Chronic Consumption of Artificial Sweetener in Packets or Tablets and Type 2 Diabetes Risk: Evidence from the E3N-European Prospective Investigation into Cancer and Nutrition Study

Fagherazzi, Guy; Gusto, Gaëlle; Affret, Aurélie; Mancini, Francesca Romana; Dow, C.; Balkau, Beverley; Clavel‐Chapelon, Françoise; Bonnet, Fabrice; Boutron‐Ruault, Marie‐Christine

doi:10.1159/000458769

Cited by 38 publications

(16 citation statements)

References 24 publications

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“…A few large prospective cohort studies98 99 100 101 102 with long term follow-up investigated the association between NSS intake and different health outcomes. However, the NSSs being investigated were not sufficiently specified to match the inclusion criteria of this review.…”

Section: Discussionmentioning

confidence: 99%

Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies

Toews

Lohner

Gaudry

et al. 2019

BMJ

192

172

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ObjectiveTo assess the association between intake of non-sugar sweeteners (NSS) and important health outcomes in generally healthy or overweight/obese adults and children.DesignSystematic review following standard Cochrane review methodology.Data sourcesMedline (Ovid), Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and reference lists of relevant publications.Eligibility criteria for selecting studiesStudies including generally healthy adults or children with or without overweight or obesity were eligible. Included study designs allowed for a direct comparison of no intake or lower intake of NSS with higher NSS intake. NSSs had to be clearly named, the dose had to be within the acceptable daily intake, and the intervention duration had to be at least seven days.Main outcome measuresBody weight or body mass index, glycaemic control, oral health, eating behaviour, preference for sweet taste, cancer, cardiovascular disease, kidney disease, mood, behaviour, neurocognition, and adverse effects.ResultsThe search resulted in 13 941 unique records. Of 56 individual studies that provided data for this review, 35 were observational studies. In adults, evidence of very low and low certainty from a limited number of small studies indicated a small beneficial effect of NSSs on body mass index (mean difference −0.6, 95% confidence interval −1.19 to −0.01; two studies, n=174) and fasting blood glucose (−0.16 mmol/L, −0.26 to −0.06; two, n=52). Lower doses of NSSs were associated with lower weight gain (−0.09 kg, −0.13 to −0.05; one, n=17 934) compared with higher doses of NSSs (very low certainty of evidence). For all other outcomes, no differences were detected between the use and non-use of NSSs, or between different doses of NSSs. No evidence of any effect of NSSs was seen on overweight or obese adults or children actively trying to lose weight (very low to moderate certainty). In children, a smaller increase in body mass index z score was observed with NSS intake compared with sugar intake (−0.15, −0.17 to −0.12; two, n=528, moderate certainty of evidence), but no significant differences were observed in body weight (−0.60 kg, −1.33 to 0.14; two, n=467, low certainty of evidence), or between different doses of NSSs (very low to moderate certainty).ConclusionsMost health outcomes did not seem to have differences between the NSS exposed and unexposed groups. Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited. Future studies should assess the effects of NSSs with an appropriate intervention duration. Detailed descriptions of interventions, comparators, and outcomes should be included in all reports.Systematic review registrationProspero CRD42017047668.

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Section: Discussionmentioning

confidence: 99%

Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies

Toews

Lohner

Gaudry

et al. 2019

BMJ

192

172

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“…Among the studies investigating the exposure to AS, 2 prospective cohort studies [ 162 , 163 ] and one case-control study [ 164 ] described an increased risk of type-2 diabetes, while 2 prospective [ 160 , 165 ] and 1 retrospective cohort studies [ 166 ] found no association between AS consumption and risk of diabetes. There were no studies investigating diabetes risk in association with NNCS consumption.…”

Section: Resultsmentioning

confidence: 99%

Health outcomes of non-nutritive sweeteners: analysis of the research landscape

Lohner

Toews

Meerpohl

2017

Nutr J

138

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BackgroundFood products containing non-nutritive sweeteners (NNSs) instead of sugar have become increasingly popular in the last decades. Their appeal is obviously related to their calorie-free sweet taste. However, with the dramatic increase in their consumption, it is reasonable and timely to evaluate their potential health benefits and, more importantly, potential adverse effects. The main aim of this scoping review was to map the evidence about health outcomes possibly associated with regular NNS consumption by examining the extent, range, and nature of research activity in this area.MethodsWe systematically searched Ovid MEDLINE, EMBASE and the Cochrane CENTRAL databases for studies on NNSs (artificial sweeteners or natural, non-caloric sweeteners, either used individually or in combination) using text terms with appropriate truncation and relevant indexing terms. All human studies investigating any health outcomes of a NNS intervention or exposure were eligible for inclusion. No studies were excluded based on language, study design or methodological quality. Data for each health outcome were summarized in tabular form and were discussed narratively.ResultsFinally, we included 372 studies in our scoping review, comprising 15 systematic reviews, 155 randomized controlled trials (RCTs), 23 non-randomized controlled trials, 57 cohort studies, 52 case-control studies, 28 cross sectional studies and 42 case series/case reports.In healthy subjects, appetite and short term food intake, risk of cancer, risk of diabetes, risk of dental caries, weight gain and risk of obesity are the most investigated health outcomes. Overall there is no conclusive evidence for beneficial and harmful effects on those outcomes. Numerous health outcomes including headaches, depression, behavioral and cognitive effects, neurological effects, risk of preterm delivery, cardiovascular effects or risk of chronic kidney disease were investigated in fewer studies and further research is needed. In subjects with diabetes and hypertension, the evidence regarding health outcomes of NNS use is also inconsistent.ConclusionsThis scoping review identifies the needs for future research to address the numerous evidence gaps related to health effects of NNSs use.It also specifies the research questions and areas where a systematic review with meta-analyses is required for the proper evaluation of health outcomes associated to regular NNSs consumption.

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“…These results suggest that higher LCSB consumption is not associated with adverse associations with prediabetes diagnostic markers or a glycemic response compared to plain water. Fagherazzi et al [ 33 ] reported that both a high frequency and a longer consumption period of LCS in packages or tablets was independently associated with type 2 diabetes risk in a European prospective cohort of women, but that the risk was partially mediated by adiposity. These results differ from those found in our study in several ways.…”

Section: Discussionmentioning

confidence: 99%

Consumption of Low-Calorie Sweetened Beverages Compared to Water Is Associated with Reduced Intake of Carbohydrates and Sugar, with No Adverse Relationships to Glycemic Responses: Results from the 2001–2012 National Health and Nutrition Examination Surveys

Leahy

Ratliff²,

Riedt³

et al. 2017

Nutrients

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Although the 2015 Dietary Guidelines Advisory Committee concluded that there was moderate evidence that substituting sugar-containing sweeteners with low-calorie sweeteners (LCS) reduces calorie intake and weight, dietary recommendations encourage substituting only water for sugar-sweetened beverages during weight management. This cross-sectional study evaluated the relation of water and no- and low-calorie sweetened beverage (LCSB) intake with nutrient intakes and prediabetes criteria using data from the National Health and Nutrition Examination Survey (NHANES) 2001–2012 in 25,817 adults that were free of diabetes. Although linear trends were observed with both beverages, higher LCSB intake was associated with significantly lower consumption of carbohydrates (−9.1 g/day vs. −1.4 g/day), total sugars (−10.9 g/day vs. −2.2 g/day), and added sugars (−2.0 tsp eq vs. −0.8 tsp eq) than those associated with higher water intake. Higher intake of both beverages was significantly associated with lower insulin levels (p < 0.01); however, higher intake of LCSB was also associated with lower hemoglobin A1c (HbA1c) and lower homeostatic model assessment of insulin resistance (HOMA-IR) (p < 0.01). We observed lower odds ratios for elevated HbA1c (adjusted odds ratio [OR] 0.79, 95% CI 0.64–0.98), HOMA-IR (0.68, 0.53–0.87), and insulin levels (0.63, 0.49–0.80) in LCSB among the higher (2+ servings) intake group compared to the lowest (<1 serving) intake group. Contrary to conventional wisdom, LCSB consumption was associated with equal, if not better, dietary intake and glycemic response than water consumption. Although observational in nature, these results contribute to the growing body of evidence from human studies suggesting that in addition to water, LCSBs can also be sensible choices for reducing sugars and carbohydrate intake, with no adverse associations to measures of glycemic response.

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Chronic Consumption of Artificial Sweetener in Packets or Tablets and Type 2 Diabetes Risk: Evidence from the E3N-European Prospective Investigation into Cancer and Nutrition Study

Cited by 38 publications

References 24 publications

Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies

Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies

Health outcomes of non-nutritive sweeteners: analysis of the research landscape

Consumption of Low-Calorie Sweetened Beverages Compared to Water Is Associated with Reduced Intake of Carbohydrates and Sugar, with No Adverse Relationships to Glycemic Responses: Results from the 2001–2012 National Health and Nutrition Examination Surveys

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