Glycemic impact of non-nutritive sweeteners: a systematic review and meta-analysis of randomized controlled trials

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Autore(i): Nichol AD, Holle MJ, and An R
Publication name: Eur J Clin Nutr. 2018 May 15. doi: 10.1038/s41430-018-0170-6. [Epub ahead of print]
Publication year: 2018

Abstract

Background/ Objectives: Nonnutritive sweeteners (NNSs) are zero- or low-calorie alternatives to nutritive sweeteners, such as table sugars. A systematic review and meta-analysis of randomized controlled trials was conducted to quantitatively synthesize existing scientific evidence on the glycemic impact of NNSs.
Subjects/ Methods: PubMed and Web of Science databases were searched. Two authors screened the titles and abstracts of candidate publications. The third author was consulted to resolve discrepancies. Twenty-nine randomized controlled trials, with a total of 741 participants, were included and their quality assessed. NNSs under examination included aspartame, saccharin, steviosides, and sucralose. The review followed the PRISMA guidelines.
Results: Meta-analysis was performed to estimate and track the trajectory of blood glucose concentrations over time after NNS consumption, and to test differential effects by type of NNS and participants’ age, weight, and disease status. In comparison with the baseline, NNS consumption was not found to increase blood glucose level, and its concentration gradually declined over the course of observation following NNS consumption. The glycemic impact of NNS consumption did not differ by type of NNS but to some extent varied by participants’ age, body weight, and diabetic status.
Conclusions: NNS consumption was not found to elevate blood glucose level. Future studies are warranted to assess the health implications of frequent and chronic NNS consumption and elucidate the underlying biological mechanisms.

Summary

This systematic review and meta-analysis of 29 randomised controlled trials (RCTs) concluded that low calorie sweeteners do not increase nor affect blood glucose levels, and that this absence of glycemic impact of low calorie sweeteners’ consumption makes them a potentially useful dietary aid for people with diabetes or on a weight loss regime. These findings are consistent with a wealth of published human studies, previous systematic reviews as well positions of nutrition/ medical organizations or scientific opinions from authorities such as EFSA.

The meta-analysis synthesized existing scientific evidence from 29 RCTs on the glycaemic impact of low calorie sweeteners and showed that, in comparison with the baseline, low calorie sweetener consumption was not found to increase blood glucose level, and its value gradually declined over the course of observation following low calorie sweeteners’ consumption. The study also found that the glycemic impact of sweetener consumption did not differ by type of low calorie sweetener. The low calorie sweeteners under examination included aspartame, saccharin, steviosides, and sucralose.

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