A Rational Review on the Effects of Sweeteners and Sweetness Enhancers on Appetite, Food Reward and Metabolic/Adiposity Outcomes in Adults

CITATION & LINK: Food Funct., 2021 Advance Article https://doi.org/10.1039/D0FO02424D

AUTHORS: Dominic O’Connor, Michelle Pang, Gabriele Castelnuova, Graham Finlayson, Ellen Blaak, Catherine Gibbons, Santiago Navas-Carretero, Eva Almiron-Roig, Jo Harrold, Anne Raben, J. Alfredo Martinez

REVIEWER: Robyn Flipse, MS, MA, RDN

The greatest value of this narrative synthesis is its deliberate focus on what the body of empirical evidence currently tells us about the effects of sweeteners and sweetness enhancers on appetite and metabolism and what we still do not know.  It also sheds much needed light on why the evidence about non-caloric sweeteners (NCS) appears to be conflicting at times. This information is imperative since the use of sugar substitutes or non-caloric sweeteners (NCS) has been steadily increasing while news about their efficacy has grown more controversial.

The authors provide a clear overview of our current understanding of the role of NCS on appetite, eating behavior, food intake, hedonic reward, and sweet taste perception and on glucose homeostasis, body weight, lipid metabolism and gastrointestinal physiology. They address the great variability in the results from trials using individual NCS versus those using commercial products containing blends of sweeteners and other ingredients and those based on animals models or in vitro studies. The paper examines the results from acute and prolonged exposure, the different doses of sweeteners used in different studies, and compares both between- and within-subject outcomes. It seeks biological and psychological mechanisms to explain any adverse effects reported and the impact of subjective differences that may influence food preferences and body weight.

The authors conclude there is consensus in the literature on the potential benefits of NCS to reduce net energy intake and assist in weight management without significant negative effects on food intake behavior or body metabolism. They also conclude the mechanisms by which NCS may impact eating behavior, glucose homeostasis, insulin metabolism, adipogenesis, and the gut microbiota “remain complex and not fully understood,” and admit answering those questions becomes more challenging as the range of NCS available in the diet increases.

Overall, the information provided by this review should make it easier for health care professionals and consumers alike to make more informed decisions about how and why they might use NCS and what knowledge we can gain from further research. 

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