Artificially Sweetened Beverages—Do They Influence Cardiometabolic Risk?

Nutrition (BV Howard, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Nutrition

Abstract

The sweeteners in artificially sweetened beverages (ASB) are potent stimulators of sweetness on the palate, yet contain no energy. This “mismatch” between sweetness and energy in ASB has raised concern about metabolism and health. This article provides a review of the recent literature on the effect of ASB on cardiometabolic risk factors and disease. Physiologic mechanisms are discussed, as well as epidemiologic studies. Prospective studies of ASB intake and the risk of obesity, diabetes, and cardiovascular disease have revealed inconsistent results. Higher-quality studies suggest either no effect of ASB or perhaps a protective effect through replacement of calorically dense alternatives. Although some studies have reported that ASB may increase risk, these observations appear to be an artifact of reverse causality. The limited experimental evidence does not support an effect of ASB on obesity or chronic disease. Indeed, experimental studies in humans suggest ASB may be effective for weight loss when replacing sugar-sweetened beverages.

Keywords

Nonnutritive sweeteners Obesity Cardiovascular disease Type 2 diabetes Glycemia Metabolic syndrome Adipose Artificial sweeteners Diet beverages Beverages Nutrition 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Popkin BM. Patterns of beverage use across the lifecycle. Physiol Behav. 2010;100(1):4–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr. 2009;89:1–14.PubMedCrossRefGoogle Scholar
  3. 3.
    •• Gardner C, Wylie-Rosett J, Gidding SS, Steffen LM, Johnson RK, Reader D, Lichtenstein AH. Nonnutritive sweeteners: current use and health perspectives. Diabetes Care. 2012;35:1798–808. This is a scientific update on the topic from a panel of experts.Google Scholar
  4. 4.
    Fakhouri TH, Kit BK, Ogden CL. Consumption of diet drinks in the United States, 2009‒2010. NCHS Data Brief. 2012;109:1–8.PubMedGoogle Scholar
  5. 5.
    Bleich SN, Wang YC. Consumption of sugar-sweetened beverages among adults with type 2 diabetes. Diabetes Care. 2011;34(3):551–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Mackenzie T, Brooks B, O'Connor G. Beverage intake, diabetes, and glucose control of adults in America. Ann Epidemiol. 2006;16(9):688–91.PubMedCrossRefGoogle Scholar
  7. 7.
    Vanselow MS, Pereira MA, Neumark-Sztainer D, Raatz SK. Adolescent beverage habits and changes in weight over time: findings from Project EAT. Am J Clin Nutr. 2009;90(6):1489–95.PubMedCrossRefGoogle Scholar
  8. 8.
    Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364(25):2392–404.PubMedCrossRefGoogle Scholar
  9. 9.
    Ludwig DS. Artificially sweetened beverages. Cause for concern. JAMA. 2009;302(22):2477–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Gophna U. The guts of dietary habits. Science. 2011;334(6052):45–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Myers RL, Myers RL. The 100 most important chemical compounds: a reference guide. Westport: Greenwood; 2007.Google Scholar
  12. 12.
    •• Fitch C, Keim KS. Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners. J Acad Nutr Diet. 2012;112(5):739–58. This is a scientific position article from the Academy of Nutrition and Dietetics.Google Scholar
  13. 13.
    •• Gardner C, Wylie-Rosett J, Gidding SS, et al. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2012;126(4):509–19. This is a scientific update on the topic from a panel of experts (it is identical to [3]).PubMedCrossRefGoogle Scholar
  14. 14.
    Renwick AG, Molinary SV. Sweet-taste receptors, low-energy sweeteners, glucose absorption and insulin release. Br J Nutr. 2010;104(10):1415–20.Google Scholar
  15. 15.
    Tordoff MG, Alleva AM. Effect of drinking soda sweetened with aspartame or high-fructose corn syrup on food intake and body weight. Am J Clin Nutr. 1990;51(6):963–9.PubMedGoogle Scholar
  16. 16.
    Raben A, Vasilaras TH, Moller AC, Astrup A. Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. Am J Clin Nutr. 2002;76(4):721–9.PubMedGoogle Scholar
  17. 17.
    Swithers SE, Martin AA, Davidson TL. High-intensity sweeteners and energy balance. Physiol Behav. 2010;100(1):55–62.PubMedCrossRefGoogle Scholar
  18. 18.
    Nelson G, Hoon MA, Chandrashekar J, Zhang Y, Ryba NJ, Zuker CS. Mammalian sweet taste receptors. Cell. 2001;106(3):381–90.PubMedCrossRefGoogle Scholar
  19. 19.
    Jang HJ, Kokrashvili Z, Theodorakis MJ, Carlson OD, Kim BJ, Zhou J, et al. Gut-expressed gustducin and taste receptors regulate secretion of glucagon-like peptide-1. Proc Natl Acad Sci U S A. 2007;104(38):15069–74.PubMedCrossRefGoogle Scholar
  20. 20.
    Brown RJ, Walter M, Rother KI. Ingestion of diet soda before a glucose load augments glucagon-like peptide-1 secretion. Diabetes Care. 2009;32(12):2184–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Brown RJ, Rother KI. Non-nutritive sweeteners and their role in the gastrointestinal tract. J Clin Endocrinol Metab. 2012;97(8):2597–605.PubMedCrossRefGoogle Scholar
  22. 22.
    Pepino MY, Tiemann CD, Patterson BW, Wice BM, Klein S. Sucralose affects glycemic and hormonal responses to an oral glucose load. Diabetes Care. 2013;36(9):2530–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Ma J, Bellon M, Wishart JM, Young R, Blackshaw LA, Jones KL, et al. Effect of the artificial sweetener, sucralose, on gastric emptying and incretin hormone release in healthy subjects. Am J Physiol Gastrointest Liver Physiol. 2009;296(4):735–9.CrossRefGoogle Scholar
  24. 24.
    Ford HE, Peters V, Martin NM, Sleeth ML, Ghatei MA, Frost GS, et al. Effects of oral ingestion of sucralose on gut hormone response and appetite in healthy normal-weight subjects. Eur J Clin Nutr. 2011;65:508–13.PubMedCrossRefGoogle Scholar
  25. 25.
    Steinert RE, Frey F, Töpfer A, Drewe J, Beglinger C. Effects of carbohydrate sugars and artificial sweeteners on appetite and the secretion of gastrointestinal satiety peptides. Br J Nutr. 2011;105(9):1320–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Wu T, Zhao BR, Bound MJ, Checklin HL, Bellon M, Little TJ, et al. Effects of different sweet preloads on incretin hormone secretion, gastric emptying, and postprandial glycemia in healthy humans. Am J Clin Nutr. 2012;95(1):78–83.PubMedCrossRefGoogle Scholar
  27. 27.
    Wu GD, Chen J, Hoffmann C, Bittinger K, Chen YY, Keilbaugh SA, et al. Linking long-term dietary patterns with gut microbial enterotypes. Science. 2011;334(6052):105–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Dhingra R, Sullivan L, Jacques PF, et al. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation. 2007;116(5):480–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Pereira MA. Diet beverages and the risk of obesity, diabetes, and cardiovascular disease: a review of the evidence. Nutr Rev. 2013;71(7):433–40.PubMedCrossRefGoogle Scholar
  30. 30.
    Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. 2001;357:505–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004;292:927–34.PubMedCrossRefGoogle Scholar
  32. 32.
    Blum JW, Jacobsen DJ, Donnelly JE. Beverage consumption patterns in elementary school aged children across a two-year period. J Am Coll Nutr. 2005;24(2):93–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Fowler SP, Williams K, Resendez RG, Hunt KJ, Hazuda HP, Stern MP. Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain. Obesity (Silver Spring). 2008;16(8):1894–900.CrossRefGoogle Scholar
  34. 34.
    Nettleton JA, Lutsey PL, Wang Y, Lima JA, Michos ED, Jacobs DR. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2009;32(4):688–94.PubMedCrossRefGoogle Scholar
  35. 35.
    Duffey KJ, Steffen LM, Van Horn L, Jacobs Jr DR, Popkin BM. Dietary patterns matter: diet beverages and cardiometabolic risks in the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J Clin Nutr. 2012;95(4):909–15.PubMedCrossRefGoogle Scholar
  36. 36.
    Odegaard AO, Choh AC, Czerwinski SA, Towne B, Demerath EW. Sugar-sweetened and diet beverages in relation to visceral adipose tissue. Obesity (Silver Spring). 2012;20(3):689–91.CrossRefGoogle Scholar
  37. 37.
    Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr. 2009;89(4):1037–42.PubMedCrossRefGoogle Scholar
  38. 38.
    Lutsey PL, Steffen LM, Stevens J. Dietary intake and the development of the metabolic syndrome: the Atherosclerosis Risk in Communities study. Circulation. 2008;117(6):754–61.PubMedCrossRefGoogle Scholar
  39. 39.
    Palmer J, Boggs DA, Krishnan S, et al. Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med. 2008;168(14):1487–92.PubMedCrossRefGoogle Scholar
  40. 40.
    • de Koning L, Malik VS, Rimm EB, Willett WC, Hu FB. Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am J Clin Nutr. 2011;93(6):1321–7. This demonstrates evidence of reverse causaility for ASB and diabetes risk.PubMedCrossRefGoogle Scholar
  41. 41.
    • Maersk M, Belza A, Stodkilde-Jorgensen H, et al. Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Am J Clin Nutr. 2012;95(2):283–9. This is important, although it is a small preliminary study. It is a randomized trial of four beverages and changes in visceral fat over 6 months, showing an effect of SSB, but not of ASB, milk, or water.PubMedCrossRefGoogle Scholar
  42. 42.
    Mezitis NH, Maggio CA, Koch P, Quddoos A, Allison DB, Pi-Sunyer FX. Glycemic effect of a single high oral dose of the novel sweetener sucralose in patients with diabetes. Diabetes Care. 1996;19(9):1004–5.PubMedCrossRefGoogle Scholar
  43. 43.
    Grotz VL, Henry RR, McGill JB, Prince MJ, Shamoon H, Trout JR, et al. Lack of effect of sucralose on glucose homeostasis in subjects with type 2 diabetes. J Am Diet Assoc. 2003;103(12):1607–12.PubMedCrossRefGoogle Scholar
  44. 44.
    Maki KC, Curry LL, Reeves MS, Toth PD, McKenney JM, Farmer MV, et al. Chronic consumption of rebaudioside A, a steviol glycoside, in men and women with type 2 diabetes mellitus. Food Chem Toxicol. 2008;46 Suppl 7:S47–53.PubMedCrossRefGoogle Scholar
  45. 45.
    Nehrling JK, Kobe P, McLane MP, Olson RE, Kamath S, Horwitz DL. Aspartame use by persons with diabetes. Diabetes Care. 1985;8(5):415–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Horwitz DL, McLane M, Kobe P. Response to single dose of aspartame or saccharin by NIDDM patients. Diabetes Care. 1988;11(3):230–4.PubMedCrossRefGoogle Scholar
  47. 47.
    Colagiuri S, Miller JJ, Edwards RA. Metabolic effects of adding sucrose and aspartame to the diet of subjects with noninsulin-dependent diabetes mellitus. Am J Clin Nutr. 1989;50(3):474–8.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division of Epidemiology & Community Health, School of Public HealthUniversity of MinnesotaMinneapolisUSA

Personalised recommendations