Clinical Summary

Author: Alexander D Nichol 1, Maxwell J Holle 2, Ruopeng An 3
Journal: J assoc Physicians India 2022 Jul;70(7):11-12
DOI: 10.1038/s41430-018-0170-6.

Aim:

To conduct a systematic review & meta-analysis to synthesize existing scientific evidence from RCT’s on the glycemic impact of NNS.

Background:

Obesity is on rise and is a leading cause of morbidity & mortality worldwide. One of the reason for increased prevalence of obesity is increased intake of energy dense food items. Sugar consumption may increase energy intake which is evident from various scientific research documenting the risk of sugar consumption leading to childhood & adult obesity. Restricting calorie intake has become an important strategy in preventing obesity & weight management. As per the 2015-2020 dietary guidelines- recommended calories from added sugar is < 10 % for Americans. NNS are non-nutritive zero or low calorie alternatives and can be a substitute to table sugars as they provide sweetness with an addition of few calories.

Study Design:

In total 29 RCT’s were reviewed with total participants of 741. The NNS evaluated were Aspartame (11 studies; n- 280) , Saccharin (12 studies; n-214), Stevia or steviosides (3 studies; n- 150) and Sucralose (5 studies; n-142). Age of the subjects ranged from 9 to 69 years old in all studies, with an average age of 38 years old.

Inclusion Criteria

Study design- RCT
Study Subject – Human
Intervention- Oral NNS consumption overnight fasting (NNS- Aspartame, Sucralose, Saccharin, Stevia)

Exclusion Criteria

1) Studies that administered NNS consumption in combination with other caloric foods or beverages
2) Studies not explicitly reporting a fasting protocol
3) Studies reporting no results from blood glucose test, or
4) Presence of other intervention components that may affect blood glucose (e.g., exercise).

Results

Meta-analysis was performed to estimate the glycemic impact and to test differential effects by types of NNS and participants age, weight & disease status of NNS consumption. Blood glucose measurements were allocated to 30-min intervals starting from the time of NNS consumption (i.e., baseline) to 210 min after consumption. Change in blood glucose level in response to NNS consumption was recorded. NNS consumption and also the type of NNS had no glycemic impact but varied to some extent by participants age, body weight and diabetic status. NNS concentration gradually declined over the observation period (210 mins) post the consumption.

The estimated changes in blood glucose level relative to the baseline were 0.048 mmol/L (95% confidence interval [CI]=−0.037,0.133) during 1–29 min, 0.006 mmol/L (95% CI=−0.177,0.189) during 30–59 min, −0.113 mmol/L (95% CI=−0.248, 0.022) during 60–89 min, −0.041 mmol/L (95%CI=−0.194, 0.112) during 90–119 min, −0.245 mmol/L (95% CI=−0.335, −0.156) during 120–149 min,−0.108 mmol/L (95% CI=−0.170, −0.045) during 150–179 min, and −0.359 mmol/L (95% CI=−0.434,−0.283) during 180–210 min following NNS consumption.

Conclusion

In comparison with baseline, NNS consumption was not found to impact blood glucose level.