ArticleNature medicine2023
The artificial sweetener erythritol and cardiovascular event risk.
Article in Nature medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 95 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Molecular Determinants of Coronary Artery Disease
Consumption of Oral Artificial Sweeteners on Platelet Aggregation and Polyol Excretion
Randomized Controlled Clinical Trial to Gauge the Effects of Dietary Erythritol on Platelet Reactivity and Vascular Inflammation
Who cites it
95 citing papers in PubMed, 3 syntheses or guidelines pooled it, 199 citations in OpenAlex.
- Health Effects of Sugar-Sweetened and Artificially Sweetened Beverages: Umbrella Review and Evidence-Based Consensus Statement of the Korean Diabetes Association and the Korean Nutrition Society.Diabetes & metabolism journal · 2026Pooled it
- 2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association.Diabetes & metabolism journal · 2024Guideline
- A terminal metabolite of niacin promotes vascular inflammation and contributes to cardiovascular disease risk.Nature medicine · 2024Pooled it
- Ingestion of the Non-Nutritive Sweetener Erythritol, but Not Glucose, Enhances Platelet Reactivity and Thrombosis Potential in Healthy Volunteers-Brief Report.Arteriosclerosis, thrombosis, and vascular biology · 2024Trial
- Erythritol and metabolic dysfunction-associated steatotic liver disease: A sweet friend, bitter foe, or reliable fellow traveler?Journal of diabetes investigation · 2026Article
- Common xenobiotics modulate gut microbial responses to low‑calorie sweeteners in vitro.Molecular systems biology · 2026Article
- Metabolomic Signatures of Inflammation in Chronic Kidney Disease.Kidney medicine · 2026Article
- Review
- Erythritol Exacerbates DSS-Induced Colitis and Influences Behavioral Responses in Mice Through Gut Microbiota and Metabolic Alterations.Microorganisms · 2026Article
- Declines in plasma erythritol levels and improvements in insulin sensitivity and glucose metabolism: POUNDS lost trial.International journal of obesity (2005) · 2026Article
- Steviol Glycosides (E960) FromFood science & nutrition · 2026Review
- Reply: Nonnutritive Sweeteners and Cardiovascular Risk: Correlation Is Not Causation.JACC. Advances · 2026Article
- Artificial and Other Non-Nutritive Sweeteners, the Microbiome, and Cardiometabolic Health.Current atherosclerosis reports · 2026Review
- Synthetic Sweeteners and Human Health: An Overview of Health Risks, Vulnerable Populations, and Effects on Key Biological Systems.Medicina (Kaunas, Lithuania) · 2026Review
- Olfactory-gustatory cross-modal integration: mechanisms of aroma-induced sweetness enhancement, sensory evaluation methodologies, neuroimaging evidence and advances in influencing factors.Journal of advanced research · 2026Review
- A liver-heart endocrine axis revealed by systems genetics and mediated by hepatocyte growth factor activator.medRxiv : the preprint server for health sciences · 2026Article
- [Nutrition recommendations for people with diabetes (Update 2026)].Wiener klinische Wochenschrift · 2026Review
- Peroxisome proliferator‑activated receptor α regulates acesulfame‑K‑induced NAFLD via hepatic PLCβ: Foe and friend.International journal of molecular medicine · 2026Article
- Food as Friend or Foe: A Decadal Narrative Review of Dietary Patterns as Determinants of Gastrointestinal Pathophysiology and Clinical Outcomes (2015-2025).International journal of molecular sciences · 2026Review
- A Clinician's Guide for Trending Cardiovascular Nutritional Controversies in 2026.JACC. Advances · 2026Review
35 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
18 authors at 9 institutions in 4 countries.
Funding
Abstract
Artificial sweeteners are widely used sugar substitutes, but little is known about their long-term effects on cardiometabolic disease risks. Here we examined the commonly used sugar substitute erythritol and atherothrombotic disease risk. In initial untargeted metabolomics studies in patients undergoing cardiac risk assessment (n = 1,157; discovery cohort, NCT00590200 ), circulating levels of multiple polyol sweeteners, especially erythritol, were associated with incident (3 year) risk for major adverse cardiovascular events (MACE; includes death or nonfatal myocardial infarction or stroke). Subsequent targeted metabolomics analyses in independent US (n = 2,149, NCT00590200 ) and European (n = 833, DRKS00020915 ) validation cohorts of stable patients undergoing elective cardiac evaluation confirmed this association (fourth versus first quartile adjusted hazard ratio (95% confidence interval), 1.80 (1.18-2.77) and 2.21 (1.20-4.07), respectively). At physiological levels, erythritol enhanced platelet reactivity in vitro and thrombosis formation in vivo. Finally, in a prospective pilot intervention study ( NCT04731363 ), erythritol ingestion in healthy volunteers (n = 8) induced marked and sustained (>2 d) increases in plasma erythritol levels well above thresholds associated with heightened platelet reactivity and thrombosis potential in in vitro and in vivo studies. Our findings reveal that erythritol is both associated with incident MACE risk and fosters enhanced thrombosis. Studies assessing the long-term safety of erythritol are warranted.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.