What are the Long-term Consequences of Nonnutritive Sweeteners?
BACKGROUND AND PURPOSE:
Consumption of nonnutritive sweetners have been suggested to manage weight and blood glucose
There are conflicting studies that have looked at BMI and body composition, with some studies suggesting that intake may actually increase BMI
Studies are more limited regarding long-term cardiometabolic effects
Azad et al. (CMAJ, 2017) sought to analyze existing evidence to determine whether routine use of non-nutritive sweeteners such as aspartame and sucralose is associated with adverse cardiometabolic effects
Systematic review and meta-analysis
Pooled data from 7 randomized controlled trials (RCTs) and 30 prospective cohort studies
Body mass index (BMI)
Weight, obesity, and other cardiometabolic end points
Primary outcome: BMI
In RCTs, no significant effect on BMI and only a modest increase in a few cohort studies
In one cohort study with 3371 participants, the Mean Difference (MD) was 0.77 kg/m2, (95% CI 0.47 to 1.07) for daily v. no intake over 8 years.
Secondary Outcomes – Associations with increased non-nutritive sweeteners found in cohort studies but not RCTs
weighted mean correlation 0.06, 95% CI 0.05 to 0.07; 4 cohorts; 32,405 participants
Increased Waist circumference
MD 2.27 cm, 95% CI 0.96 to 3.58; 1 cohort; 384 participants
HIgher incidence of obesity,
Odds Ratio (OR) 1.59, 95% CI 1.23 to 2.07; 1 cohort; 5011 participants
Higher incidence of overweight
OR 1.84, 95% CI 1.28 to 2.66 for highest v. lowest intake quantiles; 3 cohorts; 7917 participants
Increased risk for hypertension
Hazard Ratio 1.13, 95% CI 1.06 to 1.20; 5 cohorts; 232,630 participants
Increased risk for metabolic syndrome
Relative Risk (RR) 1.31, 95% CI 1.23 to 1.40; 5 cohorts; 27,914 participants
Increased risk for type 2 diabetes
RR 1.14, 95% CI 1.05 to 1.25; 9 cohorts; 400,571 participants
There was a 3% higher relative risk of type 2 diabetes per additional daily serving of nonnutritive sweetener (RR 1.03, 95% CI 1.01 to 1.05; 4 cohorts; 221,363 participants)
Increased risk of stroke (not coronary artery disease)
RR 1.14, 95% CI 1.04 to 1.26; 2 cohorts; 128,176 participants
RCTs do not clearly support the intended benefits of nonnutritive sweeteners for weight management and glucose management
RCTs were short, often industry sponsored (median follow up 6 months)
Observational data with longer follow up (median 10 years) suggests potential cardiometabolic harms
Further research is needed to fully characterize the association
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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