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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2024; 18(01): 7-12
DOI: 10.1055/a-2227-4357
Review

Süßstoffe und ihre Wirkung auf das Körpergewicht

Non-caloric Sweeteners and their impact on body weight
Stefan Kabisch
1   Charité Universitätsmedizin Berlin, Klinik für Endokrinologie und Stoffwechselmedizin, Campus Benjamin Franklin, Berlin, Deutschland
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Zusammenfassung

Süßstoffe sind chemisch, geschmacklich und biologisch heterogene, hochpotente Süßungsmittel, die in kalorienreduzierten Getränken, hochprozessierten Speisen und diätetischen Ersatzmahlzeiten verwendet werden. Maximal empfohlene Verzehrsmengen (“acceptable daily intake”, ADI) werden bei ausgewogener Ernährung und bei ausgeprägter Nutzung trotz konservativer Auslegung meist nicht erreicht. Süßstoffmischungen begünstigen die Unterschreitung der ADIs und die Geschmacksoptimierung.

Epidemiologisch ist Süßstoffverzehr mit Adipositas, Typ-2- Diabetes, kardiovaskuläre Erkrankungen und Krebs assoziiert. Starke Confounder (andere Lebensstilfaktoren) und „reverse causality“ schwächen aber die Aussagekraft.

In verblindeten randomisiert-kontrollierten Studien (RCTs) bewirken Süßstoffe gegenüber Zucker eine signifikante Reduktion von Körpergewicht und Leberfett, während glykämische Parameter zum Nachteil trenden. Der Gewichtsverlust liegt unter der Erwartung gemäß der theoretisch eingesparten Kalorien. Psychologische oder metabolische Störeffekte der Süßstoffe sind daher aktuell Gegenstand intensiver Forschung, bei der das Inkretinsystem, die Konditionierung auf Süßreize und das Darmmikrobiom Ansatzpunkte darstellen.

Summary

Non-caloric sweeteners entail a chemically, taste-wise and biologically heterogeneous group of highly potent sweeting agents, commonly used in energy-reduced beverages, highly processed foods and food replacements. The “acceptable daily intake” (ADI) is usually not exceeded by well-balanced diets or even excessive consumption, despite very low cut-offs. Sweetener blends facilitate underpassing ADIs and taste optimisation.

In epidemiological studies, the intake of non-caloric sweeteners is consistently associated with obesity, type 2 diabetes, cardiovascular disease and cancer. Strong confounders (unhealthy lifestyle in every aspect) or “reverse causality” reduce the level of evidence.

In blinded randomised-controlled trials (RCTs), non-caloric sweeteners (vs. sugar) lead to a significant reduction of body weight and liver fat, while glycemic parameters trend towards harm. Also, the weight loss effect is way smaller than expected on the basis of reduced calorie intake. Psychological or metabolic side effects of non-caloric sweeteners are therefore in the spotlight of intensive research, which focusses on the incretin system, conditioning on sweet food cues and the gut microbiome.

Schlüsselwörter

Adipositas - Süßstoffe - Epidemiologie - RCT

Key words

Obesity - sweeteners - epidemiology - RCT


Publication History

Article published online:
11 March 2024

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