Prevalence and Factors Associated with the Use of Artificial Sweeteners in Nonpregnant, Nonlactating Females of Reproductive Age – A Systematic Review

Abstract

Background

Artificial or nonnutritive sweeteners (ASs/NNSs) are widely consumed as sugar substitutes globally. Although research often focuses on specific groups such as those with diabetes or pregnant females, nonpregnant, nonlactating females of reproductive age remain understudied despite the significant implications of dietary patterns on females’ health.

Objectives

This systematic review aims 1) to summarize the global prevalence of AS/NNS consumption among nonpregnant, nonlactating females aged 15−49, and 2) to identify the factors associated with AS/NNS use within this population.

Methods

Following PRISMA reporting guidelines, we conducted a comprehensive search across multiple databases, including the Cochrane Database of Systematic Reviews, CENTRAL, Campbell Library, MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science, and eLANA (World Health Organization), covering studies up to May 2024. We included observational and experimental studies involving nonpregnant and nonlactating females aged 15 to 49, focusing on AS/NNS consumption and its associated factors. Data extraction was performed in duplicates, and quality assessment was conducted using the National Heart, Lung, and Blood Institute Quality Assessment Tool.

Results

This review identified 15 eligible studies. The pooled prevalence of AS/NNS use among females of reproductive age was 37.1% (95% confidence interval: 25.1%, 49.9%; heterogeneity: I² = 99.9%). Most of the studies were conducted in high-income countries, with only one from an upper-middle-income country. All studies were cross-sectional (n = 15), with 33% high and 67% moderate quality ratings. Factors associated with AS/NNS use included people living with obesity, ethnicity (higher prevalence among White participants), and physical activity levels. However, due to a lack of sex-disaggregated data, these factors could not be analyzed specifically for females; thus, a narrative synthesis is presented.

Conclusion

This review highlights significant AS/NNS consumption among nonpregnant, nonlactating females of reproductive age. The findings underscore the need for further research on the long-term health implications of AS/NNS use in this population.

The study was registered with PROSPERO as CRD42023450145.