Abstract：
The use of non-nutritive sweeteners (NNSs) is dramatically increasing in food commodities, and their effects on biochemical parameters have been the subject of great controversy. Liver enzymes as markers of liver injury may be helpful measures of non-alcoholic fatty liver disease (NAFLD), but the outcomes of randomized controlled trials (RCTs) suggest their associations with NNSs are contentious.
The current study was designed to provide a GRADE-assessed systematic review and meta-analysis of RCTs studying the consequences of NNS consumption on ALT, AST, and GGT concentrations (ie, the 3 main liver enzymes in adults).
Scopus, PubMed, and EMBASE were searched for relevant studies up to April 2021, with no time and language limitations.
Two independent researchers extracted information from qualified studies, and a third researcher rechecked it.
Of 3212 studies, 10 studies that enrolled a total of 854 volunteers were included. A random-effects or fixed-effects model was utilized to calculate weighted mean differences (WMDs) and 95% confidence intervals (CIs). Heterogeneity between studies was evaluated using Cochran\'s Q test and quantified using the I2 statistic. The pooled results demonstrated that, compared with control groups, NNS intake led to nonsignificant reductions in ALT (WMD: -.78, 95% CI: -2.14, .57, P = .25) and GGT (WMD: -.21, 95% CI: -1.46, 1.04, P = .74). Also, a small nonsignificant increasing effect on AST level was found (WMD: .02, 95% CI: -1.26, 1.30, P = .97). NNS significantly reduced AST levels in type 2 diabetes patients when subgroup analyses were performed. Also, in trials with ≥24-week intervention or studies that utilized stevioside for intervention, a significant reducing effect on ALT level was observed.
The results of this study showed that NNS intake has no significant effect on liver enzyme levels in adults.
PROSPERO registration no. CRD42021250067.
The current study was designed to provide a GRADE-assessed systematic review and meta-analysis of RCTs studying the consequences of NNS consumption on ALT, AST, and GGT concentrations (ie, the 3 main liver enzymes in adults).
Scopus, PubMed, and EMBASE were searched for relevant studies up to April 2021, with no time and language limitations.
Two independent researchers extracted information from qualified studies, and a third researcher rechecked it.
Of 3212 studies, 10 studies that enrolled a total of 854 volunteers were included. A random-effects or fixed-effects model was utilized to calculate weighted mean differences (WMDs) and 95% confidence intervals (CIs). Heterogeneity between studies was evaluated using Cochran\'s Q test and quantified using the I2 statistic. The pooled results demonstrated that, compared with control groups, NNS intake led to nonsignificant reductions in ALT (WMD: -.78, 95% CI: -2.14, .57, P = .25) and GGT (WMD: -.21, 95% CI: -1.46, 1.04, P = .74). Also, a small nonsignificant increasing effect on AST level was found (WMD: .02, 95% CI: -1.26, 1.30, P = .97). NNS significantly reduced AST levels in type 2 diabetes patients when subgroup analyses were performed. Also, in trials with ≥24-week intervention or studies that utilized stevioside for intervention, a significant reducing effect on ALT level was observed.
The results of this study showed that NNS intake has no significant effect on liver enzyme levels in adults.
PROSPERO registration no. CRD42021250067.
摘要：
背景：非营养性甜味剂（NNS）在食品中的使用急剧增加，它们对生化参数的影响一直是争议很大的话题。作为肝损伤标志物的肝酶可能是非酒精性脂肪性肝病（NAFLD）的有用措施，但随机对照试验(RCT)的结果表明,它们与NNS之间的关联存在争议.
目的：本研究旨在对研究NNS消费对ALT的影响的随机对照试验进行GRADE评估的系统评价和荟萃分析，AST,和GGT浓度(即，成人中的3种主要肝酶)。
方法：Scopus,PubMed,和EMBASE在2021年4月之前搜索相关研究，没有时间和语言限制。
方法：两名独立研究人员从合格研究中提取信息，第三位研究人员重新检查了它。
方法：在3212项研究中，纳入10项研究，共招募854名志愿者。使用随机效应或固定效应模型来计算加权平均差（WMD）和95％置信区间（CI）。使用CochranQ检验评估研究之间的异质性，并使用I2统计量进行量化。汇总结果表明，与对照组相比，NNS摄入导致ALT（WMD：-.78，95％CI：-2.14，.57，P=.25）和GGT（WMD：-.21，95％CI：-1.46，1.04，P=.74）无显著降低。此外，发现对AST水平的小的不显著增加效应(WMD:.02,95%CI:-1.26,1.30,P=.97)。进行亚组分析时，NNS显着降低了2型糖尿病患者的AST水平。此外，在≥24周干预的试验或使用甜菊苷进行干预的研究中，观察到对ALT水平的显著降低作用。
结论：这项研究的结果表明，摄入NNS对成年人的肝酶水平没有显著影响。
背景：PROSPERO注册号。CRD42021250067。
目的：本研究旨在对研究NNS消费对ALT的影响的随机对照试验进行GRADE评估的系统评价和荟萃分析，AST,和GGT浓度(即，成人中的3种主要肝酶)。
方法：Scopus,PubMed,和EMBASE在2021年4月之前搜索相关研究，没有时间和语言限制。
方法：两名独立研究人员从合格研究中提取信息，第三位研究人员重新检查了它。
方法：在3212项研究中，纳入10项研究，共招募854名志愿者。使用随机效应或固定效应模型来计算加权平均差（WMD）和95％置信区间（CI）。使用CochranQ检验评估研究之间的异质性，并使用I2统计量进行量化。汇总结果表明，与对照组相比，NNS摄入导致ALT（WMD：-.78，95％CI：-2.14，.57，P=.25）和GGT（WMD：-.21，95％CI：-1.46，1.04，P=.74）无显著降低。此外，发现对AST水平的小的不显著增加效应(WMD:.02,95%CI:-1.26,1.30,P=.97)。进行亚组分析时，NNS显着降低了2型糖尿病患者的AST水平。此外，在≥24周干预的试验或使用甜菊苷进行干预的研究中，观察到对ALT水平的显著降低作用。
结论：这项研究的结果表明，摄入NNS对成年人的肝酶水平没有显著影响。
背景：PROSPERO注册号。CRD42021250067。
