Debate surrounding nonnutritive sweeteners and BMI continues

Nonnutritive sweeteners, such as aspartame, sucralose, and stevioside, are widely consumed, yet their long-term health impact has been questioned. A study published in CMAJ synthesized evidence from prospective studies to determine whether routine consumption of nonnutritive sweeteners was associated with long-term adverse cardiometabolic effects.

The researchers searched MEDLINE, Embase, and Cochrane Library for randomized controlled trials (RCTs) that evaluated interventions for nonnutritive sweeteners and prospective cohort studies that reported on consumption of nonnutritive sweeteners among adults and adolescents. The primary outcome was body mass index (BMI). Secondary outcomes included weight, obesity, and other cardiometabolic end points.

From 11,774 citations, the researchers included seven RCTs (1,003 participants; median follow-up six months) and 30 cohort studies (405,907 participants; median follow-up 10 years). They found that in the included RCTs, nonnutritive sweeteners had no significant effect on BMI, however, in the included cohort studies, consumption of nonnutritive sweeteners was associated with a modest increase in BMI. Data from RCTs showed no consistent effects of nonnutritive sweeteners on other measures of body composition and reported no further secondary outcomes. In the cohort studies, consumption of nonnutritive sweeteners was associated with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes, and cardiovascular events.

The authors concluded that evidence from the RCTs does not clearly support the intended benefits of nonnutritive sweeteners for weight management, and observational data suggest that routine intake of nonnutritive sweeteners may be associated with increased BMI and cardiometabolic risk. Further research is needed to fully characterize the long-term risks and benefits of nonnutritive sweeteners.

Abstract