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Nutritive and Non-Nutritive Sweeteners

NNNS: Effect on Energy Balance (2010)

Citation:
Renwick AG. Intense Sweeteners, Food Intake, and the weight of a body of Evidence. Physiology and Behavior, 1994, vol. 55, p. 139-143. PubMed ID: 7885619
 
Study Design:
Narrative Review
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
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