Doctor: Charlotte Debras

Title: An epidemiological approach of the relationships between sugars, glycemic index, glycemic load, artificial sweenteners and risk of cancer

Supervisor: Mathilde Touvier

Doctoral school: ED 146 Doctoral school Galilée, University Sorbonne Paris Nord

Date of thesis defense: 09/2022

Jury: Anne-Kathrin Illner-Delepine, Raphaëlle Varraso, Emmanuel Cosson, Serge Hercberg, Jenab Mazda.

Thesis summary:

Several deleterious health effects of sugar are established (obesity, cardiovascular diseases, diabetes…) but its role on cancer remains unclear. Sugar could represent a risk factor, through to weight status related mechanisms but also independently: elevation of blood sugar, inflammation, etc.In addition, the carcinogenicity of artificial sweeteners has been suggested by experimental studies but human data is lacking. Several epidemiological studies have looked at artificially sweetened beverages but none has considered artifcial sweeteners from all food sources. Their associations with cardiovascular diseases have also been suggested but human data are insufficient.This thesis focuses on sugar and artificial sweeteners and their associations with cancer. Topics include total/added sugars (sugar types and sources), glycemic index/load, FODMAPs and artificial sweeteners. The risk of cardiovascular disease in relation to artificial sweetener exposure has also been studied.Based on the NutriNet-Santé cohort (n>100,000) we identified associations between sugar-related exposures and cancer risk (breast cancer in particular), as well as between artificial sweeteners and cancer and cardiovascular disease risks.Sugar consumption could therefore represent a modifiable risk factor for primary cancer prevention. In addition, this work provides new data on artificial sweeteners, which are currently being re-evaluated by EFSA and closely considered by the WHO.

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