Effect of the natural sweetener, steviol glycoside, on cardiovascular risk factors: A systematic review and meta-analysis of randomised clinical trials

Onakpoya, Igho; Heneghan, Carl

doi:10.1177/2047487314560663

Cited by 35 publications

(23 citation statements)

References 51 publications

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“…Several other systematic and narrative reviews have examined the effects of NSSs on various health outcomes 34 5 6 94 95 96 97 The methodological and clinical inclusion and exclusion criteria used in these systematic reviews differed substantially from our criteria in the present study, resulting in a different pool of included studies. The data synthesis methods also differed from the ones used in the present review.…”

Section: Discussionmentioning

confidence: 98%

Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies

Toews

Lohner

Gaudry

et al. 2019

BMJ

168

161

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ObjectiveTo assess the association between intake of non-sugar sweeteners (NSS) and important health outcomes in generally healthy or overweight/obese adults and children.DesignSystematic review following standard Cochrane review methodology.Data sourcesMedline (Ovid), Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and reference lists of relevant publications.Eligibility criteria for selecting studiesStudies including generally healthy adults or children with or without overweight or obesity were eligible. Included study designs allowed for a direct comparison of no intake or lower intake of NSS with higher NSS intake. NSSs had to be clearly named, the dose had to be within the acceptable daily intake, and the intervention duration had to be at least seven days.Main outcome measuresBody weight or body mass index, glycaemic control, oral health, eating behaviour, preference for sweet taste, cancer, cardiovascular disease, kidney disease, mood, behaviour, neurocognition, and adverse effects.ResultsThe search resulted in 13 941 unique records. Of 56 individual studies that provided data for this review, 35 were observational studies. In adults, evidence of very low and low certainty from a limited number of small studies indicated a small beneficial effect of NSSs on body mass index (mean difference −0.6, 95% confidence interval −1.19 to −0.01; two studies, n=174) and fasting blood glucose (−0.16 mmol/L, −0.26 to −0.06; two, n=52). Lower doses of NSSs were associated with lower weight gain (−0.09 kg, −0.13 to −0.05; one, n=17 934) compared with higher doses of NSSs (very low certainty of evidence). For all other outcomes, no differences were detected between the use and non-use of NSSs, or between different doses of NSSs. No evidence of any effect of NSSs was seen on overweight or obese adults or children actively trying to lose weight (very low to moderate certainty). In children, a smaller increase in body mass index z score was observed with NSS intake compared with sugar intake (−0.15, −0.17 to −0.12; two, n=528, moderate certainty of evidence), but no significant differences were observed in body weight (−0.60 kg, −1.33 to 0.14; two, n=467, low certainty of evidence), or between different doses of NSSs (very low to moderate certainty).ConclusionsMost health outcomes did not seem to have differences between the NSS exposed and unexposed groups. Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited. Future studies should assess the effects of NSSs with an appropriate intervention duration. Detailed descriptions of interventions, comparators, and outcomes should be included in all reports.Systematic review registrationProspero CRD42017047668.

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Section: Discussionmentioning

confidence: 98%

Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies

Toews

Lohner

Gaudry

et al. 2019

BMJ

168

161

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“…on arterial blood pressure in patients with normal and low arterial pressure. Metaanalysis of the existing reports does not confirm significant hypotensive effects of stevia glycosides on systolic blood pressure vs. placebo, while appreciable lowering effects on diastolic blood pressure and blood glucose level have been observed (Onakpoya and Heneghan 2014).…”

Section: Hypotensive Effectmentioning

confidence: 84%

Stevia rebaudiana Bertoni: health promoting properties and therapeutic applications

Marcinek

Krejpcio

2015

J. Verbr. Lebensm.

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“…Low-calorie sweeteners) postprandial hyperglycemia intervention trials studies in English language ND MEDLINE, Web of Science Shankar, 2013 [ 279 ] ND NNS consumption obesity/weight gain; diabetes; cardiometabolic indicators ND ND 2012 MEDLINE Spencer, 2016 [ 280 ] humans and animals aspartame, saccharin or sucralose consumption fermentation, absorption, gastrointestinal symptoms ND full articles in English language June 2015 MEDLINE, EMBASE Timpe Behnen, 2013 [ 281 ] diabetes patients acesulfame, aspartame,luo han guo, monk fruit, neotame, rebiana, saccharin, stevia, and sucralose diabetic control, including, but not limited to, blood glucose levels, postprandial blood glucose, HbA1c clinical studies studies in English language May 2012 MEDLINE, Scopus Wiebe, 2011 [ 23 ] ND a sweetener (e.g. non-caloric sweetener) weight change, energy intake, lipids, HbA1C, insulin resistance parallel or crossover RCT follow-up at least 1 week in duration; at least 10 participants per group, no trials with placebo control January 2011 MEDLINE, EMBASE, Cochrane Library CENTRAL, CAB Global Oliver, 2015 [ 85 ] ND aspartame, ace-K, cyclamic acid and its salts, steviol glycosides, neohesperidin DC, neotame, saccharine and its salts, sucralose,aspartame-acesulfame salt, thaumatin benefits and risks related to intense sweeteners meta-analysis, RCTs, quasi experimental, cohort, case-control, cross-sectional studies none ND MEDLINE, Cochrane Database of Systematic Reviews, Psychinfo Onakpoya, 2015 [ 21 ] adult volunteers (>18 y) steviol glycoside cardiovascular risk factors (blood pressure, blood sugar, cholesterol) double-blind RCTs No age, language or time restrictions. Studies in which steviol glycosides were combined with other dietary supplements were excluded May 2014 MEDLINE, EMBASE, Amed, Cinahl, Th...…”

Section: Resultsmentioning

confidence: 99%

Health outcomes of non-nutritive sweeteners: analysis of the research landscape

Lohner

Toews

Meerpohl

2017

Nutr J

119

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BackgroundFood products containing non-nutritive sweeteners (NNSs) instead of sugar have become increasingly popular in the last decades. Their appeal is obviously related to their calorie-free sweet taste. However, with the dramatic increase in their consumption, it is reasonable and timely to evaluate their potential health benefits and, more importantly, potential adverse effects. The main aim of this scoping review was to map the evidence about health outcomes possibly associated with regular NNS consumption by examining the extent, range, and nature of research activity in this area.MethodsWe systematically searched Ovid MEDLINE, EMBASE and the Cochrane CENTRAL databases for studies on NNSs (artificial sweeteners or natural, non-caloric sweeteners, either used individually or in combination) using text terms with appropriate truncation and relevant indexing terms. All human studies investigating any health outcomes of a NNS intervention or exposure were eligible for inclusion. No studies were excluded based on language, study design or methodological quality. Data for each health outcome were summarized in tabular form and were discussed narratively.ResultsFinally, we included 372 studies in our scoping review, comprising 15 systematic reviews, 155 randomized controlled trials (RCTs), 23 non-randomized controlled trials, 57 cohort studies, 52 case-control studies, 28 cross sectional studies and 42 case series/case reports.In healthy subjects, appetite and short term food intake, risk of cancer, risk of diabetes, risk of dental caries, weight gain and risk of obesity are the most investigated health outcomes. Overall there is no conclusive evidence for beneficial and harmful effects on those outcomes. Numerous health outcomes including headaches, depression, behavioral and cognitive effects, neurological effects, risk of preterm delivery, cardiovascular effects or risk of chronic kidney disease were investigated in fewer studies and further research is needed. In subjects with diabetes and hypertension, the evidence regarding health outcomes of NNS use is also inconsistent.ConclusionsThis scoping review identifies the needs for future research to address the numerous evidence gaps related to health effects of NNSs use.It also specifies the research questions and areas where a systematic review with meta-analyses is required for the proper evaluation of health outcomes associated to regular NNSs consumption.

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Effect of the natural sweetener, steviol glycoside, on cardiovascular risk factors: A systematic review and meta-analysis of randomised clinical trials

Cited by 35 publications

References 51 publications

Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies

Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies

Stevia rebaudiana Bertoni: health promoting properties and therapeutic applications

Health outcomes of non-nutritive sweeteners: analysis of the research landscape

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