What we know—and don’t—about non-nutritive sweeteners
Here’s what’s known about the safety of these sweeteners and their effect on weight, appetite, and the risk for type 2 diabetes.
PRACTICE RECOMMENDATIONS
› Advise patients who are trying to lose weight that non-nutritive sweeteners (NNSs) are not beneficial for weight loss. A
› Reassure patients that NNSs do not appear to cause, or increase the risk of, developing type 2 diabetes mellitus. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
After a 4-week washout period, the participants then switched to the opposite beverage for 12 weeks. The study concluded that consumption of 2 cans of a beverage containing aspartame and acesulfame K over 12 weeks had no significant effect on insulin sensitivity or secretion in nondiabetic adults.34
Similar results were obtained from a study involving 100 non-obese adults.35 The researchers found that aspartame ingested at 2 different doses (350 or 1050 mg/d) in beverages over 12 weeks had no effect on a 240-minute oral glucose tolerance test, blood pressure, appetite, or body weight.35
A 2016 systematic review critically evaluated the effect of NNSs on both glucose absorption and appetite.36 The review included 14 observational prospective trials, 28 RCTs, and 2 meta-analyses. The sweeteners studied included aspartame, sucralose, saccharin, acesulfame K, and stevia.36 The studies were focused largely on single-exposure outcomes (20 trials), but a minority of the studies (8 trials) looked at longer exposures from 1 to 18 weeks. Only some of the studies controlled for critical variables, such as BMI. In the end, there was no consistent pattern of increased or decreased risk for insulin resistance or diabetes.36
Two meta-analyses tried to determine if an association exists between consumption of beverages containing NNSs and the development of T2DM.37,38 The first meta-analysis with 4 studies showed a slight, but significant, relative risk (RR) of 1.13 (95% confidence interval [CI], 1.02-1.25) for those who consumed beverages containing NNSs.37 In the second meta-analysis (10 studies), NNS consumption had an RR of 1.48 (95% CI, 1.35-1.62), but the risk was lower (and no longer significant) after adjusting for BMI.38 A study of 98 Hispanic adolescents who were overweight or obese found that chronic users (n = 9) of NNSs had higher HbA1c levels 1 year later than did controls (n = 75) and people who initiated use of NNSs between the baseline and 1-year visit (n = 14).39
The American Diabetes Association (ADA) and American Heart Association joint position statement on NNSs, first published in 2012, says that NNSs can be utilized to reduce caloric and carbohydrate consumption for overall diabetes control and to obtain a healthy body weight.40 These principles were reaffirmed in the ADA Standards of Care in 2019.41
Continue to: The 2015 US Scientific Reports on Dietary Guidelines...
