Non-caloric sweeteners and kidney disease: Evidence analysis

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Autor(en) : Mariscal-Ramírez LA, Alberú-Gómez JM, Amato-Martínez JD, Bochicchio-Ricardelli T, Campos-González ID, Cervera-Saldaña VR, Chew-Wong A, Espinosa-Marrón A, Medeiro-Domingo M, Molina-Segui F, Muñoz-Arizpe R, Laviada-Molina H
Name der Veröffentlichung : Nefro Latinoam. 2019;16:46-57 (article in Spanish)
Erscheinungsjahr : 2019

Abstract

Non-caloric sweeteners (NCS) are food additives with sweet taste used as a tool to substitute sugar consumption and reduce energy intake. There is scientific controversy surrounding possible risks of its use, which is under continuous discussion in the academic and also in the public scenario. NCS are substances widely evaluated in the scientific literature. Their security is monitored by international agencies. NCS have been used as a substitute for sucrose, most often by people with diabetes mellitus and obesity, which are important risk factors for chronic renal disease (CKD). That is why a critical review of the literature is necessary. This document presents a review of topics and questions that health professionals and the public can make about whether kidney health could be affected in one way or another by these food additives. A working group convened by the Mexican Institute of Nephrological Research (MINR) condensed and classified a diversity of scientific publications under the evidence-based medicine method, analyzing whether the use of NCS, may or might not affect renal function, in order to present technical opinions of derived from analysis and discussion. Few studies have evaluated the acute impact of NCS on biomarkers of renal function in humans, showing absence of an appreciable effect; however, long-term observational cohorts exhibited contradictory associations on renal function outcomes, which could be explained by reverse causality or confounding factors. The most comprehensive meta-analysis found non-significant statistical results. In the light of available evidence, the biological and epidemiological plausibility for the hypothesis that NCS represent a direct or indirect risk for the development of CKD in humans seems unlikely.

Summary

The present review by a working group of experts convened by the Mexican Institute of Nephrological Research (MINR) concluded that few studies have evaluated the acute impact of low/no calorie sweeteners on biomarkers of renal function in humans showing no appreciable adverse effect.

Reviewing and evaluating all available scientific publications studying the potential effects of low/no calorie sweeteners on renal function, using the GRADE system for evidence-based medicine, the experts concluded that, in the light of available evidence, the biological and epidemiological plausibility for the hypothesis that low/no calorie sweeteners represent a direct or indirect risk for the development of chronic kidney disease in humans seems unlikely.

The key conclusions of the expert working group on low/no calorie sweeteners (LNCS) and risk of renal disease are:

  • LNCS safety is evaluated and confirmed by regulatory bodies of international organisations including the Joint Food and Agriculture Organisation (FAO)/ World Health Organization (WHO) Expert Committee on Food Additives (JECFA), the US Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA), which have consistently confirmed their safety.
  • Although the evidence is scarce, studies point to an absence of acute effects of LNCS consumption on markers of renal function.
  • Observational studies have reported mixed results about the association between LNCS consumption and chronic kidney disease. However, one available meta-analysis of available studies showed no statistically significant results. Intervention trials evaluating LNCS impact on markers of renal function are lacking, with the limited available evidence suggesting no adverse acute effect of LNCS on creatinine levels.
  • As obesity and diabetes are risk factors for chronic kidney disease, the effects on LNCS on these health outcomes are also important. The group concluded that, based on randomised controlled trials (RCTs), LNCS can be a helpful tool for weight reduction when used to replace sugar and in the context of a calorie-reduced diet. Similarly, RCTs show that LNCS have no effect on glycaemic control. While observational studies show inconsistent outcomes, with some reporting a positive association between LNCS consumption and obesity or diabetes, these studies suffer from limitations such as residual confounding and the possibility that the results are influenced by reverse causation. The collective evidence from RCTs, which provide higher evidence, provide no plausible explanation for how LNCS could increase the risk of weight gain or diabetes.

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