摘要:
随着全世界范围内肥胖人群不断增加,减糖和控糖已成为人们最迫切的健康需求之一。代糖(分为糖醇类、天然甜味剂和人工甜味剂)因能量低、甜度高等特点,已被当为糖的替代品,广泛应用于食品加工。本文从代糖的分类、代谢途径、优势、使用及其对人体健康的影响展开,重点介绍了代糖摄入与肥胖、糖尿病、肠道微生物、高血压和全因死亡率之间的关系。现有证据显示,总体上长期大量摄入代糖与不良结局有关,如血压升高、糖尿病风险增加、致癌和全因死亡率提高,但糖醇类和天然甜味剂对人体肠道微生物多样性可能产生有益的影响,而人工甜味剂会导致肠道微生物群失衡。不同代糖产生的健康效应不同,当前研究更多集中在单一代糖,而市面上销售的近半数使用代糖的产品中添加了2种及以上的代糖,多种代糖混合暴露对人体的健康效应尚不明确。将来的研究有必要对常见代糖组合的健康影响进行流行病学研究和分子机制研究。
关键词: 代糖 / 甜味剂 / 人体健康Abstract:
Sugar reduction and restriction have become one of the most urgent health demands as the number of obese people increases globally. Sugar substitutes (mainly classified into sugar alcohols, natural sweeteners, and artificial sweeteners) have been widely used in food processing as alternatives to sugar for their low energy and high sweetness. Thus, the classification, metabolism pathways, advantages, applications, and human health effects of sugar substitutes, their effects on human health were introduced, and the relationships between sugar substitutes and obesity, diabetes, intestinal microbes, hypertension, and all-cause mortality were emphatically summarized in this paper. Generally, long-term high intake of sugar substitutes is associated with adverse health outcomes such as elevated blood pressure, higher risks of diabetes, cancer, and increased all-cause mortality. Meanwhile, sugar alcohols and natural sweeteners are more likely to associate with beneficial effects on human gut microbial diversity, while artificial sweeteners associate with imbalance of gut microbiota based on available evidence. Current published research focuses on single sugar substitute exposure with varied health effects, while nearly half of commercial sugar substitute products contain two or more sugar substitutes. The effects of exposure to multiple sugar substitutes on human health are not clear yet, so further strengthening the relevant epidemiological and molecular mechanism research is necessary.
[1]NAVARRETE-MUÑOZ E M, WARK P A, ROMAGUERA D, et al. Sweet-beverage consumption and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC)[J]. Am J Clin Nutr, 2016, 104(3): 760-768. doi: 10.3945/ajcn.116.130963
[2]ANDERSON J J, GRAY S R, WELSH P, et al. The associations of sugar-sweetened, artificially sweetened and naturally sweet juices with all-cause mortality in 198, 285 UK Biobank participants: a prospective cohort study[J]. BMC Med, 2020, 18(1): 97. doi: 10.1186/s12916-020-01554-5
[3]SCHIANO C, GRIMALDI V, SCOGNAMIGLIO M, et al. Soft drinks and sweeteners intake: possible contribution to the development of metabolic syndrome and cardiovascular diseases. Beneficial or detrimental action of alternative sweeteners?[J]. Food Res Int, 2021, 142: 110220. doi: 10.1016/j.foodres.2021.110220
[4] 祝玉婷, 胡志和. 无糖食品的研究进展[J]. 饮料工业, 2021, 24(3): 75-79. doi: 10.3969/j.issn.1007-7871.2021.03.022ZHU Y T, HU Z H. Research progress of sugar-free foods[J]. Beverage Ind, 2021, 24(3): 75-79. doi: 10.3969/j.issn.1007-7871.2021.03.022
[5]HONG S J, AHN M H, SANGSHETTI J, et al. Sugar alcohol-based polymeric gene carriers: synthesis, properties and gene therapy applications[J]. Acta Biomater, 2019, 97: 105-115. doi: 10.1016/j.actbio.2019.07.029
[6]SARAIVA A, CARRASCOSA C, RAHEEM D, et al. Maltitol: analytical determination methods, applications in the food industry, metabolism and health impacts[J]. Int J Environ Res Public Health, 2020, 17(14): 5227. doi: 10.3390/ijerph17145227
[7]ORTIZ S R, FIELD M S. Mammalian metabolism of erythritol: a predictive biomarker of metabolic dysfunction[J]. Curr Opin Clin Nutr Metab Care, 2020, 23(5): 296-301. doi: 10.1097/MCO.0000000000000665
[8]SCHELL DOMPERT E, SIEBERT G. Metabolism of Sorbitol in the intact organism[J]. Hoppe Seylers Z Physiol Chem, 1980, 361(7): 1069-1075.
[9]ADCOCK L H, GRAY C H. Metabolism of sorbitol[J]. Nature, 1956, 177(4503): 329-330.
[10]GRIMBLE G K, PATIL D H, SILK D B. Assimilation of lactitol, an 'unabsorbed' disaccharide in the normal human colon[J]. Gut, 1988, 29(12): 1666-1671. doi: 10.1136/gut.29.12.1666
[11]GARDANA C, SIMONETTI P, CANZI E, et al. Metabolism of stevioside and rebaudioside A from Stevia rebaudiana extracts by human microflora[J]. J Agric Food Chem, 2003, 51(22): 6618-6622. doi: 10.1021/jf0303619
[12]XU F, LI D P, HUANG Z C, et al. Exploring in vitro , in vivo metabolism of mogroside V and distribution of its metabolites in rats by HPLC-ESI-IT-TOF-MSn[J]. J Pharm Biomed Anal, 2015, 115: 418-430. doi: 10.1016/j.jpba.2015.07.024
[13]COLBURN W A, BEKERSKY I, BLUMENTHAL H P. A preliminary report on the pharmacokinetics of saccharin in man: single oral dose administration[J]. J Clin Pharmacol, 1981, 21(4): 147-151. doi: 10.1002/j.1552-4604.1981.tb05692.x
[14]RYCERZ K, JAWORSKA-ADAMU J E. Effects of aspartame metabolites on astrocytes and neurons[J]. Folia Neuropathol, 2013, 51(1): 10-17.
[15]COLLINGS A J. Metabolism of cyclamate and its conversion to cyclohexylamine[J]. Diabetes Care, 1989, 12(1): 50-55. doi: 10.2337/diacare.12.1.50
[16]RENWICK A G. The metabolism of intense sweeteners[J]. Xenobiotica, 1986, 16(10/11): 1057-1071.
[17]WOOD S G, JOHN B A, HAWKINS D R. The pharmacokinetics and metabolism of sucralose in the dog[J]. Food Chem Toxicol, 2000, 38(Suppl 2): S99-S106.
[18]ROBERTS A, RENWICK A G, SIMS J, et al. Sucralose metabolism and pharmacokinetics in man[J]. Food Chem Toxicol, 2000, 38(Suppl 2): S31-S41.
[19]Future Market Insights. Sugar substitutes market outlook (2022 to 2032)[EB/OL]. [2022-10-24]. https://www.futuremarketinsights.com/reports/sugar-substitutes-market.
[20]SYLVETSKY A C, JIN Y, CLARK E J, et al. Consumption of low-calorie sweeteners among children and adults in the United States[J]. J Acad Nutr Diet, 2017, 117(3): 441-448.e2. doi: 10.1016/j.jand.2016.11.004
[21] 中国糖业协会. 我国甜味剂行业发展及市场消费情况分析[EB/OL]. (2015-07-20)[2022-10-16]. http://www.chinasugar.org.cn/i,109,1755,0.html.China Sugar Association. Analysis of the development of sweetener industry and market consumption in China[EB/OL]. (2015-07-20)[2022-10-16]. http://www.chinasugar.org.cn/i,109,1755,0.html.
[22] 町芒研究院. 2022无糖饮料行业研究报告[EB/OL]. (2022-05-26)[2022-10-26]. https://data.eastmoney.com/report/zw_industry.jshtml?infocode=AP202205261568020049.TIMON. China's sugar-free beverage industry research report in 2022[EB/OL]. (2022-05-26)[2022-10-26]. https://data.eastmoney.com/report/zw_industry.jshtml?infocode=AP202205261568020049.
[23] 常炯炯, 雍凌, 肖潇, 等. 我国食品甜味剂联合使用情况及累积风险评估[J]. 毒理学杂志, 2021, 35(3): 184-192. doi: 10.16421/j.cnki.1002-3127.2021.03.003CHANG J J, YONG L, XIAO X, et al. Combined use of food sweeteners in China and its cumulative risk assessment[J]. J Toxicol, 2021, 35(3): 184-192. doi: 10.16421/j.cnki.1002-3127.2021.03.003
[24]FITCH C, KEIM K S. Position of the academy of nutrition and dietetics: use of nutritive and nonnutritive sweeteners[J]. J Acad Nutr Diet, 2012, 112(5): 739-758. doi: 10.1016/j.jand.2012.03.009
[25] 科信食品与健康信息交流中心. 食品甜味剂科学共识(2022)[EB/OL]. (2022-10-26)[2022-10-27]. http://www.kexinzhongxin.com/html/huodong/4887.html.China Food Information Center. Scientific consensus on food sweeteners (2022)[EB/OL]. (2022-10-26)[2022-10-27]. http://www.kexinzhongxin.com/html/huodong/4887.html.
[26]TAN V W K, WEE M S M, TOMIC O, et al. Rate-All-That-Apply (RATA) comparison of taste profiles for different sweeteners in black tea, chocolate milk, and natural yogurt[J]. J Food Sci, 2020, 85(2): 486-492. doi: 10.1111/1750-3841.15007
[27]ABDEL-HAMID M, ROMEIH E, HUANG Z, et al. Bioactive properties of probiotic set-yogurt supplemented with Siraitia grosvenorii fruit extract[J]. Food Chem, 2020, 303: 125400. doi: 10.1016/j.foodchem.2019.125400
[28]DE COCK P. Erythritol functional roles in oral-systemic health[J]. Adv Dent Res, 2018, 29(1): 104-109. doi: 10.1177/0022034517736499
[29]ZHU J, LIU J, LI Z, et al. The effects of nonnutritive sweeteners on the cariogenic potential of oral microbiome[J]. Biomed Res Int, 2021, 2021: 9967035.
[30]SWITHERS S E. Not-so-healthy sugar substitutes?[J]. Curr Opin Behav Sci, 2016, 9: 106-110. doi: 10.1016/j.cobeha.2016.03.003
[31]SORRENTINO Z A, SMITH G, PALM L, et al. An erythritol-sweetened beverage induces satiety and suppresses ghrelin compared to aspartame in healthy non-obese subjects: a pilot study[J]. Cureus, 2020, 12(11): e11409.
[32] 顾景范. 《2015年美国膳食指南》简介[J]. 营养学报, 2016, 38(1): 1-6. doi: 10.13325/j.cnki.acta.nutr.sin.2016.01.001GU J F. Introduction to 2015 dietary guidelines for Americans[J]. Acta Nutr Sin, 2016, 38(1): 1-6. doi: 10.13325/j.cnki.acta.nutr.sin.2016.01.001
[33]YUNKER A G, ALVES J M, LUO S, et al. Obesity and sex-related associations with differential effects of sucralose vs sucrose on appetite and reward processing: a randomized crossover trial[J]. JAMA Netw Open, 2021, 4(9): e2126313. doi: 10.1001/jamanetworkopen.2021.26313
[34]LUDWIG D S. Artificially sweetened beverages: cause for concern[J]. JAMA, 2009, 302(22): 2477-2478. doi: 10.1001/jama.2009.1822
[35]TOEWS I, LOHNER S, DE GAUDRY D K, 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[J]. BMJ, 2019, 364: k4718.
[36]BUSO M E C, BROUWER-BROLSMA E M, NAOMI N D, et al. Dose-Response and substitution analyzes of sweet beverage consumption and body weight in Dutch adults: the lifelines cohort study[J]. Front Nutr, 2022, 9: 889042. doi: 10.3389/fnut.2022.889042
[37]MCGLYNN N D, KHAN T A, WANG L, et al. Association of low- and no-calorie sweetened beverages as a replacement for sugar-sweetened beverages with body weight and cardiometabolic risk: a systematic review and meta-analysis[J]. JAMA Netw Open, 2022, 5(3): e222092. doi: 10.1001/jamanetworkopen.2022.2092
[38]World health organization. Use of non-sugar sweeteners: WHO guideline[EB/OL]. [2023-06-19]. https://www.who.int/publications/i/item/9789240073616.
[39]PALMNÄS M S A, COWAN T E, BOMHOF M R, et al. Low-dose aspartame consumption differentially affects gut microbiota-host metabolic interactions in the diet-induced obese rat[J]. PLoS One, 2014, 9(10): e109841. doi: 10.1371/journal.pone.0109841
[40]HUANG M, QUDDUS A, STINSON L, et al. Artificially sweetened beverages, sugar-sweetened beverages, plain water, and incident diabetes mellitus in postmenopausal women: the prospective Women's Health Initiative observational study[J]. Am J Clin Nutr, 2017, 106(2): 614-622. doi: 10.3945/ajcn.116.145391
[41]DROUIN-CHARTIER J P, ZHENG Y, LI Y, et al. Changes in consumption of sugary beverages and artificially sweetened beverages and subsequent risk of type 2 diabetes: results from three large prospective U. S. cohorts of women and men[J]. Diabetes Care, 2019, 42(12): 2181-2189. doi: 10.2337/dc19-0734
[42]NETTLETON J A, LUTSEY P L, WANG Y, et al. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)[J]. Diabetes Care, 2009, 32(4): 688-694. doi: 10.2337/dc08-1799
[43]PULLICIN A J, GLENDINNING J I, LIM J. Cephalic phase insulin release: a review of its mechanistic basis and variability in humans[J]. Physiol Behav, 2021, 239: 113514. doi: 10.1016/j.physbeh.2021.113514
[44]GUERRA M L, KALWAT M A, MCGLYNN K, et al. Sucralose activates an ERK1/2-ribosomal protein S6 signaling axis[J]. FEBS Open Bio, 2017, 7(2): 174-186. doi: 10.1002/2211-5463.12172
[45]ISLAM M S, INDRAJIT M. Effects of xylitol on blood glucose, glucose tolerance, serum insulin and lipid profile in a type 2 diabetes model of rats[J]. Ann Nutr Metab, 2012, 61(1): 57-64. doi: 10.1159/000338440
[46]AHMAD U, AHMAD R S. Anti diabetic property of aqueous extract of Stevia rebaudiana Bertoni leaves in Streptozotocin-induced diabetes in albino rats[J]. BMC Complement Altern Med, 2018, 18(1): 179. doi: 10.1186/s12906-018-2245-2
[47]KASTI A N, NIKOLAKI M D, SYNODINOU K D, et al. The effects of stevia consumption on gut bacteria: friend or foe?[J]. Microorganisms, 2022, 10(4): 744. doi: 10.3390/microorganisms10040744
[48]YANG Z D, GUO Y S, HUANG J S, et al. Isomaltulose exhibits prebiotic activity, and modulates gut microbiota, the production of short chain fatty acids, and secondary bile acids in rats[J]. Molecules, 2021, 26(9): 2464. doi: 10.3390/molecules26092464
[49]XIANG S, YE K, LI M, et al. Xylitol enhances synthesis of propionate in the colon via cross-feeding of gut microbiota[J]. Microbiome, 2021, 9(1): 62. doi: 10.1186/s40168-021-01029-6
[50]VAN DEN ABBEELE P, TAMINIAU B, PINHEIRO I, et al. Arabinoxylo-oligosaccharides and inulin impact inter-individual variation on microbial metabolism and composition, which immunomodulates human cells[J]. J Agric Food Chem, 2018, 66(5): 1121-1130. doi: 10.1021/acs.jafc.7b04611
[51]GERASIMIDIS K, BRYDEN K, CHEN X, et al. The impact of food additives, artificial sweeteners and domestic hygiene products on the human gut microbiome and its fibre fermentation capacity[J]. Eur J Nutr, 2020, 59(7): 3213-3230. doi: 10.1007/s00394-019-02161-8
[52]YU Z, GUO J. Non-caloric artificial sweeteners exhibit antimicrobial activity against bacteria and promote bacterial evolution of antibiotic tolerance[J]. J Hazard Mater, 2022, 433: 128840. doi: 10.1016/j.jhazmat.2022.128840
[53]BIAN X, CHI L, GAO B, et al. Gut microbiome response to sucralose and its potential role in inducing liver inflammation in mice[J]. Front Physiol, 2017, 8: 487. doi: 10.3389/fphys.2017.00487
[54]AHMAD S Y, FRIEL J, MACKAY D. The effects of non-nutritive artificial sweeteners, aspartame and sucralose, on the gut microbiome in healthy adults: secondary outcomes of a randomized double-blinded crossover clinical trial[J]. Nutrients, 2020, 12(11): 3408. doi: 10.3390/nu12113408
[55]RISDON S, BATTAULT S, ROMO-ROMO A, et al. Sucralose and cardiometabolic health: current understanding from receptors to clinical investigations[J]. Adv Nutr, 2021, 12(4): 1500-1513. doi: 10.1093/advances/nmaa185
[56]AZAD M B, ABOU-SETTA A M, CHAUHAN B F, et al. Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies[J]. CMAJ, 2017, 189(28): E929-E939. doi: 10.1503/cmaj.161390
[57]QIN P, LI Q, ZHAO Y, et al. Sugar and artificially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose-response meta-analysis of prospective cohort studies[J]. Eur J Epidemiol, 2020, 35(7): 655-671. doi: 10.1007/s10654-020-00655-y
[58]COHEN L, CURHAN G, FORMAN J. Association of sweetened beverage intake with incident hypertension[J]. J Gen Intern Med, 2012, 27(9): 1127-1134. doi: 10.1007/s11606-012-2069-6
[59]SOUZA B D S N, CUNHA D B, PEREIRA R A, et al. Soft drink consumption, mainly diet ones, is associated with increased blood pressure in adolescents[J]. J Hypertens, 2016, 34(2): 221-225. doi: 10.1097/HJH.0000000000000800
[60]CRICHTON G, ALKERWI A, ELIAS M. Diet soft drink consumption is associated with the metabolic syndrome: a two sample comparison[J]. Nutrients, 2015, 7(5): 3569-3586. doi: 10.3390/nu7053569
[61]OLAS B. Stevia rebaudiana Bertoni and its secondary metabolites: their effects on cardiovascular risk factors[J]. Nutrition, 2022, 99-100: 111655. doi: 10.1016/j.nut.2022.111655
[62]WITKOWSKI M, NEMET I, ALAMRI H, et al. The artificial sweetener erythritol and cardiovascular event risk[J]. Nat Med, 2023, 29(3): 710-718. doi: 10.1038/s41591-023-02223-9
[63]MALIK V S, LI Y, PAN A, et al. Long-term consumption of sugar-sweetened and artificially sweetened beverages and risk of mortality in us adults[J]. Circulation, 2019, 139(18): 2113-2125. doi: 10.1161/CIRCULATIONAHA.118.037401
[64]MULLEE A, ROMAGUERA D, PEARSON-STUTTARD J, et al. Association between soft drink consumption and mortality in 10 European countries[J]. JAMA Intern Med, 2019, 179(11): 1479-1490. doi: 10.1001/jamainternmed.2019.2478
[65]LUCENTEFORTE E, SCITA V, BOSETTI C, et al. Food groups and alcoholic beverages and the risk of stomach cancer: a case-control study in Italy[J]. Nutr Cancer, 2008, 60(5): 577-584. doi: 10.1080/01635580802054512
[66]BRAVI F, SCOTTI L, BOSETTI C, et al. Food groups and endometrial cancer risk: a case-control study from Italy[J]. Am J Obstet Gynecol, 2009, 200(3): 293.e1-293.e7. doi: 10.1016/j.ajog.2008.09.015
[67]SCHERNHAMMER E S, BERTRAND K A, BIRMANN B M, et al. Consumption of artificial sweetener– and sugar-containing soda and risk of lymphoma and leukemia in men and women[J]. Am J Clin Nutr, 2012, 96(6): 1419-1428. doi: 10.3945/ajcn.111.030833
[68]ZANI F, BLAGIH J, GRUBER T, et al. The dietary sweetener sucralose is a negative modulator of T cell-mediated responses[J]. Nature, 2023, 615(7953): 705-711. doi: 10.1038/s41586-023-05801-6
[69]JONES S K, MCCARTHY D M, VIED C, et al. Transgenerational transmission of aspartame-induced anxiety and changes in glutamate-GABA signaling and gene expression in the amygdala[J]. Proc Natl Acad Sci U S A, 2022, 119(49): e2213120119. doi: 10.1073/pnas.2213120119
相关知识
健康糖果的研究进展
低聚半乳糖与婴幼儿健康关系的研究进展
研究进展
低聚果糖与婴幼儿健康关系的研究进展
“健康与疾病发育起源”学说研究进展
孕期增重过度对子代健康影响的研究进展
肠道菌群及其代谢产物与妊娠期糖尿病相关性的研究进展
余勇夫课题组合作研究在孕期环境暴露与子代精神健康研究领域取得进展
妊娠期糖尿病和糖尿病合并妊娠的研究进展
饮食疗法干预糖尿病的研究进展
网址: 代糖与健康的研究进展 https://m.trfsz.com/newsview655748.html