Non-nutritive Sweeteners and Their Associations with Obesity and Type 2 Diabetes.

Journal of obesity & metabolic syndrome. 2020;29(2):114-123
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Plain language summary

Nutritive sweeteners (NS) contribute to overall caloric intake, and their adverse effects on metabolic health are well known. Non-nutritive sweeteners (NNS) on the other hand, have negligible or no calorific value and are therefore used as replacement of NS to negate their associated health risks. Whilst the consumption of NNS has steadily increased over the recent years, so has the evidence questioning their benefits. Some research suggesting that NNS could be an indirect contributor to the development of metabolic diseases. This review presents a brief compilation of current knowledge relating to NNS and metabolic syndrome, obesity, type 2 diabetes, and cardiovascular disease. Summarised are findings from randomised controlled trials (RCT), prospective cohort studies, observations from animal studies and recent microbiome research. The authors noted that NNS frequently exerted negative influences on health in prospective cohort studies, which observed selected population groups over time. Whilst in controlled trials, NNS often showed neutral or positive health benefits. Following a discussion of possible causes leading to such variations and conflicting outcomes, the authors called for more carefully designed studies to evaluate NNS and their metabolic influences. For clinicians, it may be worth considering further evidence relating to the individual types of sweeteners when evaluating NNS and their risks and benefits on cardiometabolic health.


Evidence linking the excessive consumption of nutritive sweeteners (NS) to adverse metabolic health outcomes has led to an increase in consumption of non-nutritive sweeteners (NNS), particularly among the obese and individuals with diabetes. NNS are characterized by having zero-to-negligible caloric load, while also having a sweet taste. They are utilized as a replacement for traditional NS to reduce energy intake and to limit carbohydrate-related negative health outcomes. However, recent studies have suggested that NNS may actually contribute to the development or worsening of metabolic diseases, including metabolic syndrome, obesity, type 2 diabetes, and cardiovascular disease. Thus, it is imperative to understand the NNS efficacy and the relationship between NNS and metabolic diseases.

Lifestyle medicine

Fundamental Clinical Imbalances : Hormonal ; Immune and inflammation
Patient Centred Factors : Mediators/Non-Nutritive Sweeteners
Environmental Inputs : Diet ; Nutrients
Personal Lifestyle Factors : Nutrition
Functional Laboratory Testing : Not applicable

Methodological quality

Jadad score : Not applicable
Allocation concealment : Not applicable
Publication Type : Journal Article ; Review