Early Exposure to Nonnutritive Sweeteners and Long-term Metabolic Health: A Systematic Review

Pediatrics. 2016 Mar;137(3):e20153603. doi: 10.1542/peds.2015-3603. Epub 2016 Feb 25.


Context: Nonnutritive sweetener (NNS) consumption is increasing among children, yet its long-term health impact is unclear, particularly when exposure occurs during early life.

Objective: To synthesize evidence from prospective studies evaluating the association of early-life NNS exposure and long-term metabolic health.

Data sources: Medline, Embase, and Cochrane Library (inception to July 2015).

Study selection: We aimed to include randomized controlled trials (RCTs) evaluating NNS-based interventions and prospective cohort studies reporting NNS exposure among pregnant women, infants, or children (<12 years of age), with a minimum study duration of 6 months.

Data extraction: The primary outcome was BMI; secondary outcomes included growth velocity, overweight/obesity, adiposity, and adverse metabolic effects. Study quality and risk of bias were evaluated using validated assessment tools.

Results: We identified 6 eligible cohort studies and 2 RCTs (n = 15,641 children). Half of the cohorts reported increasing weight gain or fat mass accumulation with increasing NNS intake, and pooled data from 2 cohorts showed a significant correlation with BMI gain (weighted mean correlation 0.023, 95% confidence interval 0.006 to 0.041). RCTs reported contradictory effects on weight change in children receiving NNSs. No eligible studies evaluated prenatal or infant NNS exposure.

Limitations: Meta-analysis was limited because of the small number of eligible studies and heterogeneity of populations and outcomes.

Conclusions: There is limited and inconsistent evidence of the long-term metabolic effects of NNS exposure during gestation, infancy, and childhood. Further research is needed to inform recommendations for the use of NNSs in this sensitive population.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Child
  • Female
  • Follow-Up Studies
  • Global Health
  • Health Status*
  • Humans
  • Incidence
  • Non-Nutritive Sweeteners / adverse effects*
  • Obesity* / epidemiology
  • Obesity* / etiology
  • Obesity* / physiopathology
  • Pregnancy
  • Time Factors
  • Weight Gain / drug effects*


  • Non-Nutritive Sweeteners