Why is this important?
Several intense sweeteners are now authorized in Europe and incorporated into the formulation of foods and beverages because they are generally considered safe by health authorities. It should be noted, however, that there is little data on their long-term effect on health. However, more and more epidemiological evidence underlines the existence of an association between the consumption of artificial sweeteners and unfavorable cardiometabolic phenotypes (overweight/obesity, type 2 diabetes, cardiovascular diseases, mortality, etc.). Erythritol is a sugar present in the natural state in small quantities, on the other hand, the doses used in the food industry can be up to 1,000 times higher than those found in fruits and vegetables. A US national survey conducted in 2013-2014 estimated daily consumption of erythritol at 30 g/day.
Methodology
Researchers performed untargeted metabolomic studies to assess circulating levels of several polyols (especially erythritol) and the incident risk of associated major cardiovascular events (MACE including cardiac death, myocardial infarction non-fatal and stroke). Then a quantitative relationship was sought on two independent validation cohorts (American and European) to examine the relationship between plasma levels of erythritol and MACE events. Then the impact of erythritol on platelet function in humans was observed after ingestion of drinks containing erythritol and in animal models with arterial lesions.
Principle results
Results from untargeted longitudinal metabolomic studies in subjects undergoing cardiac risk assessment (n=1,157) showed an association between circulating levels of polyols (especially erythritol) and the risk of incident MACE over 3 years (adjusted hazard ratio or HRa 3.22 [1,91-5,41]p<0,0001).
Other targeted metabolomic validation studies conducted on an independent cohort of American (n = 2,149) and European (n = 833) origin have confirmed the existence of an association between erythritol levels and the risk of MACE ( HRa4e quartile vs 1er quartile 1,80 [1,18-2,77] for the American cohort and 2.21 [1,20-4,07] for the European cohort).
At the physiological level, a marked and lasting (>2 days) increase in plasma erythritol levels was observed during a pilot, prospective study conducted in eight healthy volunteers who had ingested erythritol. The plasma erythritol thresholds reached were well above thresholds associated with increased platelet reactivity and increased thrombosis potential.