ArticlePublisher preview availableLiterature Review

The Association Between Artificial Sweeteners and Obesity

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

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.
NUTRITION AND OBESITY (S MCCLAVE AND J OBERT, SECTION EDITORS)
The Association Between Artificial Sweeteners and Obesity
Michelle Pearlman
1
&Jon Obert
2
&Lisa Casey
1
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) [25].
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
1
Department of Medicine, Division of Gastroenterology and
Hepatology, University ofTexas Southwestern Medical Center, 5323
Harry Hines, K5.136, Dallas, TX 75390, USA
2
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.
... [1][2][3] The use of artificial low calorie sweeteners such as saccharin, aspartame, cyclamate and acesulfame K, thought to reduce the sugar-related problems, have also been linked to severe long-term side effects, including psychological and mental disorders, heart failure, bladder and brain tumours. [4][5][6][7] These health concerns drive the increasing interest in naturally occurring sweet and taste modifying proteins isolated from African native plants. The protein sweeteners have the potential to replace sugars and artificial sweeteners by acting as good natural, low calorie sweeteners, and unlike sugars, they do not trigger a demand for insulin. ...
... The protein sweeteners have the potential to replace sugars and artificial sweeteners by acting as good natural, low calorie sweeteners, and unlike sugars, they do not trigger a demand for insulin. 5,8,9 Among the naturally occurring sweet proteins is thaumatin, a group of intensely sweet-tasting proteins, about 3000 times sweeter than sucrose on weight basis, extracted from fruits of Thaumatococcus daniellii (Benn.) Benth, a rhizomatous plant found mainly in the tropical rain forests of West and Central Africa. ...
Article
Full-text available
Thaumatin is a naturally occurring protein sweetener found in the arils of Thaumatococcus daniellii fruits. In spite of its high market value as a safe flavour enhancer and high-intensity sweetener, challenges associated with the extraction and purification process have limited the economic exploitation of T. daniellii for thaumatin production in the West and Central Africa. This study examined a simple extraction technique that could be adapted locally. The arils of T. daniellii fruits were homogenized (in water), and filtered through a double-folded muslin cloth to obtain a crude protein extract. The extract was precipitated with 80% ammonium sulphate, dialysed and purified by gel filtration (Sephadex G-75). The crude protein extract and proteins from dialysed and gel chromatographic fractions were separately freeze-dried and run through SDS-PAGE. The extract of T. daniellii arils contained sweet-tasting proteins (thaumatin) with average molecular weight of about 22 kDa. The proteins were extremely sweet at 20 – 40oC; the sweetness decreased as temperature increased and became faint at 70oC. Protein recovery from ammonium sulphate precipitation and gel filtration was 76.14% and 63.0%, respectively. The crude extract was light brown whereas the purified protein was cream coloured. The simple process of homogenisation and filtration through muslin cloth can be adapted for extraction and initial processing of thaumatin in West Africa. Enzymatic hydrolysis of the sticky substances (polysaccharides) in the arils can enhance the extraction process.
... Also, non-caloric soft drinks' sweetness may increase appetite [25]. It has also been proposed that the intake of non-caloric soft drinks may result in energy compensation or overcompensation [26]. ...
... First, Chen, et al., applied mixed-effects models to estimate blood pressure changes in responding to changes in SSBs. This method, in contrast to fixed-effects models, uses both within-and between-individual exposure-outcome associations, increasing the potential variance to be explained (i.e., the effect of soft drinks on blood pressure within each individual as in fixed-effects, plus the differences in blood pressure across different types of soft drink consumers) but at the expense of potentially introducing time-invariant confounding [26]. Second, the study mentioned above analyzed SSBs, which include soft drinks and other sweetened non-carbonated drinks. ...
Article
Full-text available
Background A few prospective studies have investigated the potential association of soft drink and non-caloric soft drink intake with high blood pressure using methods that adequately consider changes in intake over time and hypertensive status at baseline. Objective To prospectively examine the association of soft drink and non-caloric soft drink intake with systolic and diastolic blood pressure in a sample of Mexican adults, overall and by hypertension status. Methods We used data from the Health Workers Cohort Study spanning from 2004 to 2018 ( n = 1,324 adults). Soft drink and non-caloric soft drink intake were assessed with a semiquantitative food frequency questionnaire. We fit multivariable-adjusted fixed-effects models to test the association of soft drink and non-caloric soft drink intake with systolic and diastolic blood pressure. The models were adjusted for potential confounders and considering the potential modifying effect of hypertension status at baseline. Results A one-serving increase in soft drink intake was associated with a 2.08 mm Hg (95% CI: 0.21, 3.94) increase in systolic blood pressure and 2.09 mm Hg (95% CI: 0.81, 3.36) increase in diastolic blood pressure over ten years. A stronger association between soft drink intake and diastolic pressure was observed among participants with versus without hypertension at baseline. We found no association between non-caloric soft drink intake and blood pressure. Conclusions Our findings support the hypothesis that soft drink intake increases blood pressure. While further studies should be conducted to confirm our findings, food policies and recommendations to limit soft drink intake are likely to help reduce blood pressure at the population level. We probably did not find an association between non-caloric soft drink intake and blood pressure because of the low consumption of this type of beverage in the cohort. More studies will be needed to understand the potential effect of non-caloric beverages on blood pressure.
... Published data from both animal models and humans suggest that high-fat diet and artificial sweeteners such as ASM exacerbate obesity and metabolic syndrome epidemic [17]. In this study, we investigated the biomarkers of metabolic syndrome in mouse serum to assess the effects of SG and ASM treatments. ...
... For example, the current antiobesity drugs including sibutramine, orlistat, and rimonabant were not fully used due to serious side effects or expensive prices [25]. As for the risk factors contributing to obesity, mounting evidence from epidemic investigations and experimental researches indicates potential obesogenic risks of artificial sweeteners although the exact relationship between artificial sweeteners and abnormal metabolic population is still a controversial topic [17,[26][27][28]. However, seeking sweetness is the nature of human being. ...
Article
Full-text available
Long-term artifi cial sweetener intake is linked to increased risk of obesity. In the present study, supplement of natural sweetener from Siraitia grosvenorii (SG) (or Momordica grosvenorii) fruit, compared with the artifi cial sweetener aspartame (ASM), was evaluated for anti-obesity effects on mice fed with high fat diet (HFD). We found that, in contrary to ASM, SG extracts prevented body weight gain, the insulin resistance and fat mass accumulation in HFD mice. SG extracts treatment inhibited the infi ltration of infl ammatory macrophages and lowered the levels of the fat infl ammatory cytokines (leptin, macrophage chemoattractant protein 1 (MCP-1) and tumor necrosis factor-α (TNF-α)) in adipose tissues. In addition, SG extracts supplement counteracted the remodeling of gut microbiota resulted from HFD. However, ASM supplement aggravated the HFD-induced obese performances, fat infl ammation and dysregulation of gut microbiota. Taken together, our results indicate that supplement of SG extracts may represent a promising alternation of artifi cial sweeteners in preventing metabolic diseases.
... The prevalence of obesity worldwide has increased tremendously [1], leading to increasing interest in low-calorie alternatives to sugar [2]. Artificial sweeteners (ASs), or sugar alternatives, can replace sugar in foods, drinks, and other products, and they are chemical additives with a strong sweet taste and a non-existing or extremely small caloric load. ...
Article
Full-text available
Artificial sweeteners (ASs) are calorie-free chemical substances used instead of sugar to sweeten foods and drinks. Pregnant women with obesity or diabetes are often recommended to substitute sugary products with ASs to prevent an increase in body weight. However, some recent controversy surrounding ASs relates to concerns about the risk of obesity caused by a variety of metabolic changes, both in the mother and the offspring. This study addressed these concerns and investigated the biodistribution of ASs in plasma and breast milk of lactating women to clarify whether ASs can transfer from mother to offspring through breast milk. We recruited 49 lactating women who were provided with a beverage containing four different ASs (acesulfame-potassium, saccharin, cyclamate, and sucralose). Blood and breast milk samples were collected before and up to six hours after consumption. The women were categorized: BMI < 25 (n = 20), BMI > 27 (n = 21) and type 1 diabetes (n = 8). We found that all four ASs were present in maternal plasma and breast milk. The time-to-peak was 30–120 min in plasma and 240–300 min in breast milk. Area under the curve (AUC) ratios in breast milk were 88.9% for acesulfame-potassium, 38.9% for saccharin, and 1.9% for cyclamate. We observed no differences in ASs distributions between the groups.
... Some studies have found no adverse effect on diabetics' blood glucose after they consumed artificial sweeteners [9]. Others claimed that the consumption of artificial sweeteners could trigger a small rise in insulin levels [10], negatively change gut bacteria [11], and could have a positive association with obesity [11][12][13]. These contradictory results have negatively impacted consumers' perceptions of artificial HISs [14] and increased their interest in natural sweetener options such as stevia [15]. ...
Article
Full-text available
There has been a challenge in overcoming the bitter aftertaste of stevia, a natural non-caloric sweetener. Recent research focuses on investigating various types of steviol glycosides, the sweet compounds in stevia leaves, as they exhibit different sensory characteristics. This study determined the sensory properties and acceptability of ice cream sweetened solely with three steviol glycosides, rebaudioside (Reb) A, D, and M (0.09% w/v), using sucrose-sweetened ice cream as a control (14% w/v). Ice cream consumers (n = 92) rated their overall liking, attribute liking, and sweetness and bitterness intensities and described the aftertastes of each sample using check-all-that-apply. The liking scores of Reb D- and M-sweetened ice creams were significantly higher than those of Reb A-sweetened ice cream. Among the three glycosides, only Reb M showed a sweetness intensity comparable with that of sucrose. Consumers perceived the aftertastes of Reb D and M ice creams as being more sweet, pleasant, creamy, and milky, while Reb A was more artificial and chemical. Reb D and M ice creams were also plotted close to sucrose in the correspondence analysis graph, meaning that their aftertaste characteristics were similar to those of sucrose. The present study clearly highlights that Reb D and M have better tastes and provide better perceptions to consumers than Reb A, which is the most widely used glycoside in food industry.
... Artificial sweeteners (ATS) have gained prominence as sugar replacements in several applications; nevertheless, their safety and long-standing health effects continue to be debatable [2]. For instance, the use of ATS alters the host microbiome, reduces satiety, affects glucose homeostasis, and leads to augmented caloric intake and weight increase [7]. Furthermore, a number of health-related effects, like headaches, dizziness, mood changes, and gastrointestinal problems, are also linked with consuming a widely utilized ATS, aspartame [8]. ...
Article
Full-text available
Owing to various undesirable health effects of sugar overconsumption, joint efforts are being made by industrial sectors and regulatory authorities to reduce sugar consumption practices, worldwide. Artificial sweeteners are considered potential substitutes in several products, e.g., sugar alcohols (polyols), high-fructose corn syrup, powdered drink mixes, and other beverages. Nevertheless, their long-standing health effects continue to be debatable. Consequently, growing interest has been shifted in producing non-caloric sweetenersfrom renewable resources to meet consumers' dietary requirements. Except for the lysozyme protein, various sweet proteins including thaumatin, mabinlin, brazzein, monellin, miraculin, pentadin, and curculin have been identified in tropical plants. Given the high cost and challenging extortion of natural resources, producing these sweet proteins using engineered microbial hosts, such as Yarrowia lipolytica, Pichia pastoris, Hansenula polymorpha, Candida boidinii, Arxula adeninivorans, Pichia methanolica, Saccharomyces cerevisiae, and Kluyveromyces lactis represents an appealing choice. Engineering techniques can be applied for large-scale biosynthesis of proteins, which can be used in biopharmaceutical, food, diagnostic, and medicine industries. Nevertheless, extensive work needs to be undertaken to address technical challenges in microbial production of sweet-tasting proteins in bulk. This review spotlights historical aspects, physicochemical properties (taste, safety, stability, solubility, and cost), and recombinant biosynthesis of sweet proteins. Moreover, future opportunities for process improvement based on metabolic engineering strategies are also discussed.
... When examining individual beverage categories, a substantial proportion of the respondents reported buying less of most of the taxed beverage categories and more of plain bottled water (this is in contrast to a recent study that found reduced bottled water purchases in the UK following the introduction of the SDIL [68], although this finding may have resulted from a concurrent media focus on the environmental problems of single use plastics), but also reported buying less of untaxed beverages such as diet soda, low-/no-calorie drinks, and chocolate/ flavoured milk. Although these results do not necessarily reflect the price mechanisms of the tax, shifting consumers away from artificially-sweetened beverages-whose health effects are still debated [69,70]-may be a positive outcome. These results also suggest that the majority of consumers are not substituting reductions in sugary drinks with increases in diet drinks, possibly because of concerns about sugar substitutes [71,72], which reflects patterns of beverage consumption observed in recent years [73]. ...
Article
Full-text available
Background The public health benefits of sugar-sweetened beverage (SSB) taxes often rely on, among other things, changes to consumer purchases. Thus, perceived cost of SSBs and signalling effects—via awareness of the tax—may impact the effectiveness of SSB taxes on consumer purchases. Objective The study sought to examine perceived cost of SSBs, tax awareness, and changes in beverage purchasing over time and across four countries with and without SSB taxes. Methods The study used data from the 2017, 2018 and 2019 waves of the International Food Policy Study. Annual cross-sectional online surveys were conducted in Australia, Mexico, UK and US, which captured perceived cost of SSBs relative to non-SSBs in all countries (with Australia as a no-tax comparator), and measures of tax awareness and participants’ reported changes in beverage purchasing in response to SSB taxes in Mexico (tax implemented in 2014), UK (tax implemented in 2018) and US (subnational taxes since 2015). Logistic regression models evaluated the measures across years and socio-demographic groups. Results Perceived cost of SSBs relative to non-SSBs was higher in Mexico (all three years) and the UK (2018 and 2019 following tax implementation) than Australia and the US. Tax awareness was higher in UK than Mexico, and decreased over time among Mexican respondents. Patterns of reported beverage purchasing changes in response to the tax were similar across Mexico, UK and US, with the largest changes reported by Mexican respondents. Respondents with characteristics corresponding to lower socioeconomic status were less likely to be aware of an SSB tax, but more likely to perceive SSBs to cost more than non-SSBs and report changes in purchasing in response to the tax, where there was one. Conclusions This study suggests that in countries where a national SSB tax was present (Mexico, UK), perceived cost of SSBs and tax awareness were higher compared to countries with no SSB tax (Australia) or subnational SSB taxes (US), respectively, and suggests that perceived cost and tax awareness represent distinct constructs. Improving the ‘signalling effect’ of existing SSB taxes may be warranted, particularly in tax settings where consumer behaviour change is a policy objective.
Article
Exposure to excess food additives is a potential health risk for humans. This study aimed to assess the dietary exposure to nine priority food additives in Turkey. The study took a conservative approach (based on individual consumption data combined with maximum permitted levels) was used in the study. The dietary exposure was estimated using a food frequency questionnaire and food additives content in various foodstuffs. The study has 433 participants (72.3% female, 27.7% male) who completed the study. None of the food additives included in the study exceeded the acceptable daily intake (ADI). Intake of nitrite and nitrate, especially in frozen meat/chicken/fish was higher compared to ADI by 215% and sulfites were higher than the ADI in some food groups (“pickled fruit and vegetables”, “dried tomatoes”, and “apricots, peaches, grapes, plums, and figs”) at P95. There is a growing concern about food additives in the food supply. Their exposure should be the responsibility of both the producer and the consumer. Therefore, it is necessary to monitor both the use of food additives and their consumption.
Article
Purpose This study aims to determine what consumers take into consideration while buying food and to increase awareness. We also demonstrated food additives knowledge, and the association between food additive consumption and illness. Design/methodology/approach An online survey was used to collect data from respondents ( n = 433). Findings Gender and knowledge of food additives and E numbers were found to be statistically different, as were education status and knowledge of food additives ( p < 0.05). When purchasing foods, 40.0% of the respondents seldom read labels and also 34.9% were reading for each buy who verified the product’s expiration date (94.2%), followed by brand name (84.8%). Sucralose, Acesulfame potassium (Ace-K) and aspartame consumption were associated with type II diabetes mellitus (T2DM). Additionally, sulfite consumption was linked to diarrhea/constipation. Research limitations/implications This study has some limitations. First, the study was cross-sectional, which does not allow the establishment of causal relationships for the associations found here. Second, the study was limited to one city in Turkey. Therefore, the study's findings cannot be extrapolated to Turkey. Practical implications Nutrition education should be given by the experts, and the policies should be implemented so that food labels may be used more effectively. Furthermore, nutritional education and policies can increase the general public's awareness of food additives. Social implications Nutrition education should be given by the experts, and the policies should be implemented so that food labels may be used more effectively. Furthermore, nutritional education and policies can increase the general public's awareness of food additives. Originality/value Consumers must be knowledgeable about food additives and E numbers. However, the findings revealed that the majority of Turkish consumers seldom read product labels, and the use of several food additives resulted in negative health repercussions. Therefore, professionals should provide nutrition education, and legislation should be put in place so that food labels may be used more effectively.
Article
Full-text available
Most medical specialties including the field of gastroenterology are mainly aimed at treating diseases rather than preventing them. Genomic medicine studies the health/disease process based on the interaction of the human genes with the environment. The gastrointestinal (GI) system is an ideal model to analyze the interaction between our genes, emotions and the gut microbiota. Based on the current knowledge, this mini-review aims to provide an integrated synopsis of this interaction to achieve a better understanding of the GI disorders related to bad eating habits and stress-related disease. Since human beings are the result of an evolutionary process, many biological processes such as instincts, emotions and behavior are interconnected to guarantee survival. Nourishment is a physiological need triggered by the instinct of survival to satisfy the body’s energy demands. The brain-gut axis comprises a tightly connected neural-neuroendocrine circuitry between the hunger-satiety center, the dopaminergic reward system involved in the pleasure of eating and the gut microbiota that regulates which food we eat and emotions. However, genetic variations and the consumption of high-sugar and high-fat diets have overridden this energy/pleasure neurocircuitry to the point of addiction of several foodstuffs. Consequently, a gut dysbiosis generates inflammation and a negative emotional state may lead to chronic diseases. Balancing this altered processes to regain health may involve personalized-medicine and genome-based strategies. Thus, an integrated approach based on the understanding of the gene-emotions-gut microbiota interaction is the next frontier that awaits the gastroenterologist to prevent and treat GI disorders associated with obesity and negative emotions.
Article
Full-text available
Background: Substituting sweeteners with non-nutritive sweeteners (NNS) may aid in glycaemic control and body weight management. Limited studies have investigated energy compensation, glycaemic and insulinaemic responses to artificial and natural NNS. Objectives: This study compared the effects of consuming NNS (artificial versus natural) and sucrose (65 g) on energy intake, blood glucose and insulin responses. Methods: Thirty healthy male subjects took part in this randomised, crossover study with four treatments: aspartame-, monk fruit-, stevia- and sucrose-sweetened beverages. On each test day, participants were asked to consume a standardised breakfast in the morning, and they were provided with test beverage as a preload in mid-morning and ad libitum lunch was provided an hour after test beverage consumption. Blood glucose and insulin concentrations were measured every 15 min within the first hour of preload consumption and every 30 min for the subsequent 2 h. Participants left the study site 3 h after preload consumption and completed a food diary for the rest of the day. Results: Ad libitum lunch intake was significantly higher for the NNS treatments compared with sucrose (P=0.010). The energy 'saved' from replacing sucrose with NNS was fully compensated for at subsequent meals; hence, no difference in total daily energy intake was found between the treatments (P=0.831). The sucrose-sweetened beverage led to large spikes in blood glucose and insulin responses within the first hour, whereas these responses were higher for all three NNS beverages following the test lunch. Thus, there were no differences in total area under the curve (AUC) for glucose (P=0.960) and insulin (P=0.216) over 3 h between the four test beverages. Conclusions: The consumption of calorie-free beverages sweetened with artificial and natural NNS have minimal influences on total daily energy intake, postprandial glucose and insulin compared with a sucrose-sweetened beverage.
Article
Full-text available
Introduction Low-calorie sweetener use for weight control has come under increasing scrutiny as obesity, especially abdominal obesity, remain entrenched despite substantial low-calorie sweetener use. We evaluated whether chronic low-calorie sweetener use is a risk factor for abdominal obesity. Participants and Methods We used 8268 anthropometric measurements and 3096 food diary records with detailed information on low-calorie sweetener consumption in all food products, from 1454 participants (741 men, 713 women) in the Baltimore Longitudinal Study of Aging collected from 1984 to 2012 with median follow-up of 10 years (range: 0–28 years). At baseline, 785 were low-calorie sweetener non-users (51.7% men) and 669 participants were low-calorie sweetener users (50.1% men). Time-varying low-calorie sweetener use was operationalized as the proportion of visits since baseline at which low-calorie sweetener use was reported. We used marginal structural models to determine the association between baseline and time-varying low-calorie sweetener use with longitudinal outcomes—body mass index, waist circumference, obesity and abdominal obesity—with outcome status assessed at the visit following low-calorie sweetener ascertainment to minimize the potential for reverse causality. All models were adjusted for year of visit, age, sex, age by sex interaction, race, current smoking status, dietary intake (caffeine, fructose, protein, carbohydrate, and fat), physical activity, diabetes status, and Dietary Approaches to Stop Hypertension score as confounders. Results With median follow-up of 10 years, low-calorie sweetener users had 0.80 kg/m² higher body mass index (95% confidence interval [CI], 0.17–1.44), 2.6 cm larger waist circumference (95% CI, 0.71–4.39), 36.7% higher prevalence (prevalence ratio = 1.37; 95% CI, 1.10–1.69) and 53% higher incidence (hazard ratio = 1.53; 95% CI 1.10–2.12) of abdominal obesity than low-calorie sweetener non-users. Conclusions Low-calorie sweetener use is independently associated with heavier relative weight, a larger waist, and a higher prevalence and incidence of abdominal obesity suggesting that low-calorie sweetener use may not be an effective means of weight control.
Article
Full-text available
Diet soda consumption has not been associated with tangible weight loss. Aspartame (ASP) commonly substitutes sugar and one of its breakdown products is phenylalanine (PHE), a known inhibitor of intestinal alkaline phosphatase (IAP), a gut enzyme shown to prevent metabolic syndrome in mice. We hypothesized that ASP consumption might contribute to the development of metabolic syndrome based on PHE's inhibition of endogenous IAP. The design of the study was such that for the in vitro model, IAP was added to diet and regular soda, and IAP activity was measured. For the acute model, a closed bowel loop was created in mice. ASP or water was instilled into it and IAP activity was measured. For the chronic model, mice were fed chow or high-fat diet (HFD) with/without ASP in the drinking water for 18 weeks. The results were that for the in vitro study, IAP activity was lower (p < 0.05) in solutions containing ASP compared with controls. For the acute model, endogenous IAP activity was reduced by 50% in the ASP group compared with controls (0.2 ± 0.03 vs 0.4 ± 0.24) (p = 0.02). For the chronic model, mice in the HFD + ASP group gained more weight compared with the HFD + water group (48.1 ± 1.6 vs 42.4 ± 3.1, p = 0.0001). Significant difference in glucose intolerance between the HFD ± ASP groups (53 913 ± 4000.58 (mg·min)/dL vs 42 003.75 ± 5331.61 (mg·min)/dL, respectively, p = 0.02). Fasting glucose and serum tumor necrosis factor-alpha levels were significantly higher in the HFD + ASP group (1.23- and 0.87-fold increases, respectively, p = 0.006 and p = 0.01). In conclusion, endogenous IAP's protective effects in regard to the metabolic syndrome may be inhibited by PHE, a metabolite of ASP, perhaps explaining the lack of expected weight loss and metabolic improvements associated with diet drinks.
Article
Full-text available
Escalating rates of obesity and public health messages to reduce excessive sugar intake have fuelled the consumption of artificial sweeteners in a wide range of products from breakfast cereals to snack foods and beverages. Artificial sweeteners impart a sweet taste without the associated energy and have been widely recommended by medical professionals since they are considered safe. However, associations observed in long-term prospective studies raise the concern that regular consumption of artificial sweeteners might actually contribute to development of metabolic derangements that lead to obesity, type 2 diabetes and cardiovascular disease. Obtaining mechanistic data on artificial sweetener use in humans in relation to metabolic dysfunction is difficult due to the long time frames over which dietary factors might exert their effects on health and the large number of confounding variables that need to be considered. Thus, mechanistic data from animal models can be highly useful because they permit greater experimental control. Results from animal studies in both the agricultural sector and the laboratory indicate that artificial sweeteners may not only promote food intake and weight gain but can also induce metabolic alterations in a wide range of animal species. As a result, simple substitution of artificial sweeteners for sugars in humans may not produce the intended consequences. Instead consumption of artificial sweeteners might contribute to increases in risks for obesity or its attendant negative health outcomes. As a result, it is critical that the impacts of artificial sweeteners on health and disease continue to be more thoroughly evaluated in humans.
Article
The present study investigated the feasibility of a new experimental approach for studying the effect of covert nutritive dilution on the spontaneous food intake of obese individuals. Eight obese subjects were studied as inpatients on a metabolic unit for 15 days, during which time they were unaware that their food intake was being monitored. A platter method of food presentation encouraged ad libitum ingestion. Caloric dilution was achieved by replacing sucrose-containing products with aspartame-sweetened analogues in an otherwise normal diet. During the base-line period the subjects spontaneously ate sufficient conventional food to maintain or even slightly increase body weight. Covert substitution of aspartame-sweetened products for their sucrose counterparts resulted in an immediate reduction in spontaneous energy intake of approximately 25%. The aspartame analogues were as well accepted as their conventional counterparts, as indicated by the equal quantity of each consumed. These preliminary results demonstrate that, in a metabolic ward setting, it is possible to maintain the spontaneous food intake of obese individuals at levels sufficient to preserve body weight and arbitrarily to decrease those levels of intake by 25% or more through covert changes in the caloric density of the diet.
Article
Background/objectives: Artificial sweeteners are used widely to replace caloric sugar as one of the strategies to lessen caloric intake. However, the association between the risk of obesity and artificially-sweetened soda consumption is controversial. The objective of this meta-analysis aimed to assess the association between consumption of sugar and artificially-sweetened soda and obesity. Methods: A literature search was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from inception through May 2015. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of obesity in patients consuming either sugar or artificially-sweetened soda versus those who did not consume soda were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Eleven studies were included in our analysis to assess the association between consumption of sugar-sweetened soda and obesity. The pooled RR of obesity in patients consuming sugar-sweetened soda was 1.18 (95% CI, 1.10-1.27). Three studies were included to assess the association between consumption of artificially-sweetened soda and obesity. The pooled RR of obesity in patients consuming artificially-sweetened soda was 1.59 (95% CI, 1.22-2.08). Conclusions: Our study demonstrated a significant association between sugar and artificially-sweetened soda consumption and obesity. This finding raises awareness and question of negative clinical impact on both sugar and artificially-sweetened soda and the risk of obesity.
Article
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.
Article
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.
Article
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.