Early-Life Exposure to Non-Nutritive Sweeteners and the Developmental Origins of Childhood Obesity: Global Evidence from Human and Rodent Studies

Abstract

Non-nutritive sweeteners (NNS) are increasingly consumed by children and pregnant women around the world, yet their long-term health impact is unclear. Here, we review an emerging body of evidence suggesting that early-life exposure to NNS may adversely affect body composition and cardio-metabolic health. Some observational studies suggest that children consuming NNS are at increased risk for obesity-related outcomes; however, others find no association or provide evidence of confounding. Fewer studies have examined prenatal NNS exposure, with mixed results from different analytical approaches. There is a paucity of RCTs evaluating NNS in children, yielding inconsistent results that can be difficult to interpret due to study design limitations (e.g., choice of comparator, multifaceted interventions). The majority of this research has been conducted in high-income countries. Some rodent studies demonstrate adverse metabolic effects from NNS, but most have used extreme doses that are not relevant to humans, and few have distinguished prenatal from postnatal exposure. Most studies focus on synthetic NNS in beverages, with few examining plant-derived NNS or NNS in foods. Overall, there is limited and inconsistent evidence regarding the impact of early-life NNS exposure on the developmental programming of obesity and cardio-metabolic health. Further research and mechanistic studies are needed to elucidate these effects and inform dietary recommendations for expectant mothers and children worldwide.

Consumption of low‐calorie sweetened beverages is associated with higher total energy and sugar intake among children, NHANES 2011–2016

“…These include augmentation of insulin levels, failure to suppress ghrelin, alteration of the central reward response to carbohydrate ingestion, promotion of sweet taste preferences, and dysregulation of the predictive relationship between sweetness and calorie ingestion, leading to overconsumption . However, these mechanisms have not been confirmed in humans and are severely understudied in children to date …”

Anticipatory effects of the implementation of the Chilean Law of Food Labeling and Advertising on food and beverage product reformulation

“…Since the implementation of the Chilean Law of Food Labeling and Advertising at the end of June 2016, there have been some reports by industry that reformulation has occurred, particularly for beverages and dairy products, but these have not been verified by formal studies. An increase in the use of sugar substitutes has been suggested, especially among dairy products, and this brings unknown health risks, especially for children who are still developing . This study has additional important health implications for the entire Chilean population where overweight and obesity have rapidly increased to over 11% in those less than 6 years, and to a third of those less than 14 years, while one in 11 deaths among Chilean adults is attributable to overweight and obesity .…”

“…An increase in the use of sugar substitutes has been suggested, especially among dairy products, 16 and this brings unknown health risks, especially for children who are still developing. [61][62][63][64] This study has additional important health implications for the entire Chilean population where overweight and obesity have rapidly increased to over 11% in those less than 6 years, and to a third of those less than 14 years, while one in 11 deaths among Chilean adults is attributable to overweight and obesity. 47 The prevalence of type 2 diabetes is increasing in all age groups (>15 y) up to 18% in those 45 to 64 years and 31% in those older than 65 years.…”

Low‐calorie sweetener use, weight, and metabolic health among children: A mini‐review

“…This is particularly important because dietary patterns early in life are known to be key factors in shaping dietary choices, weight trajectory, and onset of chronic disease later in life . As potential health implications of LCS exposure in utero or via breast milk have been recently detailed elsewhere, studies investigating effects of LCS exposure during gestation and infancy are not discussed herein. The purpose of this mini‐review is to summarize existing evidence on LCS consumption in relation to weight management and metabolic health in children (≥2 y) and adolescents.…”

“…recently detailed elsewhere, [5][6][7][8][9] studies investigating effects of LCS exposure during gestation and infancy are not discussed herein. The purpose of this mini-review is to summarize existing evidence on LCS consumption in relation to weight management and metabolic health in children (≥2 y) and adolescents.…”