Abstract

A poor diet is one of the leading causes for non-communicable diseases. Due to the increasing prevalence of overweight and obesity, there is a strong focus on dietary overconsumption and energy restriction. Many strategies focus on improving energy balance to achieve successful weight loss. One of the strategies to lower energy intake is refraining from sugars and replacing them with artificial sweeteners, which maintain the palatability without ingesting calories. Nevertheless, the safety and health benefits of artificial sweeteners consumption remain a topic of debate within the scientific community and society at large. Notably, artificial sweeteners are metabolized differently from each other due to their different properties. Therefore, the difference in metabolic fate of artificial sweeteners may underlie conflicting findings that have been reported related to their effects on body weight control, glucose homeostasis, and underlying biological mechanisms. Thus, extrapolation of the metabolic effects of a single artificial sweetener to all artificial sweeteners is not appropriate. Although many rodent studies have assessed the metabolic effects of artificial sweeteners, long-term studies in humans are scarce. The majority of clinical studies performed thus far report no significant effects or beneficial effects of artificial sweeteners on body weight and glycemic control, but it should be emphasized that the study duration of most studies was limited. Clearly, further well-controlled, long-term human studies investigating the effects of different artificial sweeteners and their impact on gut microbiota, body weight regulation and glucose homeostasis, as well as the underlying mechanisms, are warranted.

Highlights

  • Diet is among the most important health influencers

  • The scope of this review was to review the physiological effects of artificial sweeteners on body weight control and glucose homeostasis, and to identify the controversies of the existing evidence between different artificial sweeteners surrounding their use

  • Artificial sweeteners affect body weight and glucose homeostasis differently compared to natural sugars via underlying physiological processes comprising the gut microbiota, reward-system, adipogenesis, insulin secretory capacity, intestinal glucose absorption, and insulin resistance

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Summary

INTRODUCTION

Diet is among the most important health influencers. Along with globalization and economic growth, a shift in dietary habits has occurred since 1970 [1, 2]. Energy intake has increased along with the consumption of animal fat and energy-dense foods, while fiber intake has decreased [2] This dietary shift contributes to the rise of non-communicable diseases, including obesity, type 2 diabetes mellitus (T2DM), cardiovascular disease, and cancer [3,4,5]. In particular the consumption of sugar-sweetened beverages has been associated with cardiometabolic complications, driven by an increased energy intake and obesity [12]. Considering the rising prevalence of obesity and T2DM along with the increased consumption of artificial sweeteners, it is important to clarify their health benefits and/or harms [18, 32, 33]. Effects of artificial sweeteners on body weight and glycemic control will be discussed

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