Low-calorie sweeteners and human health: a rapid review of systematic reviews

Nutr Rev. 2021 Sep 7;79(10):1145-1164. doi: 10.1093/nutrit/nuaa123.


Introduction: Low-calorie sweeteners are increasingly prevalent in the food supply and their consumption has increased in recent decades. Although low-calorie sweeteners approved for use are considered safe from a toxicological perspective, their short- and long-term impacts on chronic disease risk remain uncertain. The aim of this review was to summarize the evidence from systematic reviews on low-calorie sweetener use and chronic conditions and risk factors in children and adults.

Methods: MEDLINE and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews of randomized and nonrandomized studies that considered low-calorie sweeteners in relation to type 2 diabetes, cardiovascular disease, cancer, anthropometric measures, hypertension, hyperglycemia, hyperlipidemia, insulin resistance, and dental caries. Data were extracted from 9 reviews deemed of moderate or high quality on the basis of AMSTAR-2.

Results: Narrative synthesis suggested inconsistent evidence on low-calorie sweetener use in relation to chronic conditions and associated risk factors, with nonrandomized studies suggesting positive associations and randomized studies suggesting negative or no associations.

Conclusion: Continued research on the long-term health impacts of low-calorie sweeteners across all life stages is warranted.

Keywords: chronic disease; low-calorie sweeteners; non-nutritive sweeteners; obesity; review of reviews; sugars; type 2 diabetes; weight.

Publication types

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

MeSH terms

  • Dental Caries
  • Diabetes Mellitus, Type 2
  • Health* / statistics & numerical data
  • Humans
  • Non-Nutritive Sweeteners* / adverse effects
  • Systematic Reviews as Topic


  • Non-Nutritive Sweeteners