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Research

Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj-2022-071204 (Published 07 September 2022) Cite this as: BMJ 2022;378:e071204

Rapid Response:

Re: No place for causation

Dear Editor,

Whereas in the text of the article, the authors correctly mention that causation may not be derived from the results of the study, their abstract and main tune of the text leads readers to the understanding of sweeteners as a cause of the disease. The wording 'risk factors' may help, but for a long time it has been misused as a synonym for causative factor.

This is a cohort study, and it is not well suited for the cause and effect interpretation. It is well known that the use of sweeteners is a personal choice of people. It was shown, that overweight people, who use sweeteners, increase their weight faster. Such results are many.

Small increase in the relative risk is additional advice not to go for a causal interpretation.

While the study is great and informative, there is a danger that the almost explicit invitation to the causal interpretation may lead to public misunderstanding.

Competing interests: No competing interests

12 September 2022
Vasiliy Vlassov
physician
HSE University
Miasnitskaia 20 Moscow 101000 Russia