Sweeteners may not be so sweet afterall
A summary of research investigating the association between non-nutritive sweeteners and cardio-metabolic health
Obesity has become one of the major public health challenges that we face today. Obesity is associated with range of cardio-metabolic conditions such as type 2 diabetes and cardiovascular disease. Research has suggested that excessive sugar consumption is associated with the rise of obesity and as such is fueling this epidemic. The World Health Organisation (WHO) recently recommenced that countries implement taxes on sugar sweetened beverages in order to reduce the consumption of sugar, especially in children. As a result of the impacts of sugar, and recommendations from the WHO, there has been an increasing amount of artificial/ calorie free/ non-nutritive sweeteners added to food and drink in place of sugar.
Calorie free or 'non-nutritive' sweeteners such as sucralose and aspartame are in many foods and drinks and as such are widely consumed. However, the long term health impacts of these sweeteners is not known. Azad et al. wanted to find out mores o they conducted a systematic review to investigate the long term impact of sweeteners on cardio-metabolic health. Their research was published in CMAJ in July 2017 (DOI: https://doi.org/10.1503/cmaj.161390).
The researchers conducted an extensive review of published research in order to gather evidence that could shed light on whether consuming non-nutritive sweeteners is associated with negative impacts on cardio-metabolic health.
The researchers identified 11 774 citations which included 7 trials (1003 participants; median follow-up 6 mo) and 30 cohort studies (405 907 participants; median follow-up 10 yr). The randomized controlled trials (RCTs) included in the review evaluated interventions for non-nutritive sweeteners and the prospective cohort studies that were included reported on consumption of non-nutritive sweeteners among adults and adolescents. In both RCTs and prospective studies the primary outcome was body mass index (BMI), and secondary outcomes included weight, obesity and other cardio-metabolic end points.
The RCTs suggested that non-nutritive sweeteners had no significant effect on BMI (mean difference −0.37 kg/m2; 95% confidence interval [CI] −1.10 to 0.36; I2 9%; 242 participants). Data from RCTs showed no consistent effects of non-nutritive sweeteners on other measures of body composition and reported no further secondary outcomes.
The evidence from RCTs does not clearly support the intended benefits of non-nutritive sweeteners for weight management.
The cohort studies suggested that consumption of non-nutritive sweeteners was associated with a modest increase in BMI (mean correlation 0.05, 95% CI 0.03 to 0.06; I2 0%; 21 256 participants). In the cohort studies, consumption of non-nutritive sweeteners was associated with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events. Publication bias was indicated for studies with diabetes as an outcome.
The data from cohort studies suggests that routine intake of non-nutritive sweeteners may be associated with increased BMI and cardio-metabolic risk.
As a result of the widespread consumption of non-nutritive sweeteners and the likelihood that their consumption will increase over the coming years following the sugar levy in April 2018, it is important that further research is conducted in order to fully characterize the long-term risks and benefits of non-nutritive sweeteners.
What do you think about non-nutritive sweeteners?