title: Safety of long-term large doses of aspartame. Acute hyperglycemia alters von Willebrand factor but not the fibrinolytic system in elderly subjects with normal or impaired glucose tolerance Long-term dietary compensation for added sugar: effects of supplementary sucrose drinks over a 4-week period. Functional magnetic resonance imaging of human hypothalamic responses to sweet taste and calories. The effect of aspartame as part of a multidisciplinary weight-control program on short- and long-term control of body weight. Comparative effects of fructose, aspartame, glucose, and water preloads on calorie and macronutrient intake. Aspartame Sensitivity? A Double Blind Randomised Crossover Study Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. The neuropsychiatric effects of aspartame in normal volunteers. Sucralose enhances GLP-1 release and lowers blood glucose in the presence of carbohydrate in healthy subjects but not in patients with type 2 diabetes Response to Single Dose of Aspartame or Saccharin by NIDDM Patients Blood glucose and meal patterns in time-blinded males, after aspartame, carbohydrate, and fat consumption, in relation to sweetness perception. Consuming aspartame with and without taste: Differential effects on appetite and food intake of young adult males Sweetener augmentation of serum triacylglycerol during a fat challenge test in humans. Aspartame Use By Persons with Diabetes Administration of aspartame in non-insulin-dependent diabetics. GRADE guidelines: 3. Rating the quality of evidence. No difference in ad libitum energy intake in healthy men and women consuming beverages sweetened with fructose, glucose, or high-fructose corn syrup: a randomized trial. An evaluation of the effect of aspartame on weight loss
abstract: Safety of long-term administration of 75 mg/kg of aspartame per day was evaluated with the use of a r and omized , double-blind , placebo-controlled , parallel-group design in 108 male and female volunteers aged 18 to 62 years . Subjects received either aspartame or placebo in capsule form three times daily for 24 weeks . No persistent changes over time were noted in either group in vital signs ; body weight ; results of st and ard laboratory tests ; fasting blood levels of aspartame 's constituent amino acids ( aspartic acid and phenylalanine ) , other amino acids , and methanol ; or blood formate levels and 24-hour urinary excretion of formate . There also were no statistically significant differences between groups in the number of subjects experiencing symptoms or in the number of symptoms per subject . These results further document the safety of the long-term consumption of aspartame at doses equivalent to the amount of aspartame in approximately 10 L of beverage per day To assess whether acute hyperglycemia affects fibrinolytic balance in elderly subjects with normal glucose tolerance ( NGT ) or impaired glucose tolerance ( IGT ) , 40 non-obese elderly subjects ( 20 NGT , age 68 ± 8 years ; and 20 IGT , age 69 ± 11 years ) were studied . On two experimental days , r and omly allocated and spaced 1 week apart , plasma concentrations of glucose , insulin , fibrinogen , tissue plasminogen activator , plasminogen activator inhibitor type 1 and von Willebr and factor ( vWF ) were measured in each subject at baseline ( 0 ) and 30 , 60 , 90 , 120 min after the ingestion of 75 g glucose or a similarly sweet dose of aspartame ( 250 mg ) ( control test ) . In both NGT and IGT elderly subjects , tissue plasminogen activator , plasminogen activator inhibitor type 1 and fibrinogen plasma levels did not significantly change after both oral aspartame and glucose load . In IGT subjects , vWF plasmatic levels decreased after glucose ( not aspartame ) oral load , reaching the minimum level at 90 min after load ( 82.7 ± 7.8 versus 93.7 ± 10.2 , P < 0.01 ) . These results demonstrate that acute hyperglycemia does not modify plasma fibrinolysis in elderly subjects . The decrease of plasma concentration of vWF in IGT elderly subjects requires cautious interpretation and further extensive investigations The long-term physiological effects of refined carbohydrates on appetite and mood remain unclear . Reported effects when subjects are not blind may be due to expectations and have rarely been studied for more than 24 h. The present study compared the effects of supplementary soft drinks added to the diet over 4 weeks on dietary intake , mood and BMI in normal-weight women ( n 133 ) . Subjects were categorised as ' watchers ' or ' non-watchers ' of what they ate then received sucrose or artificially sweetened drinks ( 4 x 250 ml per d ) . Expectancies were varied by labelling drinks ' sugar ' or ' diet ' in a counter-balanced design . Sucrose supplements provided 1800 kJ per d and sweetener supplements provided 67 kJ per d. Food intake was measured with a 7 d diary and mood with ten single Likert scales . By 4 weeks , sucrose supplements significantly reduced total carbohydrate intake ( F(1,129 ) = 53.81 ; P<0.001 ) , fat ( F(2,250 ) = 33.33 ; P<0.001 ) and protein intake ( F(2,250 ) = 28.04 ; P<0 - 001 ) compared with sweetener supplements .  Mean daily energy intake increased by just under 1000 kJ compared with baseline ( t ( 67 df ) = 3.82 ; P < 0.001 ) and was associated with a non-significant trend for those receiving sucrose to gain weight . There were no effects on appetite or mood . Neither dietary restraint status as measured by the Dutch Eating Behaviour Question naire nor the expectancy procedure had effects . Expectancies influenced mood only during baseline week . It is concluded that sucrose satiates , rather than stimulates , appetite or negative mood in normal-weight subjects BACKGROUND Evidence exists that beverages do not trigger appropriate anticipatory physiologic responses , such as cephalic phase insulin release . Therefore , it is of interest to eluci date the food properties necessary for triggering adaptive responses . Previously , we found a prolonged dose-dependent decrease in the hypothalamic functional magnetic resonance imaging signal after ingestion of a glucose solution . OBJECTIVES The aims of the present study were to measure the effects of sweet taste and energy content on the hypothalamic response to glucose ingestion and to measure the concomitant changes in blood glucose and insulin concentrations . DESIGN Five healthy , normal-weight men participated in a r and omized crossover design trial . The subjects were scanned 4 times for 37 min on separate days with functional magnetic resonance imaging . After 7 min , they ingested 1 of the following 4 stimuli ( 300 mL of each ) : water ( control ) , a glucose solution , an aspartame ( sweet taste ) solution , or a maltodextrin ( nonsweet carbohydrate ) solution . RESULTS Glucose ingestion result ed in a prolonged and significant signal decrease in the upper hypothalamus ( P < 0.05 ) . Water , aspartame , and maltodextrin had no such effect . Glucose and maltodextrin ingestions result ed in similar increases in blood glucose and insulin concentrations . However , only glucose triggered an early rise in insulin concentrations . Aspartame did not trigger any insulin response . CONCLUSIONS Our findings suggest that both sweet taste and energy content are required for a hypothalamic response . The combination of sweet taste and energy content could be crucial in triggering adaptive responses to sweetened beverages This study investigated whether the addition of the high-intensity sweetener aspartame to a multidisciplinary weight-control program would improve weight loss and long-term control of body weight .  One hundred sixty-three obese women were r and omly assigned to consume or to abstain from aspartame-sweetened foods and beverages during 16 wk of a 19-wk weight-reduction program ( active weight loss ) , a 1-y maintenance program , and a 2-y follow-up period . Women in both treatment groups lost approximately 10 % of initial body weight ( 10 kg ) during active weight loss . Among women assigned to the aspartame-treatment group , aspartame intake was positively correlated with percentage weight loss during active weight loss ( r = 0.32 , P < 0.01 ) . During maintenance and follow-up , participants in the aspartame group experienced a 2.6 % ( 2.6 kg ) and 4.6 % ( 4.6 kg ) regain of initial body weight after 71 and 175 wk , respectively , whereas those in the no-aspartame group gained an average of 5.4 % ( 5.4 kg ) and 9.4 % ( 9.4 kg ) , respectively . The aspartame group lost significantly more weight overall ( P = 0.028 ) and regained significantly less weight during maintenance and follow-up ( P = 0.046 ) than did the no-aspartame group . Percentage weight losses at 71 and 175 wk were also positively correlated with exercise ( r = 0.32 , P < 0.001 ; and r = 0.34 , P < 0.01 , respectively ) and self-reported eating control ( r = 0.37 , P < 0.001 ; and r = 0.33 , P < 0.01 , respectively ) . These data suggest that participation in a multidisciplinary weight-control program that includes aspartame may facilitate the long-term maintenance of reduced body weight Using a within-subjects design , we gave over-weight and normal-weight subjects a 500-mL drink of fructose , glucose , or aspartame diluted in lemon-flavored water or plain water in a r and omized fashion at about weekly intervals . Food intake was assessed at a buffet lunch that began 38 min after the preload was completed . Blood was drawn throughout and assayed for concentrations of glucose , insulin , glucagon , and free fatty acid . When subjects drank the fructose preload , they subsequently ate fewer overall calories and fewer grams of fat than when they drank any of the other preloads . The aspartame load did not stimulate intake beyond the plain-water control . The effects of the oxidation of fructose as a possible mechanism for the reduction in food intake is discussed . The effects of insulin in stimulating intake are also discussed Background Aspartame is a commonly used intense artificial sweetener , being approximately 200 times sweeter than sucrose . There have been concerns over aspartame since approval in the 1980s including a large anecdotal data base reporting severe symptoms . The objective of this study was to compare the acute symptom effects of aspartame to a control preparation . Methods This was a double-blind r and omized cross over study conducted in a clinical research unit in United Kingdom . Forty-eight individual who has self reported sensitivity to aspartame were compared to 48 age and gender matched aspartame non-sensitive individuals . They were given aspartame (100mg)-containing or control snack bars r and omly at least 7 days apart . The main outcome measures were acute effects of aspartame measured using repeated ratings of 14 symptoms , biochemistry and metabonomics . Results Aspartame sensitive and non-sensitive participants differed psychologically at baseline in h and ling feelings and perceived stress . Sensitive participants had higher triglycerides ( 2.05 ± 1.44 vs. 1.26 ± 0.84mmol/L ; p value 0.008 ) and lower HDL-C ( 1.16 ± 0.34 vs. 1.35 ± 0.54 mmol/L ; p value 0.04 ) , reflected in 1H NMR serum analysis that showed differences in the baseline lipid content between the two groups . Urine metabonomic studies showed no significant differences . None of the rated symptoms differed between aspartame and control bars , or between sensitive and control participants . However , aspartame sensitive participants rated more symptoms particularly in the first test session , whether this was placebo or control . Aspartame and control bars affected GLP-1 , GIP , tyrosine and phenylalanine levels equally in both aspartame sensitive and non-sensitive subjects . Conclusion Using a comprehensive battery of psychological tests , biochemistry and state of the art metabonomics there was no evidence of any acute adverse responses to aspartame . This independent study gives reassurance to both regulatory bodies and the public that acute ingestion of aspartame does not have any detectable psychological or metabolic effects in humans . Trial Registration IS RCT N Registry IS RCT BACKGROUND The consumption of sucrose-sweetened soft drinks ( SSSDs ) has been associated with obesity , the metabolic syndrome , and cardiovascular disorders in observational and short-term intervention studies . Too few long-term intervention studies in humans have examined the effects of soft drinks . OBJECTIVE We compared the effects of SSSDs with those of isocaloric milk and a noncaloric soft drink on changes in total fat mass and ectopic fat deposition ( in liver and muscle tissue ) . DESIGN Overweight subjects ( n = 47 ) were r and omly assigned to 4 different test drinks ( 1 L/d for 6 mo ) : SSSD ( regular cola ) , isocaloric semiskim milk , aspartame-sweetened diet cola , and water . The amount of intrahepatic fat and intramyocellular fat was measured with (1)H-magnetic resonance spectroscopy . Other endpoints were fat mass , fat distribution ( dual-energy X-ray absorptiometry and magnetic resonance imaging ) , and metabolic risk factors . RESULTS The relative changes between baseline and the end of 6-mo intervention were significantly higher in the regular cola group than in the 3 other groups for liver fat ( 132 - 143 % , sex-adjusted mean ; P < 0.01 ) , skeletal muscle fat ( 117 - 221 % ; P < 0.05 ) , visceral fat ( 24 - 31 % ; P < 0.05 ) , blood triglycerides ( 32 % ; P < 0.01 ) , and total cholesterol ( 11 % ; P < 0.01 ) . Total fat mass was not significantly different between the 4 beverage groups . Milk and diet cola reduced systolic blood pressure by 10 - 15 % compared with regular cola ( P < 0.05 ) . Otherwise , diet cola had effects similar to those of water . CONCLUSION Daily intake of SSSDs for 6 mo increases ectopic fat accumulation and lipids compared with milk , diet cola , and water . Thus , daily intake of SSSDs is likely to enhance the risk of cardiovascular and metabolic diseases . This trial is registered at clinical trials.gov as NCT00777647 CONTEXT Sugar-sweetened beverages like soft drinks and fruit punches contain large amounts of readily absorbable sugars and may contribute to weight gain and an increased risk of type 2 diabetes , but these relationships have been minimally addressed in adults . OBJECTIVE To examine the association between consumption of sugar-sweetened beverages and weight change and  risk of type 2 diabetes in women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort analyses conducted from 1991 to 1999 among women in the Nurses ' Health Study II . The diabetes analysis included 91,249 women free of diabetes and other major chronic diseases at baseline in 1991 . The weight change analysis included 51,603 women for whom complete dietary information and body weight were ascertained in 1991 , 1995 , and 1999 . We identified 741 incident cases of confirmed type 2 diabetes during 716,300 person-years of follow-up . MAIN OUTCOME MEASURES Weight gain and incidence of type 2 diabetes . RESULTS Those with stable consumption patterns had no difference in weight gain , but weight gain over a 4-year period was highest among women who increased their sugar-sweetened soft drink consumption from 1 or fewer drinks per week to 1 or more drinks per day ( multivariate-adjusted means , 4.69 kg for 1991 to 1995 and 4.20 kg for 1995 to 1999 ) and was smallest among women who decreased their intake ( 1.34 and 0.15 kg for the 2 periods , respectively ) after adjusting for lifestyle and dietary confounders . Increased consumption of fruit punch was also associated with greater weight gain compared with decreased consumption . After adjustment for potential confounders , women consuming 1 or more sugar-sweetened soft drinks per day had a relative risk [ RR ] of type 2 diabetes of 1.83 ( 95 % confidence interval [ CI ] , 1.42 - 2.36 ; P<.001 for trend ) compared with those who consumed less than 1 of these beverages per month . Similarly , consumption of fruit punch was associated with increased diabetes risk ( RR for > or = 1 drink per day compared with < 1 drink per month , 2.00 ; 95 % CI , 1.33 - 3.03 ; P = .001 ) . CONCLUSION Higher consumption of sugar-sweetened beverages is associated with a greater magnitude of weight gain and an increased risk for development of  type 2 diabetes in women , possibly by providing excessive calories and large amounts of rapidly absorbable sugars Ten healthy volunteers with no history of aspartame intolerance ( 6 men and 4 women , aged 21 - 36 years ) received a single dose of aspartame ( 15 mg/kg body weight in capsules ) or matching placebo in a r and omized , double-blind crossover study . Eleven blood sample s collected over 24 hours were analyzed for plasma glucose and amino acid concentrations . The following variables were evaluated at 1 , 2 , 4 , 8 , and 24 hours post-dosage : changes in mood measured on visual analog scales , cognitive function determined by digit-symbol substitution test ( DSST ) and arithmetic test scores , and reaction time measured with a brake-pedal reaction timer . Memory was tested at 2 and 24 hours after dosage based on recall of st and ardized 16-item word lists . No significant differences between aspartame and placebo were found in measures of sedation , hunger , headache , reaction-time , cognition , or memory at any time during the study . Plasma phenylalanine levels were significantly higher following aspartame ( P less than .01 ) than with placebo between 1 and 6 hours postdosage , reaching a maximum difference of + 3.36 mumols/dl at 2 hours . Plasma glucose concentrations were not significantly different between aspartame and placebo . The results of this study suggest that following a single 15 mg/kg dose of aspartame , no detectable effects are observed in a group of healthy volunteers with no history of aspartame intolerance , despite significant increases in plasma phenylalanine concentrations Background / objective : Artificial sweeteners were thought to be metabolically inactive , but after demonstrating that the gustatory mechanism was also localized in the small intestine , suspicions about the metabolic effects of artificial sweeteners have emerged . The objective of this study was to determine the effect of artificial sweeteners ( aspartame and sucralose ) on blood glucose , insulin , c-peptide and glucagon-like peptide-1 ( GLP-1 ) levels . Subjects/ methods : Eight newly diagnosed drug-naive type 2 diabetic patients ( mean age 51.5±9.2 years ; F/M : 4/4 ) and eight healthy subjects ( mean age 45.0±4.1 years ; F/M : 4/4 ) underwent 75 g oral glucose tolerance test ( OGTT ) . During OGTT , glucose , insulin , c-peptide and GLP-1 were measured at 15- min intervals for 120 min . The OGTTs were performed at three setting s on different days , where subjects were given 72 mg of aspartame and 24 mg of sucralose in 200 ml of water or 200 ml of water alone 15 min before OGTT in a single-blinded r and omized order . Results : In healthy subjects , the total area under the curve ( AUC ) of glucose was statistically significantly lower in the sucralose setting than in the water setting ( P=0.002 ) . There was no difference between the aspartame setting and the water setting ( P=0.53 ) . Total AUC of insulin and c-peptide was similar in aspartame , sucralose and water setting s. Total AUC of GLP-1 was significantly higher in the sucralose setting than in the water setting ( P=0.04 ) . Total AUC values of glucose , insulin , c-peptide and GLP-1 were not statistically different in three setting s in type 2 diabetic patients . Conclusions : Sucralose enhances GLP-1 release and lowers blood glucose in the presence of carbohydrate in healthy subjects but not in newly diagnosed type 2 diabetic patients Twelve normal subjects and 10 subjects with non-insulin-dependent diabetes mellitus were given , in r and om order at intervals of ≥ 1 wk , three drinks of the same beverage : one unsweetened , one sweetened with 400 mg aspartame , and one sweetened with 135 mg saccharin . The amount of sweetener approximated that in 1 L of sugar-free soft drink . Plasma glucose , insulin , and glucagon were measured for 3 h after ingestion of the test beverage . Plasma glucose declined slightly throughout the test period , probably due to fasting , with no differences between the three treatments . Neither sweetener affected peak insulin levels in subjects with or without diabetes . Analysis of area under the curve showed that mean insulin levels were statistically significantly higher after aspartame than after saccharin or unsweetened beverage in normal subjects only , but the magnitude of the difference was small and unlikely to be of physiological importance in the absence of differences in glucose levels . Furthermore , the differences could largely be accounted for by a decrease in insulin values after both unsweetened beverage and saccharin , with no change from baseline after aspartame . Glucagon levels showed time-to-time variation but no overall differences . We conclude that ingestion of aspartame- or saccharin-sweetened beverages by fasting subjects , with or without diabetes , did not affect blood glucose homeostasis In a study of the impact of aspartame , fat , and carbohydrate on appetite , we monitored blood glucose continuously for 431 ( SE 16 ) min . Ten healthy males ( 19 - 31 years ) participated in three time-blinded visits . As blood glucose was monitored , appetite ratings were scored at r and omized times . On the first meal initiation , volunteers consumed one of three isovolumetric drinks ( aspartame , 1 MJ simple carbohydrate , and 1 MJ high-fat ; r and omized order ) . High-fat and high-carbohydrate foods were available ad libitum subsequently . Blood glucose patterns following the carbohydrate drink ( + 1.78 ( SE 0.28 ) mmol/l in 38 ( SE 3 ) min ) and high-fat drink ( + 0.83 ( SE 0.28 ) mmol/l in 49 ( SE 6 ) min ) were predictive of the next intermeal interval ( R 0.64 and R 0.97 respectively ) . Aspartame ingestion was followed by blood glucose declines ( 40 % of subjects ) , increases ( 20 % ) , or stability ( 40 % ) . These patterns were related to the volunteers ' perception of sweetness of the drink ( R 0.81 , P = 0.014 ) , and were predictive of subsequent intakes ( R -0.71 , P = 0.048 ) . For all drinks combined , declines in blood glucose and meal initiation were significantly associated ( chi 2 16.8 , P < 0.001 ) , the duration of blood glucose responses and intermeal intervals correlated significantly ( R 0.715 , P = 0.0001 ) , and sweetness perception correlated negatively with hunger suppression ( R -0.471 , P = 0.015 ) . Effects of fat , carbohydrate , and aspartame on meal initiation , meal size , and intermeal interval relate to blood glucose patterns . Varied blood glucose responses after aspartame support the controversy over its effects , and may relate to sweetness perception Despite some reports that aspartame (APM)-sweetened beverages may increase subjective appetite , previously we demonstrated that drinking 280 ml of an APM-sweetened soft drink ( 170 mg APM ) had no effect on appetite , and 560 ml of the same soft drink ( 340 mg APM ) reduced appetite . The present study examined this appetite reduction to determine its cause . Eighteen normal weight young adult males received five treatments ( beverage preloads ) at 1100 h in a r and omized order , one per week : 280 ml of carbonated mineral water ( CMW ) ( control ) , 560 ml of CMW , 280 ml of CMW with 340 mg of encapsulated APM , 280 ml of CMW sweetened with 340 mg APM , 560 ml of an APM-sweetened soft drink ( 340 mg APM ) . Subjective hunger and food appeal were measured from 0930 a.m. to 1230 h , and food intake from a buffet lunch offered at 1205 h was measured . Treatment had no effect on food intake or macronutrient selection . Both 560 ml of CMW or soft drink suppressed appetite , although 280 ml of APM-sweetened mineral water significantly increased subjective appetite relative to the control . Encapsulated APM had no effect on appetite . Therefore , appetite reduction following consumption of an APM-sweetened drink is likely due to drink volume and not the APM content . In addition , consuming APM-sweetened CMW produces a short-term increase in subjective appetite OBJECTIVE High concentrations of fructose enhance postpr and ial lipemia following lipid loading whereas glucose exerts a negative or minimal effect . This study evaluated the effect of lower sweetener concentrations and the contribution of their sweetness level and palatability . METHODS At each of four test sessions , twelve male and ten female healthy adults ingested one of four milkshakes containing 108 g dairy cream alone or supplemented with 30 g fructose , 17.5 g glucose or 1 g aspartame .  Blood sample s were collected at baseline , two , four , six and eight hours after ingestion . Sensory discrimination tests were conducted after the last two sessions . RESULTS Fructose and glucose led to 37 % ( p = 0.03 ) and 59 % ( p = 0.08 ) rises in triacylglycerol area under the curve ( TG AUC ) when compared to the plain milkshake , respectively . Although the sweetened shakes were equisweet and were more palatable than the plain shake , the TG rise after the aspartame milkshake did not differ from the plain milkshake . CONCLUSIONS These data indicate that low levels of glucose and fructose consumed with lipid enhance postpr and ial lipemia . Sweetness and palatability did not account for the effect Sixty-two subjects having either insulin-dependent or non-insulin-dependent diabetes completed a r and omized , double-blind study comparing effects of aspartame or a placebo on blood glucose control . Twenty-nine subjects consumed 2.7 g aspartame per day for 18 wk , given as aspartame-containing capsules with meals , while 33 subjects took identical appearing placebo capsules . After 18 wk , no changes were seen in fasting or 2-h postpr and ial blood glucose levels or glycohemoglobin levels in either the aspartame- or placebo-treated groups . Adverse reactions were no more common in the group taking aspartame . We conclude that use of aspartame as a low-calorie sweetener does not adversely affect glycemic control of persons with diabetes A study was design ed to determine the effect of the consumption of the nutritive sweetener aspartame on non-insulin-dependent diabetics . Forty-three adult diabetics between the ages of 21 and 70 completed a 90-day study ; all were diabetics whose conditions were managed by diet and /or hypoglycemic agents . Participants in the blind study were instructed to continue their usual diet and to take two capsules of an assigned preparation three times daily with meals , either the aspartame or the placebo . The 1.8 g of aspartame administered is approximately three times the expected daily consumption of aspartame if used as a sweetener to replace sugar . Throughout the study subjects were examined for ( 1 ) symptoms of intolerance , ( 2 ) fasting plasma phenylalanine levels exceeding 4 mg/100 ml , and ( 3 ) deterioration of diabetic control . At the conclusion of the study subjects exhibited no symptoms that could be traced to the administration of aspartame or the placebo , and diabetic control was unaffected by the chronic administration of these substances . Aspartame seems to be well tolerated by non-insulin-dependent diabetics This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence BACKGROUND Increased energy intake is consistently observed in individuals consuming sugar-sweetened beverages ( SSBs )  , likely mainly because of an inadequate satiety response to liquid calories . However , SSBs have a high content of fructose , the consumption of which acutely fails to trigger responses in key signals involved in energy homeostasis . It is unclear whether the fructose content of SSBs contributes to the increased energy intake in individuals drinking SSBs . OBJECTIVE We investigated whether the relative amounts of fructose and glucose in SSBs modifies ad libitum energy intake over 8 d in healthy adults without fructose malabsorption . DESIGN We conducted 2 r and omized , controlled , double-blind crossover studies to compare the effects of consuming 4 servings/d of a fructose- , glucose- , or aspartame-sweetened beverage  ( study A ; n = 9 )  or a fructose- , glucose- , or high-fructose corn syrup (HFCS)-sweetened beverage  ( study B ; n = 24 ) for 8 d on overall energy intake . SSBs were provided at 25 % of estimated energy requirement , or an equivalent volume of the aspartame-sweetened beverage , and consumption was m and atory . All solid foods were provided at 125 % of estimated energy requirements and were consumed ad libitum . RESULTS In study A , ad libitum energy intake was 120 % ± 10 % , 117 % ± 12 % , and 102 % ± 15 % of estimated energy requirements when subjects consumed the fructose- , glucose- , and aspartame-sweetened beverages . Energy intake was significantly higher in the fructose and glucose phases than in the aspartame phase ( P < 0.003 for each ) , with no difference between the fructose and glucose phases ( P = 0.462 ) . In study B , total energy intake during the fructose , HFCS , and glucose phases was 116 % ± 14 % , 116 % ± 16 % , and 116 % ± 16 % of the subject 's estimated total energy requirements ( P = 0.880 ) . CONCLUSIONS In healthy adults , total 8-d ad libitum energy intake was increased in individuals consuming SSBs compared with aspartame-sweetened beverages . The energy overconsumption observed in individuals consuming SSBs occurred independently of the relative amounts of fructose and glucose in the beverages . These trials were registered at clinical trials.gov as NCT00475475 and NCT01424306 This study explores whether the addition of aspartame-sweetened foods and beverages to a low fat , hypocaloric diet enhances compliance and result ing weight loss .  Fifty-nine obese ( 130 - 225 % of ideal body weight ) , free living men and women were r and omly assigned to either a Balanced Deficit Diet ( BDD ) or a BDD supplemented with aspartame . Over a 12-week weight loss period , volunteers attended weekly support group meetings including behavior modification training and exercise instruction . Males achieved a clinical ly significant weight loss ( greater than 23 lb ) in both study groups , while females lost an average of 12.8 lb in the control group vs. 16.5 lb in the experimental group . In both treatment groups , sleep , general energy level , level of physical activity , and feeling of well-being showed clinical ly meaningful improvement . This study suggests possible advantages to supplementing a BDD with aspartame-sweetened foods as part of a multidisciplinary weight loss program . The small sample size prohibits definitive conclusions but does provide the protocol for a larger , outpatient clinical trial
target: Data concerning effects of aspartame on main metabolic variables associated to diabetes and obesity do not support a beneficial related to its consumption
background: ABSTRACT Data about harms or benefits associated with the consumption of aspartame , a nonnutritive sweetener worldwide consumed , are still controversial .
  This systematic review and meta- analysis of r and omized controlled clinical trials aim ed to assess the effect of aspartame consumption on  metabolic parameters related to diabetes and obesity .