School of Nutrition, Université Laval, Quebec City, Quebec, Canada; Centre Nutrition, santé et société (NUTRISS)-Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec City, Quebec, Canada.
Center for Nutrition Research; Department of Nutrition, Food Sciences and Physiology; School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.
Nutrition. 2024 Jan;117:112237. doi: 10.1016/j.nut.2023.112237. Epub 2023 Sep 23.
Use of non-nutritive sweeteners (NNSs) has increased worldwide in recent decades. However, evidence from preclinical studies shows that sweetener consumption may induce glucose intolerance through changes in the gut microbiota, which raises public health concerns. As studies conducted on humans are lacking, the aim of this review was to gather and summarize the current evidence on the effects of NNSs on human gut microbiota. Only clinical trials and cross-sectional studies were included in the review. Regarding NNSs (i.e, saccharin, sucralose, aspartame, and stevia), only two of five clinical trials showed significant changes in gut microbiota composition after the intervention protocol. These studies concluded that saccharin and sucralose impair glycemic tolerance. In three of the four cross-sectional studies an association between NNSs and the microbial composition was observed. All three clinical trials on polyols (i.e, xylitol) showed prebiotic effects on gut microbiota, but these studies had multiple limitations (publication date, dosage, duration) that jeopardize their validity. The microbial response to NNSs consumption could be strongly mediated by the gut microbial composition at baseline. Further studies in which the potential personalized microbial response to NNSs consumption is acknowledged, and that include longer intervention protocols, larger cohorts, and more realistic sweetener dosage are needed to broaden these findings.
几十年来，非营养性甜味剂（NNSs）在全球范围内的使用有所增加。然而，临床前研究的证据表明，甜味剂的消费可能通过改变肠道微生物群引起葡萄糖不耐受，这引起了公众健康的关注。由于缺乏对人类进行的研究，本综述的目的是收集和总结目前关于 NNSs 对人类肠道微生物群影响的证据。本综述仅纳入了临床试验和横断面研究。关于 NNSs（即糖精、三氯蔗糖、阿斯巴甜和甜菊糖），仅五项临床试验中的两项在干预方案后显示肠道微生物群组成发生了显著变化。这些研究得出的结论是，糖精和三氯蔗糖会损害血糖耐量。在四项横断面研究中有三项观察到 NNSs 与微生物组成之间存在关联。所有三项关于多元醇（即木糖醇）的临床试验都显示出对肠道微生物群的益生元作用，但这些研究存在多个限制因素（出版日期、剂量、持续时间），这使其有效性受到威胁。NNSs 消费引起的微生物反应可能受到基线时肠道微生物群组成的强烈介导。需要进一步开展研究，承认 NNSs 消费的潜在个性化微生物反应，并纳入更长的干预方案、更大的队列和更现实的甜味剂剂量，以扩大这些发现。
