Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: Systematic review and meta‐analysis

Abstract

There is an ongoing debate about the possible influences of nonnutritive sweeteners (NNS) on body weight. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) with NNS to assess their impact on body weight. We systematically searched for RCTs at least 4 weeks in duration, evaluating the effect of NNS on body weight, both in subjects with healthy weight and in subjects with overweight/obesity at any age, and compared the effects of NNS vs caloric and noncaloric comparators. The primary outcome was the difference in body weight between NNS and comparators. Twenty studies were eligible (n = 2914). Participants consuming NNS showed significant weight/BMI differences favouring NNS compared with nonusers. Grouping by nature of comparator revealed that NNS vs placebo/no intervention and NNS vs water produced no effect. When comparing NNS vs sucrose, significant weight/BMI differences appeared favouring NNS. Consumption of NNS led to significantly negative weight/BMI differences in unrestricted energy diets, but not in weight-reduction diets. Participants with overweight/obesity and adults showed significant favourable weight/BMI differences with NNS. Data suggest that replacing sugar with NNS leads to weight reduction, particularly in participants with overweight/obesity under an unrestricted diet, information that could be utilized for evidence-based public policy decisions. K E Y W O R D S artificial sweeteners, body weight, obesity, systematic review

The Importance of Sweet Beverage Definitions When Targeting Health Policies—The Case of Switzerland

“…Low-calorie sweet beverages, which represent potential solutions for reducing sugar and energy intake, were consumed at levels as high as 100% juices and carbonated drinks. However, there is considerable controversy concerning the associated health effects of the consumption of these beverages [14][15][16]44]. Emerging evidence shows that non-sugar sweeteners do not contribute to weight loss in adults or children with overweight or obesity actively trying to lose weight [15].…”

Practical Strategies to Help Reduce Added Sugars Consumption to Support Glycemic and Weight Management Goals

“…Based on evidence from recent RCTs (30)(31)(32)(33)35,39,58), experts on LNCS have published consensus statements (8,40,41,59) that recognize the potential of LNCS to reduce calorie intake and assist in weight loss and weight management when consciously substituted for added sugars (30)(31)(32)(33)35,58). Importantly, these benefits can be realized without adversely affecting blood glucose levels (A1C or fasting or postprandial blood glucose) or insulin regulation in individuals with diabetes (36,37,39).…”

“…Randomized controlled trials (RCTs) and meta-analyses/ systematic reviews have demonstrated the impact of LNCS use on glucose metabolism (29)(30)(31)(32)(33)(34)(35) and weight management (36)(37)(38)(39). A summary of findings from these studies is presented in Tables 2 and 3.…”

“…Sensationalized headlines have created unwarranted public alarm and confusion about the safety of LNCS over the course of many years. Conversely, a recent welldesigned meta-analysis/systematic review by Laviada-Molina et al (36), which demonstrated significant benefits of using LNCS in weight management, received no media coverage.…”

Knowledge and acceptance of interventions aimed at reducing sugar intake in Portugal

“…Although this type of sweeteners has been marketed as a healthier alternative to sugar intake, the debate about its benefits is still ongoing. For instance, it has been suggested that while it may contribute to weight reduction (37) , some important safety issues have also been detected (38,39) . Overall, because the intake of sweeteners has not been consistently associated with health benefits, some dietary guidelines (e.g., in Canada (40) ) proposed that the intake of free sugars should be achieved through the promotion of unsweetened beverages instead.…”