Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies
Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies
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DOI：
10.1503/cmaj.161390
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发表时间：
2017-07-17
影响因子：
14.6
通讯作者：
Zarychanski, Ryan
中科院分区：
文献类型：
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作者：
Azad, Meghan B.;Abou-Setta, Ahmed M.;Zarychanski, Ryan
背景：非营养性甜味剂，如甜菊糖、三氯蔗糖和甜菊糖，被广泛消费，但其长期健康影响尚不确定。我们综合了前瞻性研究的证据，以确定常规食用非营养性甜味剂是否与长期不良心脏代谢效应相关。我们搜索了医疗热线，Embase和科克伦图书馆（开始至2016年1月），用于评估非营养性甜味剂干预措施的随机对照试验（RCT）和报告成人和青少年非营养性甜味剂消费的前瞻性队列研究。主要结局是体重指数（BMI）。次要结果包括体重，肥胖和其他心脏代谢终点。结果：从11774引文，我们包括7个试验（1003参与者，中位随访6个月）和30个队列研究（405907参与者，中位随访10年）。在纳入的随机对照试验中，非营养性甜味剂对BMI没有显著影响（平均差异-0.37 kg/m2; 95%置信区间[CI] -1.10至0.36; I-2 9%; 242名参与者）。在纳入的队列研究中，非营养性甜味剂的摄入与BMI的适度增加相关（平均相关性0.05，95% CI 0.03至0.06; I-2 0%; 21256名参与者）。来自随机对照试验的数据显示，非营养性甜味剂对身体组成的其他指标没有一致的影响，也没有进一步的次要结果。在队列研究中，非营养性甜味剂的消费与体重和腰围的增加以及肥胖、高血压、代谢综合征、2型糖尿病和心血管事件的发生率较高有关。以糖尿病为结局的研究存在出版偏见。解释：来自随机对照试验的证据并不明确支持非营养性甜味剂对体重管理的预期益处，观察数据表明，常规摄入非营养性甜味剂可能与BMI增加和心脏代谢相关风险。需要进一步的研究来充分描述非营养甜味剂的长期风险和益处。
BACKGROUND: Nonnutritive sweeteners, such as aspartame, sucralose and stevioside, are widely consumed, yet their long-term health impact is uncertain. We synthesized evidence from prospective studies to determine whether routine consumption of nonnutritive sweeteners was associated with long-term adverse cardiometabolic effects.METHODS: We searched MEDLINE, Embase and Cochrane Library (inception to January 2016) 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.RESULTS: From 11 774 citations, we included 7 trials (1003 participants; median follow-up 6 mo) and 30 cohort studies (405 907 participants; median follow-up 10 yr). In the included RCTs, nonnutritive sweeteners had no significant effect on BMI (mean difference -0.37 kg/m(2); 95% confidence interval [CI] -1.10 to 0.36; I-2 9%; 242 participants). In the included cohort studies, consumption of nonnutritive sweeteners was associated with a modest increase in BMI (mean correlation 0.05, 95% CI 0.03 to 0.06; I-2 0%; 21 256 participants). 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. Publication bias was indicated for studies with diabetes as an outcome.INTERPRETATION: Evidence from 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.