Impacto da sucralose na resposta pós-prandial glicémica e insulinémica e na secreção de GLP-1 em adultos: revisão sistemática e meta-análise

Abstract

Background and Objectives: The metabolic neutrality of non-nutritive sweeteners (NNS) remains inconsistent. This systematic review and meta-analysis evaluated the acute effects of sucralose, alone or with carbohydrates, on postprandial glycemic, insulinemic, and glucagon-like peptide-1 (GLP-1) responses in adults. Methods: Following PRISMA guidelines, the search was conducted across PubMed and Web of Science up to November 1, 2025, for randomized controlled trials (RCTs) assessing glycemic and insulinemic responses and GLP-1 secretion. Risk of bias was evaluated via Cochrane RoB 2.0, and random-effects meta-analyses were performed. Results: Seventeen RCTs (424 participants) were included, with eight suitable for quantitative analysis. In healthy adults, sucralose demonstrated showed no statistically significant overall effect. Conversely, in obesity or insulin resistance, oral sucralose modulated insulin kinetics, showing up to a 20% increase in insulin incremental area under the curve (iAUC) and decreased insulin sensitivity. GLP-1 responses and gastrointestinal infusions yielded no variations (except under complex matrices), while sham-feeding suggested, without statistical confirmation, a role for cephalic oral signaling. Conclusion: Sucralose is not uniformly inert. While neutral in healthy individuals, it acts as an endocrine modulator in populations with metabolic vulnerabilities, depending on host phenotype, cephalic oral engagement, and nutrient co-ingestion.