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

Abstract

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.

Low-/No-Calorie Sweeteners: A Review of Global Intakes

“…Another area of concern, for which there is a growing body of research, is the potential association between low-/no-calorie sweeteners and health parameters, including weight management and obesity, cardiometabolic health, and diabetes, among other health effects. However, there is no conclusive evidence that high intakes of low-/no-calorie sweeteners are associated with these health conditions [113,114,115,116]. Nonetheless, researchers should continue to monitor the available data and consider all intake information for these additives in light of the most robust and concrete scientific literature.…”

Consumo de edulcorantes no nutritivos: efectos a nivel celular y metabólico

“…Actualmente, existe cierta polémica sobre la seguridad en el consumo de ENN (14)(15)(16). Se han reportado daños a nivel de ADN o daño citotóxico en líneas celulares de cáncer de colon, de páncreas y de seno, derivado del uso de algunos edulcorantes sintéticos (17)(18)(19)(20)(21). A su vez, existen reportes que sostienen no haber encontrado ningún tipo de alteración celular o relación con cáncer debido a su ingesta (22).…”

Anticipatory effects of the implementation of the Chilean Law of Food Labeling and Advertising on food and beverage product reformulation

“…Since the implementation of the Chilean Law of Food Labeling and Advertising at the end of June 2016, there have been some reports by industry that reformulation has occurred, particularly for beverages and dairy products, but these have not been verified by formal studies. An increase in the use of sugar substitutes has been suggested, especially among dairy products, and this brings unknown health risks, especially for children who are still developing . This study has additional important health implications for the entire Chilean population where overweight and obesity have rapidly increased to over 11% in those less than 6 years, and to a third of those less than 14 years, while one in 11 deaths among Chilean adults is attributable to overweight and obesity .…”

“…An increase in the use of sugar substitutes has been suggested, especially among dairy products, 16 and this brings unknown health risks, especially for children who are still developing. [61][62][63][64] This study has additional important health implications for the entire Chilean population where overweight and obesity have rapidly increased to over 11% in those less than 6 years, and to a third of those less than 14 years, while one in 11 deaths among Chilean adults is attributable to overweight and obesity. 47 The prevalence of type 2 diabetes is increasing in all age groups (>15 y) up to 18% in those 45 to 64 years and 31% in those older than 65 years.…”