The Combined Effects of Aspartame and Acesulfame-K Blends on Appetite: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Abstract

Aspartame (Asp) and acesulfame-K (Ace-K) are nonnutritive sweeteners (NNSs) commonly used in combination to replace added sugars in reduced- or low-calorie foods and beverages. Despite Asp/Ace-K blends having negligible calories, their effects on appetite have not been reviewed systematically. We therefore undertook a systematic review and meta-analysis of the metabolic effects of Asp/Ace-K blends on energy intake (EI), subjective appetite scores, blood glucose, and the incretin hormones glucose-dependent insulinotropic peptide and glucagon-like peptide. MEDLINE, Web of Science, and Cochrane CENTRAL databases (Embase, PubMed, and CINAHL) were searched (May 2021) for randomized controlled trials (RCTs). Human RCTs using Asp/Ace-K blends compared with sugar and water controls were included, whereas isolated cell and animal studies were excluded. An overall 4829 publications were identified and 8 studies, including 274 participants, were retrieved for review. The Asp/Ace-K group's EI was significantly reduced compared with sugar [mean difference (MD): –196.56 kcal/meal; 95% CI: –332.01, –61.11 kcal/meal; P = 0.004] and water (MD: –213.42 kcal/meal; 95% CI: –345.4, –81.44 kcal/meal; P = 0.002). Meta-analysis of subjective appetite scores and incretins could not be undertaken due to inconsistencies in data reporting and insufficient data, respectively, but of the 4 studies identified, no differences were observed between Asp/Ace-K blends and controls. The Asp/Ace-K group's blood glucose was nonsignificantly reduced compared with sugar (MD: –1.48 mmol/L; 95% CI: –3.26, 0.3 mmol/L; P = 0.1) and water (MD: –0.08 mmol/L; 95% CI: –0.62, 0.47 mmol/L; P = 0.78). Lower EI in participants who were predominantly healthy and assigned to Asp/Ace-K blends could not be reliably attributed to changes in subjective appetite scores. Blood glucose and incretins were also generally not affected by Asp/Ace-K blends when compared with controls. Additional short- and long-term RCTs using NNSs and sugars at dietarily relevant levels are needed. This trial was registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42017061015).

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

“…In a study by Mehat et al (2022), metabolic effects of Aspartame-Acesulfame K (Asp/Ace K) blends were observed on energy intake, blood glucose, subjective appetite scores and hormones like incretin and glucagon. It was found that the energy intake reduced significantly compared with sugar [mean difference (MD): À196.56 kcal/meal; 95% CI: À332.01, À61.11 kcal/meal; and p ¼ 0.004] and water (MD: À213.42 kcal/meal; 95% CI: À345.4, À81.44 kcal/meal; and p ¼ 0.002).…”

Süßstoffe und ihre Wirkung auf das Körpergewicht

“…Das getrunkene Volumen eines nicht-kalorischen Softdrinks füllt sicherlich den Magen und dämpft Ghrelin, der volle neuroendokrine Effekt einer kalorischen Mahlzeit bleibt aber aus. So zeigen manche RCTs eine Zunahme des Appetits [35], andere wiederum nicht [36]. Funktionelle Hirnuntersuchungen beschreiben, dass Süßstoffe in ähnlicher Weise wie Zucker das hedonische System (Striatum und andere Teile des limbischen Apparates) ansprechen, allerdings mit insgesamt inkonsistentem Ergebnismuster [37][38][39].…”

Süßstoffe und ihre Wirkung auf das Körpergewicht

“…Das getrunkene Volumen eines nicht-kalorischen Softdrinks füllt sicherlich den Magen und dämpft Ghrelin, der volle neuroendokrine Effekt einer kalorischen Mahlzeit bleibt aber aus. So zeigen manche RCTs eine Zunahme des Appetits 35 , andere wiederum nicht 36 . Funktionelle Hirnuntersuchungen beschreiben, dass Süßstoffe in ähnlicher Weise wie Zucker das hedonische System (Striatum und andere Teile des limbischen Apparates) ansprechen, allerdings mit insgesamt inkonsistentem Ergebnismuster 37 – 39 .…”