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Non-nutritive sweeteners pose no effect on blood glucose levels
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The consumption of non-nutritive sweeteners had no glycemic effect, according to a systematic review and meta-analysis published in the European Journal of Clinical Nutrition.
“Unlike sugar consumption that raises glycemia ... through metabolism, it is widely believed that [non-nutritive sweeteners] may not have a substantial impact on glycemia,” Maxwell J. Holle, PhD candidate in the department of food science and human nutrition at the University of Illinois at Urbana-Champaign, and colleagues wrote. “The purpose of the current study was to systematically review and quantitatively synthesize existing scientific evidence from randomized controlled trials on the glycemic impact of [non-nutritive sweeteners].”
Holle and colleagues performed a keyword search in the PubMed and Web of Science databases to identify peer-reviewed randomized controlled trials (published from the time of the database inception to February 2018) that involved oral non-nutritive sweetener consumption after overnight fasting and contained results related to the change in blood glucose level in response to the consumption. The researchers used a standardized data extraction form to collect methodological and outcome variables from each study, including author, publication year, type of non-nutritive sweetener, blood glucose levels, sample size and characteristics of participants (age, sex, BMI and diabetic status).
Researchers then conducted a meta-analysis to estimate the glycemic impact of non-nutritive sweeter consumption, looking at blood glucose measurements in 30-minute intervals starting from baseline non-nutritive sweetener consumption to 210 minutes after consumption and change in blood glucose concentration. Meta-regressions were used to account for potential differences among type of non-nutritive sweetener and participants’ age, weight and diabetes status.
In total, 29 studies that included 741 participants aged 9 to 69 years were reviewed (mean age, 38 years; 406 with normal weight; 71 had overweight; 20 had obesity; 244 did not report BMI). The selected studies evaluated various kinds of non-nutritive sweeteners, with 11 focused on aspartame, 12 on saccharin, three on stevia and five on sucralose. Among participants, 280 consumed aspartame, 214 saccharin, 105 stevia and 142 sucralose. Most participants reported no chronic condition (n = 526), and 69 reported type 2 diabetes.
Researchers found that the estimated changes in blood glucose level after non-nutritive sweetener consumption compared with baseline were 0.048 mmol/L (95% CI, –0.037 to 0.133) from minute 1 to 29, 0.006 mmol/L (95% CI, –0.177 to 0.189) from minute 30 to 59, –0.113 mmol/L (95% CI, –0.248 to 0.022) from minute 60 to 89, –0.041 mmol/L (95% CI, –0.194 to 0.112) from minute 90 to 119, –0.245 mmol/L (95% CI, –0.335 to –0.156) from minute 120 to 149, –0.108 mmol/L (95% CI, –0.17 to –0.045) from minute 150 to 179, and –0.359 mmol/L (95% CI, –0.434 to –0.238) from minute 180 to 210.
From 1 to 29 minutes, 150 to 79 minutes, and 180 to 210 minutes after consumption, changes in blood glucose level among participants with type 2 diabetes were, respectively, 0.128 mmol/L (95% CI, 0.023–0.233), 0.844 mmol/L (95% CI, 0.349-1.338) and 0.613 mmol/L (95% CI, 0.204-1.022) lower than participants without diabetes.
Researchers also found that each unit increase in BMI was associated with a decrease in the glycemic impact of non-nutritive sweetener consumption by 0.049 mmol/L (95% CI, 0.008-0.091) during the 120 to 149 minute interval and 0.074 mmol/L (95% CI, 0.008-0.140) during the 180 to 210 minute interval and that each additional year of age was associated with a decrease in the glycemic impact of non-nutritive sweetener consumption by 0.026 mmol/L (95% CI, 0.002-0.051) during the 150 to 179 minute interval after consumption.
“The absence of glycemic impact of [non-nutritive sweetener] consumption makes [them] a potentially useful dietary aid for people with diabetes or on a weight-loss regime,” the researchers wrote. “However, some [non-nutritive sweetener] products may contain energy and carbohydrate from other sources that impact blood glucose level. ... Future studies are warranted to assess the health implications of frequent and chronic [non-nutritive sweetener] consumption and elucidate the underlying biological mechanisms.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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