Low-calorie sweeteners and human health: a rapid review of systematic reviews

Abstract

Introduction Low-calorie sweeteners are increasingly prevalent in the food supply and their consumption has increased in recent decades. Although low-calorie sweeteners approved for use are considered safe from a toxicological perspective, their short- and long-term impacts on chronic disease risk remain uncertain. The aim of this review was to summarize the evidence from systematic reviews on low-calorie sweetener use and chronic conditions and risk factors in children and adults. Methods MEDLINE and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews of randomized and nonrandomized studies that considered low-calorie sweeteners in relation to type 2 diabetes, cardiovascular disease, cancer, anthropometric measures, hypertension, hyperglycemia, hyperlipidemia, insulin resistance, and dental caries. Data were extracted from 9 reviews deemed of moderate or high quality on the basis of AMSTAR-2. Results Narrative synthesis suggested inconsistent evidence on low-calorie sweetener use in relation to chronic conditions and associated risk factors, with nonrandomized studies suggesting positive associations and randomized studies suggesting negative or no associations. Conclusion Continued research on the long-term health impacts of low-calorie sweeteners across all life stages is warranted.

No Association between Low-Calorie Sweetener (LCS) Use and Overall Cancer Risk in the Nationally Representative Database in the US: Analyses of NHANES 1988–2018 Data and 2019 Public-Use Linked Mortality Files

“…In past studies, we used retroactive 10-y weight history—another component of NHANES—to show that previously expressed desire to lose/control body weight was linked to higher LCS use [ 16 ]. That study counters the still-repeated arguments that LCS leads to weight gain and is a causal factor in the development of obesity [ 8 , 11 , 12 ]; assertions that were not confirmed in recent systematic reviews [ 34 , 35 ] It is important to note here that obesity is a recognized risk factor for many cancers that may be unrelated to LCS use.…”

“…Assigning participants to LCS consumers and nonconsumer groups can be problematic—even two-day intakes are not representative of habitual consumption. In general, randomized controlled trials make for a higher standard of evidence [ 35 , 37 ]. Secondly, LCS beverages and foods are not flagged and need to be searched for in FNDDS, the USDA nutrient composition data file, using custom designed coding.…”

Is There an Academic Bias against Low-Energy Sweeteners?

“…Observational studies (and the reviews citing them) lean toward finding adverse associations of LES with metabolic health outcomes, whereas RCTs lean toward neutral or beneficial effects, often for the same outcomes, such as body weight [ 40 , 41 ]. Large, well-designed observational studies with appropriate analyses can highlight legitimate areas of concern, although there is considerable debate around the use and limitations of observational data in nutrition [ 30 ].…”

Association between sugar‐free beverage intake and childhood obesity among Chinese children and adolescents

“…11 In high-income countries, limited observational studies suggested a positive association between SFB intake and childhood obesity, while conflicting findings were reported from randomized controlled trials (RCTs). [12][13][14] The research beyond high-income countries is relatively less. 15 Additionally, these studies mainly addressed general obesity based on anthropometric measurements but failed to consider body fat distributions, which require the data on body composition, such as body fat percentage (BF%) and visceral fat area (VFA).…”