Therapies and Prevention
Artificial Sweetener Use Among Children: Epidemiology, Recommendations, Metabolic Outcomes, and Future Directions

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Artificial sweeteners and obesity

Childhood obesity is associated with many unfavorable consequences, including type 2 diabetes mellitus, nonalcoholic fatty liver disease, hypertension, and psychosocial problems, and often results in obesity during adulthood.1 Consumption of added sugars is positively associated with higher energy intakes and is thought to be a significant contributor to the rapid rise in obesity worldwide.2 Because the majority of added sugars are obtained from consumption of soft drinks,3 artificially

Regulatory status of artificial sweeteners

There are currently 5 artificial sweeteners approved by the Food and Drug Administration (FDA) for use in the United States (Table 1). These include aspartame, acesulfame potassium, saccharin, sucralose, and neotame.7 In addition, stevia, a natural sweetener made from extracts of the intensely sweet Stevia rebaudiana Bertoni plant has been approved for limited use.8 For each sweetener, the FDA establishes an acceptable daily intake (ADI),9 in mg per kg body weight, which is the amount of

Artificial sweetener consumption among children

Apparent consumption of artificial sweeteners (based on servings of foods and beverages containing these sweeteners) has increased with time across all age groups.10 Because the FDA does not require manufacturers to report the actual amounts of sweeteners contained in foods and beverages,11 quantification of the precise amount of sweeteners present in the food supply is difficult. Hence, information about the total quantity of sweeteners in use is extracted from intake information for the

Current recommendations

There are few explicit recommendations regarding consumption of artificially sweetened foods and beverages in children; however, the American Dietetic Association (ADA) states that both nutritive and artificial sweeteners may comprise part of a diet that follows the Dietary Guidelines for Americans.5 Specifically, a position statement from the ADA stated that artificial sweeteners can allow consumers to enjoy sweetness while continuing to manage weight, diabetes, and other chronic illnesses.

Artificial sweeteners and the control of body weight

Although artificial sweeteners do not contribute significantly to energy intake, their effectiveness in promoting weight loss and weight control has been questioned.16 To date, 8 observational studies have explored the relationship between consumption of artificial sweeteners and weight in children.17, 18, 19, 20, 21, 22 Of the 3 cross-sectional studies, including between 385 and 3311 children, the 2 conducted in school-age and adolescent children showed positive associations between artificial

Effects artificial sweeteners on glycemia and glucoregulatory hormones

Because artificial sweeteners are frequently recommended for use by patients with diabetes, it is critical to understand their effects on glycemia. Early studies in adults with diabetes did not show acute or chronic effects artificial sweeteners on blood glucose or insulin levels.47, 48 This topic has recently been readdressed, however, as a result of new evidence that artificial sweeteners may be biologically active in the gastrointestinal tract, via binding to sweet taste receptors located on

Artificial sweeteners and their potential effects on taste, reward, and addiction pathways

In an effort to further understand and explain the etiology behind the rising epidemic of obesity, a new research area exploring potentially addictive properties of sugar has emerged. The concept of addiction is hard to define but is commonly characterized by compulsive and uncontrollable behaviors that are driven by cravings. Although most addiction research examines more common drugs of abuse, such as alcohol, cocaine, morphine, and nicotine, various studies have drawn parallels between

Summary

This review aims to provide clinicians with current and comprehensive information regarding the effects of artificial sweeteners on food intake, body weight, glycemic control, and sweet liking, craving, and addiction in children. Understanding and critically evaluating past research will assist clinicians in making informed recommendations for use of artificial sweeteners as a means of combating pediatric obesity. Taking into consideration the evidence that exists, the authors cautiously

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    • Cited by (0)

    This work was supported, in part, by the Intramural Research Program of the National Institutes of Health, and the National Institute of Diabetes, Digestive, and Kidney Diseases.

    The authors have nothing to disclose.

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