The effects of artificial- and stevia-based sweeteners on lipid profile in adults: a GRADE assessed systematic review, meta-analysis, and meta-regression of randomized clinical trials

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Autore(i): Movahedian M, Golzan SA, Ashtary-Larky D, Clark CT, Asbaghi O & Hekmatdoost A.
Publication name: Crit Rev Food Sci Nutr 2021 Dec 9;1-17.
Publication year: 2021


It has been posited that Non-nutritive sweeteners (NNS) intake may affect lipid profile. However, its proven effects on lipid profile are unclear, as clinical studies on this topic have produced inconsistent results. To fill this gap in knowledge, this systematic review and meta-analysis of randomized controlled trials (RCTs) sought to evaluate the effects of artificial- and stevia-based sweeteners consumption on lipid profile markers. To identify eligible RCTs, a systematic search up to April 2021 was completed in PubMed/Medline, Scopus, and EMBASE, using relevant keywords. A random-effect model was utilized to estimate the weighted mean difference (WMD) and 95% confidence (95% CI) for TG, TC, and LDL. On the other hand, a fixed-effect model was used to estimate the WMD and 95% CI for HDL. Fourteen RCTs were included in the present meta-analysis. The pooled analysis revealed that NNS did not affect TG (WMD:-1.31, 95% CI:-5.89, 3.27 mg/dl), TC (WMD:-2.27,95% CI:-7.61,3.07 mg/dl), LDL (WMD:1,95% CI: -2.72, 4.71 mg/dl), and HDL (WMD:0.06, 95% CI:-0.62,0.73 mg/dl). Subgroup analysis showed that NNS may be related to a small, but statistically significant, increase in LDL (WMD:4.23, 95% CI:0.50,7.96 mg/dl) in subjects with normal levels of LDL (<100 mg/dl). We found that consumption of artificial- and stevia-based sweeteners is not associated with lipid profile changes in adults. This study has been registered at PROSPERO (registration number: CRD42021250025).


The current systematic review and meta-analysis of randomised controlled trials (RCTs) supports the assertion that the consumption of low/no calorie sweeteners (LNCS) does not affect lipid profile.

The aim of this study was to systematically review and analyse published data examining the effects of low/no calorie sweeteners on lipid profile of humans. Fourteen RCTs met the criteria and were included in the meta-analysis. These studies examined the impact of LNCS on blood triglyceride levels, total cholesterol, LDL- and HDL-cholesterol. The sample size of the included trials varied from 16 to 221 subjects, resulting to a total of 1407 participants, including healthy individuals, patients with type 1 and type 2 diabetes, hypertensive patients, people with overweight of obesity and patients with hyperlipidemia.

Overall, the results showed non-significant effects of LNCS on lipid profile (serum levels of triglycerides, total-, LDL-, and HDL-cholesterol). The overall quality of the body of evidence presented in this systematic review and meta-analysis was regarded as moderate.

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