Artificially Sweetened Beverages Beyond the Metabolic Risks: A Systematic Review of the Literature

Abstract

We carried out a review of the available literature on the effects that artificially sweetened beverages (ASBs) such as diet soda (DS) have on health, particularly those not related to incident diabetes mellitus, obesity, and metabolic syndrome.A search of scientific articles was carried out using 11 different databases: PubMed, Cochrane, LILACS, MEDLINE Ovid, JAMA Network, IBECS, Cumed, Scopus, SciELO, MEDLINE-EBSCO, and Taylor & Francis Online. Articles published in the last 10 years were considered, considering cross-sectional studies, retrospective or prospective cohort studies, case-control studies, and randomized controlled clinical trials. Only articles in Spanish or English were considered using the MeSH (Medical Subject Heading) and DeCS (Descriptores en Ciencias de la Salud) terms, including "Diet soda," "Health," "Artificial sweetener," "Gaseosa sin azúcar," "Refresco sin azúcar," and "Salud." Additionally, Boolean operators "AND" and "Y" were used.A total of 1,323 articles were obtained in the initial search, of which 21 main ones were selected for review, which included the topic of DS consumption and explored the health consequences that it poses on different organs.The question of whether ASBs such as DS are a preferred substitute is becoming more and more important in terms of public policy due to mounting evidence of the potential negative health effects of their excessive consumption. This systematic review, the first of its kind to our knowledge, sheds light on how excessive DS consumption can affect multiple organ systems, and associations have been made to mental health burden, delays in child neurodevelopment, cardiac remodeling, worsening retinopathy in diabetics, incidental endstage renal disease, non-Hodgkin's lymphoma and multiple myeloma in men, rheumatoid arthritis in women, hip fractures, dental erosion, increases in breath alcohol concentration when used in alcoholic beverages, and accelerated cell aging. Further studies should delve further to understand the pathophysiologic mechanisms of these associations.

Comparative network pharmacology of artificial sweeteners to understand Its health consequences

“…The expression of the targets was classified as either high (green), medium (red), or low/none (blank) (Figure 4). We further defined these targets as highly significant if the target was highly expressed in > 15 organs, and the resultant highly significant targets identified were as follows: CAPN1 (30), LTA4H (16), MKNK2 (25), ITGA2 (17), HDAC1 (19), CDK9 (25). Of these targets CAPN1, LTA4H, MKNK2, ITGA2, HDAC1 are targets of As, and CDK9 is the only one that's a target of Su.…”

“…A WHO systematic review 3 revealed that replacement of ASwt with sugar does not provide a means for weight management in the long-term, and several studies have discovered a positive correlation between long term ASwt consumption and risk of developing cardiovascular disease [5][6][7][8] , type 2 diabetes mellitus 6,[8][9][10][11] , and mortality in adults 6,8,9,12 . Current literature also reveals other concerning associations between ASwt consumption and various routinely observed clinical conditions, including heightened risks of developing cancer [13][14][15] , chronic kidney disease 16,17 , adiposity related diseases 8,9,18,19 , as well as non-alcoholic fatty liver disease 20 .…”

Effect of non-nutritive sweeteners on insulin regulation, glycemic response, appetite and weight management: a systematic review

“…In a systematic review by Gil et al (2023), it was reported that consuming diet soda in high amount increases not only the cardiovascular risk but also HbA1c in diabetics. In the Multi-Ethnic Study of Atherosclerosis cohort, consuming diet soda daily was linked with a 67% higher relative risk of T2DM and 36% higher relative risk of metabolic syndrome (Nettleton et al , 2009).…”

The Lower the Better? Discussion on Non-Alcoholic Wine and Its Marketing

“…Escobar Gil and Laverde Gil [24] conducted a review study on the effects of artificially sweetened beverages, including diet soda (DS), on health, particularly those not related to incident diabetes mellitus, obesity, or metabolic syndrome. The study investigated how artificially sweetened beverages (ASBs) affect several aspects of health, revealing a strong correlation between ASB intake and depression, especially among females.…”