Effects of non-nutritive (artificial vs natural) sweeteners on 24-h glucose profiles

Defining a Continuous Glucose Baseline to assess the impact of nutritional interventions

Accurate and robust estimation of individuals' basal glucose level is a crucial measure in nutrition research but is typically estimated from one or more morning fasting samples. The use of Continuous Glucose Monitoring (CGM) devices presents an opportunity to define more robust basal glucose levels, which estimates can be generalized to any time of the day. However, to date, no standardized method has been delineated. The current paper seeks to define a reliable algorithm to characterize the individual's basal glucose level over 24 h from CGM measurements. Data drawn from four nutritional intervention studies performed on adults free from chronic diseases were used to define that basal glucose levels were optimally estimated using the 40th percentile of the previous 24 h CGM data. This simple algorithm provides a Continuous Glucose Baseline over 24 h (24 h-CGB) that is an unbiased and highly correlated estimator (r = 0.86, p-value < 0.01) of standard fasting glucose. We conclude that 24-CGB can provide reliable basal glucose estimates across the day while being more robust to interference than standard fasting glucose, adaptable to evolving daily routines and providing useful reference values for free-living nutritional intervention research in non-diabetic individuals.

Impact of acute consumption of beverages containing plant-based or alternative sweetener blends on postprandial appetite, food intake, metabolism, and gastro-intestinal symptoms: Results of the SWEET beverages trial

Project SWEET examined the barriers and facilitators to the use of non-nutritive sweeteners and sweetness enhancers (hereafter "S&SE") alongside potential risks/benefits for health and sustainability. The Beverages trial was a double-blind multi-centre, randomised crossover trial within SWEET evaluating the acute impact of three S&SE blends (plant-based and alternatives) vs. a sucrose control on glycaemic response, food intake, appetite sensations and safety after a carbohydrate-rich breakfast meal. The blends were: mogroside V and stevia RebM; stevia RebA and thaumatin; and sucralose and acesulfame-potassium (ace-K). At each 4 h visit, 60 healthy volunteers (53% male; all with overweight/obesity) consumed a 330 mL beverage with either an S&SE blend (0 kJ) or 8% sucrose (26 g, 442 kJ), shortly followed by a standardised breakfast (∼2600 or 1800 kJ with 77 or 51 g carbohydrates, depending on sex). All blends reduced the 2-h incremental area-under-the-curve (iAUC) for blood insulin (p < 0.001 in mixed-effects models), while the stevia RebA and sucralose blends reduced the glucose iAUC (p < 0.05) compared with sucrose. Post-prandial levels of triglycerides plus hepatic transaminases did not differ across conditions (p > 0.05 for all). Compared with sucrose, there was a 3% increase in LDL-cholesterol after stevia RebA-thaumatin (p < 0.001 in adjusted models); and a 2% decrease in HDL-cholesterol after sucralose-ace-K (p < 0.01). There was an impact of blend on fullness and desire to eat ratings (both p < 0.05) and sucralose-acesulfame K induced higher prospective intake vs sucrose (p < 0.001 in adjusted models), but changes were of a small magnitude and did not translate into energy intake differences over the next 24 h. Gastro-intestinal symptoms for all beverages were mostly mild. In general, responses to a carbohydrate-rich meal following consumption of S&SE blends with stevia or sucralose were similar to sucrose.

Amplitude of low-frequency fluctuation after taste exposure revealed by resting-state fMRI

Taste perception has been deeply explored from the behavioural level to delineating neural mechanisms. However, most previous studies about the neural underpinnings of taste perception have focused on task-related brain activation. Notably, evidence indicates that task-induced brain activation often involves interference from irrelevant task materials and only accounts for a small fraction of the brain's energy consumption. Investigation of the resting-state spontaneous brain activity would bring us a comprehensive understanding of the neural mechanism of taste perception. Here we acquired resting-state functional magnetic resonance imaging (rs-fMRI) data from twenty-two participants immediately after they received sweet, sour and tasteless gustatory stimulation. Our results showed that, in contrast to the tasteless condition, the sour exposure induced decreased amplitude of low-frequency fluctuation (ALFF) in the somatosensory cortex in the left post-central gyrus, and the sweet exposure led to increased ALFF in the bilateral putamen involved in reward processing. Moreover, in contrast to the sweet stimulation condition, the sour stimulation condition showed increased ALFF in the right superior frontal gyrus, which has been linked to functioning in high-order cognitive control. Altogether, our data indicate that taste exposure may affect the spontaneous functional activity in brain regions, including the somatosensory areas, reward processing areas and high-order cognitive functioning areas. Our findings may contribute to a further understanding the neural network and mechanisms after taste exposure.

Sweetened beverages are associated with a higher risk of differentiated thyroid cancer in the EPIC cohort: a dietary pattern approach

BACKGROUND

Dietary pattern analysis has gained particular interest, because it reflects the complexity of dietary intake. The aim of this study was to explore the associations between a posteriori dietary patterns, derived using a data-driven approach, and the risk of differentiated thyroid cancer (TC) in Europe.

METHODS

This investigation included 450,064 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Dietary intake was assessed using validated country-specific dietary questionnaires. A posteriori dietary patterns were computed using principal component analyses. Cox regression was used to calculate multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

After a mean follow-up time of 14 years, 712 first differentiated TCs were diagnosed. In the fully adjusted model, a dietary pattern characterized by alcohol consumption (basically beer and wine) was negatively associated with differentiated TC risk (HRQ4vs.Q1 = 0.75; 95% CI:0.60-0.94, P-trend = 0.005), while a dietary pattern rich in sweetened beverages was positively associated with differentiated TC risk (HRQ4vs.Q1 = 1.26; 95% CI:0.99-1.61; P-trend = 0.07). The remaining 8 dietary patterns were not related to differentiated TC risk. The intake of sweetened beverages was positively associated with differentiated TC risk (HR100mL/d = 1.05; 95% CI:1.00-1.11), especially with papillary TC risk (HR100mL/d = 1.07; 95% CI:1.01-1.13). Similar results were observed with sugary and artificially sweetened beverages.

CONCLUSIONS

The investigation of dietary patterns detected that the consumption of sweetened beverages was associated with a higher risk of differentiated thyroid cancer. Our results are in line with the general dietary recommendations of reducing the consumption of sweetened beverages.

The effect of regular consumption of four low- or no-calorie sweeteners on glycemic response in healthy women: A randomized controlled trial

OBJECTIVES

The aim of this study was to determine the effects of regular exposure to certain low- or no-calorie sweeteners (LNCS) on glucose tolerance and glucagon-like peptide 1 (GLP-1) release in healthy individuals.

METHODS

It was designed as a randomized, single-blinded, controlled study. Healthy and normoglycemic adults who did not have regular consumption of LNCS were recruited. Participants underwent a 75-g oral glucose tolerance test (OGTT) at baseline and were randomly assigned to consume 330 mL water sweetened with saccharine, sucralose, or aspartame + acesulfame-K (Asp+Ace-K), or plain water for the control group, daily for 4 wk. Fasting plasma glucose, insulin, GLP-1, and glycated hemoglobin A_1c (HbA_1c) levels and 1-h, 2-h, and 3-h plasma glucose and insulin levels during OGTT were obtained at baseline. The change in insulin sensitivity was assessed by both the Homeostatic Model Assessment Insulin Resistance (HOMA-IR) Index and the Matsuda Index. Anthropometric measurements and dietary intakes were determined at baseline. Baseline measurements were repeated at week 4.

RESULTS

Of the participants enrolled in the study, 42 (age, 21.24 ± 2.26 y; body mass index, 20.65 ± 2.88 kg/m²) completed the 4-wk intervention period. There were no differences for glucose, insulin, GLP-1, or HbA_1c levels or HOMA-IR scores at baseline or at week 4 when compared with the control group. The area under the curve of mean glucose and insulin values during OGTT were also found to be similar between groups at baseline and week 4. There were also no effects of LNCS intake on body weight, body composition, and waist circumference.

CONCLUSIONS

These results suggest that regular consumption of LNCS-sweetened water similar to doses consumed in daily life over 4 wk had no significant effect on glycemic response, insulin sensitivity, GLP-1 release, and body weight in healthy individuals. This trial was registered at www.

CLINICALTRIALS

gov as NCT04904133.

Sakarinin İştah, Enerji Alımı ve Serum Ghrelin Üzerinde Etkisi Var mı? Sağlıklı Erkeklerde Randomize, Kontrollü, Çapraz Bir Çalışma

Amaç: Günümüzde şeker yerine enerji içermeyen yapay tatlandırıcılar yaygın olarak kullanılmaktadır. Ancak bilinenin aksine yapay tatlandırıcıların metabolizmayı çeşitli yönlerden etkilediği düşünülmektedir. Bu çalışmanın amacı sakarinin serum ghrelin düzeyi, iştah ve besin tüketimi üzerindeki etkilerini değerlendirmektir. Metod: Randomize, kontrollü ve çapraz olarak yapılan çalışmaya 20-29 yaşları arasında dokuz sağlıklı erkek katılmıştır. Her katılımcıya 300 ml su, 75 gram sakaroz içeren 300 ml su ve 240 miligram sakarin içeren 300 ml su verilmiştir. Başlangıç, 30., 60., 90., 120. ve 180. dakikalarda iştahı değerlendirmek için Görsel Analog Skala uygulanmış ve ghrelin analizi için kan örnekleri alınmıştır. Yüzsekseninci sonra katılımcılar ad libitum beslenmişler ve her uygulama günün sonuna kadar 24 saatlik diyet besin tüketim kaydı tutmuşlardır. Bulgular: Altmışıncı ve 120. dakikalarda sadece su ve sakarinli içeceklerde ortalama ghrelin düzeyi sükroz içeren içeceğe kıyasla daha yüksektir (p

Effect of saccharin, a non-nutritive sweeteners, on insulin and blood glucose levels in healthy young men: A crossover trial

BACKGROUND AND AIMS

Artificial sweeteners used instead of sugar were considered as the best alternatives that have no endocrine effects. However, it has recently been suggested that artificial sweeteners may cause impaired metabolic parameters. The hypothesis of the study was there is an association between acute saccharin consumption and both glycemia and insulin response in young healthy adult men.

METHODS

9 healthy adult males were included in this study. This study randomly provided participants with preloads as (a)300 ml of water, or 300 ml of water sweetened with (b)75 g of sucrose, (c)240 mg of saccharine (adjusted to the sweetness of 75 g of sucrose) 1 h before a standard breakfast.

RESULTS

Compared to mean blood glucose and serum insulin after test drinks consumption, there was only one difference between sucrose and saccharin trials in the 15th minute (117.0 ± 18.70, 95.4 ± 5.64 mg/dl respectively, p < 0.05). At the 60th minute, insulin secretion (0.80 ± 0.27 pg/dl) after the sucrose trial was found significantly higher than the saccharin trial (0.53 ± 0.09 pg/dl) and water (0.49 ± 0.06 pg/dl) (p < 0.05). Although at all intervals (except 90th minute), the mean insulin is higher after the saccharin trial compared to the water trial, these were non-statistically significant differences (p > 0.05).

CONCLUSIONS

Consequently, it was determined that saccharin had no glycemic effect. However, for the effect on serum insulin to be clarified, the long-term effects should be investigated.

Consumption of Non-nutritive Sweeteners and Risk for Type 2 Diabetes: What Do We Know, and Not?

PURPOSE OF REVIEW

The article explores the relationship between non-nutritive sweetener consumption and the risk of developing type 2 diabetes through reviewing meta-analyses and systematic reviews, as well as clinical trials and observational studies.

RECENT FINDINGS

The data overall has yet to show a strong and clear link between consumption of non-nutritive sweeteners and the development of type 2 diabetes. However, several observational studies have shown a positive relationship between these two variables, with a stronger association found among women. Regarding non-nutritive sweeteners that are currently commercially available, there is not one specific non-nutritive sweetener that appears to be more strongly associated with the development of type 2 diabetes than other non-nutritive sweeteners. There is still much to be learned regarding non-nutritive sweeteners and their potential link to metabolic disorders. Further research is needed to identify the long-term impacts of non-nutritive sweetener consumption and identify the nuances in terms of risk of developing type 2 diabetes concerning specific non-nutritive sweeteners.

Chronic Intake of Energy Drinks and Their Sugar Free Substitution Similarly Promotes Metabolic Syndrome

Energy drinks containing significant quantities of caffeine, taurine and sugar are increasingly consumed, particularly by adolescents and young adults. The putative effects of chronic ingestion of either standard energy drink, Mother^TM (ED), or its sugar-free formulation (sfED) on metabolic syndrome were determined in wild-type C57BL/6J mice, in comparison to a soft drink, Coca-Cola (SD), a Western-styled diet enriched in saturated fatty acids (SFA), and a combination of SFA + ED. Following 13 weeks of intervention, mice treated with ED were hyperglycaemic and hypertriglyceridaemic, indicating higher triglyceride glucose index, which was similar to the mice maintained on SD. Surprisingly, the mice maintained on sfED also showed signs of insulin resistance with hyperglycaemia, hypertriglyceridaemia, and greater triglyceride glucose index, comparable to the ED group mice. In addition, the ED mice had greater adiposity primarily due to the increase in white adipose tissue, although the body weight was comparable to the control mice receiving only water. The mice maintained on SFA diet exhibited significantly greater weight gain, body fat, cholesterol and insulin, whilst blood glucose and triglyceride concentrations remained comparable to the control mice. Collectively, these data suggest that the consumption of both standard and sugar-free forms of energy drinks induces metabolic syndrome, particularly insulin resistance.

Effect of sucralose and aspartame on glucose metabolism and gut hormones

Non-nutritive sweeteners are thought to be useful replacements for caloric sweeteners in sweet food and beverages, since the reduction in energy and carbohydrate intake may lead to health benefits stemming from weight management and glycemic control. However, the potential effects of non-nutritive sweeteners on glucose metabolism and gut hormones have not been determined definitively. Here, the available evidence of the effects of aspartame and sucralose consumption on glucose metabolism and gut hormones is reviewed. A majority of studies have found that consumption of aspartame or sucralose has no effect on concentrations of blood glucose, insulin, or gut hormones; however, 2 trials have shown that aspartame consumption affects glucose, insulin, and glucagon-like peptide 1 concentrations, while only a few trials have shown that sucralose consumption affects glucose, insulin, and glucagon-like peptide 1 concentrations. One study found higher glucose concentrations after sucralose consumption, while 3 studies found lower concentrations and 33 studies found no change in glucose concentrations. Moreover, only 4 studies reported increased concentrations of glucagon-like peptide 1. Three studies reported decreased insulin sensitivity following sucralose consumption, while 1 trial reported an increase in insulin sensitivity. In summary, the evidence from the clinical trials conducted to date is contradictory because of the different protocols used.

The sensory properties and metabolic impact of natural and synthetic sweeteners

The global rise in obesity, type II diabetes, and other metabolic disorders in recent years has been attributed in part to the overconsumption of added sugars. Sugar reduction strategies often rely on synthetic and naturally occurring sweetening compounds to achieve their goals, with popular synthetic sweeteners including saccharin, cyclamate, acesulfame potassium, aspartame, sucralose, neotame, alitame, and advantame. Natural sweeteners can be further partitioned into nutritive, including polyols, rare sugars, honey, maple syrup, and agave, and nonnutritive, which include steviol glycosides and rebaudiosides, luo han guo (monk fruit), and thaumatin. We choose the foods we consume largely on their sensory properties, an area in which these sugar substitutes often fall short. Here, we discuss the most popular synthetic and natural sweeteners, with the goal of providing an understanding of differences in the sensory profiles of these sweeteners versus sucrose, that they are designed to replace, essential for the effectiveness of sugar reduction strategies. In addition, we break down the influence of these sweeteners on metabolism, and present results from a large survey of consumers' opinions on these sweeteners. Consumer interest in clean label foods has driven a move toward natural sweeteners; however, neither natural nor synthetic sweeteners are metabolically inert. Identifying sugar replacements that not only closely imitate the sensory profile of sucrose but also exert advantageous effects on body weight and metabolism is critical in successfully the ultimate goals of reducing added sugar in the average consumer's diet. With so many options for sucrose replacement available, consumer opinion and cost, which vary widely with suagr replacements, will also play a vital role in which sweeteners are successful in widespread adoption.

Consumption of a Beverage Containing Aspartame and Acesulfame K for Two Weeks Does Not Adversely Influence Glucose Metabolism in Adult Males and Females: A Randomized Crossover Study

There is an association between the consumption of artificial sweeteners and Type 2 diabetes in cohort studies, but intervention studies do not show a clear elevation of blood glucose after the use of artificial sweeteners. The objective of this study was to examine whether two commonly used artificial sweeteners had an adverse effect on glucose control in normal-weight subjects, and in overweight and obese subjects when consumed for 2 weeks. In the study, 39 healthy subjects (body-mass index, kg/m²) (18–45) without Type 2 diabetes with an age of 18–75 years were randomly assigned to 0.6 L/day of an artificially sweetened soft drink containing acesulfame K (950) and aspartame (951) or 0.6 L/day of mineral water for 2 weeks each in a crossover study. There was a 4 week washout period with no drinks consumed. Glucose levels were read by a continuous glucose monitor (CGM) during each 2 week period. A 75 g oral glucose-tolerance test (OGTT) was performed at the beginning and end of each intervention period. Blood samples were collected at baseline, and 1 and 2 h for glucose and insulin. A 2 week intake of artificially sweetened beverage (ASB) did not alter concentrations of fasting glucose and fasting insulin, the area under the curve (AUC) for OGTT glucose and insulin, the incremental area under the curve (iAUC) for OGTT glucose and insulin, the homeostatic model assessment for insulin resistance (HOMA-IR), and the Matsuda index compared with the baseline and with the changes after a 2 week intake of mineral water. Continuous 2 week glucose concentrations were not significantly different after a 2 week intake of ASB compared with a 2 week intake of mineral water. This study found no harmful effect of the artificially sweetened soft drink containing acesulfame K (950) and aspartame (951) on glucose control when consumed for 2 weeks by people without Type 2 diabetes.

Effects of preferred music on physiological responses, perceived exertion, and anaerobic threshold determination in an incremental running test on both sexes

This study aimed to investigate and compare the effects of preferred music on anaerobic threshold determination in an incremental running test, as well the physiological responses and perceived exertion at this intensity, in physically active men and women. Additionally, by using area under the curve (AUC) analysis of the parameters of interest during the graded test, we studied the effects of music at two physiological moments-before and after anaerobic threshold intensity (iAT)-in men and women. Twenty (men = 10; women = 10) healthy and active participants completed four visits to the laboratory. The first and second sessions were used for sample characterization. In the third and fourth sessions, participants performed an incremental running test (started at 7 km.h-1 with increments of 1 km.h-1 at each 3-minute stage) under preferred music and non-music conditions. Blood lactate ([Lac]), heart rate (HR), and perceived exertion were measured by two scales (RPEBorg and the estimation of time limit ‒ ETL) during all tests, and the total time of effort (TT) was considered as performance. Individual curves of the "intensity vs blood lactate" analyzed by the bissegmentation method provide the iAT and the AUC of [Lac], HR, RPEBorg, and ETL before and after the iAT attainment were calculated. The iAT for men (non-music: 11.5±0.9km.h-1 vs music: 11.6±1.1km.h-1) and women (non-music: 9.8±0.7km.h-1 vs music: 9.7±0.7km.h-1) was not affected by music, and for both sexes, there was no difference between non-music and music conditions in all variables obtained at iAT. The AUC of all variables were not affected by music before the iAT attainment. However, [Lac], HR, and RPEBorg presented higher values of AUC after iAT for the female group with preferred music. This may be due to the fact that 70% of women have increased TT under music conditions. Overall, preferred music did not affect the iAT determination in an incremental running test. However, some physiological responses and perceived exertion after iAT of female subjects seems to be influenced by preferred music.

Effects of Non-nutritive Sweeteners on Sweet Taste Processing and Neuroendocrine Regulation of Eating Behavior

PURPOSE OF REVIEW

Non-nutritive sweeteners (NNS) are increasingly used as a replacement for nutritive sugars as means to quench the desire for "sweets" while contributing few or no dietary calories. However, there is concern that NNS may uncouple the evolved relationship between sweet taste and post-ingestive neuroendocrine signaling. In this review, we examine the effects of NNS exposure on neural and peripheral systems in humans.

RECENT FINDINGS

NNS exposure during early development may influence sweet taste preferences, and NNS consumption might increase motivation for sweet foods. Neuroimaging studies provide evidence that NNS elicit differential neuronal responsivity in areas related to reward and satiation, compared with caloric sweeteners. Findings are heterogenous regarding whether NNS affect physiological responses. Additional studies are warranted regarding the consequences of NNS on metabolic outcomes and neuroendocrine pathways. Given the widespread popularity of NNS, future studies are essential to establish their role in long-term health.

Trends in use, pharmacology, and clinical applications of emerging herbal nutraceuticals

The nutraceuticals market is vast, encompassing many different products with inconsistent levels of evidence available to support their use. This overview represents a Western perspective of the nutraceuticals market, with a brief comparison with that in China, as an illustration of how individual health supplements increase and decrease in popularity in regional terms. Recent changes in sales patterns, mainly taken from the US market, are summarized and a selection of five newer products, which have not been subject to extensive recent review are profiled: astaxanthin, a carotenoid found in red algae, seafood, salmon and trout, as an antioxidant; cannabidiol, a non-euphoric marijuana ingredient used as mood enhancer and for painful/inflammatory conditions; modified extracts of ginseng used in new indications including dementia and space travel; monk fruit, a non-sugar high intensity sweetener and nigella seed, a popular food ingredient and Asian medicine, which has experienced an extraordinary rise in sales recently. LINKED ARTICLES: This article is part of a themed section on The Pharmacology of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.6/issuetoc.

Natural Alternative Sweeteners and Diabetes Management

PURPOSE OF REVIEW

The goal of this review is to discuss the data on natural alternative sweeteners and their effects on glucose homeostasis and other metabolic parameters within the past five years. We sought to answer whether common natural alternative sweeteners have a positive or negative effect on glucose control in both human and animal models, and whether the data supports their widespread use as a tool to help reduce the prevalence of diabetes and associated comorbid conditions.

RECENT FINDINGS

Recent studies suggest that natural alternative sweeteners may reduce hyperglycemia, improve lipid metabolism, and have antioxidant effects particularly in those that have baseline diabetes. Diabetes and metabolic syndrome have become a global healthcare crisis and the sugar overconsumption plays a major role. The use of artificial sweeteners has become more prevalent to improve insulin resistance in those with diabetes, obesity, and metabolic syndrome, although the evidence does not support this result. There are however some promising data to suggest that natural alternative sweeteners may be a better alternative to sugar and artificial sweeteners.

The effect of the artificial sweeteners on glucose metabolism in healthy adults: a randomized, double-blinded, crossover clinical trial

This study aimed to determine the effect of pure forms of sucralose and aspartame, in doses reflective of common consumption, on glucose metabolism. Healthy participants consumed pure forms of a non-nutritive sweetener (NNS) that were mixed with water and standardized to doses of 14% (0.425 g) of the acceptable daily intake (ADI) for aspartame and 20% (0.136 g) of the ADI for sucralose every day for 2 weeks. Blood samples were collected and analyzed for glucose, insulin, active glucagon-like peptide-1 (GLP-1), and leptin. Seventeen participants (10 females and 7 males; age, 24 ± 6.8 years; body mass index, 22.9 ± 2.5 kg/m²) participated in the study. The total area under the curve values of glucose, insulin, active GLP-1 and leptin were similar for the aspartame and sucralose treatment groups compared with the baseline values in healthy participants. There was no change in insulin sensitivity after NNS treatment compared with the baseline values. These findings suggest that daily repeated consumption of pure sucralose or aspartame for 2 weeks had no effect on glucose metabolism among normoglycaemic adults. However, these results need to be tested in studies with longer durations. Novelty Daily consumption of pure aspartame or sucralose for 2 weeks had no effect on glucose metabolism. Daily consumption of pure aspartame or sucralose for 2 weeks had no effect on insulin sensitivity among healthy adults.

Non-nutritive sweeteners and type 2 diabetes: Should we ring the bell?

Non-nutritive sweeteners (NNS) were thought to be healthy sugar substitutes used instead of sugar for caloric and glycemic control but evidences blaming them for contributing to type 2 diabetes (T2D) are rising. We aim to investigate whether NNS consumption prevents or causes T2D. Articles of all designs conducted on humans were retrieved from three databases in addition to manually reviewed articles. The literature is highly heterogeneous, and conclusions vary with different studies' types and designs. While some studies highlighted the neutral effect of NNS on T2D or reported inconclusive evidences to make their conclusion, others either found NNS culprit for increasing the risk for T2D or reported their protective effect against it. Those results were changing after adjustment for confounders. Due to the inconsistency in the literature, well-designed studies that take into consideration all types of confounders are needed. RESEARCH IN CONTEXT: Evidence before this study: The epidemic of obesity is the result of many factors and causes several chronic diseases where its association with type 2 diabetes is well established. The first line of treatment for obesity is lifestyle changes including physical activity and dietary intervention where non-nutritive sweeteners have received a high attention; those were thought to be healthy sugar substitutes used instead of sugar for caloric and glycemic control but several evidences have blamed them for having a role in the development of type 2 diabetes. In our paper, we aim to investigate whether non-nutritive sweeteners consumption prevents or causes type 2 diabetes. To respond to this question, an extensive search of the literature was conducted between October and December 2018 using the key terms "non-nutritive sweeteners", "artificial sweeteners", "high-intensity sweeteners", "type 2 diabetes" and "prediabetes" on three databases including Pubmed, Science direct and Scopus. Additional search for relevant articles was carried out manually from the reference list of selected articles. Animal studies, studies involving sugar alcohols or those conducted on children, adolescents, pregnant women, or on participants with diabetes were excluded. Human studies conducted from January 2004 to October 2018 were included and divided into observational, interventional, and systematic review and meta-analysis for discussion and analysis Added value of this study: In the literature, the term high-intensity sweeteners has been used interchangeably with non-nutritive sweeteners, artificial sweeteners or low-calorie sweeteners but few articles, if any, clarified the difference between them. In our review, we gathered the different definitions and classifications and summarized them to help the reader understand the difference. Since artificial sweeteners are nowadays widely used and prescribed for caloric and glycemic control, and are unintentionally consumed because they enter in the manufacturing process of thousands of products and due to their potential side effects reported in several studies, we found it interesting to gather, summarize and discuss the available results assessing the role of non-nutritive sweeteners in the development of type 2 diabetes. Those results showed the heterogeneity of the literature and the difficulty in having a firm conclusion; this helps researchers to profit from our study and to conduct well-designed studies leading to firm conclusions and recommendations. Implications of all the available evidence: Despite the absence of strong conclusion that confirms the fact that non-nutritive sweeteners consumption increases the risk for diabetes, no firm conclusion rejects this statement. In result, the existing evidences in addition to our study should ring the bell for clinicians and practitioners who are prescribing those sugar-alternatives as "healthy substitute" to white sugar. Moreover, this encourages the manufacturers to search for a healthy natural alternative to artificial sweeteners to be used in the manufacturing process.

Commercially available non-nutritive sweeteners modulate the antioxidant status of type 2 diabetic rats

Non-nutritive sweeteners (NNS) are increasingly being used by diabetics, but little is known about their effects on antioxidant status. We investigated the effects of ad libitum consumption of commercially available NNS (aspartame, saccharin, sucralose, and cyclamate-based sweeteners) on antioxidative markers in a rat model of type 2 diabetes (T2D). NNS consumption reduced (p < 0.05) T2D-induced lipid peroxidation and boosted serum, hepatic, renal, cardiac, and pancreatic glutathione (GSH) levels. Catalase, glutathione reductase, superoxide dismutase, and glutathione peroxidase activity was increased in the serum and most organs upon diabetes induction, perhaps due to adaptative antioxidant response to the diabetes-induced lipid peroxidation. NNS showed varying effects on serum and tissue antioxidant enzymes of animals. An antioxidant capacity scores sheet of NNS, suggest that aspartame-based NNS may not exert antioxidant effects in diabetics, while saccharin-based NNS may be a potent antioxidative sweetener as seen in the animal model of T2D. PRACTICAL APPLICATIONS: The use of NNS is becoming more popular, especially for diabetic individuals. While there are several commercial NNS available in the market, little is known about how they affect the antioxidant status of consumers. We therefore investigated how some commercially available NNS affect the antioxidant status of diabetic rats. Observed data revealed varying effects of NNS on serum and different organs, which suggest that some NNS may be better than others for diabetic oxidative stress and thus may be recommended for consumers. However, this finding is subject to additional corroborative clinical studies.

Effects of Consuming Preloads with Different Energy Density and Taste Quality on Energy Intake and Postprandial Blood Glucose

Consumption of reduced energy dense foods and drink has the potential to reduce energy intake and postprandial blood glucose concentrations. In addition, the taste quality of a meal (e.g., sweet or savoury) may play a role in satiation and food intake. The objective of this randomised crossover study was to examine whether energy density and taste quality has an impact on energy intake and postprandial blood glucose response. Using a preload design, participants were asked to consume a sweet ("Cheng Teng") or a savoury (broth) preload soup in high energy density (HED; around 0.50 kcal/g; 250 kcal) or low energy density (LED; around 0.12 kcal/g; 50 kcal) in mid-morning and an ad libitum lunch was provided an hour after the preload. Participants recorded their food intake for the rest of the day after they left the study site. Energy compensation and postprandial blood glucose response were measured in 32 healthy lean males (mean age = 28.9 years, mean BMI = 22.1 kg/m²). There was a significant difference in ad libitum lunch intake between treatments (p = 0.012), with higher intake in sweet LED and savoury LED compared to sweet HED and savoury HED. Energy intake at subsequent meals and total daily energy intake did not differ between the four treatments (both p ≥ 0.214). Consumption of HED preloads resulted in a larger spike in postprandial blood glucose response compared with LED preloads, irrespective of taste quality (p < 0.001). Energy density rather than taste quality plays an important role in energy compensation and postprandial blood glucose response. This suggests that regular consumption of low energy-dense foods has the potential to reduce overall energy intake and to improve glycemic control.