BMJ |非糖类甜味剂到底是否有益健康?这是一项WHO委托进行的研究

过度的糖类摄入是导致肥胖、糖尿病、心血管疾病等各类疾病的凶手。包括世界卫生组织(WHO)在内的卫生组织均建议人们减少糖的摄入量。但甜味的诱惑总是难以抵挡的,一些人则推荐使用非糖类甜味剂作为替代品。


可是问题又来了——不论是天然甜味剂还是合成甜味剂,非糖类甜味剂带来健康益处的证据相互矛盾。有些研究已将非糖类甜味剂与降低2型糖尿病和超重和肥胖的风险联系起来。但也有研究表明,非糖类甜味剂可能会增加超重,糖尿病和癌症的风险。


于是,WHO委托进行一项研究,为其即将出台的关于儿童和成人应如何使用非糖类甜味剂的指南作参考,该研究结果最近发表在了BMJ上。

这是一项meta分析,分析了符合条件的27项观察性研究和29项随机/非随机临床试验。目的为研究非糖类甜味剂是否影响健康结果,包括体重或体重指数,血糖控制,口腔健康,饮食行为,甜味偏好,癌症,血压,心血管疾病,肾脏疾病,情绪,行为,神经认知和不良反应等各个方面。符合条件的研究必须直接比较较低或不摄入非糖类甜味剂,并且在一般健康的成人或儿童中,不论其体重如何,至少保持7天较高的摄入量。


1,一些小型随机临床试验表明,非糖类甜味剂对成人体重指数(BMI)和空腹血糖拥有微小的益处,但这些研究的证据确凿性比较低。

2,在儿童中,2项随机临床试验涉及528名参与者,表明使用非糖类甜味剂的人群中BMI增幅低于使用糖类的人群,但体重没有显著差异。

3,没有证据支持使用非糖类甜味剂能够用来帮助超重或肥胖的成人或儿童减肥。

4,虽然没有实质性危害的证据,但研究人员不能排除非糖类甜味剂的负面健康影响,特别是长期大剂量使用时。


虽然研究人员网罗现有文献,纳入了许多研究,但目前大多数研究的样本量都很小,持续时间短,质量低。这些研究的侧重点也不同,包括用于评估的甜味剂类型,使用的剂量和考察指标。对于大多数指标,只有一个或若干个研究可用,且研究结果经常发生冲突。由于这些原因,作者写道,“对该Meta分析报告结果的信心有限。”


文章的作者,德国弗莱堡大学医学证据研究所所长,医学博士Joerg J. Meerpohl表示,他自己的看法是,非糖类甜味剂没有明显的危害,但也没有明显的益处证据。“就个人而言,我宁愿喝含水或不加糖的茶,而不是健怡可乐。”


总而言之,目前仍然没有足够的证据表明使用非糖类甜味剂可改善成人和儿童的健康状况,包括体重,血糖控制和牙齿健康。需要进行大规模,良好进行的随机临床试验,以标准化时间点以标准化方式评估重要结果。

OBJECTIVE:

To assess the association between intake of non-sugar sweeteners (NSS) and important health outcomes in generally healthy or overweight/obese adults and children.

DESIGN:

Systematic review following standard Cochrane review methodology.

DATA SOURCES:

Medline (Ovid), Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and reference lists of relevant publications.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES:

Studies including generally healthy adults or children with or without overweight or obesity were eligible. Included study designs allowed for a direct comparison of no intake or lower intake of NSS with higher NSS intake. NSSs had to be clearly named, the dose had to be within the acceptable daily intake, and the intervention duration had to be at least seven days.

MAIN OUTCOME MEASURES:

Body weight or body mass index, glycaemic control, oral health, eating behaviour, preference for sweet taste, cancer, cardiovascular disease, kidney disease, mood, behaviour, neurocognition, and adverse effects.

RESULTS:

The search resulted in 13 941 unique records. Of 56 individual studies that provided data for this review, 35 were observational studies. In adults, evidence of very low and low certainty from a limited number of small studies indicated a small beneficial effect of NSSs on body mass index (mean difference -0.6, 95% confidence interval -1.19 to -0.01; two studies, n=174) and fasting blood glucose (-0.16 mmol/L, -0.26 to -0.06; two, n=52). Lower doses of NSSs were associated with lower weight gain (-0.09 kg, -0.13 to -0.05; one, n=17 934) compared with higher doses of NSSs (very low certainty of evidence). For all other outcomes, no differences were detected between the use and non-use of NSSs, or between different doses of NSSs. No evidence of any effect of NSSs was seen on overweight or obese adults or children actively trying to lose weight (very low to moderate certainty). In children, a smaller increase in body mass index z score was observed with NSS intake compared with sugar intake (-0.15, -0.17 to -0.12; two, n=528, moderate certainty of evidence), but no significant differences were observed in body weight (-0.60 kg, -1.33 to 0.14; two, n=467, low certainty of evidence), or between different doses of NSSs (very low to moderate certainty).

CONCLUSIONS:

Most health outcomes did not seem to have differences between the NSS exposed and unexposed groups. Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited. Future studies should assess the effects of NSSs with an appropriate intervention duration. Detailed descriptions of interventions, comparators, and outcomes should be included in all reports.

出 处:

Toews, I., et al., Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ, 2019: p. k4718.


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