No abstract available
The Letter by Khan and Sievenpiper presents a re-analysis of data and discusses the findings of an earlier study by Dalenberg et al (2020), rejecting the assertion that the consumption of sucralose in the presence of a carbohydrate impairs glucose metabolism.
Dalenberg et al supported in their study that the consumption of sucralose in the presence of a carbohydrate, but not alone, impairs glucose metabolism. However, Khan and Sievenpiper comment that the most important methodological concern in Dalenberg et al is the inappropriate choice of carbohydrate comparators, i.e. sugar vs maltodextrin. Sucrose and maltodextrin are very different in their composition, metabolism and effects. Compared to sugar, maltodextrin lacks fructose in its synthesis and has a higher glycemic index. Therefore, the carbohydrate comparators used in Dalenberg et al were not sufficiently matched to test the question of whether a low/no calorie sweetener in combination with carbohydrate could impair glucose metabolism or insulin sensitivity. The difference found between the sugar and the sucralose-maltodextrin groups may be entirely attributed to maltodextrin and to the differences in the fructose content and glycemic index and not to the presence or absence of sucralose.
In order to test the above methodological consideration, Khan and Sievenpiper re-analysed the results in Dalenberg et al and found no difference in insulin indexes between maltodextrin alone vs the combination of sucralose-maltodextrin. These results showed that the combination of sucralose with a carbohydrate (maltodextrin) did not affect insulin sensitivity differently compared to maltodextrin alone, and as a result an effect of maltodextrin alone cannot be ruled out. On this basis, Khan and Sievenpiper reject the conclusion by Dalenberg et al that sucralose in the presence of a carbohydrate impairs glucose metabolism.