Applied Evidence

What we know—and don’t—about non-nutritive sweeteners

Author and Disclosure Information

Here’s what’s known about the safety of these sweeteners and their effect on weight, appetite, and the risk for type 2 diabetes.

PRACTICE RECOMMENDATIONS

› Advise patients who are trying to lose weight that non-nutritive sweeteners (NNSs) are not beneficial for weight loss. A

› Reassure patients that NNSs do not appear to cause, or increase the risk of, developing type 2 diabetes mellitus. A

Strength of recommendation (SOR)

A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series


 

References

An estimated 93.3 million Americans (roughly 40% of the US population) were obese in 2015-2016, and most of them had at least 1 chronic disease.1 As a result, patient education focused on lifestyle modification, including healthy nutrition and physical activity, has become an integral part of our everyday practice.

At the same time, the most recent dietary guidelines recommend that added sugar make up < 10% of daily calories.2 In the United States, low-calorie food and beverages containing non-nutritive sweeteners (NNSs; TABLE3-8) have become a popular means of keeping the sweetness in our diet without the health ramifications associated with sugar. These NNSs (aka, artificial sweeteners, high-intensity sweeteners, and non-caloric sweeteners) are ubiquitous in soft drinks, processed grains (including breads, cereals, and granola bars), and dairy products (including yogurts, flavored milk, and ice cream). As examples, NNSs are present in 42% of flavored waters, 33% of yogurts, and all diet beverages.9,10 They can even be found in medications, multivitamins, toothpaste, and mouthwash.

Available non-nutritive sweeteners

Business is booming

Global NNS consumption has been growing more than 5% per year, meaning that by 2020, NNSs are expected to be a $2.2 billion industry.11 One study using data from the National Health and Nutrition Examination Survey (NHANES) found that the use of NNSs in the United States increased from 21.1% in 2003 to 24.9% in 2009-2010 among adults and increased from 7.8% to 18.9% over the same time period among children.12

The main increase in the consumption of NNSs across all age groups has been via the consumption of beverages. Approximately 11% of healthy weight, 19% of overweight, and 22% of obese adults consume diet beverages.13,14 Consumption of diet beverages or NNSs increases with age12 and is especially common among women with higher levels of education and income.15

However, concerns remain about the safety of these agents and their effect on weight, appetite, and the body’s glycemic response. This article reviews the available research and current recommendations regarding the use of NNSs.

WHAT EFFECT DO NNSs HAVE ON WEIGHT?

The data on NNSs and weight are inconsistent. One randomized controlled trial(RCT) compared weight loss over the course of 1 year (12-week weight loss phase; 9-month weight maintenance phase) when 303 participants consumed either water or drinks sweetened with NNSs.16 Weight loss was significantly greater in the NNS drink group when compared with the water group.16

Observational studies have revealed similar findings.17,18 Data from NHANES revealed that US adults (n = 14,098) during 2 nonconsecutive 24-hour dietary recall periods demonstrated lower total energy (calorie) intake if they consumed NNSs vs no NNSs.19 Another study using 2011-2016 NHANES data on adolescents (n = 7026) found no difference in energy intake between those who consumed beverages containing NNSs vs those who consumed beverages containing sugar.20

Continue to: Other lines of investigation...

Pages

Next Article: