College of Human Medicine, Michigan State University, Grand Rapids, Michigan; Department of Endocrinology & Diabetes, Spectrum Health West Michigan, Grand Rapids, Michigan.
Endocr Pract. 2021 Oct;27(10):1056-1061. doi: 10.1016/j.eprac.2021.06.013. Epub 2021 Sep 3.
Nonnutritive (NNSs) are used in place of sugars to reduce caloric and glycemic intake while providing desired sweetness, commonly replacing sugar-sweetened beverages (SSBs) with "diet" (zero-calorie) alternatives. Concern has developed due to observational data associating NNSs with obesity and adiposity-based chronic disease. This counterpoint argues that, in general, NNSs used in place of added or excess sugars in the diet are likely beneficial.
A literature review was conducted on interventional trials investigating NNSs and obesity or type 2 diabetes mellitus. Key words used in the search included artificial sweeteners, nonnutritive sweeteners, saccharin, sucralose, aspartame, stevia/steviol, acesulfame potassium, meal replacements, type 2 diabetes mellitus, obesity, and weight.
Interventional data and indirect interventional data consistently showed beneficial effects on weight and cardiometabolic health, including glycemia, when SSBs or other energy-dense foods were replaced by artificially sweetened beverages or artificially sweetened meal replacements.
Although NNSs correlate with obesity and adiposity-based chronic disease, those data are fraught with confounding and error. Plausibility has been suggested on the basis of preclinical research on neuroendocrine control of appetite, satiety, and cravings plus the gut microbiome. However, interventional data reveal that replacing caloric/glycemic energy intake via NNSs creates an energy deficit resulting in weight loss and improvement in disease-especially dysglycemic disease. Intensive dietary intervention using artificially sweetened meal replacements shows a marked clinical benefit without detriment from their NNSs. Furthermore, beverages sweetened with NNSs rather than SSBs have been noted to be a critical component for those succeeding in maintaining weight loss. Although individual responses to the effects of NNSs are always warranted just like in any clinical situation, patients should not be advised to avoid NNSs in the context of dietary intervention to improve quality and energy deficit.
非营养性甜味剂（NNSs）被用于替代糖以减少热量和血糖摄入，同时提供所需的甜度，通常用“无糖”（零卡路里）替代品代替含糖饮料（SSBs）。由于观察性数据表明 NNSs 与肥胖和肥胖相关的慢性病有关，因此人们对此表示担忧。本文提出了相反的观点，即一般来说，在饮食中用 NNSs 替代添加糖或过量糖可能是有益的。
对研究 NNSs 与肥胖或 2 型糖尿病关系的干预试验进行了文献回顾。搜索中使用的关键词包括人工甜味剂、非营养性甜味剂、糖精、三氯蔗糖、阿斯巴甜、甜菊糖/甜菊醇、安赛蜜钾、代餐、2 型糖尿病、肥胖和体重。
干预数据和间接干预数据一致表明，当 SSBs 或其他高热量食物被人工甜味饮料或人工甜味代餐替代时，对体重和心血管代谢健康有有益影响，包括血糖。
尽管 NNSs 与肥胖和肥胖相关的慢性病有关，但这些数据存在混杂和误差。基于对食欲、饱腹感和渴望的神经内分泌控制以及肠道微生物组的临床前研究，提出了合理性假设。然而，干预数据表明，通过 NNSs 替代热量/血糖能量摄入会导致能量不足，从而导致体重减轻和疾病改善，特别是血糖异常疾病。使用人工甜味代餐进行强化饮食干预显示出显著的临床益处，而不会因 NNSs 而受到损害。此外，与 SSBs 相比，用 NNSs 甜味剂调味的饮料已被证明是成功维持体重减轻的关键组成部分。尽管在任何临床情况下都应始终考虑个体对 NNSs 影响的反应，但在进行饮食干预以改善质量和能量不足时，不应建议患者避免 NNSs。
