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Review
. 2017 Sep 8;16(1):55.
doi: 10.1186/s12937-017-0278-x.

Health Outcomes of Non-Nutritive Sweeteners: Analysis of the Research Landscape

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Free PMC article
Review

Health Outcomes of Non-Nutritive Sweeteners: Analysis of the Research Landscape

Szimonetta Lohner et al. Nutr J. .
Free PMC article

Abstract

Background: Food products containing non-nutritive sweeteners (NNSs) instead of sugar have become increasingly popular in the last decades. Their appeal is obviously related to their calorie-free sweet taste. However, with the dramatic increase in their consumption, it is reasonable and timely to evaluate their potential health benefits and, more importantly, potential adverse effects. The main aim of this scoping review was to map the evidence about health outcomes possibly associated with regular NNS consumption by examining the extent, range, and nature of research activity in this area.

Methods: We systematically searched Ovid MEDLINE, EMBASE and the Cochrane CENTRAL databases for studies on NNSs (artificial sweeteners or natural, non-caloric sweeteners, either used individually or in combination) using text terms with appropriate truncation and relevant indexing terms. All human studies investigating any health outcomes of a NNS intervention or exposure were eligible for inclusion. No studies were excluded based on language, study design or methodological quality. Data for each health outcome were summarized in tabular form and were discussed narratively.

Results: Finally, we included 372 studies in our scoping review, comprising 15 systematic reviews, 155 randomized controlled trials (RCTs), 23 non-randomized controlled trials, 57 cohort studies, 52 case-control studies, 28 cross sectional studies and 42 case series/case reports. In healthy subjects, appetite and short term food intake, risk of cancer, risk of diabetes, risk of dental caries, weight gain and risk of obesity are the most investigated health outcomes. Overall there is no conclusive evidence for beneficial and harmful effects on those outcomes. Numerous health outcomes including headaches, depression, behavioral and cognitive effects, neurological effects, risk of preterm delivery, cardiovascular effects or risk of chronic kidney disease were investigated in fewer studies and further research is needed. In subjects with diabetes and hypertension, the evidence regarding health outcomes of NNS use is also inconsistent.

Conclusions: This scoping review identifies the needs for future research to address the numerous evidence gaps related to health effects of NNSs use.It also specifies the research questions and areas where a systematic review with meta-analyses is required for the proper evaluation of health outcomes associated to regular NNSs consumption.

Keywords: Artificial sweetener; Aspartame; Cancer; Dental caries; Diabetes; Non-nutritive sweetener; Obesity; Overweight; Saccharin; Scoping review; Stevia; Weight gain.

Conflict of interest statement

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram for the systematic search on artificial sweeteners, natural non-caloric sweeteners and non-nutritive sweeteners. *All manuscripts which described neither a primary study nor were systematic reviews (e.g. narrative summaries, commentaries, and letters) were excluded as “Wrong publication format”
Fig. 2
Fig. 2
Health outcomes by intervention investigated in primary studies. a studies, where authors investigated effects of “artificial sweeteners” (no further details for the intervention/exposure is provided); b authors investigated the combined effects of two or more artificial sweeteners (type of sweeteners is described); c any type of “diet beverage”, where the type of sweetener is not defined; d combined effect of AS and NNCS was investigated or the intervention/exposure was described as “non-nutritive sweeteners” (without further details); e the investigated intervention/exposure is a combination of NNS and other non-sugar sweeteners (e.g. sugar alcohols). * haematological parameters, blood chemistries and hormone levels; **any other health outcome, which couldn’t be classified to any of the above listed categories (e.g. male fertility [289], offspring forearm fractures [290], emotional state [291], analgesia [292] or mortality [293]). Abbreviations: AS, artificial sweeteners; CVD, cardiovascular disease; NNS, non-nutritive sweeteners
Fig. 3
Fig. 3
Cancer outcomes by exposure investigated in primary studies

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