‘Inconsistent findings’ across studies assessing link between artificial sweeteners, type 2 diabetes risk
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An analysis of more than four dozen studies suggests that an association between the consumption of artificial sweeteners and type 2 diabetes remains inconclusive, although multiple studies indicate a positive association between nonnutritive sweeteners and weight gain, according to findings published in Current Atherosclerosis Reports.
In a literature review, Peter M. Clifton, MD, PhD, professor of nutrition at the University of South Australia, and colleagues sought to identify diabetes risk associated with intake of nonnutritive sweeteners by examining glucose homeostasis, body weight and gut microbiota in epidemiologic and clinical studies, as well as clarify the potential mechanisms of action of nonnutritive sweeteners on glucose homeostasis.
“Consumers of artificial sweeteners do not reduce their overall intake of sugar,” Clifton said in a press release. “They use both sugar and low-calorie sweeteners and may psychologically feel they can indulge in their favorite foods. Artificial sweeteners also change the gut bacteria, which may lead to weight gain and risk of type 2 diabetes.”
The researchers assessed 13 prospective epidemiologic studies investigating the effects of artificially sweetened beverage intake on the risk for type 2 diabetes, noting “inconsistent findings” across the studies as well as publication bias and residual confounding. In one analysis of the Nurses’ Health Study (n = 82,902), researchers found that substitution of artificially sweetened beverages for sugar-sweetened beverages or fruit juices was associated with a 5% to 7% lower risk for type 2 diabetes. However, in the Women’s Health Initiative observational study of postmenopausal women, researchers found that artificially sweetened beverage intake was associated with a small increased risk for type 2 diabetes, with an adjusted HR of 1.21 (95% CI, 1.08-1.36) when consuming at least two servings per day vs. no artificially sweetened beverage consumption.
“A meta-analysis of nine prospective studies of 400,571 subjects from eight publications showed a significant, 14%, increased incidence of type 2 diabetes for the highest vs. lowest quantiles of nonnutritive sweetener intake,” the researchers wrote. “However, this association was attenuated after imputation for missing studies. Similar findings were observed in other meta-analyses.”
Researchers did find that artificially sweetened beverage intake was positively associated with weight gain or adiposity. Among a cohort of 5,158 primarily Mexican American adults living in San Antonio, the researchers observed a mean 1.46 kg/m² increase in BMI among participants who reported consuming two servings of artificially sweetened beverages per day when compared with nonusers. Intake of at least 21 servings per week of artificially sweetened beverages was also associated with weight gain among 1,250 normal-weight individuals.
“It is not clear that nonnutritive sweetener consumption has an effect on the incidence of type 2 diabetes or on glycemic control, even though there is some evidence for the modification of the microbiome and for interaction with sweet taste receptors in the oral cavity and the intestines’ modification of secretion of GLP-1, peptide YY (PYY), ghrelin and glucose-dependent insulinotropic polypeptide (GIP), which may affect glycemia following consumption of nonnutritive sweeteners,” the researchers wrote.
The researchers wrote that, in the absence of a glucose preload, nonnutritive sweetener intake does not appear to differ from water in glucose control; however, it is difficult to confirm whether nonnutritive sweetener intake adversely influences glucose response.
“Long-term studies of nonnutritive sweetener consumption are required to draw a firm conclusion about the role of nonnutritive sweetener consumption on glycemic control,” the researchers wrote.
In the release, Clifton stated that a better option than low-calorie sweeteners is a healthy diet consisting of whole grains, dairy, seafood, legumes, vegetables and fruits and water. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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