Individuals who routinely consume nonnutritive sweeteners may have an increased risk for long-term weight gain, obesity, diabetes, high BP and heart disease, according to new research published in the Canadian Medical Association Journal.
“Obesity is a major public health challenge that contributes to type 2 diabetes and cardiovascular disease,” Meghan B. Azad, PhD, from George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Canada, and colleagues wrote. “Evidence that sugar consumption is fueling this epidemic has stimulated the increasing popularity of nonnutritive sweeteners, including aspartame, sucralose and stevioside.”
To determine whether regular consumption of nonnutritive sweeteners is associated with long-term adverse cardiometabolic effects, Azad and colleagues searched several databases for randomized controlled trials (RCTs)that assessed interventions for nonnutritive sweeteners and cohort studies that evaluated the consumption of such sweeteners among adults and adolescents. They identified 30 cohort studies (n = 405,907) and seven RCTs (n =1,003) including more than 400,000 individuals who were followed for an average of 10 years and 6 months, respectively.
BMI was not significantly affected by consumption of nonnutritive sweeteners (mean difference –0.37 kg/m²; 95% CI –1.1 to 0.36) according to data from the RCTs. In the RCTs, nonnutritive sweeteners also did not pose any consistent effects on other measures of body composition such as weight and obesity.
However, data from the cohort studies indicated a modest increase in BMI as a result of consuming nonnutritive sweeteners (mean correlation 0.05, 95% CI 0.03-0.06). In addition, the cohort studies showed that there was an association between nonnutritive sweetener consumption and increases in weight and waist circumference, as well as a greater prevalence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events.
The researchers noted that studies with diabetes as an outcome demonstrated publication bias.
“Despite the fact that millions of individuals routinely consume artificial sweeteners, relatively few patients have been included in clinical trials of these products,” Ryan Zarychanski, MD, MSc, coauthor from the University of Manitoba, said in a related press release. “We found that data from clinical trials do not clearly support the intended benefits of artificial sweeteners for weight management.”
While evidence from small RCTs suggested inconsistent associations between the consumption of nonnutritive sweeteners and reductions in body weight, BMI or waist circumference, data from larger cohort studies with longer follow-up periods indicated that each of these measures as well as obesity, hypertension, metabolic syndrome, type 2 diabetes, stroke and CVD events were significantly related to nonnutritive sweetener intake, according to the researchers.
“Caution is warranted until the long-term health effects of artificial sweeteners are fully characterized,” Azad said in the release.
“Given the widespread and increasing use of artificial sweeteners, and the current epidemic of obesity and related diseases, more research is needed to determine the long-term risks and benefits of these products,” she added.
Azad and researchers from the Children’s Hospital Research Institute of Manitoba are currently conducting a new study to determine how maternal consumption of artificial sweeteners affects weight gain, metabolism and gut bacteria in offspring. – by Alaina Tedesco
Disclosure: The researchers report no relevant financial disclosures.