Abstract
BackgroundThe effects of non-nutritive sweeteners (NNS) on glucose metabolism and appetite regulating hormones are not clear. There is an ongoing debate concerning NNS use and deleterious changes in metabolism.ObjectivesThe aim of this review is to analyze the scientific available evidence regarding the effects of NNS on glucose metabolism and appetite regulating hormones.Data Sources and Study Eligibility CriteriaWe identified human observational studies evaluating the relation between NNS consumption and obesity, diabetes, and metabolic syndrome, in addition to clinical trials evaluating the effects of NNS in glucose metabolism and appetite regulating hormones.ResultsFourteen observational studies evaluating the association between NNS consumption and the development of metabolic diseases and twenty-eight clinical trials studying the effects of NNS on metabolism were included. Finally, two meta-analyses evaluating the association between the consumption of NNS-containing beverages and the development of type 2 diabetes were identified.ConclusionsSome observational studies suggest an association between NNS consumption and development of metabolic diseases; however, adiposity is a confounder frequently found in observational studies. The effects of the NNS on glucose metabolism are not clear. The results of the identified clinical trials are contradictory and are not comparable because of the major existing differences between them. Studies evaluating specific NNS, with an adequate sample size, including a homogeneous study group, identifying significant comorbidities, with an appropriate control group, with an appropriate exposure time, and considering adjustment for confounder variables such as adiposity are needed.
Highlights
The prevalence of obesity has more than doubled since 1980; in parallel in 2014, the estimated number of patients with diabetes in the world was 385 million with a projection to increase to 592 million by 2035
We identified human observational studies evaluating the relation between nonnutritive sweeteners (NNS) consumption and obesity, diabetes, and metabolic syndrome, in addition to clinical trials evaluating the effects of NNS in glucose metabolism and appetite regulating hormones
Fourteen observational studies evaluating the association between NNS consumption and the development of metabolic diseases and twenty-eight clinical trials studying the effects of NNS on metabolism were included
Summary
The prevalence of obesity has more than doubled since 1980; in parallel in 2014, the estimated number of patients with diabetes in the world was 385 million with a projection to increase to 592 million by 2035. To avoid the negative health conditions associated with the excessive sugar intake, there has been an upsurge in the consumption of nonnutritive sweeteners (NNS) as an alternative [2] At this time six NNS, sucralose, aspartame, saccharin, acesulfame-K, neotame, and advantame, are approved to be used as sweeteners in food, and two naturally derived NNS, steviol glycosides and Luo han guo extract, are generally recognized as safe and endorsed for use in food by the US Food Drug Administration (FDA) and the European Food Safety Authority (EFSA) [3, 4]. There is an ongoing debate concerning NNS use and deleterious changes in metabolism.
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