Resumen
Los edulcorantes no calóricos (ENC) son aditivos alimentarios cuyo uso como herramienta para reducir el consumo de azúcares y la ingesta energética está a debate. Hay una controversia científica en torno a posibles riesgos de su consumo. Los ENC son sustancias evaluadas extensamente por la literatura científica. Su seguridad es monitoreada por agencias internacionales. Estos edulcorantes se han utilizado como sustitutos de sacarosa, con mayor frecuencia por personas con diabetes mellitus y obesidad, que son factores de riesgo muy relevantes para la enfermedad renal crónica. Por ello es necesaria una revisión crítica de la literatura. Este documento pretende revisar tópicos y cuestionamientos que los profesionales de la salud y el público pueden hacerse acerca de si la salud renal pudiese verse afectada de una u otra manera por estos aditivos en los alimentos. Un grupo de trabajo convocado por el Instituto Mexicano de Investigaciones Nefrológicas (IMIN) condensó y clasificó una diversidad de publicaciones científicas bajo el método de la medicina basada en evidencia, para analizar si el uso de ENC puede o no afectar la función renal y presentar opiniones técnicas sustentadas en dicho análisis. Los escasos estudios que evalúan el impacto agudo de los ENC sobre biomarcadores de la función renal en humanos arrojan ausencia de un efecto apreciable; sin embargo, los estudios observacionales de largo plazo muestran resultados contradictorios sobre desenlaces de la función renal, que podrían ser explicados por causalidad inversa o factores de confusión. El metaanálisis más comprehensivo encontró resultados estadísticos no significativos. A la luz de la evidencia disponible, la plausibilidad biológica y epidemiológica de que los ENC representen un riesgo directo o indirecto para el desarrollo de ERC en humanos parece improbable.
Sumario
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.