women DBP (mmHg)	78.7±0.7	78.9±0.7	77.3±2.4	0.57^* ***** Mann-Whitney U-test.
	Men DBP (mmHg)	83.8±1.1	83.3±1.1	90.3±3.9	0.04^* ***** Mann-Whitney U-test.
Variables		Mean±Standard error	Mean±Standard error	Mean±Standard error	p-value
% contribution to the TEV of ultra-processed foods		19.7±0.8	19.6±0.9	20.7±2.5	0.53^* ***** Mann-Whitney U-test.
% contribution of unprocessed or minimally processed foods and culinary ingredients to TEV		76.7±0.8	76.6±0.9	76.9±2.5	0.94^* ***** Mann-Whitney U-test.
% contribution to TEV of processed foods		3.6±0.4	3.8±0.4	2.4±0.8	0.46^* ***** Mann-Whitney U-test.
TEV^### ### TEV: Total Energy Value. (kcal/day)		1797.8±40.1	1818.4±42.8	1617.1±111.2	0.12^* ***** Mann-Whitney U-test.
Dietary sodium (mg)		1425.9±64.3	1459.4±69.7	1132.1±141.4	0.02^* ***** Mann-Whitney U-test.

Types and sources of Non-nutritive sweeteners consumed		n	%
Non-nutritive sweeteners
	Non-consumers	440	89.8
	Sacharin/cyclamate	34	06.9
	Aspartame/acesulfame K	19	02.1
	Sucralose	4	00.8
	Stevia	2	00.4
Sources of Non-nutritive sweeteners
	Tabletop sweeteners added to beverages	40	80.0
	Powdered fruit juices	8	16.0
	Diet soda	2	04.0

Non-nutritive sweeteners	Mean milligrams ingested (standard error)	Mean body weight (kg)	ADI (mg/kg body weight)^* * JECFA/WHO [6];	Mean consumption limit	Consumption adequacy percentage
Sacharin/cyclamate^ The sweeteners were used as a blend and it was not possible to establish the individual quantities in the product to calculate adequacy, as they have different ADI values.	1.84 (0.47)	69.05	–	–	–
Sucralose	0.10 (0.06)		5.0	345.25	0.03
Stevia	0.04 (0.03)		4.0	276.20	0.01
Aspartame	1.50 (0.52)		40.0	2762.00	0.05
Acesulfame K	0.52 (0.20)		15.0	1,035.75	0.05
Total	4.00 (1.15)		–	–	–

Groups		Systemic Arterial Hypertension
Groups		% (95% CI)	PR (95% CI)	p-value	PR adjusted (95% CI)^* * Adjusted for age, sex, education, family income, skin color, alcohol consumption, smoking, physical activity, diagnosis of diabetes mellitus, Body Mass Index, Waist Circumference, sodium intake, total calories in the diet and the percentage of caloric contribution of the NOVA groups in the Total Energy Value;	p-value
Total population (n=489)
	Non-consumers of NNS	41.0 (36.8-45.3)	Ref.		Ref.
	Consumers of NNS	66.0 (48.8-79.8)	1.61 (1.25-2.07)	0.001	1.36 (1.01-1.83)	0.04
Women (n= 327)
	Non-consumers of NNS	37.7(33.3-42.3)	Ref.		Ref.
	Consumers of NNS	60.5 (44.0-74.0)	1.60 (1.20-2.14)	0.002	1.31 (1.02-1.69)^ Adjusted for all other variables except sex.	0.04
Men (n=162)
	Non-consumers of NNS	47.3 (38.4-56.4)	Ref.		Ref.
	Consumers of NNS	83.3 (49.0-96.3)	1.76 (1.27-2.43)	0.001	1.46 (0.82-2.61)^ Adjusted for all other variables except sex.	0.19

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[1] Correspondence to: KMG FROTA. E-mail: karolfrota@ufpi.edu.br.