Sugar Types and Sugar Alternatives: Metabolic and Glycemic Health Outcomes

The World Health Organization (WHO) endorses an operational framework that distinguishes free sugars (including monosaccharides and disaccharides added to foods, and sugars in honey and syrups), non-sugar sweeteners (NSS), and sugar alcohols (polyols). Recent evidence links high intake of free sugars to unhealthy weight gain, while studies on NSS suggest limited long-term benefits for weight control and raise concerns about potential adverse effects. Despite growing prevalence, key questions about the health consequences and mechanisms of sugar alternative use remain unanswered, including their implications for glycemic regulation and metabolic health.This Research Topic aims to synthesize and advance understanding of the health impacts of sugar replacement strategies using WHO-aligned categories. The goal is to move beyond associations to clarify causal and molecular mechanisms, and to identify for whom, under what circumstances, and through which biological pathways these dietary interventions exert their effects. The collection also seeks to provide evidence relevant to dietary guidelines and labeling standards. We particularly encourage clinically anchored, real-world and causal-inference studies in people with prediabetes and type 2 diabetes that evaluate sweetener substitution in the context of contemporary glucose-lowering therapies (e.g., GLP-1RA, SGLT2i, insulin) and relate exposure to validated glycemic endpoints and complication risk stratification.This Research Topic invites studies in human and in vitro models, with a focus on health outcomes and mechanisms related to free sugars, NSS, and polyols. To gather further insights in these areas, we welcome articles addressing, but not limited to, the following themes:• Free sugars and obesity: pathways and risk factors• Long-term cardiometabolic outcomes of NSS use, including diabetes-related outcomes (e.g., glycemic variability and insulin dynamics)• Impact of NSS/polyol substitution on HbA1c and CGM-derived outcomes (time-in-range, glycemic variability) in routine clinical practice, using EHR/claims registries and pragmatic designs (e.g., target trial emulation)• Sensory, neuroendocrine, and appetite regulation by sweeteners, including links to eating behavior and meal microstructure (e.g., chewing, meal duration)• Interactions between natural and artificial sweeteners and the gut microbiome, gut hormones, and barrier function• Polyols: gastrointestinal effects, dose–response, and real-world exposure patterns• Molecular and metabolic mechanisms of sugar replacement (e.g., hepatic carbohydrate sensing pathways) Topic editors: Katsumi Iizuka, Daisuke Yabe Source: https://www.frontiersin.org/research-topics/77508/sugar-types-and-sugar-alternatives-metabolic-and-glycemic-health-outcomes