Despite the critical evaluation of low-energy sweeteners (LES) by regulatory bodies, there is an ongoing debate on the detrimental health outcomes of their intake. These concerns are expressed mainly due to the animal and human observational study outcomes, suggesting that LES may lead to increased risk of metabolic diseases, especially obesity and TY2DM. Although the LES stimulation of the gut and systemic mechanism are limited to in vitro and rodent models, and it is uncertain that these effects are physiologically relevant in humans. Moreover, there is substantial human interventional data that suggest, LES intake have no significant acute or chronic effect on measures of glucose homeostasis.
The objective of the current review was to conduct an comprehensive systemic review and meta-analysis of human controlled studies, that investigated the effects of LES intake on two main glycemic responses – PPG and PPI. A search was done on Medline, OVA FSTA, and SCOPUS databases up till January 2020, and RCTs comparing post-prandial effects on PPG and PPI post-LES exposure in different conditions were observed. A total of 26 papers (34 PPG trials and 29 PPI trials) were included and reported no statistically significant differences in the effects of LES on both PPG and PPI responses compared to the control interventions. The results also did not appreciably differ with the change in time period dosage of LES, including co-intervention consumption type, or fasting glucose and insulin levels.
In diabetic patients, there was a mean difference indicating a smaller PPG response post exposure to LES compared to the control (-0.3 mmol/L: 95% Cl: -0.53, -0.07). The administration of LES, alone or in combination with a nutrient containing preload had no acute effects on the mean changes in post-prandial glycemic or insulinemic responses compared to the control interventions. Apart from some beneficial effect on PPG (−0.3 mmol/L) in studies enrolling TY2DM patients, the effects did not differ by type or dose of LES, fasting glucose or insulin levels.
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