EAL

NNNS: Effect on Energy Balance (2010)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

The review provides a brief summary of the main findings and limitations of two original articles, followed by a resume of the more recent investigations in human volunteers.

Inclusion Criteria:

Human subjects
Papers published in peer-reviewed journals.

Exclusion Criteria:

Animal studies
Anecdotal findings
Unsubstantiated case reports.

Description of Study Protocol:

Review of articles.

Data Collection Summary:

Findings were divided into four tables relating to:

Do intense sweeteners increase perceived hunger?
Do intense sweeteners increase food intake?
Do intense sweeteners affect insulin release and the control of blood glucose concentrations?
Do intense sweeteners help in weight control when consumed regularly?

Description of Actual Data Sample:

Summary of Results:

Do Intense Sweeteners Increase Perceived Hunger?

The report by Blundell and Hill has not been substantiated by later studies. Three subsequent studies have reported a subjective increase in hunger ratings: Two by Blundell and collegues (one with saccharin in yogurt and a repeat of their earlier study) and one by Tordoff and Alleva, with gum. The differences between the studies may be due to the artificial nature of the test solution in which sweeteners were added to water and no other taste component was present. Therefore, the drinks were not representative of normally available products.

Hunger Ratings Following Single Doses of Intense Sweeteners


Reference	Year	Sweetener	Vehicle	N	Time After Dose	Hunger Rating
Roger et al	1988	Acek	Water	12	60 minutes	No difference, compared with placebo
Roger et al	1988	ASP	Water	12	60 minutes	Increased, compared with placebo
Rogers et al	1990	ASP	Water	27	60 minutes	No difference, compared with placebo
Blundell and Hill	1986	ASP	Water	95	40 to 60 minutes	Increased, compared with placebo
Anderson et al	1989	ASP	Drink	20	90 minutes	No difference, compared with placebo
Black et al	1991	ASP	Drink	20	60 minutes	No difference, compared with placebo
Rolls et al	1990	ASP	Drink	42	30 and 60 minutes	No difference, compared with placebo
Rolls et al	1989	ASP	Dessert	32	Up to 120 minutes	No difference, compared with placebo
Tordoff and Alleva	1990	ASP	Gum	120	30 to 90 minutes	Increased, compared with placebo
Ryan-Harshman et al	1987	ASP	Capsules	26	105 minutes	No difference, compared with placebo
Rogers et al	1990	ASP	Capsules	27	60 minutes	Decreased, compared to placebo
Rogers et al	1991	ASP	Capsules	16	60 minutes	No difference, compared with placebo
Rogers et al	1988	Sacc	Water	12	60 minutes	No difference, compared with placebo
Canty et al	1991	Sacc + ASP	Drink	20	30 to 60 minutes	No difference, compared with placebo
Rogers et al	1989	Sacc	Yogurt	24	60 minutes	Increased, compared with placebo

Do Intense Sweeteners Increase Food Intake?

There is no scientific evidence that intense sweeteners make you eat more or cause an increase in body weight.

Food Intake Following Single Doses of Intense Sweeteners


Reference	Year	Sweetener	Vehicle	N	Time After Dose	Food Intake
Roger et al	1988	Acek	Water	12	65 minutes	No difference, compared with placebo
Roger et al	1988	ASP	Water	12	65 minutes	No difference, compared with placebo
Rogers et al	1990	ASP	Water	27	60 minutes	No difference, compared with placebo
Rodin	1990	ASP	Water	24	38 minutes	No difference, compared with placebo
Anderson	1989	ASP	Drink	20	90 minutes	No difference, compared with placebo
Black et al	1991	ASP	Drink	20	60 minutes	No difference, compared with placebo
Birch	1989	ASP	Drink	24	Zero, 30 and 60 minutes	Decreased or no difference, compared with placebo
Brala	1983	ASP	Drink	106	60 minutes	No difference, compared with placebo
Rolls	1990	ASP	Drink	42	30 to 60 minutes	No difference, compared with placebo
Rolls	1990	ASP	Dessert	32	120 minutes	No difference, compared with placebo
Drewnoswki	1992	ASP	Cheese	24	Three, 5.5, and 9.5 hours	No difference, compared with placebo
Rogers et al	1990	ASP	Capsules	26	105 minutes	No difference, compared to placebo
Rogers et al	1991	ASP	Capsules	16	60 minutes	Decreased, compared with placebo
Rogers et al	1988	SACC	Water	12	65 minutes	No difference, compared with placebo
Canty et al	1991	Sacc + ASP	Drink	20	60 minutes	No difference, compared with placebo
Rogers et al	1989	Sacc	Yogurt	24	60 minutes	Increased, compared with placebo

Studies were run under blind or covert conditions so that subjects were unaware of the dietary manipulation or which product was sweetened with an intense sweetner or a sugar.

Do Intense Sweeteners Affect Insulin Release and the Control of Blood Glucose Concentrations?

Studies indicate that intense sweeteners do not significantly affect blood glucose levels, so that there would not be this physiological stimulus for an increase in perceived hunger.

Effects of Intense Sweeteners on Insulin and Blood Glucose Concentrations


Reference	Date	Sweetener	Vehicle	N	Insulin Concentration	Glucose Concentration
Healthy Subjects
Hartel et al	1993	AceK	Water	14	No difference, compared with placebo	No difference, compared with placebo
Bruce et al	1987	ASP	Water	17	No difference, compared to placebo	No difference, compared with placebo
Carlson et al	1989	ASP	Water	16	No difference, compared to placebo	No difference, compared with placebo
Okuno et al	1986	ASP	Water	7	No difference, compared to placebo	No difference, compared with placebo
Rodin	1990	ASP	Water	24	No difference, compared to placebo	No difference, compared with placebo
Hartel	1993	ASP	Water	14	No difference, compared to placebo	No difference, compared with placebo
Horwitz et al	1988	ASP	Drink	12	Increase, compared to placebo	No difference, compared with placebo
Teff et al	1991	ASP	Dessert	20	Increase, compared to placebo	Decrease, compared to placebo
Carlson et al	1989	ASP	Capulse	16	No difference, compared to placebo	No difference, compared with placebo
Hartell	1993	CHS	Water	14	No difference, compared to placebo	No difference, compared with placebo
Hartell	1993	SACC	Water	14	No difference, compared to placebo	No difference, compared with placebo
Horwitz et al	1988	SACC	Drink	12	No difference, compared to placebo	No difference, compared with placebo
Diabetic Patients
Okuno et al	1986	ASP	Water	22	No difference, compared to placebo	No difference, compared to placebo
Shigeta et al	1985	ASP	Water	26	No difference, compared to placebo	No difference, compared to placebo
Horwitz et al	1988	ASP	Drink	10	No difference, compared to placebo	No difference, compared to placebo
Horwitz et al	1988	Sacc	Drink	10	No difference, compared to placebo	No difference, compared to placebo

Do intense sweetners help in weight control when consumed regularly?

Studies in subjects on weight control programs have shown that intense sweeteners can be helpful in making their regime both more acceptable and successful.

Food Intake and Body Weight Following Chronic Intakes of Intense Sweeteners


Reference	Year	Sweetener	Vehicle	N	Duration of Study	Effect
Tordoff and Alleva	1990	ASP	Sodas	30	Three weeks	Decreased kcal, compared with placebo
Tordoff and Alleva	1990	ASP	Sodas	30	Three weeks	Decrease in weight, compared to placebo
Mattes	1990	ASP	Cereal	24	Four weeks	No difference, compared to placebo
Porikos et al	1977	ASP	Diet	8	Six days	Decreased kcal, compared to placebo
Porikos et al	1982	ASP	Diet	6	12 days	Decreased kcal, compared to placebo
Porikos et al	1984	ASP	Diet	13	12 days	Decreased kcal, compared to placebo
Leon et al	1989	ASP	Capsules	108	24 weeks	No change in weight, compared to placebo
Berryman et al	1968	CHS-SACC	Diet	25	41 days	Decrease in weight, compared to placebo

Author Conclusion:

The review of published data shows that although intense sweeteners have been shown to increase hunger ratings in some studies in humans, this hasn't been consistent and reproducible. Any slight effect on perceived hunger has not been translated into an increase in food ingestion or effects on blood concentrations of insulin or glucose.
Studies on the covert substitution of caloric sweeteners with intense sweeteners have shown either a decrease or no change in body weight.
The database reviewed does not support the idea that consumption of intense sweeteners results in a paradoxical increase in calorie intake and body weight.

Funding Source:

University/Hospital:

University of Southampton (UK)

Reviewer Comments:

Quality Criteria Checklist: Review Articles
Relevance Questions
	1.	Will the answer if true, have a direct bearing on the health of patients?	Yes
	1.	Will the answer if true, have a direct bearing on the health of patients?	Yes
	2.	Is the outcome or topic something that patients/clients/population groups would care about?	Yes
	2.	Is the outcome or topic something that patients/clients/population groups would care about?	Yes
	3.	Is the problem addressed in the review one that is relevant to dietetics practice?	Yes
	3.	Is the problem addressed in the review one that is relevant to dietetics practice?	Yes
	4.	Will the information, if true, require a change in practice?	Yes
	4.	Will the information, if true, require a change in practice?	Yes

Validity Questions
	1.	Was the question for the review clearly focused and appropriate?	Yes
	1.	Was the question for the review clearly focused and appropriate?	Yes
	2.	Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described?	No
	2.	Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described?	No
	3.	Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased?	No
	3.	Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased?	No
	4.	Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible?	No
	4.	Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible?	No
	5.	Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?	Yes
	5.	Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?	Yes
	6.	Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?	Yes
	6.	Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?	Yes
	7.	Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?	No
	7.	Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?	No
	8.	Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included?	Yes
	8.	Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included?	Yes
	9.	Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?	Yes
	9.	Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?	Yes
	10.	Was bias due to the review's funding or sponsorship unlikely?	Yes
	10.	Was bias due to the review's funding or sponsorship unlikely?	Yes