Non-nutritive Sweeteners and Glycaemic Control

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Kim Y, Keogh JB and Clifton PM.

Curr Atheroscler Rep (2019) 21: 49; https://doi.org/10.1007/s11883-019-0814-6

Objective

• The primary objective of this review is to identify diabetes risk associated with intake of non-nutritive sweeteners (NNS) by examining glucose homeostasis, body weight and gut microbiota in epidemiological and clinical studies. The secondary objective is to clarify the potential mechanisms of action of NNS on glucose homeostasis.

Background

• The consumption of NNS has rapidly increased in the past few decades globally.
• Some studies suggest suggested that increasing NNS consumption may have resulted from the WHO guidelines on sugar intake, increased availability of NNS-containing products, as well as decreased prices of NNS.
• Studies has also found that NNS consumers reported lower calorie intake compared with non-NNS consumers, although NNS consumers were overweight and obese compared with non-NNS consumers.
• Consumers’ choice of NNS rather than sugar or other nutritive sweeteners may be attributable to their potential to reduce weight gain. However, it is not clear what the effects of NNS consumption are on glycaemic control and the incidence of type 2 diabetes.

Methods

• No information was given on the methodology of this review.

Findings

• Though meta-analyses of prospective studies showed a positive association between ASB intake and risk of T2DM, confounding in the studies is a potential problem.
• NNS intake does not appear to differ from water in glucose control in the absence of a glucose preload, while NNS intake does not appear to influence postprandial glucose responses in the presence of a glucose load.

Conclusions

• The authors conclude that, given that there are so few chronic human interventions, there is difficulty in confirming whether NNS intake adversely influences glucose control.
• They also note that, while most animal studies demonstrated gut microbiota alteration by NNS intake, a limited number of clinical studies failed to support this finding.
• Long-term, well-designed clinical interventions are needed to identify the effect of NNS on glucose control related with risk of T2DM.