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Sweeteners may be linked to weight gain rather than loss

Consumption also linked to higher risks of hypertension, diabetes and heart disease

Louise Prime

Tuesday, 18 July 2017

Consumption of artificial sweeteners appears not only to be unhelpful in keeping weight down, but might also be associated with long-term weight gain and an increased risk of obesity, diabetes, hypertension and cardiovascular events, research has shown. The authors of the study,* published in the Canadian Medical Association Journal, said that given the widespread and increasing use of non-nutritive (artificial) sweeteners, caution is warranted until their long-term risks and benefits have been fully evaluated in further research.

The research team explained that consumption of artificial sweeteners such as aspartame, sucralose and stevia, is widespread and increasing; but emerging data indicate that artificial sweeteners might have negative effects on metabolism, gut bacteria and appetite, although the evidence is conflicting. So, they decided to investigate whether or not consumption of artificial sweeteners was associated with long-term adverse cardiometabolic effects.

They conducted a systematic review of 37 studies that had followed 406,910 people for an average of 10 years. Of these studies, only seven were randomised controlled trials (RCT) and these included a total of 1,003 people, who at baseline were obese, overweight, or hypertensive, and who were followed for six months on average. The other 30 were cohort studies.

The study authors reported that data from the RCTs showed that artificial sweeteners had no significant effect on BMI, furthermore, these data showed no consistent effects of artificial sweeteners on other measures of body composition, and reported no further secondary outcomes.

In the cohort studies, consumption of artificial sweeteners was associated with a modest increase in BMI. It was also associated in these studies with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events.

The researchers pointed out: “Despite the fact that millions of individuals routinely consume artificial sweeteners, relatively few patients have been included in clinical trials of these products.”
They said their study showed that evidence from RCTs does not clearly support the intended benefits of artificial sweeteners for weight management; and that observational data suggest that routine intake of artificial sweeteners may be associated with increased BMI and cardiometabolic risk.

They commented: “Caution is warranted until the long-term health effects of artificial sweeteners are fully characterised.

“Given the widespread and increasing use of artificial sweeteners, and the current epidemic of obesity and related diseases, more research is needed to determine the long-term risks and benefits of these products.”

* Azad MB, Abou-Setta AM, Chauhan BF, et al. Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies. CMAJ, July 17, 2017 vol. 189 no. 28 doi: 10.1503/cmaj.161390

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