ArticlePublisher preview availableLiterature Review

The Association Between Artificial Sweeteners and Obesity

November 2017
Current Gastroenterology Reports 19(12)

Authors:

Purpose of review: The purpose of this paper is to review the epidemiology of obesity and the evolution of artificial sweeteners; to examine the latest research on the effects of artificial sweeteners on the host microbiome, the gut-brain axis, glucose homeostasis, and energy consumption; and to discuss how all of these changes ultimately contribute to obesity. Recent findings: Although artificial sweeteners were developed as a sugar substitute to help reduce insulin resistance and obesity, data in both animal models and humans suggest that the effects of artificial sweeteners may contribute to metabolic syndrome and the obesity epidemic. Artificial sweeteners appear to change the host microbiome, lead to decreased satiety, and alter glucose homeostasis, and are associated with increased caloric consumption and weight gain. Artificial sweeteners are marketed as a healthy alternative to sugar and as a tool for weight loss. Data however suggests that the intended effects do not correlate with what is seen in clinical practice. Future research should focus on the newer plant-based sweeteners, incorporate extended study durations to determine the long-term effects of artificial sweetener consumption, and focus on changes in the microbiome, as that seems to be one of the main driving forces behind nutrient absorption and glucose metabolism.

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NUTRITION AND OBESITY (S MCCLAVE AND J OBERT, SECTION EDITORS)

The Association Between Artificial Sweeteners and Obesity

Michelle Pearlman

&Jon Obert

&Lisa Casey

Published online: 21 November 2017

#Springer Science+Business Media, LLC 2017

Abstract

Purpose of Review The purpose of this paper is to review the

epidemiology of obesity and the evolution of artificial sweet-

eners; to examine the latest research on the effects of artificial

sweeteners on the host microbiome, the gut-brain axis, glu-

cose homeostasis, and energy consumption; and to discuss

how all of these changes ultimately contribute to obesity.

Recent Findings Although artificial sweeteners were devel-

oped as a sugar substitute to help reduce insulin resistance

and obesity, data in both animal models and humans suggest

that the effects of artificial sweeteners may contribute to met-

abolic syndrome and the obesity epidemic. Artificial sweet-

eners appear to change the host microbiome, lead to decreased

satiety, and alter glucose homeostasis, and are associated with

increased caloric consumption and weight gain.

Summary Artificial sweeteners are marketed as a healthy al-

ternative to sugar and as a tool for weight loss. Data however

suggests that the intended effects do not correlate with what is

seen in clinical practice. Future research should focus on the

newer plant-based sweeteners, incorporate extended study du-

rations to determine the long-term effects of artificial sweet-

ener consumption, and focus on changes in the microbiome,

as that seems to be one of the main driving forces behind

nutrient absorption and glucose metabolism.

Keywords Obesity .Artificial sweeteners .Microbiome .

Insulinresistance .Metabolic syndrome .Calorieconsumption

Introduction

Epidemiology of Obesity

Obesity is a major public health problem that exhibits no

boundaries. It affects children and adults, and spans all ethnic-

ities and races. In the USA between 1980 and 2000, the over-

all prevalence of obesity increased significantly among adult

men and women. For unclear reasons, thoughthe overall prev-

alence has remained stable since 2000, there seems to be an

increasing trend toward obesity in women and the extreme

obesity class [1]. Studies suggest that obesity is far more com-

plex than previously thought and is a result of numerous in-

ternal host factors and external environmental factors. Several

factors that contribute to obesity include but are not limited to

the consumption of energy dense foods, large portion sizes,

physical inactivity, alterations in the host gut microbiome,

consumption of a predominantly high fat and/or high sugar

diet, and the use of artificial sweeteners (AS) [2–5].

The Evolution of Artificial Sweeteners

Sugar-laden diets are ubiquitous because humans and animals

display preferences for sweet taste that starts early in life [6,

7]. The use of AS, also known as non-caloric or non-nutritive

sweeteners (NNS), has grown in popularity as awareness of

the obesity epidemic increases, and in particular due to the

growing concern for obesity-related complications including

metabolic syndrome and insulin resistance [8,9]. Based on the

NHANES database, the prevalence of AS from 1999 to 2007

increased from 6.1 to 12.5% among children and 18.7% to

This article is part of the Topical Collection on Nutrition and Obesity

*Michelle Pearlman

pearlmanmi@gmail.com

Department of Medicine, Division of Gastroenterology and

Hepatology, University ofTexas Southwestern Medical Center, 5323

Harry Hines, K5.136, Dallas, TX 75390, USA

Division of Gastroenterology and Hepatology, University of

Louisville, Louisville, KY, USA

Curr Gastroenterol Rep (2017) 19: 64

https://doi.org/10.1007/s11894-017-0602-9

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

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Jul 2016

Objective: To examine the timing, frequency, and type of antibiotic exposure during the first 10 years of life in association with (over)weight across this period in a cohort of 979 children. Study design: Within the Child, Parents and Health: Lifestyle and Genetic Constitution Birth Cohort Study, antibiotic exposure record was obtained from general practitioners. Anthropometric outcomes (age- and sex-standardized body mass index, weight and height z-scores, and overweight) were measured repeatedly at 7 time points during the first 10 years of life. Generalized estimating equations method was used for statistical analysis. Results: After adjusting for confounding factors, children exposed to one course of antibiotics compared with none in the first 6 months of life had increased weight- (adjusted generalized estimating equations estimates [adjβ] 0.24; 95% CI 0.03-0.44) and height (adjβ 0.23; 95% CI 0.0002-0.46) z-scores; exposure to ≥2 courses during the second year of life was associated with both increased weight (adjβ 0.34; 95% CI 0.07-0.60), and height z-scores (adjβ 0.29; 95% CI -0.003 to 0.59). Exposure later in life was not associated with anthropometric outcomes. Associations with weight z-scores were mainly driven by exposure to broad- (≥2 courses: adjβ 0.11; 95% CI 0.003-0.22) and narrow-spectrum β-lactams (1 course: adjβ 0.18; 95% CI 0.005-0.35) during the follow-up period. Specific antibiotic used was not associated with body mass index z-scores and overweight. Conclusions: Repeated exposure to antibiotics early in life, especially β-lactam agents, is associated with increased weight and height. If causality of obesity can be established in future studies, this further highlights the need for restrictive antibiotic use and avoidance of prescriptions when there is minimal clinical benefit.

Artificial sweeteners as a sugar substitute: Are they really safe?

Article

May 2016
INDIAN J PHARMACOL

Nonnutritive sweeteners (NNS) have become an important part of everyday life and are increasingly used nowadays in a variety of dietary and medicinal products. They provide fewer calories and far more intense sweetness than sugar-containing products and are used by a plethora of population subsets for varying objectives. Six of these agents (aspartame, saccharine, sucralose, neotame, acesulfame-K, and stevia) have previously received a generally recognized as safe status from the United States Food and Drug Administration, and two more (Swingle fruit extract and advantame) have been added in the recent years to this ever growing list. They are claimed to promote weight loss and deemed safe for consumption by diabetics; however, there is inconclusive evidence to support most of their uses and some recent studies even hint that these earlier established benefits regarding NNS use might not be true. There is a lack of properly designed randomized controlled studies to assess their efficacy in different populations, whereas observational studies often remain confounded due to reverse causality and often yield opposite findings. Pregnant and lactating women, children, diabetics, migraine, and epilepsy patients represent the susceptible population to the adverse effects of NNS-containing products and should use these products with utmost caution. The overall use of NNS remains controversial, and consumers should be amply informed about the potential risks of using them, based on current evidence-based dietary guidelines. © 2016 Indian Journal of Pharmacology Published by Wolters Kluwer - Medknow.

Association Between Artificially Sweetened Beverage Consumption During Pregnancy and Infant Body Mass Index

Article

May 2016

Importance: The consumption of artificial sweeteners has increased substantially in recent decades, including among pregnant women. Animal studies suggest that exposure to artificial sweeteners in utero may predispose offspring to develop obesity; however, to our knowledge, this has never been studied in humans. Objective: To determine whether maternal consumption of artificially sweetened beverages during pregnancy is associated with infant body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]). Design, setting, and participants: This cohort study included 3033 mother-infant dyads from the Canadian Healthy Infant Longitudinal Development (CHILD) Study, a population-based birth cohort that recruited healthy pregnant women from 2009 to 2012. Women completed dietary assessments during pregnancy, and their infants' BMI was measured at 1 year of age (n = 2686; 89% follow-up). Statistical analysis for this study used data collected after the first year of follow-up, which was completed in October 2013. The data analysis was conducted in August 2015. Exposures: Maternal consumption of artificially sweetened beverages and sugar-sweetened beverages during pregnancy, determined by a food frequency questionnaire. Main outcomes and measures: Infant BMI z score and risk of overweight at 1 year of age, determined from objective anthropometric measurements and defined according to World Health Organization reference standards. Results: The mean (SD) age of the 3033 pregnant women was 32.4 (4.7) years, and their mean (SD) BMI was 24.8 (5.4). The mean (SD) infant BMI z score at 1 year of age was 0.19 (1.05), and 5.1% of infants were overweight. More than a quarter of women (29.5%) consumed artificially sweetened beverages during pregnancy, including 5.1% who reported daily consumption. Compared with no consumption, daily consumption of artificially sweetened beverages was associated with a 0.20-unit increase in infant BMI z score (adjusted 95% CI, 0.02-0.38) and a 2-fold higher risk of infant overweight at 1 year of age (adjusted odds ratio, 2.19; 95% CI, 1.23-3.88). These effects were not explained by maternal BMI, diet quality, total energy intake, or other obesity risk factors. There were no comparable associations for sugar-sweetened beverages. Conclusions and relevance: To our knowledge, we provide the first human evidence that maternal consumption of artificial sweeteners during pregnancy may influence infant BMI. Given the current epidemic of childhood obesity and widespread use of artificial sweeteners, further research is warranted to confirm our findings and investigate the underlying biological mechanisms, with the ultimate goal of informing evidence-based dietary recommendations for pregnant women.