The effect of coconut sugar on cariogenic traits in Streptococcus mutans / Efeito do Açúcar de Coco na cariogenicidade do Streptococcus mutans

Aim: The consumption of foods rich in sugar is linked to several non-communicable diseases, including dental caries. Coconut sugar has systemic benefits due to its lower glycemic indexes (GI) than other table sugars. However, there is currently no data regarding its ca-riogenic potential. This study aimed to evaluate the effect of coconut sugar on acidogenicity and adhesion of Streptococcus mutans in vitro, compared to sugarcane products. Materials and methods: Aliquots of cultu-res of S. mutans UA159 were resuspended in a buffer solution enriched with coconut sugar, crystal sugar (refined sugar), and minimally processed sugarcane (demerara light brown sugar and maskavo dark brown sugar), as well as positive (sucrose) and negative con-trols. The decrease in pH and its corresponding area under the curve (AUC; cm2) were evaluated for the analysis of acidogenicity. S.mutans was incubated in BHI supplemented with each sugar and the percentages of microbial adhesion were calculated. After testing data normality, the one-way ANOVA test (Bonferroni post hoc) was used to compare the AUC and the pro-portion of adhesion of each group. Results: Regarding the acidogenic potential, statistical differences were found only between the negative control versus all other groups (p<0.001). Likewise, no significant difference in adhesion was found between the tested sugars (p>0.05). Discussion: Although the tested sugars are marketed as "healthy products," their amount and frequency of usage should be controlled. Conclusion: Coconut su-gar presents a similar cariogenic potential to that of sugarcane products when acidogenicity and adhesion are evaluated. Coconut sugar is not indicated as a substitute for sucrose in the control of cariogenic activity.

Objetivo: O consumo de alimentos ricos em açúcar está associado a diversas doenças não transmissíveis, incluindo a doença cárie. O açúcar de coco tem benefícios sistêmi-cos devido aos seus índices glicêmicos (IG) mais baixos do que outros açúcares de mesa. No entanto, atualmente não há dados sobre seu potencial cariogênico. Esse estu-do teve como objetivo avaliar o efeito do açúcar do coco na acidogenicidade e adesão de Streptococcus mutans in vitro, em comparação com produtos derivados da cana--de-açúcar. Materiais e métodos: alíquotas de culturas de S. mutans UA159 foram suspensas em solução tampão enriquecida com açúcar de coco, açúcar cristal (açúcar refinado) e cana-de-açúcar minimamente processada (açúcar mascavo demerara claro e açúcar mascavo), além de controles positivo (sacarose) e negativo. A diminuição do pH e correspondente área sob a curva (AUC; cm2) fo-ram avaliadas na análise de acidogenicidade. S. mutansfoi incubado em BHI suplementado com cada tipo de açúcar e as porcentagens de adesão microbiana foram calculadas. Após testar a normalidade dos dados, o teste ANOVA de uma via (Bonferroni post hoc) foi utilizado para comparar a AUC e a proporção de adesão de cada grupo. Resultados: Em relação ao potencial acidogênico, diferenças estatísticas foram encontradas apenas entre o controle negativo versus todos os outros grupos (p <0,001). Não foi encontrada diferença significativa na adesão en-tre os açúcares testados (p> 0,05). Discussão: Apesar dos açúcares testados serem comercializados como "produtos saudáveis", sua quantidade e frequência de consumo deve ser controlada. Conclusão: O açúcar do coco apresenta potencial cariogênico semelhante à dos produtos da cana-de-açúcar quanto a acidogenicidade e a adesão. O açúcar de coco não é indicado como substituto da sacarose no controle da atividade cariogênica.

Efectos de azúcares totales sustitutos de sacarosa en la salud bucal. Revisión bibliográfica / Effects of sucrose substitute total sugars on oral health. Bibliographic review

Se realizó una revisión bibliográfica sobre los efectos de azúcares totales sustitutos de sacarosa sobre el estado de salud bucal. Los artículos científicos fueron localizados en bases de datos científicas digitales: Scopus, PubMed, Web Of Science y Ovid. Las fuentes empleadas son de libre acceso, 49 de los manuscritos fueron descartados, quedando 23. El 43,5% de los artículos mostraban resultados de ensayos clínicos sobre las gomas de mascar con xilitol, el 39,1% acerca de otros compuestos (stevia, magnolia, eritritol, fostato de calcio), el 13% revisiones narrativas y el 4,4% metaanálisis. Las gomas de mascar hechas con sustitutos de sacarosa estimulan la producción salival, neutralizan y elevan su pH, reconociéndosele su función promotora de salud bucal en varias publicaciones científicas. Los efectos anticariogénicos del xilitol están establecidos en diversos estudios. No existen suficientes estudios sobre los efectos de las sustancias: stevia, d-tagatosa, magnolia, eritritol y fostato de calcio.

A bibliographic review was carried out on the effects of sucrose substitute total sugars on the state of oral health. The scientific articles were in the following digital scientific databases: Scopus, PubMed, Web of Science and Ovid. The sources used were freely accessible, 49 of the manuscripts gotten by the search were discarded and 23 were used. 43.5% of the articles inclu-ded showed results of clinical trials on chewing gums with xylitol, 39.1% about other com-pounds (stevia, magnolia, erythritol, calcium phosphate), 13% narrative reviews and the 4.4% meta-analysis. Chewing gums made with sucrose substitutes stimulate salivary production, neutralize and raise its pH. That is why, its role in promoting oral health is recognized in several scientific publications. The anticariogenic effects of xylitol were established in various studies. There were not enough studies on the effects of the substances: stevia, d-tagatose, magnolia, erythritol and calcium phosphate

Edulcorantes artificiales y su papel en la enfermedad renal crónica: una revisión

Los edulcorantes no calóricos surgieron como una opción segura y saludable en el marco de la alimentación y, por lo tanto, han sido de gran interés en la cultura dietética adquirida en la actualidad; es importante mencionar que en esta cultura adquirida el consumo de comida rápida y con altos niveles de azúcar ha tomado especial fuerza, lo que repercute negativamente en la incidencia de enfermedades metabólicas. En este orden de ideas, los edulcorantes no calóricos se convierten en una mejor opción para la salud en la que no es necesario hacer un cambio drástico en el estilo de vida. No obstante, los beneficios de los edulcorantes artificiales no calóricos no han sido estudiados a profundidad y no se ha evidenciado que una dieta a base de estos sustitutivos provoque un cambio significativo en el desarrollo de enfermedades metabólicas asociadas al consumo de azúcar, por el contrario, se han relacionado con enfermedades como obesidad, diabetes mellitus tipo 2 y síndrome metabólico. Asimismo, estos pueden provocar una serie de cambios metabólicos a través de distintos mecanismos que terminan en proteinuria progresiva y descenso de la tasa de filtrado glomerular. A partir de lo anterior, se hace necesario un análisis del riesgo que se corre al elegir esta opción alimenticia, para así no dejarse llevar por los procesos mediáticos que los promocionan, sino más bien, regirse por los hallazgos científicos.

Non-caloric artificial sweeteners have emerged to offer a safe and healthy option in the framework of food. They have received special attention in recent decades, precisely because of the current food culture, where fast food and high sugar consumption have taken on special strength, which has a negative impact on the incidence of metabolic diseases. In that order of ideas, non-caloric artificial sweeteners propose better health without the need for a drastic change in lifestyle. However, its benefits have not been studied in depth, in addition to the fact that there has been no significant change in the development of metabolic diseases associated with sugar consumption, on the contrary, they have been related to diseases such as obesity, type 2 diabetes mellitus and metabolic syndrome. Likewise, they cause a series of metabolic changes by different mechanisms that end in progressive proteinuria and a decrease in the glomerular filtration rate. In order with the above, an analysis of the risk to which one is subjected when choosing this food option is necessary, and not be deafened, much less dazzled by the media processes, if not rather, be governed by scientific findings.

Consumo crónico de edulcorantes en ratones y su efecto sobre el sistema inmunitario y la microbiota del intestino delgado / Chronic consumption of sweeteners in mice and its effect on the immune system and the small intestine microbiota

Resumen Introducción. Los edulcorantes son aditivos que se consumen en los alimentos. Pueden ser naturales (sacarosa y estevia) o artificiales (sucralosa). Actualmente, se consumen rutinariamente en múltiples productos, y sus efectos en la mucosa y la microbiota del intestino delgado aún son controversiales. Objetivo. Relacionar el consumo de edulcorantes y su efecto en el sistema inmunitario y la microbiota del intestino delgado en ratones CD1. Materiales y métodos. Se utilizaron 54 ratones CD1 de tres semanas de edad divididos en tres grupos: un grupo de tres semanas sin tratamiento, un grupo tratado durante seis semanas y un grupo tratado durante 12 semanas. Se les administró sacarosa, sucralosa y estevia. A partir del intestino delgado, se obtuvieron linfocitos B CD19+ y células IgA+, TGF-ß (Transforming Growth Factor-beta) o el factor de crecimiento transformador beta (TGF-beta), IL-12 e IL-17 de las placas de Peyer y de la lámina propia. De los sólidos intestinales se obtuvo el ADN para identificar las especies bacterianas. Resultados. Después del consumo de sacarosa y sucralosa durante 12 semanas, se redujeron las comunidades bacterianas, la IgA+ y el TGF-beta, se aumentó el CD19+, y además, se incrementaron la IL-12 y la IL-17 en las placas de Peyer; en la lámina propia, aumentaron todos estos valores. En cambio, con la estevia mejoraron la diversidad bacteriana y el porcentaje de linfocitos CD19+, y hubo poco incremento de IgA+, TGF-ß e IL-17, pero con disminución de la IL-17. Conclusión. La sacarosa y la sucralosa alteraron negativamente la diversidad bacteriana y los parámetros inmunitarios después de 12 semanas, en contraste con la estevia que resultó benéfica para la mucosa intestinal.

Abstract Introduction: Sweeteners are additives used in different foods. They can be natural (sucrose and stevia) or artificial (sucralose). Currently, they are routinely consumed in multiple products and their effects on the mucosa of the small intestine and its microbiota are still controversial. Objective: To relate the consumption of sweeteners and their effect on the immune system and the microbiota of the small intestine in CD1 mice. Materials and methods: We used 54 three-week-old CD1 mice divided into three groups in the experiments: 1) A group of three weeks without treatment, 2) a group treated for six weeks, and 3) a group treated for 12 weeks using sucrose, sucralose, and stevia. We obtained CD19+ B lymphocytes, IgA+ antibodies, transforming growth factor-beta (TGF-b), and interleukins 12 and 17 (IL-12 and -17) from Peyer's patches and lamina propria cells while DNA was obtained from intestinal solids to identify bacterial species. Results: After 12 weeks, sucrose and sucralose consumption caused a reduction in bacterial communities with an increase in CD19+, a decrease in IgA+ and TGF-b, and an increase in IL-12 and -17 in the Peyer's patches while in the lamina propria there was an increase in all parameters. In contrast, stevia led to an improvement in bacterial diversity and percentage of CD19+ lymphocytes with minimal increase in IgA+, TGF-b, and IL-12, and a decrease in IL-17. Conclusion: Sucrose and sucralose caused negative alterations in bacterial diversity and immune parameters after 12 weeks; in contrast, stevia was beneficial for the intestinal mucosa.

Consumo de edulcorantes no nutritivos: efectos a nivel celular y metabólico / Consumption of Non-nutritive Sweeteners: Cellular and Metabolic Effects

Resumen Antecedentes: la función principal de los edulcorantes no nutritivos es proveer al consumidor un producto dulce sin la carga calórica del azúcar. El consumo de edulcorantes no nutritivos se relaciona con alteraciones en el ADN, con apoptosis y con la síntesis de precursores de cáncer. Además, su consumo también se relaciona recientemente con un incremento de tejido adiposo. Objetivo: analizar el efecto de los edulcorantes no nutritivos a largo plazo, evaluando el riesgo de estos compuestos. Materiales y métodos: búsqueda en bases de datos, PubMed, SciELO y Redalyc, y análisis de bibliografía relacionada con efectos tóxicos y metabólicos del consumo de edulcorantes no nutritivos. Resultados: el consumo de estos edulcorantes presentó efectos citotóxicos en diferentes modelos de estudio. Parece existir una relación con el incremento en la síntesis de tejido adiposo, que provoca obesidad y enfermedades derivadas. Los edulcorantes sintéticos fueron los que presentaron más alteraciones citotóxicas, mientras que edulcorantes naturales, a excepción de los esteviósidos, no presentaron efectos adversos. Múltiples investigaciones explican el efecto del consumo de estos edulcorantes en el metabolismo y los efectos citotóxicos. Conclusiones: el tema de edulcorantes es controversial, por ello la información recopilada en esta revisión busca proporcionar un panorama que ayude a comprender la respuesta a nivel celular y metabólico sobre su consumo.

Abstract Background: The primary function of non-nutritive sweeteners is to provide the consumer with a sweet product without the caloric load of sugar. The consumption of non-nutritive sweeteners is related to alterations in DNA, apoptosis, and the synthesis of cancer precursors. Recently, its consumption has been related to an increase in adipose tissue. Objective: To analyze the effect of long-term consumption of these sweeteners and evaluate the risk of these related factors. Materials and Methods: Pubmed, Scielo and Redalyc database search and analysis of references related to toxic and metabolic effects of consumption of non-nutritrive sweeteners. Results: The consumption presents cytotoxic effects in different study models. There appears to be a relationship with an increase in synthesis of adipose tissue, which causes obesity and derived diseases. Synthetic sweeteners have the most cytotoxic alterations, whereas natural sweeteners, except steviosides, do not present adverse effects. Multiple investigations explain the impact of non-nutritive sweetener consumption on metabolism and related cytotoxic effects. Conclusion: The issue of sweeteners is controversial; therefore the information compiled in this review seeks to provide a panorama that helps understand the cellular and metabolic level responses of their consumption.

Regulation of Inflammation by Sucrose Isomer, Turanose, in Raw 264.7 Cells

Increased sugar consumption has been proposed to be a risk factor for obesity-related metabolic disorders. The objective of this study was to investigate the anti-inflammatory effect of turanose in Raw 264.7 macrophages. Turanose (3-O-α-D-glucosyl-D-fructose), an isomer of sucrose, naturally exists in honey. For these studies, macrophages were treated with total glucose (Glu), 50% Glu/50% turanose (T50), 25% Glu/75% turanose (T75), and 100% turanose (T100), each with a total concentration of 25 mM in cell media. Expressions of inflammatory enzymes and cytokines were analyzed. Cell viability was not affected in the turanose treated groups compared to the Glu group. Lipopolysaccharide and glucose-induced nitric oxide production, protein expression of inducible nitric oxide synthase, COX-2, and superoxide dismutase 2, and mRNA expression levels of interleukin (IL)-1β and IL-18 were significantly suppressed by turanose treatment. These results demonstrate that turanose exerts anti-inflammatory effects in vitro, and possesses potential to serve therapeutic functional sweetener for testing in vivo and in clinical trials.

Artificial Sweeteners: A Systematic Review and Primer for Gastroenterologists

Artificial sweeteners (AS) are ubiquitous in food and beverage products, yet little is known about their effects on the gastrointestinal (GI) tract, and whether they play a role in the development of GI symptoms, especially in patients with irritable bowel syndrome. Utilizing the PubMed and Embase databases, we conducted a search for articles on individual AS and each of these terms: fermentation, absorption, and GI tract. Standard protocols for a systematic review were followed. At the end of our search, we found a total of 617 eligible papers, 26 of which were included. Overall, there is limited medical literature available on this topic. The 2 main areas on which there is data to suggest that AS affect the GI tract include motility and the gut microbiome, though human data is lacking, and most of the currently available data is derived from in vivo studies. The effect on motility is mainly indirect via increased incretin secretion, though the clinical relevance of this finding is unknown as the downstream effect on motility was not studied. The specific effects of AS on the microbiome have been conflicting and the available studies have been heterogeneous in terms of the population studied and both the AS and doses evaluated. Further research is needed to assess whether AS could be a potential cause of GI symptoms. This is especially pertinent in patients with irritable bowel syndrome, a population in whom dietary interventions are routinely utilized as a management strategy.

Anticariogenic properties and effects on periodontal structures of Stevia rebaudiana Bertoni: narrative review / Propiedades anticariogénicas y efectos a nivel periodontal de Stevia rebaudiana Bertoni: revisión narrativa

Introduction: Stevia rebaudiana Bertoni is a natural non-caloric sweetener, withmore sweetness than sucrose, without adverse effects, which has demonstrated to have multiples benefits to the systemic health and recently to the oral health. This review’s objective is to describe anti-cariogenic and anti-periodontophatics properties of its extracts. Results: Stevioside and rebaudioside A are the most important glycosides of the Stevia and none is cariogenic. In vitro researches have shown that Stevia extracts have anti-bacterial activity on Streptococcus mutans, Streptococcus sobrinus and Lactobacillus acidophilus, organisms that are closely related to the production and development of tooth decay. In vivo and in vitro it has been observed that the production of bacterial acids decrease attributing it a low acidogenic potential and a lesser effect of the demineralization of the enamel in comparison with others sweeteners. Furthermore, in vivo it has been proved an anti-plaque effect mainly due to a decrease in the production of bacterial insoluble polymers. These characteristics in combination with antiinflammatory properties could result potentially effective in the treatment of periodontal diseases in significant numbers, as it has been observed in studies conducted in animals. Conclusion: Stevia presents properties that potentially are anti-caries and anti periodontal diseases. However, in vivo studies are necessary to confirm these assumptions and provide a greater understanding of the mechanisms of action of this plant and the components involved. Notwithstanding, with the existing background, this sweetener can be postulated as a potential therapeutic complement in the odontological care, especially in patients that present base conditions such as obesity, diabetes and high blood pressure.

Introducción: Stevia rebaudiana bertoni es un edulcorante natural no calórico, con mayor dulzor que la sacarosa, sin efectos adversos, que ha demostrado tener múltiples beneficiosos para la salud sistémica y recientemente para la salud oral. El objetivo de esta revisión es describir propiedades anticariogénicas y antiperiodontopáticas de sus extractos. Resultados: Esteviósido y rebaudiósido A son los glicósidos más importantes de Stevia y ninguno es cariogénico. Estudios in vitro han demostrado que extractos de Stevia presentan actividad antibacteriana sobre Streptococcus mutans, Streptococcus sobrinus y Lactobacillus acidophillus, organismos estrechamente relacionados en la producción y desarrollo de caries. In vivo e in vitro se ha observado que disminuye la producción de ácidos bacterianos atribuyéndosele un bajo potencial acidogénico y un menor efecto de desmineralización del esmalte en comparación con otros edulcorantes. Además, in vivo se ha comprobado un efecto antiplaca principalmente debido a una disminución en la producción de polímeros insolubles bacterianos. Estas características, más sus propiedades antiinflamatorias y cicatrizantes, podrían resultar potencialmente efectivas en el tratamiento de enfermedades periodontales en cifras significativas, como se ha observado en estudios desarrollados en animales. Conclusión: Stevia presenta propiedades potencialmente anti-caries y anti-enfermedades periodontales. Sin embargo, son necesarios estudios in vivo que confirmen estos postulados y proporcionen una mayor comprensión de sus mecanismos de acción y de los componentes que intervienen. No obstante, con los antecedentes existentes, se puede postular a este edulcorante como un potencial complemento terapéutico en la atención odontológica, sobre todo en pacientes que presentan condiciones de base como obesidad, diabetes e hipertensión.

Utilização de adoçantes dietéticos entre adultos em Pelotas, Rio Grande do Sul, Brasil: um estudo de base populacional / Use of diet sweeteners by adults in Pelotas, Rio Grande do Sul State, Brazil: a population-based study

Estudo de base populacional avaliou o uso de adoçantes dietéticos na população com idade ≥ 20 anos, residente na zona urbana do Município de Pelotas, Rio Grande do Sul, Brasil. A coleta de dados ocorreu entre janeiro e julho de 2010, e 2.732 indivíduos foram entrevistados. Além das questões específicas quanto ao uso de adoçante dietético, foram coletadas informações sobre características demográficas, socioeconômicas e de saúde. Para as análises estatísticas, foram utilizados testes qui-quadrado de heterogeneidade e de tendência linear. A prevalência de uso de adoçante dietético foi 19 por cento (IC95 por cento: 17,1; 20,9), sendo 3,7 vezes maior entre idosos do que entre aqueles com 20-29 anos de idade. Nível econômico e estado nutricional apresentaram associação direta e significativa com o desfecho. Quase 98 por cento da amostra utilizou adoçantes na forma líquida, sendo os mais consumidos (89,2 por cento) aqueles constituídos por sacarina e ciclamato de sódio. A mediana de ingestão diária foi 10 gotas (P25; P75 = 6; 18), entre usuários de adoçante líquido, ou 1,5 sachet (P25; P75 = 1; 4), para adoçante em pó. O uso de adoçante dietético foi maior entre mulheres e idosos.

This population-based study evaluated the use of diet sweeteners by adults (> 20 years) in Pelotas, Rio Grande do Sul State, Brazil. Data were collected from January to July 2010 (n = 2,732). Besides specific questions on diet sweeteners, demographic, socioeconomic, and health characteristics were recorded. Heterogeneity and linear trend chi-square tests were used for the statistical analysis. Prevalence of sweetener use was 19 percent (95 percentCI: 1.1-20.9), and was 3.7 times higher in elderly individuals as compared to 20-29-year-olds. Economic level and nutritional status were significantly associated with sweetener use. Nearly 98 percent of the sample used liquid sweeteners; the most frequently consumed (89.2 percent) were those containing saccharin or sodium cyclamate. Average intake was 10 drops of liquid sweetener or 1.5 sachets of powdered sweetener. Use of diet sweeteners was higher among women and the elderly.

Avaliação do efeito do aspartame em ratas tratadas durante a prenhez e o reflexo do tratamento em seus fetos / The evaluation of aspartame administration in rats treated during pregnancy and its effect in their fetuses

JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi avaliar o efeito do aspartame em ratas tratadas durante a prenhez e o reflexo do tratamento em seus fetos. MÉTODO: Foram estudadas 33 ratas (11 em cada grupo) da espécie Rattus norvegicus albinus Wistar, com peso médio de 200 g divididas em três grupos distintos: G1 (controle - água), G2 (aspartame - 25 mg/kg/dia) e G3 (aspartame - 50 mg/kg/dia), cujo tratamento ocorreu a partir do 8º ao 12º dia de prenhez. Realizaram-se as determinações séricas de glicose, triglicerídeos, colesterol total e colesterol HDL dos animais. Para as análises estatísticas utilizou-se a Análise de Variância, seguidas pela comparação múltipla, por meio do teste de Tukey (p < 0,05). RESULTADOS: As ratas tratadas do G3 apresentaram as maiores taxas de glicose, colesterol total e HDL. Com relação aos dados morfométricos, o G2 apresentou maior média nas medidas do cordão umbilical e do peso da placenta, com diferença estatisticamente significante apenas no peso da placenta. O G2 apresentou maior média no peso corpóreo e no peso do encéfalo, com diferença estatística, entre todos os grupos, para as duas medidas. Os fetos das ratas tratadas com aspartame (25 e 50 mg/kg/dia) apresentaram resultado estatisticamente significante de malformações em comparação com o G1. CONCLUSÃO: O uso de aspartame pela gestante deve ser restrito a menos que a quantidade diária máxima recomendada.

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the effect of aspartame in rats treated during pregnancy and its consequences on their fetuses. METHOD: We studied 33 rats (11 in each group) of the species Rattus norvegicus Wistar albinos, weighing an average of 200 g that were divided into three groups: G1 (control - water), G2 (aspartame 25 mg/kg/day), and G3 (aspartame 50 mg/kg/day), whose treatment occurred from the 8th to the 12th day of pregnancy. The levels of serum glucose, triglycerides, total cholesterol and HDL cholesterol of the animals were determined. For statistical analysis we used Variance Analysis followed by multiple comparisons using the Tukey test (p < 0.05).RESULTS: The rats treated with G3 showed the highest rates of glucose, total cholesterol and HDL. Regarding the morphometric data, the rats treated with G2 had higher average in measurements of the umbilical cord and placental weight. There was statistically significance only in placental weight. The group of fetuses of rats treated with G2 had higher average in body and brain weights, with statistical difference between all groups for both measures. The fetuses of rats treated with aspartame (25 and 50 mg/kg/day) showed a statistically significant result of malformations compared with the control group. CONCLUSION: The use of aspartame for pregnant women should be restricted to less than the maximum recommended daily dosage

Revisão da literatura sobre recomendações de utilização de edulcorantes em gestantes portadoras de diabetes mellitus / Literature Review about recommendations of use of sweeteners in pregnant women with diabetes mellitus

Trata-se de uma revisão narrativa do conhecimento disponível na literatura sobre a recomendação de edulcorantes nos casos de diabetes na gestação, com consulta às seguintes bases de dados: Medline, Lilacs e PubMed, tendo como base os períodos de 1978 a 2009. Os edulcorantes são classificados em nutritivos e não-nutritivos. Atualmente, o aspartame é alvo de várias críticas, porém a American Diabetes Association (ADA), revisando as evidências científicas acerca da inocuidade do aspartame, declara que o edulcorante não é carcinogênico e não está associado a desordens neurológicas. Quanto à sacarina, alguns autores recomendam restrição do consumo desta por gestantes, devido à falta de informações conclusivas sobre possíveis efeitos no desenvolvimento fetal, além das poucas evidências sobre seu efeito transplacentário e transmamário. A ADA não recomenda o uso do esteviosidio como edulcorante. Os edulcorantes não-calóricos atualmente aprovados para uso pela população em geral, incluindo as gestantes são: aspartame, acesulfame-K, sacarina, sucralose e neotame. Na orientação dietética, deve-se considerar a quantidade permitida por dia e esclarecer à cliente sobre a importância de controlar a dose utilizada, além de revisar periodicamente os tipos de edulcorantes presentes nos adoçantes e produtos dietéticos disponíveis no mercado.

The present narrative review article accounts for the available knowledge about the recommended use of sweeteners in cases of gestational diabetes, according to the Medline, Lilacs and PubMed databases from 1978 to 2009. Sweeteners are classified as nutritive and non-nutritive. Currently, aspartame is being strongly criticised despite the American Diabetes Association (ADA) having stated that it is not carcinogenic nor associated with neurological disorders. As for saccharin, some authors recommend a restricted intake by pregnant women due to the lack of conclusive information about its possible effects on fetal development, and to the little evidence of its transplacental and transmammary effects. The ADA does not recommend the use of stevioside as a sweetener. The approved low-calorie sweeteners for all population, including pregnant women, are aspartame, acesulfame-K, saccharin, sucralose and neotame. During diet orientation, the allowed daily intake should be considered, the importance of controlling the dose should be explained to the patient, and the sweeteners used in diet products available in the market should be frequently revised.

O uso de adoçantes na gravidez: uma análise dos produtos disponíveis no Brasil / The use of sweeteners in pregnancy: an analysis of products available in Brazil

Os adoçantes são freqüentemente utilizados por mulheres em idade reprodutiva. Esta é uma revisão narrativa da literatura a respeito dos adoçantes atualmente comercializados no mercado brasileiro. Existem poucas informações sobre o uso da sacarina e ciclamato na gestação, e seus efeitos sobre o feto. Devido às limitadas informações disponíveis e ao seu potencial carcinogênico em animais, a sacarina e o ciclamato devem ser evitados durante a gestação (risco C). O aspartame tem sido extensivamente estudado em animais, sendo considerado seguro para uso na gestação (risco B), exceto para mulheres homozigóticas para fenilcetonúria (risco C). A sucralose e o acessulfame-K não são tóxicos, carcinogênico ou mutagênicos em animais, mas não existem estudos controlados em humanos. Porém, como esses dois adoçantes não são metabolizados, parece improvável que seu uso durante a gestação possa ser prejudicial (risco B). A estévia, substância derivada de uma planta nativa brasileira, não produz efeitos adversos sobre a gestação em animais, porém não existem estudos em humanos (risco B). Os agentes de corpo usados na formulação dos adoçantes (manitol, sorbitol, xilitol, eritrol, lactilol, isomalte, maltilol, lactose, frutose, maltodextrina, dextrina e açúcar invertido) são substâncias consideradas seguras para o consumo humano. Concluindo, segundo as evidências atualmente disponíveis, o aspartame, a sucralose, o acessulfame e a estévia podem ser utilizados com segurança durante a gestação.

Sweeteners are frequently used by women of reproductive age. This is a narrative review about the sweeteners currently sold in the Brazilian commerce. There is a few information on the use of saccharin and cyclamates in pregnancy and their effects on the fetus. Due to the limited information available and their carcinogenic potential in animal species, saccharin and cyclamates should be avoided during pregnancy (risk C). Aspartame has been extensively studied in animals and it is considered safe for use during pregnancy (risk B), except by women homozygous for phenylketonuria (risk C). Sucralose and acessulfame-K are not toxic, carcinogenic or mutagenic in animals, but there are no controlled studies in humans. However, since these two sweeteners are not metabolized, it is unlikely that their use during pregnancy could be harmful (risk B). Stevia, a substance extracted from a native Brazilian plant, is innocuous in animal pregnancies, but there are no controlled studies in humans (risk B). Body agents found in the composition of artificial sweeteners (mannitol, sorbitol, xylitol, erithrol, lactilol, isomalt, maltilol, lactose, fructose, maltodextrin, dextrin, and inverted sugar) are substances generally regarded as safe for human consumption. In conclusion, according to the currently available evidence, aspartame, sucralose, acessulfame-K and stevia can be safely used during pregnancy.