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GDM: Nonnutritive Sweeteners (2008)

Citation:

Council on Scientific Affairs, American Medical Association. Saccharin: Review of safety issues. JAMA 1985;254(18):2622-4.

PubMed ID: 3932690

Study Design:

Consensus Report

Class:

R - Click here for explanation of classification scheme.

Quality Rating:

NEUTRAL: See Quality Criteria Checklist below.

Research Purpose:

This report reviews the experimental and epidemiologic data related to the carcinogenicity of saccharin. Specifically, these two questions are addressed: 1) Is saccharin itself carcinogenic, or do impurities in commercial saccharin contribute to tumor development? 2) Is there epidemiologic evidence that exposure to saccharin is associated with increased cancer morbidity in humans?

Inclusion Criteria:

Article inclusion not specified, only described as most recent research findings.

Exclusion Criteria:

Not mentioned.

Description of Study Protocol:

Recruitment: Methods of article selection not described.

Design: Consensus report

Blinding used (if applicable): Not applicable

Intervention (if applicable): Not applicable

Statistical Analysis: Not performed

Data Collection Summary:

Timing of Measurements: Not applicable

Dependent Variables: Not applicable

Independent Variables: Not applicable

Control Variables: Not applicable

Description of Actual Data Sample:

Initial N: 25 references included

Attrition (final N): 25

Age: Not mentioned

Ethnicity: Animal studies used largely

Other relevant demographics:

Anthropometrics: Not applicable

Location: Not specified

Summary of Results:

The Panel concluded that the development of tumors in rats seems to be a species- and organ specific phenomenon for which there is currently no explanation. Further, while evidence of its carcinogenicity in laboratory animals is suggestive of a potential risk, it is not possible to estimate with any confidence the magnitude of this risk to humans.

Recent epidemiologic studies provide no evidence of increased risk of bladder cancer to users of artificial sweetners, including saccharin.

Little or no data exist, however, the effects of saccharin on young children and pregnant women are two subgroups about which special concern has been indicated.

Consumption patterns and reports of adverse health effects associated with the use of saccharin should continue to be monitored and evaluated.

Author Conclusion:

The moratorium on the saccharin ban, since the evidence of its carcinogenicity in humans has not been forthcoming, with the caution that the AMA is not implying that it condones the use of saccharin.

Careful consideration should be given to saccharin use by young children and pregnant women.

The continued monitoring and evaluation of consumption patterns and reports of adverse health effects associated with the consumption of saccharin.

The continued development and evaluation of both nonnutritive and nutritive sweeteners for use either singly or in combination with other sweeteners as alternatives to the natural sugars.

Funding Source:

Not-for-profit

Foundation associated with industry:

Reviewer Comments:

While the evidence seems to be lacking with regard to the carcinogenic affects of saccharin on humans and the council recommended a moratorium on the ban, ongoing evaluation of the effect of non nutritive sweetners in humans is recommended.

While the evidence presented is thorough, the council did not indicate their specific search strategy for identifying research articles, nor were their methods of review described. This is likely due to the fact that this is a report and was not intended to be a comprehensive review.

Quality Criteria Checklist: Review Articles
Relevance Questions
	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
	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?	No

Validity Questions
	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
	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
	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
	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
	9.	Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?	???
	10.	Was bias due to the review's funding or sponsorship unlikely?	Yes