Review

International Journal of Obesity (2016) 40, 381–394; doi:10.1038/ijo.2015.177; published online 10 November 2015

Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies
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P J Rogers1, P S Hogenkamp2, C de Graaf3, S Higgs4, A Lluch5, A R Ness6, C Penfold6, R Perry6, P Putz7, M R Yeomans8 and D J Mela9

  1. 1School of Experimental Psychology, University of Bristol, Bristol, UK
  2. 2Department of Neuroscience, Uppsala University, Uppsala, Sweden
  3. 3Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
  4. 4The School of Psychology, University of Birmingham, Birmingham, UK
  5. 5Danone Research, Centre Daniel Carasso, RD, Palaiseau Cedex, France
  6. 6National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Level 3, University Hospitals Bristol Education Centre, Bristol, UK
  7. 7European Branch, ILSI Europe a.i.s.b.l., Brussels, Belgium
  8. 8School of Psychology, University of Sussex, Brighton, UK
  9. 9Unilever R&D Vlaardingen, Vlaardingen, the Netherlands

Correspondence: Dr P Putz, European Branch, ILSI Europe a.i.s.b.l., Avenue E. Mounier 83, Box 6, Brussels B-1200, Belgium. E-mail: publications@ilsieurope.be

Received 13 November 2014; Revised 28 August 2015; Accepted 28 August 2015
Accepted article preview online 14 September 2015; Advance online publication 10 November 2015

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Abstract

By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that LES exposure (versus sugars or unsweetened alternatives) has no effect on EI or BW, we conducted a systematic review of relevant studies in animals and humans consuming LES with ad libitum access to food energy. In 62 of 90 animal studies exposure to LES did not affect or decreased BW. Of 28 reporting increased BW, 19 compared LES with glucose exposure using a specific ‘learning’ paradigm. Twelve prospective cohort studies in humans reported inconsistent associations between LES use and body mass index (−0.002kgm2 per year, 95% confidence interval (CI) −0.009 to 0.005). Meta-analysis of short-term randomized controlled trials (129 comparisons) showed reduced total EI for LES versus sugar-sweetened food or beverage consumption before an ad libitum meal (−94kcal, 95% CI −122 to −66), with no difference versus water (−2kcal, 95% CI −30 to 26). This was consistent with EI results from sustained intervention randomized controlled trials (10 comparisons). Meta-analysis of sustained intervention randomized controlled trials (4 weeks to 40 months) showed that consumption of LES versus sugar led to relatively reduced BW (nine comparisons; −1.35kg, 95% CI –2.28 to −0.42), and a similar relative reduction in BW versus water (three comparisons; −1.24kg, 95% CI –2.22 to −0.26). Most animal studies did not mimic LES consumption by humans, and reverse causation may influence the results of prospective cohort studies. The preponderance of evidence from all human randomized controlled trials indicates that LES do not increase EI or BW, whether compared with caloric or non-caloric (for example, water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water.

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