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Cardiometabolic Effects of Non-Nutritive Sweeteners
TAKE-HOME MESSAGE
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The authors of this meta-analysis evaluated the association between consumption of non-nutritive sweeteners and adverse cardiometabolic outcomes. The consumption of non-nutritive sweeteners was shown to have no effect on BMI in 7 randomized trials and was associated with a modest increase in BMI in 30 cohort studies. Further analysis of the cohort studies demonstrated an association between consumption of non-nutritive sweeteners and obesity, hypertension, metabolic syndrome, type 2 diabetes, and cardiovascular events.
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The study found that non-nutritive sweeteners are not associated with weight loss and may increase cardiometabolic risk. Further research is needed to define the associated long-term outcomes.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Nonnutritive sweeteners, such as aspartame, sucralose and stevioside, are widely consumed, yet their long-term health impact is uncertain. We synthesized evidence from prospective studies to determine whether routine consumption of non-nutritive sweeteners was associated with long-term adverse cardiometabolic effects.
METHODS
We searched MEDLINE, Embase and Cochrane Library (inception to January 2016) for randomized controlled trials (RCTs) that evaluated interventions for nonnutritive sweeteners and prospective cohort studies that reported on consumption of non-nutritive sweeteners among adults and adolescents. The primary outcome was body mass index (BMI). Secondary outcomes included weight, obesity and other cardiometabolic end points.
RESULTS
From 11 774 citations, we included 7 trials (1003 participants; median follow-up 6 mo) and 30 cohort studies (405 907 participants; median follow-up 10 yr). In the included RCTs, nonnutritive sweeteners had no significant effect on BMI (mean difference -0.37 kg/m(2); 95% confidence interval [CI] -1.10 to 0.36; I(2) 9%; 242 participants). In the included cohort studies, consumption of nonnutritive sweeteners was associated with a modest increase in BMI (mean correlation 0.05, 95% CI 0.03 to 0.06; I(2) 0%; 21 256 participants). Data from RCTs showed no consistent effects of nonnutritive sweeteners on other measures of body composition and reported no further secondary outcomes. In the cohort studies, consumption of nonnutritive 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.
INTERPRETATION
Evidence from RCTs does not clearly support the intended benefits of nonnutritive sweeteners for weight management, and observational data suggest that routine intake of nonnutritive sweeteners may be associated with increased BMI and cardiometabolic risk. Further research is needed to fully characterize the long-term risks and benefits of nonnutritive sweeteners.
Additional Info
Disclosure statements are available on the authors' profiles:
Nonnutritive Sweeteners and Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies
CMAJ 2017 Jul 17;189(28)E929-E939, MB Azad, AM Abou-Setta, BF Chauhan, R Rabbani, J Lys, L Copstein, A Mann, MM Jeyaraman, AE Reid, M Fiander, DS MacKay, J McGavock, B Wicklow, R ZarychanskiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The study by Azad et al adds to a growing body of literature demonstrating no or little association of artificial sweeteners with healthier body weights. Instead, it found a counterintuitive association with overweight and cardiometabolic risk. Previous meta-analyses have produced contradictory evidence. Studies showing non-nutritive sweeteners to be useful for weight loss are generally sponsored by the makers or users of these substances, raising questions of bias. Industry-sponsored studies are well-known to produce results favorable to the sponsor’s interest, and studies of artificial sweeteners and weight loss are no exception.
Why these substances might be linked to weight gain and its metabolic consequences remains a matter of speculation. Perhaps individuals consuming diet drinks compensate for the energy saved by consuming more calories from other foods. Or, more complicated, the sweeteners fool the body into behaving as if it had been fed sugars. These hypotheses remain to be tested. In the meantime, diet drinks containing these sweeteners cannot be recommended as methods to help lose weight. It is unfortunate that, when it comes to preventing weight gain, no shortcuts exist. The best advice is still to eat a healthy diet, consume fewer calories, and be physically active. And, when thirsty, drink water.