GEBELİKTE STEVİA KULLANIMI

Yıl 2021, Cilt: 2 Sayı: 1, 76 - 92, 26.04.2021

Yağmur Demirel Özlem Akın

Öz

Çeşitli yiyecek ve içeceklerde kullanılan şekere alternatif olarak, çoğu ülkede oldukça popülerdir. Stevia dünyanın birçok yerinde tatlandırıcı olarak kullanılmaktadır. Steviarebaudiana Bertoni, doğal tatlandırıcı özelliğini steviol glikozit kaynağından alan Asteraceae familyasına ait dallı bir bitkidir. Son zamanlarda, stevianın potansiyel kullanımlarını keşfetmeye yönelik ilgi artmıştır ve çeşitli çalışmalar, stevianın biyokimyasal bileşiminin sağlık üzerine yararlarının olduğunu bildirmektedir. Hayvanlarda ve insanlarda yapılan çeşitli çalışmalarda bu bitkinin güvenli olup olmadığı henüz belirlenememiştir. Gebelik sırasında fazla ağırlık kazanımını engellemek amacıyla için birçok kadın, kalorisiz tatlandırıcılar içeren yiyecek ve içecekleri tüketmeyi tercih etmektedir. Literatürde gebelikte besin değeri olmayan tatlandırıcıların tüketimi için belirli bir kılavuz bulunmamaktadır. Bununla birlikte, klinik etkinliği ve kullanımı hala tartışma konusudur. Bu nedenle, gebelerde stevia kullanımının güvenlik, sağlık yararları ve fizyolojik mekanizmaları hakkında ayrıntılı bilgi sağlamak gerekmektedir. Güncel kanıta dayalı beslenme kılavuzlarından haberdar olmak ve tüketicileri besin değeri olmayan tatlandırıcıların kullanımıyla ilişkili potansiyel riskler konusunda bilgilendirmek sağlık profesyonellerinin görevidir. Sağlık profesyonellerinin stevia kullanımlarını önermeden önce gebelere besin değeri olmayan tatlandırıcılar kullanımının genel bireysel faydalarını ve risklerini değerlendirmeleri, besin değeri olmayan tatlandırıcıların fetüs için güvenli olup olmadığını ve gebelik sırasında kullanmaya devam edip edemeyecekleri konusunda bilgi sağlamaları gereklidir. Bu derlemede gebelikte kalorisiz tatlandırıcılardan popüler hale gelen stevia kullanımına ilişkin mevcut kanıtlar gözden geçirilecektir.

Anahtar Kelimeler

Stevia rebaudiana, steviosides, gebelik, doğal tatlandırıcı, sağlık uzmanları

USE OF STEVIA IN PREGNANCY

Öz

As an alternative to sugar used in a variety of foods and beverages, stevia is extremely popular in most countries. It is used as a sweetener in many parts of the world.Stevia rebaudianaBertoni is a branched plant belonging to the Asteraceae family, which derives its natural sweetener from the steviol glycoside source. The interest in exploring the potential uses of stevia has recently increased, and several studies report that the biochemical composition of stevia has benefits for health.The safety of this herb has not yet been proved in various studies on animals and humans. In order to prevent excess weight gain during pregnancy, many women prefer to consume foods and drinks that contain non-calorie sweeteners.In literature, there is no specific guideline for the consumption of non-nutritional sweeteners during pregnancy. However, its clinical efficacy and use is still a matter of debate. Therefore, it is necessary to provide detailed information about the safety, benefits, and physiological mechanisms of stevia use in pregnant women.It is the duty of health professionals to be aware of current evidence-based dietary guidelines, and to inform consumers about the potential risks associated with the use of non-nutritional sweeteners.Before recommending the use of stevia, healthcare professionals should evaluate the general individual benefits and risks of using non-nutritional sweeteners, and provide information on whether non-nutritional sweeteners are safe for the fetus and whether they can continue to use them during pregnancy.In this review, the current evidence on the use of stevia, which has become popular among non-calorie sweeteners in pregnancy, will be reviewed.

Anahtar Kelimeler

Stevia rebaudiana, steviosides, pregnancy, natural sweetener, health professionals

Kaynakça

• Abdel-Salam, O. M., Salem, N. A., & Hussein, J. S. (2012). Effect of aspartame on oxidative stress and monoamine neurotransmitter levels in lipopolysaccharide-treated mice. Neurotoxicity research, 21(3), 245-255.
• Abdullateef, R. A., & Osman, M. (2012). Studies on effects of pruning on vegetative traits in Stevia rebaudiana Bertoni (Compositae). International Journal of Biology, 4(1), 146–153.
• Ahmad, J., Khan, I., Blundell, R., Azzopardi, J., & Mahomoodally, M. F. (2020). Stevia rebaudiana Bertoni.: An updated review of its health benefits, industrial applications and safety. Trends in Food Science & Technology.
• Araújo, J. R., Martel, F., & Keating, E. (2014). Exposure to non-nutritive sweeteners during pregnancy and lactation: Impact in programming of metabolic diseases in the progeny later in life. Reproductive Toxicology, 49, 196-201.
• Becker, S. L., Chiang, E., Plantinga, A., Carey, H. V., Suen, G., & Swoap, S. J. (2020). Effect of stevia on the gut microbiota and glucose tolerance in a murine model of diet-induced obesity. FEMS microbiology ecology, 96(6), fiaa079.
• Carrera-Lanestosa, A., Moguel-Ordóñez, Y., & Segura-Campos, M. (2017). Stevia rebaudiana Bertoni: a natural alternative for treating diseases associated with metabolic syndrome. Journal of medicinal food, 20(10), 933-943.
• Cavagnari, B. M. (2020). Edulcorantes no calóricos en embarazo y lactancia. Revista Española de Salud Pública, 93, e201908052.
• Chranioti, C., Chanioti, S., & Tzia, C. (2016). Comparison of spray, freeze and oven drying as a means of reducing bitter aftertaste of steviol glycosides (derived from Stevia rebaudiana Bertoni plant)–Evaluation of the final products. Food Chemistry, 190, 1151-1158.
• Collison, K. S., Makhoul, N. J., Zaidi, M. Z., Al-Rabiah, R., Inglis, A., Andres, B. L., ... & Al-Mohanna, F. A. (2012). Interactive effects of neonatal exposure to monosodium glutamate and aspartame on glucose homeostasis. Nutrition & metabolism, 9(1), 1-13.
• Deniņa, I., Semjonovs, P., Fomina, A., Treimane, R., & Linde, R. (2014). The influence of stevia glycosides on the growth of L actobacillus reuteri strains. Letters in applied microbiology, 58(3), 278-284.
• EFSA Panel on Food Additives and Flavourings (FAF), Younes, M., Aquilina, G., Engel, K. H., Fowler, P., Frutos Fernandez, M. J., ... & Castle, L. (2020). Safety of a proposed amendment of the specifications for steviol glycosides (E 960) as a food additive: to expand the list of steviol glycosides to all those identified in the leaves of Stevia Rebaudiana Bertoni. EFSA Journal, 18(4), e06106.
• EFSA Panel on Food Additives and Nutrient Sources Added to Food. (2015). Scientific opinion on the safety of the proposed amendment of the specifications for steviol glycosides (E 960) as a food additive. EFSA Journal, 13(12), 4316.
• Englund-Ögge, L., Brantsæter, A. L., Haugen, M., Sengpiel, V., Khatibi, A., Myhre, R., ... & Jacobsson, B. (2012). Association between intake of artificially sweetened and sugar-sweetened beverages and preterm delivery: a large prospective cohort study. The American journal of clinical nutrition, 96(3), 552-559.
• Fuentealba Arevalo, F., Espinoza Espinoza, J., Salazar Ibacache, C., & Duran Aguero, S. (2019). Consumption of non-caloric sweeteners among pregnant Chileans: a cross-sectional study,36(4), 890-897.
• Gardana, C., Scaglianti, M., & Simonetti, P. (2010). Evaluation of steviol and its glycosides in Stevia rebaudiana leaves and commercial sweetener by ultra-high-performance liquid chromatography-mass spectrometry. Journal of chromatography A, 1217(9), 1463-1470.
• Gardner, C., Wylie-Rosett, J., Gidding, S. S., Steffen, L. M., Johnson, R. K., Reader, D., & Lichtenstein, A. H. (2012). Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation, 126(4), 509-519.
• Geuns, J. M., Buyse, J., Vankeirsbilck, A., & Temme, E. H. (2007). Metabolism of stevioside by healthy subjects. Experimental biology and medicine, 232(1), 164-173.
• Gregersen, S., Jeppesen, P. B., Holst, J. J., & Hermansen, K. (2004). Antihyperglycemic effects of stevioside in type 2 diabetic subjects. Metabolism, 53(1), 73-76.
• Grembecka, M. (2015). Sugar alcohols—their role in the modern world of sweeteners: a review. European Food Research and Technology, 241(1), 1-14.
• Gupta, E., Purwar, S., Sundaram, S., & Rai, G. K. (2013). Nutritional and therapeutic values of Stevia rebaudiana: A review. Journal of Medicinal Plants Research, 7(46), 3343-3353.
• Halldorsson, T. I., Strøm, M., Petersen, S. B., & Olsen, S. F. (2010). Intake of artificially sweetened soft drinks and risk of preterm delivery: a prospective cohort study in 59,334 Danish pregnant women. The American journal of clinical nutrition, 92(3), 626-633.
• Hsieh, M. H., Chan, P., Sue, Y. M., Liu, J. C., Liang, T. H., Huang, T. Y., ... & Chen, Y. J. (2003). Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomized, placebo-controlled study. Clinical therapeutics, 25(11), 2797-2808.
• Huang, X. Y., Tian, M., Pei, D., Liu, J. F., & Di, D. L. (2018). Development of overlapping repeated separation of steviol glycosides with counter current chromatography and a comparison with a conventional repeated separation method. Journal of separation science, 41(15), 3163-3169.
• Jahangir Chughtai, M. F., Pasha, I., Zahoor, T., Khaliq, A., Ahsan, S., Wu, Z., ... & Tanweer, S. (2020). Nutritional and therapeutic perspectives of Stevia rebaudiana as emerging sweetener; a way forward for sweetener industry. CYTA-Journal of Food, 18(1), 164-177.
• Kobus-Moryson, M., & Gramza-Michałowska, A. (2015). Directions on the use of stevia leaves (Stevia rebauidana) as an additive in food products. Acta Scientiarum Polonorum Technologia Alimentaria, 14(1), 5-13.
• Kumar, R. D., & Oommen, O. V. (2008). Stevia Rebaudiana Bertani does not produce female reproductive toxic effect: Study in Swiss albino mouse. J. Endocrinol Reprod, 12, 57-60.
• Lemus-Mondaca, R., Vega-Gálvez, A., Zura-Bravo, L., & Ah-Hen, K. (2012). Stevia rebaudiana Bertoni, source of a high-potency natural sweetener: A comprehensive review on the biochemical, nutritional and functional aspects. Food chemistry, 132(3), 1121-1132.
• Liauchonak, I., Qorri, B., Dawoud, F., Riat, Y., & Szewczuk, M. R. (2019). Non-nutritive sweeteners and their implications on the development of metabolic syndrome. Nutrients, 11(3), 644.
• Lopes, S. M. S., Francisco, M. G., Higashi, B., de Almeida, R. T. R., Krausová, G., Pilau, E. J., ... & de Oliveira, A. J. B. (2016). Chemical characterization and prebiotic activity of fructo-oligosaccharides from Stevia rebaudiana (Bertoni) roots and in vitro adventitious root cultures. Carbohydrate polymers, 152, 718-725.
• Madan, S., Ahmad, S., Singh, G. N., Kohli, K., Kumar, Y., Singh, R., & Garg, M. (2010). Stevia rebaudiana (Bert.) Bertoni-a review, 1(September), 267–286.
• Magnuson, B. A., Burdock, G., Doull, J., Kroes, R. M., Marsh, G. M., Pariza, M. W., ... & Williams, G. M. (2007). Aspartame: a safety evaluation based on current use levels, regulations, and toxicological and epidemiological studies. Critical reviews in toxicology, 37(8), 629-727.
• Maslova, E., Strøm, M., Olsen, S. F., & Halldorsson, T. I. (2013). Consumption of artificially-sweetened soft drinks in pregnancy and risk of child asthma and allergic rhinitis. PloS one, 8(2), e57261.
• Mischke, M., & Plösch, T. (2013). More than just a gut instinct–the potential interplay between a baby's nutrition, its gut microbiome, and the epigenome. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 304(12), R1065-R1069.
• Moriconi, E., Feraco, A., Marzolla, V., Infante, M., Lombardo, M., Fabbri, A., & Caprio, M. (2020). Neuroendocrine and metabolic effects of low-calorie and non-calorie sweeteners. Frontiers in Endocrinology, 11, 444.
• Nettleton, J. E., Cho, N. A., Klancic, T., Nicolucci, A. C., Shearer, J., Borgland, S. L., ... & Reimer, R. A. (2020). Maternal low-dose aspartame and stevia consumption with an obesogenic diet alters metabolism, gut microbiota and mesolimbic reward system in rat dams and their offspring. Gut, 69(10), 1807-1817.
• Nikiforov, A. I., Rihner, M. O., Eapen, A. K., & Thomas, J. A. (2013). Metabolism and toxicity studies supporting the safety of rebaudioside D. International journal of toxicology, 32(4), 261-273.
• Olendzki, B. C., Silverstein, T. D., Persuitte, G. M., Ma, Y., Baldwin, K. R., & Cave, D. (2014). An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report. Nutrition journal, 13(1), 1-7.
• Palatnik, A., Moosreiner, A., & Olivier-Van Stichelen, S. (2020). Consumption of non-nutritive sweeteners during pregnancy. American journal of obstetrics and gynecology, 223(2), 211-218.
• Philippaert, K., Pironet, A., Mesuere, M., Sones, W., Vermeiren, L., Kerselaers, S., ... & Vennekens, R. (2017). Steviol glycosides enhance pancreatic beta-cell function and taste sensation by potentiation of TRPM5 channel activity. Nature communications, 8(1), 1-16.
• Pope, E., Koren, G., & Bozzo, P. (2014). Sugar substitutes during pregnancy. Canadian Family Physician, 60(11), 1003-1005.
• Purohit, V., & Mishra, S. (2018). The truth about artificial sweeteners–are they good for diabetics?. pp 197-199.
• Romo-Romo, A., Aguilar-Salinas, C. A., Gómez-Díaz, R. A., Brito-Córdova, G. X., Gómez-Velasco, D. V., López-Rocha, M. J., & Almeda-Valdés, P. (2017). Non-nutritive sweeteners: evidence on their association with metabolic diseases and potential effects on glucose metabolism and appetite. Revista de investigacion clinica, 69(3), 129-138.
• Ruiz-Ojeda, F. J., Plaza-Díaz, J., Sáez-Lara, M. J., & Gil, A. (2019). Effects of sweeteners on the gut microbiota: a review of experimental studies and clinical trials. Advances in Nutrition, 10(suppl_1), S31-S48.
• Saenphet, K., Aritajat, S., Saenphet, S., Manosroi, J., & Manosroi, A. (2006). Safety evaluation of aqueous extracts from Aegle marmelos and Stevia rebaudiana on reproduction of female rats. Southeast Asian journal of tropical medicine and public health, 37, 203-205.
• Sharma, A., Amarnath, S., Thulasimani, M., & Ramaswamy, S. (2016). Artificial sweeteners as a sugar substitute: Are they really safe?. Indian journal of pharmacology, 48(3), 237–240.
• Shwide-Slavin, C., Swift, C., & Ross, T. (2012). Nonnutritive sweeteners: where are we today?. Diabetes Spectrum, 25(2), 104-110.
• Skreden, M., Bere, E., Sagedal, L. R., Vistad, I., & Øverby, N. C. (2015). Changes in beverage consumption from pre-pregnancy to early pregnancy in the Norwegian Fit for Delivery study. Public health nutrition, 18(7), 1187-1196.
• Soejima, A., Tanabe, A. S., Takayama, I., Kawahara, T., Watanabe, K., Nakazawa, M., ... & Yahara, T. (2017). Phylogeny and biogeography of the genus Stevia (Asteraceae: Eupatorieae): an example of diversification in the Asteraceae in the new world. Journal of plant research, 130(6), 953-972.
• Soffritti, M., Belpoggi, F., Tibaldi, E., Esposti, D. D., & Lauriola, M. (2007). Life-span exposure to low doses of aspartame beginning during prenatal life increases cancer effects in rats. Environmental health perspectives, 115(9), 1293-1297.
• Stichelen, O. V., Rother, K. I., & Hanover, J. A. (2019). Maternal exposure to non-nutritive sweeteners impacts progeny’s metabolism and microbiome. Frontiers in microbiology, 10, 1360.
• Suttajit, M., Vinitketkaumnuen, U., Meevatee, U., & Buddhasukh, D. (1993). Mutagenicity and human chromosomal effect of stevioside, a sweetener from Stevia rebaudiana Bertoni. Environmental health perspectives, 101(suppl 3), 53-56.
• Sylvetsky, A. C., Jin, Y., Clark, E. J., Welsh, J. A., Rother, K. I., & Talegawkar, S. A. (2017). Consumption of low-calorie sweeteners among children and adults in the United States. Journal of the Academy of Nutrition and Dietetics, 117(3), 441-448.
• Takahashi, K., Sun, Y., Yanagiuchi, I., Hosokawa, T., Saito, T., Komori, M., ... & Kurasaki, M. (2012). Stevioside enhances apoptosis induced by serum deprivation in PC12 cells. Toxicology mechanisms and methods, 22(4), 243-249.
• Thomas, J. E., & Glade, M. J. (2010). Stevia: Its not just about calories. The Open Obesity Journal, 2(1)., 101–9.
• Thompson, L. P., & Al-Hasan, Y. (2012). Impact of oxidative stress in fetal programming. Journal of pregnancy, 8,1-8.
• Valsamakis, G., Kyriazi, E. L., Mouslech, Z., Siristatidis, C., & Mastorakos, G. (2015). Effect of maternal obesity on pregnancy outcomes and long-term metabolic consequences. Hormones, 14(3), 345-357.
• van der Wielen, N., Ten Klooster, J. P., Muckenschnabl, S., Pieters, R., Hendriks, H. F., Witkamp, R. F., & Meijerink, J. (2016). The noncaloric sweetener rebaudioside a stimulates glucagon-like peptide 1 release and increases enteroendocrine cell numbers in 2-dimensional mouse organoids derived from different locations of the intestine. The Journal of nutrition, 146(12), 2429-2435.
• Yildiz-Ozturk, E., Nalbantsoy, A., Tag, O., & Yesil-Celiktas, O. (2015). A comparative study on extraction processes of Stevia rebaudiana leaves with emphasis on antioxidant, cytotoxic and nitric oxide inhibition activities. Industrial Crops and Products, 77, 961-971.
• Yu, M., Gao, T., Liu, Z., & Diao, X. (2020). Effects of Dietary Supplementation with High Fiber (Stevia Residue) on the Fecal Flora of Pregnant Sows. Animals, 10(12), 2247.