TOPLINE:
The inclusion of sugar-substitute sweeteners and sweetness enhancers in a sugar-reduced maintenance diet following weight loss improves weight maintenance as well as well-being in adults, with no increases in type 2 diabetes or cardiovascular disease risk compared with a diet excluding the sweeteners, a randomized trial showed.
The study also showed that among overweight or obese children, greater reductions in uncontrolled eating were observed among those receiving the sweeteners.
The findings counter previous reports that raised concerns about the non-sugar sweeteners, including recent research from the World Health Organization suggesting no benefits in weight control and a possible increase in the risk for type 2 diabetes or cardiovascular disease with the sweeteners.
METHODOLOGY:
- The findings are from an exploratory analysis of the multicenter, randomized SWEET trial.
- The trial involved 341 adults with overweight or obesity (aged 18-65 years, 71% women, body mass index [BMI] ≥ 25) and 38 children with overweight (aged 6-12 years, 60% girls, BMI-for-age > 85th percentile), recruited in Denmark, Spain, Greece, and the Netherlands through webpages, social media, newspapers, and registries.
- For the first 2 months of the trial, adults were instructed to follow a low-energy diet (the Cambridge Weight Plan) with the goal of achieving at least 5% weight loss, while children received dietary advice to maintain body weight.
- In the subsequent 10 months, adults as well as children were randomized to healthy diets that either consisted of less than 10% of calories from added sugar but permitted foods and drinks with sweeteners and sweetness enhancers, or the same diet but not allowing the use of the sweeteners or sweetness enhancers.
- Participants had weight, BMI, anthropometry, and risk markers for type 2 diabetes and cardiovascular disease monitored at the trial's baseline, as well as at 2, 6, and 12 months.
- In addition, participants completed food frequency questionnaires and provided urine samples to assess biomarkers of the sweeteners, fructose and sucrose, in order to measure compliance with the dietary instructions.
TAKEAWAY:
- While the sweetener and non-sweetener groups both had decreases in consumption of products high in sugar, the reduction was significantly higher in the group that allowed use of the sweeteners (P = .002).
- In the intention-to-treat analyses, adults (n = 277) permitted sweeteners showed a small but significantly greater weight loss maintenance after 1 year than the non-sweetener group (average weight loss, 7.2 kg vs 5.6 kg; P = .029).
- Among 203 participants who completed the trial, there were no differences between the groups in terms of markers for type 2 diabetes and cardiovascular disease.
- There were also no differences between the groups in terms of subjective appetite sensations and appetite hormones in a subgroup of 104 patients.
- In an analysis of 22 children who completed the study, there were no differences in BMI-for-age z-scores between sweetener and non-sweetener groups.
- In terms of effects on eating behavior, adults in the sweetener group reported greater diet satisfaction when eating out (P = .03), increased positive mood (P = .013), and reduced craving for sweet food (P = .034) at 6 months than in the non-sweetener group.
- Conversely, those receiving no sweeteners had a greater liking bias for sweet vs savory foods at 6 months (P = .023) and 12 months (P = .005).
- There were no differences between the groups in reported physical activity or quality of life.
- However, among children with higher uncontrolled eating scores at baseline, the uncontrolled eating scores at 12 months were significantly lower among children who were allowed the sugar-substitute sweeteners vs the non-sweetener children (P = .021).
IN PRACTICE:
"Our findings suggest that the inclusion of low/no energy-sweetened products may benefit children who show high levels of uncontrolled eating," said the study's colead author, Clarissa Dakin, of the Appetite Control and Energy Balance Research Group at the University of Leeds, Leeds, England, in a press statement.
"Together, these findings provide important insights for the ongoing reevaluation of food additive sweeteners by the European Food Safety Authority and other health agencies worldwide," she said.
Coauthor Jason Halford, head of the School of Psychology at the University of Leeds, Leeds, England, added in the press statement that "the use of low-calorie sweeteners in weight management has been questioned, in part because of the link between their use and apparent weight gain in observational studies."
"However, increasingly, it is becoming apparent that is not the case in long-term studies," said a study coauthor in a press statement."
SOURCE:
The findings from the two abstracts will be presented in May at the European Congress on Obesity (ECO 2024). The study abstracts were issued in advance.
LIMITATIONS:
Some of the results, particularly in children's subgroups, were limited by the relatively low number of children, underscoring the need for future studies on the issue, the authors noted.
DISCLOSURES:
Halford has received research funding from the American Beverage Association.