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Therefore, one common approach to improve energy balance is to refrain from sugars by replacing them with artificial sweeteners. In particular the consumption of sugar-sweetened beverages has been associated with cardiometabolic complications, driven by an increased energy intake and obesity ( 12). The intake of sugar contributes to the overall energy density of diets, thereby promoting obesity ( 10, 11). However, even more challenging than achieving weight loss is the maintenance of body weight after weight loss ( 9). Many strategies exist to achieve successful weight loss by improving dietary habits and energy balance. However, obesity and its associated metabolic disorders, including T2DM, cardiovascular disease, and fatty liver disease, are preventable. Over 340 million children and adolescents (5–19 year of age) were overweight or obese in 2016 ( 8). Beside adults, the prevalence of childhood obesity has also increased dramatically worldwide. In 2016, there were more than 1.9 billion overweight adults and 650 million obese adults, representing a global prevalence of 13% ( 8).
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Due to the increasing trends in overweight and obesity, there is a strong focus on dietary overconsumption and energy restriction. Globally, 11 million deaths and 255 million disability-adjusted life-years were attributable to dietary risk factors in 2017 ( 7). A poor diet was found to be the leading risk factor of death and third leading risk factor for disability-adjusted life-years loss in the United States ( 6). This dietary shift contributes to the rise of non-communicable diseases, including obesity, type 2 diabetes mellitus (T2DM), cardiovascular disease, and cancer ( 3– 5). Energy intake has increased along with the consumption of animal fat and energy-dense foods, while fiber intake has decreased ( 2). Along with globalization and economic growth, a shift in dietary habits has occurred since 1970 ( 1, 2). Clearly, further well-controlled, long-term human studies investigating the effects of different artificial sweeteners and their impact on gut microbiota, body weight regulation and glucose homeostasis, as well as the underlying mechanisms, are warranted.ĭiet is among the most important health influencers. The majority of clinical studies performed thus far report no significant effects or beneficial effects of artificial sweeteners on body weight and glycemic control, but it should be emphasized that the study duration of most studies was limited. Although many rodent studies have assessed the metabolic effects of artificial sweeteners, long-term studies in humans are scarce. Thus, extrapolation of the metabolic effects of a single artificial sweetener to all artificial sweeteners is not appropriate. Therefore, the difference in metabolic fate of artificial sweeteners may underlie conflicting findings that have been reported related to their effects on body weight control, glucose homeostasis, and underlying biological mechanisms. Notably, artificial sweeteners are metabolized differently from each other due to their different properties. Nevertheless, the safety and health benefits of artificial sweeteners consumption remain a topic of debate within the scientific community and society at large. One of the strategies to lower energy intake is refraining from sugars and replacing them with artificial sweeteners, which maintain the palatability without ingesting calories. Many strategies focus on improving energy balance to achieve successful weight loss. Due to the increasing prevalence of overweight and obesity, there is a strong focus on dietary overconsumption and energy restriction. Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, NetherlandsĪ poor diet is one of the leading causes for non-communicable diseases.