I don't really have a problem with feeding lettuce as a supplement to more natural foods. I wonder about what the high moisture content does to their osmolarity, but I doubt it's a huge deal. Might be a bit of extra metabolic effort, but probably not much. As an aquarium service tech, I have seen a strong correlation between tanks that feed lettuce and tanks with a crap ton of cyano, but that is purely anecdotal evidence, so take that for what it's worth.
Feeding lettuce in lieu of more natural foods? That I do not approve of. We have safer, more natural methods easily accessible to us. Even without some of the citations above for what it's actually doing to your fish (the liver deposits in particular) there's a lot we simply don't know about the long term effects of alternative diets.
There haven't been formal scientific studies done on a lot of common questions in the aquarium hobby. I think this is mostly because it's a set of pretty niche questions. The studies above were, if you note, done in regards to fish farming. Important work, and economically worth a very long study. Digestive health in captive tangs? Not worth studying, not compared to other demands. Zoos, public aquaria, and aquaculture facilities by and large endeavor to replicate natural diet. Why risk your specimens comparing a readily available natural food you know works to a slightly cheaper but riskier food? Cost benefit on that study sucks.
This hobby is hard enough already without screwing around with corner cutting. Just feed the right foods.