Obesity often originates in early life, and is linked to excess sugar intake. Nonnutritive sweeteners (NNS) are widely consumed as “healthier” alternatives to sugar, yet recent evidence suggests NNS may adversely influence weight gain and metabolic health. The impact of NNS during critical periods of early development has rarely been studied. We investigated the effect of prenatal NNS exposure on postnatal adiposity and adipocyte development.
In the CHILD birth cohort (N = 2298), we assessed maternal NNS beverage intake during pregnancy and child body composition at 3 years, controlling for maternal BMI and other potential confounders. To investigate causal mechanisms, we fed NNS to pregnant C57BL6J mice at doses relevant to human consumption (42 mg/kg/day aspartame or 6.3 mg/kg/day sucralose), and assessed offspring until 12 weeks of age for: body weight, adiposity, adipose tissue morphology and gene expression, glucose and insulin tolerance. We also studied the effect of sucralose on lipid accumulation and gene expression in cultured 3T3-L1 pre-adipocyte cells.
In the CHILD cohort, children born to mothers who regularly consumed NNS beverages had elevated body mass index (mean z-score difference +0.23, 95% CI 0.05–0.42 for daily vs. no consumption, adjusted for maternal BMI). In mice, maternal NNS caused elevated body weight, adiposity, and insulin resistance in offspring, especially in males (e.g., 47% and 15% increase in body fat for aspartame and sucralose vs. controls, p < 0.001). In cultured adipocytes, sucralose exposure at early stages of differentiation caused increased lipid accumulation and expression of adipocyte differentiation genes (e.g., C/EBP-α, FABP4, and FASN). These genes were also upregulated in adipose tissue of male mouse offspring born to sucralose-fed dams.
By triangulating evidence from humans, mice, and cultured adipocytes, this study provides new evidence that maternal NNS consumption during pregnancy may program obesity risk in offspring through effects on adiposity and adipocyte differentiation.
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We are grateful to all the families who took part in the CHILD study, and the whole CHILD team, which includes interviewers, nurses, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, and receptionists. We also acknowledge the excellent technical work of Mario Fonseca and Bo Xiang (University of Manitoba), critical review by Shirin Moossavi (University of Manitoba), and editorial assistance from John Schellenberg (University of Manitoba). A preprint of this work was posted on bioRxiv (https://doi.org/10.1101/713974).
The Canadian Institutes of Health Research (CIHR) and the Allergy, Genes and Environment Network of Centers of Excellence (AllerGen NCE) provided core support for the CHILD Study. This research was supported, in part, by the Canada Research Chairs program. MBA holds the Tier 2 Canada Research Chair in the Developmental Origins of Chronic Disease, and is a Canadian Institute for Advanced Research Fellow in the Humans and the Microbiome Program. VWD holds the Allen Rouse-Manitoba Medical Services Foundation Basic Scientist Award. MMT is the recipient of a Research Manitoba/CHRIM studentship. This research was supported by a Children’s Hospital Research Institute of Manitoba Grant, a CIHR Operating Grant #151540, and a CIHR Environments, Genes and Chronic Disease Team Grant #144626. These entities had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the paper.
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Azad, M.B., Archibald, A., Tomczyk, M.M. et al. Nonnutritive sweetener consumption during pregnancy, adiposity, and adipocyte differentiation in offspring: evidence from humans, mice, and cells. Int J Obes 44, 2137–2148 (2020). https://doi.org/10.1038/s41366-020-0575-x