2017, Number 3
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Rev Invest Clin 2017; 69 (3)
Non-Nutritive Sweeteners: Evidence on their Association with Metabolic Diseases and Potential Effects on Glucose Metabolism and Appetite
Romo-Romo A, Aguilar-Salinas CA, Gómez-Díaz RA, Brito-Córdova GX, Gómez-Velasco DV, López-Rocha MJ, Almeda-Valdés P
Language: English
References: 64
Page: 129-138
PDF size: 150.02 Kb.
ABSTRACT
There is ongoing debate concerning non-nutritive sweeteners, their usage, and their effects on metabolism. The association
between non-nutritive sweeteners consumption, development of metabolic diseases, and changes in appetite-regulating
hormones is not clear. The aim of this article is to present an overview of non-nutritive sweeteners and to examine the scientific
evidence of their effects on glucose metabolism and appetite-regulating hormones. Some observational studies suggest an
association between non-nutritive sweeteners consumption and development of metabolic diseases; however, adiposity is a
confounder frequently found in these studies. Results of the available clinical trials are heterogeneous and not comparable
because of major differences between them. Future controlled studies evaluating specific non-nutritive sweeteners, with an
appropriate sample size, including a uniform study group, with sufficient exposure time, and considering adjustment for confounder
variables, such as anthropometric characteristics, previous consumption of non-nutritive sweeteners, and coexistence
of significant metabolic comorbidities, are needed.
REFERENCES
Gardner C, Wylie-Rosett J, Gidding SS, et al. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. 2012;35:1798-808.
US Food and Drug Administration. Food Additives & Ingredients - Additional Information about High-Intensity Sweeteners Permitted for use in Food in the United States [Internet]. Center for Food Safety and Applied Nutrition. Available at: http:// www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditi vesIngredients/ucm397725.htm [Accessed 2016 Jan 29].
European Food Safety Authority. Sweeteners [Internet]. EFSA, 2013. Available at: http://www.efsa.europa.eu/en/topics/to pic/sweeteners [Accessed 2016 Jan 29].
Pepino MY. Metabolic effects of non-nutritive sweeteners. Physiol Behav. 2015;152:450-5.
Tandel KR. Sugar substitutes: Health controversy over perceived benefits. J Pharmacol Pharmacother. 2011;2:236-43.
Magnuson BA, Carakostas MC, Moore NH, Poulos SP, Renwick AG. Biological fate of low-calorie sweeteners. Nutr Rev. 2016; 74:670-89.
Fitch C, Keim KS. Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners. J Acad Nutr Diet. 2012;112:739-58.
Shankar P, Ahuja S, Sriram K. Non-nutritive sweeteners: review and update. Nutrition. 2013;29:1293–9.
Roberts A, Renwick AG, Sims J, Snodin DJ. Sucralose metabolism and pharmacokinetics in man. Food Chem Toxicol. 2000; 38:S31-41.
Qurrat-ul-Ain, Khan SA. Artificial sweeteners: safe or unsafe? J Pak Med Assoc. 2015;65:225-7.
Chattopadhyay S, Raychaudhuri U, Chakraborty R. Artificial sweeteners - a review. J Food Sci Technol. 2014;51:611-21.
Carakostas MC, Curry LL, Boileau AC, Brusick DJ. Overview: the history, technical function and safety of rebaudioside A, a naturally occurring steviol glycoside, for use in food and beverages. Food Chem Toxicol. 2008;46(Suppl 7):S1-10.
Urban JD, Carakostas MC, Taylor SL. Steviol glycoside safety: are highly purified steviol glycoside sweeteners food allergens? Food Chem Toxicol. 2015;75:71-8.
Warrington S, Lee C, Otabe A, et al. Acute and multiple-dose studies to determine the safety, tolerability, and pharmacokinetic profile of advantame in healthy volunteers. Food Chem Toxicol. 2011;49:S77-83.
Sharma A, Amarnath S, Thulasimani M, Ramaswamy S. Artificial sweeteners as a sugar substitute: Are they really safe? Indian J Pharmacol. 2016;48:237-40.
Li XE, Lopetcharat K, Drake MA. Parents’ and children’s acceptance of skim chocolate milks sweetened by monk fruit and stevia leaf extracts. J Food Sci. 2015;80:S1083-92.
Calvo SS-C, Egan JM. The endocrinology of taste receptors. Nat Rev Endocrinol. 2015;11:213-27.
Jang H-J, Kokrashvili Z, Theodorakis MJ, et al. Gut-expressed gustducin and taste receptors regulate secretion of glucagonlike peptide-1. Proc Natl Acad Sci USA. 2007;104:15069-74.
Raybould HE. Sensing of glucose in the gastrointestinal tract. Auton Neurosci. 2007;133:86-90.
Margolskee RF, Dyer J, Kokrashvili Z, et al. T1R3 and gustducin in gut sense sugars to regulate expression of Na+-glucose cotransporter 1. Proc Natl Acad Sci USA. 2007;104:15075-80.
Mace OJ, Affleck J, Patel N, Kellett GL. Sweet taste receptors in rat small intestine stimulate glucose absorption through apical GLUT2. J Physiol. 2007;582:379-92.
Abou-Donia MB, El-Masry EM, Abdel-Rahman AA, McLendon RE, Schiffman SS. Splenda alters gut microflora and increases intestinal p-glycoprotein and cytochrome p-450 in male rats. J Toxicol Environ Health A. 2008;71:1415-29.
Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014; 514:181-6.
Palmnäs MSA, Cowan TE, Bomhof MR, et al. Low-dose aspartame consumption differentially affects gut microbiota-host metabolic interactions in the diet-induced obese rat. PLoS One. 2014;9:e109841.
Morales P, Brignardello J, Gotteland M. [The association of intestinal microbiota with obesity]. Rev Med Chil. 2010;138: 1020-7.
Conlon M, Bird A. The impact of diet and lifestyle on gut microbiota and human health. Nutrients. 2014;7:17-44.
Icaza-Chávez ME. [Gut microbiota in health and disease]. Rev Gastroenterol Mex. 2013;78:240-8.
Valdovinos-Díaz MÁ. [Intestinal microbiota in digestive disorders. Probiotics, prebiotics and symbiotics]. Rev Gastroenterol Mex. 2013;78:25-7.
Renwick AG. Acceptable daily intake and the regulation of intense sweeteners. Food Addit Contam. 1990;7:463-75.
Bhupathiraju SN, Pan A, Malik VS, et al. Caffeinated and caffeine- free beverages and risk of type 2 diabetes. Am J Clin Nutr. 2013;97:155-66.
Schulze MB, Manson JE, Ludwig DS, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004;292:927-34.
de Koning L, Malik VS, Rimm EB, Willett WC, Hu FB. Sugarsweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am J Clin Nutr. 2011;93:1321-7.
Romaguera D, Norat T, Wark PA, et al. Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct. Diabetologia. 2013;56:1520-30.
Greenwood DC, Threapleton DE, Evans CEL, et al. Association between sugar-sweetened and artificially sweetened soft drinks and type 2 diabetes: systematic review and dose-response metaanalysis of prospective studies. Br J Nutr. 2014;112:725-34.
Imamura F, O’Connor L, Ye Z, et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ. 2015;351:h3576.
Dhingra R, Sullivan L, Jacques PF, et al. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation. 2007;116:480-8.
Lutsey PL, Steffen LM, Stevens J. Dietary intake and the development of the metabolic syndrome: the Atherosclerosis Risk in Communities study. Circulation. 2008;117:754-61.
Duffey KJ, Steffen LM, Van Horn L, Jacobs DR, Popkin BM. Dietary patterns matter: diet beverages and cardiometabolic risks in the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr. 2012;95:909-15.
Nettleton JA, Lutsey PL, Wang Y, Lima JA, Michos ED, Jacobs DR. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2009;32:688-94.
Fowler SP, Williams K, Resendez RG, Hunt KJ, Hazuda HP, Stern MP. Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain. Obesity (Silver Spring). 2008; 16:1894-900.
Romo-Romo A, Aguilar-Salinas CA, Brito-Córdova GX, Gómez Díaz RA, Vilchis Valentín D, Almeda-Valdes P. Effects of the nonnutritive sweeteners on glucose metabolism and appetite regulating hormones: Systematic review of observational prospective studies and clinical trials. PLoS One. 2016;11:e0161264.
Okuno G, Kawakami F, Tako H, et al. Glucose tolerance, blood lipid, insulin and glucagon concentration after single or continuous administration of aspartame in diabetics. Diabetes Res Clin Pract. 1986;2:23-7.
Härtel B, Graubaum H, Schneider B, Bier A. The influence of sweetener solutions on the secretion of insulin and blood glucose level. Ernährungsunschau. 1993;40:152-5.
Anton SD, Martin CK, Han H, et al. Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels. Appetite. 2010;55:37-43.
Gregersen S, Jeppesen PB, Holst JJ, Hermansen K. Antihyperglycemic effects of stevioside in type 2 diabetic subjects. Metabolism. 2004;53:73-6.
Temizkan S, Deyneli O, Yasar M, et al. Sucralose enhances GLP- 1 release and lowers blood glucose in the presence of carbohydrate in healthy subjects but not in patients with type 2 diabetes. Eur J Clin Nutr. 2015;69:162-6.
Horwitz DL, McLane M, Kobe P. Response to single dose of aspartame or saccharin by NIDDM patients. Diabetes Care. 1988; 11:230-4.
Pepino MY, Tiemann CD, Patterson BW, Wice BM, Klein S. Sucralose affects glycemic and hormonal responses to an oral glucose load. Diabetes Care. 2013;36:2530-5.
Hall WL, Millward DJ, Rogers PJ, Morgan LM. Physiological mechanisms mediating aspartame-induced satiety. Physiol Behav. 2003;78:557-62.
Ford HE, Peters V, Martin NM, et al. Effects of oral ingestion of sucralose on gut hormone response and appetite in healthy normal-weight subjects. Eur J Clin Nutr. 2011;65:508-13.
Steinert RE, Frey F, Töpfer A, Drewe J, Beglinger C. Effects of carbohydrate sugars and artificial sweeteners on appetite and the secretion of gastrointestinal satiety peptides. Br J Nutr. 2011;105:1320-8.
Maersk M, Belza A, Holst JJ, et al. Satiety scores and satiety hormone response after sucrose-sweetened soft drink compared with isocaloric semi-skimmed milk and with non-caloric soft drink: a controlled trial. Eur J Clin Nutr. 2012;66:523-9.
Brown AW, Bohan Brown MM, Onken KL, Beitz DC. Short-term consumption of sucralose, a nonnutritive sweetener, is similar to water with regard to select markers of hunger signaling and short-term glucose homeostasis in women. Nutr Res. 2011; 31:882-8.
Bryant CE, Wasse LK, Astbury N, Nandra G, McLaughlin JT. Nonnutritive sweeteners: no class effect on the glycaemic or appetite responses to ingested glucose. Eur J Clin Nutr. 2014;68: 629-31.
Rodin J. Comparative effects of fructose, aspartame, glucose, and water preloads on calorie and macronutrient intake. Am J Clin Nutr. 1990;51:428-35.
Melanson KJ, Westerterp-Plantenga MS, Campfield LA, Saris WH. Blood glucose and meal patterns in time-blinded males, after aspartame, carbohydrate, and fat consumption, in relation to sweetness perception. Br J Nutr. 1999;82:437-46.
Tey SL, Salleh NB, Henry J, Forde CG. Effects of aspartame-, monk fruit-, stevia- and sucrose-sweetened beverages on postprandial glucose, insulin and energy intake. Int J Obes. 2017; [Epub ahead of print].
Brown RJ, Walter M, Rother KI. Effects of diet soda on gut hormones in youths with diabetes. Diabetes Care. 2012;35:959-64.
Sylvetsky AC, Brown RJ, Blau JE, Walter M, Rother KI. Hormonal responses to non-nutritive sweeteners in water and diet soda. Nutr Metab (Lond). 2016;13:71.
Drewnowski A, Mennella JA, Johnson SL, Bellisle F. Sweetness and food preference. J Nutr. 2012;142:1142-8S.
Burke MV, Small DM. Physiological mechanisms by which nonnutritive sweeteners may impact body weight and metabolism. Physiol Behav. 2015;152:381-8.
Fagherazzi G, Vilier A, Saes Sartorelli D, Lajous M, Balkau B, Clavel-Chapelon F. Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidemiologique aupres des femmes de la Mutuelle Generale de l’Education Nationale-European Prospective Investigation into Cancer and Nutrition cohort. Am J Clin Nutr. 2013;97:517-23.
O’Connor L, Imamura F, Lentjes MA, Khaw KT, Wareham NJ, Forouhi NG. Prospective associations and population impact of sweet beverage intake and type 2 diabetes, and effects of substitutions with alternative beverages. Diabetologia. 2015;58: 1474-83.
Sakurai M, Nakamura K, Miura K, et al. Sugar-sweetened beverage and diet soda consumption and the 7-year risk for type 2 diabetes mellitus in middle-aged Japanese men. Eur J Nutr. 2014; 53:251-8.