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The effects of low-calorie sweeteners on energy intake and body weight: a systematic review and meta-analyses of sustained intervention studies

Abstract

Previous meta-analyses of intervention studies have come to different conclusions about effects of consumption of low-calorie sweeteners (LCS) on body weight. The present review included 60 articles reporting 88 parallel-groups and cross-over studies ≥1 week in duration that reported either body weight (BW), BMI and/or energy intake (EI) outcomes. Studies were analysed according to whether they compared (1) LCS with sugar, (2) LCS with water or nothing, or (3) LCS capsules with placebo capsules. Results showed an effect in favour of LCS vs sugar for BW (29 parallel-groups studies, 2267 participants: BW change, −1.06 kg, 95% CI −1.50 to −0.62, I2 = 51%), BMI and EI. Effect on BW change increased with ‘dose’ of sugar replaced by LCS, whereas there were no differences in study outcome as a function of duration of the intervention or participant blinding. Overall, results showed no difference in effects of LCS vs water/nothing for BW (11 parallel-groups studies, 1068 participants: BW change, 0.10 kg, 95% CI −0.87 to 1.07, I2 = 82%), BMI and EI; and inconsistent effects for LCS consumed in capsules (BW change: −0.28 kg, 95% CI −0.80 to 0.25, I2 = 0%; BMI change: 0.20 kg/m2, 95% CI 0.04 to 0.36, I2 = 0%). Occurrence of adverse events was not affected by the consumption of LCS. The studies available did not permit robust analysis of effects by LCS type. In summary, outcomes were not clearly affected when the treatments differed in sweetness, nor when LCS were consumed in capsules without tasting; however, when treatments differed in energy value (LCS vs sugar), there were consistent effects in favour of LCS. The evidence from human intervention studies supports the use of LCS in weight management, constrained primarily by the amount of added sugar that LCS can displace in the diet.

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Fig. 1
Fig. 2: Forest plots showing individual and overall standardised mean differences (SMD) for the effects of LCS vs sugar for ΔBW and EI measured in parallel-groups studies (random effects models).
Fig. 3: Forest plots showing individual and overall standardised mean differences (SMD) for the effects of LCS vs water/nothing for ΔBW and EI measured in parallel-groups studies (random effects models).
Fig. 4: Forest plots showing individual and overall standardised mean differences (SMD) for the effects of LCS capsules vs placebo capsules for ΔBW and ΔBMI measured in parallel-groups studies (random effects models).

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Acknowledgements

We are grateful to authors we contacted who supplied us with results and other information about their studies. This research was supported by the School of Psychological Science, University of Bristol, and the Department of Psychology, Faculty of Science and Technology, Bournemouth University. Part of this research was supported by the NIHR (National Institute for Health Research) Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. These Institutions played no role in the design of the research, the collection and analysis of data or the decision to publish. The views expressed in this publication are those of the authors and not necessarily those of the NHS, NIHR, or the Department of Health and Social Care.

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Correspondence to Peter J. Rogers.

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In connection with research on LCS and sugar, PJR. has received funding for research from Sugar Nutrition UK; provided consultancy services for Coca-Cola Great Britain; received speaker’s fees from the International Sweeteners Association, the Global Stevia Research Institute, ILSI-Brasil, ILSI-Europe and ILSI-India; and received honoraria from ILSI-Europe. KMA has received funding for relevant research from Unilever R&D Vlaardingen, NL; has current funding from TIFN, NL (in collaboration with Arla Foods, DK, American Beverage Association, USA, Cargill, USA, Dutch Knowledge Centre for Sugar, NL, Firmenich, CH, the International Sweeteners Association, BE, SinoSweet, China, Unilever, NL), and from the International Sweeteners Association; and has received speaker’s expenses from the International Sweeteners Association, PepsiCo and ILSI-North America.

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Rogers, P.J., Appleton, K.M. The effects of low-calorie sweeteners on energy intake and body weight: a systematic review and meta-analyses of sustained intervention studies. Int J Obes 45, 464–478 (2021). https://doi.org/10.1038/s41366-020-00704-2

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