Cited by 358Biochemical Analysis and Sensing TechniquesDiet, Metabolism, and DiseaseRegulation of Appetite and Obesity

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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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Rogers, P J, Hogenkamp, P S, de Graaf, C, Higgs, S, Lluch, A, Ness, A R, Penfold, C, Perry, R, Putz, P, Yeomans, M R, Mela, D J·2016·International Journal of Obesity

DOI 10.1038/ijo.2015.177PMC PMC4786736

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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 (-0.002 kg m(-)(2) 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 (-94 kcal, 95% CI -122 to -66), with no difference versus water (-2 kcal, 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; -1.35 kg, 95% CI -2.28 to -0.42), and a similar relative reduction in BW versus water (three comparisons; -1.24 kg, 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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Metabolic and cognitive improvement from switching to saccharin or water following chronic consumption by female rats of 10% sucrose solution
Kendig, M. D., Fu, M. X., Rehn, S., Martire, S. I., Boakes, R. A., & Rooney, K. B. (2018) · Physiology & Behavior · doi:10.1016/j.physbeh.2018.02.008 · Cited by 18
Rationale, Design and Participants Baseline Characteristics of a Crossover Randomized Controlled Trial of the Effect of Replacing SSBs with NSBs versus Water on Glucose Tolerance, Gut Microbiome and Cardiometabolic Risk in Overweight or Obese Adult SSB Consumer: Strategies to Oppose SUGARS with Non-Nutritive Sweeteners or Water (STOP Sugars NOW) Trial and Ectopic Fat Sub-Study
Ayoub‐Charette, S., McGlynn, N. D., Lee, D., Khan, T. A., Mejía, S. B., Chiavaroli, L., Kavanagh, M. E., Seider, M., Taïbi, A., Chen, C. T., et al. (2023) · Nutrients · doi:10.3390/nu15051238 · Cited by 17
Effects of non‐nutritive sweetened beverages versus water after a 12‐week weight‐loss program: A randomized controlled trial
Harrold, J. A., Hill, S., Radu, C. C. P., Thomas, P., Thorp, P., Hardman, C. A., Christiansen, P., & Halford, J. C. G. (2023) · Obesity · doi:10.1002/oby.23796 · Cited by 17
“Some studies in rodents and small mechanistic studies in humans have suggested that non-nutritive sweeteners potentially promote overweight and obesity through a variety of mechanisms such as changing eating behavior [15] or altering gut microbiota [16].”
Background
Effect of Stevia Consumption on Blood Pressure, Stress Hormone Levels and Anthropometrical Parameters in Healthy Persons
Al‐Dujaili, E. A. S., Twaij, H. A. A., Bataineh, Y. A., Arshad, U., & Amjid, F. (2017) · American Journal of Pharmacology and Toxicology · doi:10.3844/ajptsp.2017.7.17 · Cited by 17
“…compared the effects of stevia and other lowcalorie sweeteners with sucrose intake, satiety and body weight in healthy and obese individuals observed that stevia reduced the calorie intake of healthy and obese participants compared to those consuming sucrose (Ashwell, 2015; Rogers et al., 2016).”
Background
Anion Exchange Reaction for Preparing Acesulfame Solid Forms
Wang, C., Perumalla, S. R., & Sun, C. C. (2018) · Crystal Growth & Design · doi:10.1021/acs.cgd.8b00106 · Cited by 17
Associations between Psycho-Hedonic Responses to Sweet and Savoury Tastes with Diet and Body Composition in a Sample of Asian Females
Lim, A. J., Teo, P. S., Tan, V. W. K., & Forde, C. G. (2020) · Foods · doi:10.3390/foods9091318 · Cited by 17
“Extensive research has demonstrated that replacing sugar with low-calorie sweeteners can be used to decrease energy intake and reduce body weight [58].”
Background
Perceived Healthiness of Sweeteners among Young Adults in Canada
Goodman, S. E., Vanderlee, L., Jones, A. C., White, C. M., & Hammond, D. G. (2020) · Canadian Journal of Dietetic Practice and Research · doi:10.3148/cjdpr-2020-030 · Cited by 17
Finding the Sweet Spot: Measurement, Modification, and Application of Sweet Hedonics in Humans
Cheon, E., Reister, E. J., Hunter, S., & Mattes, R. D. (2021) · Advances in Nutrition · doi:10.1093/advances/nmab055 · Cited by 17
Hypotheses and evidence related to intense sweeteners and effects on appetite and body weight changes: A scoping review of reviews
Mosdøl, A., Vist, G. E., Svendsen, C., Dirven, H. A. A. M., Lillegaard, I. T., Mathisen, G. H., & Husøy, T. (2018) · PLoS ONE · doi:10.1371/journal.pone.0199558 · Cited by 20
“[19] had a systematic search and separate analyses of animal studies, while two publications presents some evidence from animal studies [24, 27].”
BackgroundResultInfluential
The Combined Effects of Aspartame and Acesulfame-K Blends on Appetite: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Mehat, K., Chen, Y., & Corpe, C. P. (2022) · Advances in Nutrition · doi:10.1093/advances/nmac072 · Cited by 16
“In conclusion, our findings are in line with previously published systematic reviews (5, 9) showing that NNS intake can lead to a reduction in EI compared with caloric (sugar) or noncaloric (water) intake.”
BackgroundResultInfluential
Are energy drinks unique mixers in terms of their effects on alcohol consumption and negative alcohol-related consequences?
Johnson, S. J., Alford, C., Stewart, K., & Verster, J. C. (2018) · International Journal of General Medicine · doi:10.2147/ijgm.s143476 · Cited by 16
Research Priorities for Studies Linking Intake of Low-Calorie Sweeteners and Potentially Related Health Outcomes
Bright, O.-J. M., Wang, D. D., Shams‐White, M., Bleich, S. N., Foreyt, J. P., Franz, M. J., Johnson, G., Manning, B. T., Mattes, R. D., Pi‐Sunyer, X., et al. (2017) · Current Developments in Nutrition · doi:10.3945/cdn.117.000547 · Cited by 17
“(21) suggested switching the research focus to how to best utilize LCSs to achieve specific public health goals.”
Background
Low- and No- Calorie Sweeteners (LNCS): critical evaluation of their safety and health risks
Maluly, H. D. B., Johnston, C. A., Giglio, N., Schreiner, L. L., Roberts, A. S., & ABEGAZ, E. G. (2020) · Food Science and Technology · doi:10.1590/fst.36818 · Cited by 15
No difference in compensation for sugar in a drink versus sugar in semi-solid and solid foods
Gadah, N. S., Kyle, L., Smith, J. E., Brunstrom, J. M., & Rogers, P. J. (2015) · Physiology & Behavior · doi:10.1016/j.physbeh.2015.12.025 · Cited by 15
A workshop on ‘Dietary Sweetness—Is It an Issue?’
Wittekind, A., Higgins, K., McGale, L. S., Schwartz, C., Stamataki, N. S., Beauchamp, G. K., Bonnema, A. L., Dussort, P., Gibson, S. A., de Graaf, C., et al. (2017) · International Journal of Obesity · doi:10.1038/ijo.2017.296 · Cited by 15
Low-Calorie Beverage Consumption, Diet Quality and Cardiometabolic Risk Factors in British Adults
Patel, L., Alicandro, G., & Vecchia, C. L. (2018) · Nutrients · doi:10.3390/nu10091261 · Cited by 15
“Our findings are also similar to those from a recent systematic review and meta-analysis [9], based on 129 short-term randomised controlled trials in children and adults, reported that the consumption of low-calorie sweeteners in place of sugar reduces energy intake and body weight.”
BackgroundResult
Effect of non-nutritive sweeteners on insulin regulation, glycemic response, appetite and weight management: a systematic review
Mathur, P., & Bakshi, A. (2023) · Nutrition & Food Science · doi:10.1108/nfs-03-2023-0060 · Cited by 14
Effect S of non-nutritive s W eetened beverages on appet IT e during a C tive weig H t loss (SWITCH): Protocol for a randomized, controlled trial assessing the effects of non-nutritive sweetened beverages compared to water during a 12-week weight loss period and a follow up weight maintenance period
Masic, U., Harrold, J. A., Christiansen, P., Cuthbertson, D. J., Hardman, C. A., Robinson, E., & Halford, J. C. G. (2016) · Contemporary Clinical Trials · doi:10.1016/j.cct.2016.12.012 · Cited by 15
Artificially Sweetened Beverage Consumption and Cancer Risk: A Comprehensive Dose–Response Meta-Analysis of Prospective Studies
Yin, T., Li, J., Wang, Y., Liu, K., Long, T., & Cheng, L. (2022) · Nutrients · doi:10.3390/nu14214445 · Cited by 16
“supposed to be attributed to reverse causality [85].”
Background
The impact of non-caloric artificial sweetener aspartame on female reproductive system in mice model
Naik, A. Q., Zafar, T., & Shrivastava, V. K. (2023) · Reproductive Biology and Endocrinology · doi:10.1186/s12958-023-01115-4 · Cited by 15
“These observations are supported by some researchers [49, 50] who reported that ASP intake induces satiety, decreases food intake and bodyweight.”
Background
Dietary Sugar Intake and Risk of Noncommunicable Diseases
Mojto, V., Singh, R. B., Gvozdjáková, A., Mojtová, M., Kucharská, J., Jaglan, P., Vančová, O., & Takahashi, T. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-813148-0.00017-7 · Cited by 13
Comparación del contenido de azúcares y edulcorantes no calóricos en néctares y bebidas antes y después de implementar la ley chilena 20.606
Vilma Quitral, R., Arteaga, J., Rivera, M., Galleguillos, J., & Valdés, I. (2019) · Revista chilena de nutrición · doi:10.4067/s0717-75182019000300245 · Cited by 13
Is There an Academic Bias against Low-Energy Sweeteners?
Mela, D. J. (2022) · Nutrients · doi:10.3390/nu14071428 · Cited by 13
“caloric sweeteners, and generally has neutral effects on total energy intakes relative to unsweetened (mainly water) controls [10,11,15,16].”
BackgroundResult
Sensory influences on food choice and energy intake
Forde, C. G., & de Graaf, K. C. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-89903-1.00013-x · Cited by 12
Assessing the impact of non-nutritive sweeteners on anthropometric indices and leptin levels in adults: A GRADE-assessed systematic review, meta-analysis, and meta-regression of randomized clinical trials
Movahedian, M., Golzan, S. A., Asbaghi, O., Prabahar, K., & Hekmatdoost, A. (2023) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2023.2233615 · Cited by 14
“Cohort studies investigating the relationship between low-calorie sweetener use and BMI have reported conflicting results, with some studies reporting an increase (Azad et al. 2017; Miller and Perez 2014) in BMI and others finding no significant change (Rogers et al. 2016).”
Diet and physical activity as possible mediators of the association between educational attainment and body mass index gain among Australian adults
Gearon, E., Peeters, A., Ng, W. L., Hodge, A. M., & Backholer, K. (2018) · International Journal of Public Health · doi:10.1007/s00038-018-1100-z · Cited by 14
Combating Excessive Eating: A Role for Four Evidence‐Based Remedies
Rogers, P. J. (2018) · Obesity · doi:10.1002/oby.22280 · Cited by 15
“As predicted by the lack of short-term balancing of energy intake against energy expenditure, recent meta-analyses of acute and longer-term randomized controlled trials in human participants have demonstrated that consumption of LCS compared with consumption of sugars reduces energy intake and body weight (58,59).”
BackgroundMethodResultInfluential
The Chain-Mediating Effect of Obesity, Depressive Symptoms on the Association between Dietary Quality and Cardiovascular Disease Risk
Zhang, S., Limei, E., Lu, Z., Yu, Y., Yang, X., Chen, Y., & Jiang, X. (2023) · Nutrients · doi:10.3390/nu15030629 · Cited by 12
A Comparison of the Satiety Effects of a Fruit Smoothie, Its Fresh Fruit Equivalent and Other Drinks
Rogers, P. J., & Shahrokni, R. O. (2018) · Nutrients · doi:10.3390/nu10040431 · Cited by 12
“This may be partly true for gulped liquids, but the energy consumed will be detected in the gut and post-absorptively and clearly does have a satiating effect as confirmed by the effects of sugar-containing drinks, outlined above [11].”
BackgroundMethodResultInfluential
Sensory Responses in Nutrition and Energy Balance: Role of Texture, Taste, and Smell in Eating Behavior
de Graaf, K. C. (2020) · Springer eBooks · doi:10.1007/978-3-030-14504-0_117 · Cited by 13
Effects of gastrointestinal delivery of non-caloric tastants on energy intake: a systematic review and meta-analysis
Klaassen, T., Keszthelyi, D., Troost, F. J., Bast, A., & Masclee, A. (2021) · European Journal of Nutrition · doi:10.1007/s00394-021-02485-4 · Cited by 12
In Vitro Antioxidant Activities and the Therapeutic Potential of Some Newly Synthesized Chalcones Against 4-Acetaminophenol Induced Hepatotoxicity in Rats
Akhtar, M. S., Rehman, A., Arshad, H., Malik, A., Fatima, M., Tabassum, T., Raza, A. R., Bukhsh, M., Murtaza, M. A., Mehmood, M. H., et al. (2021) · Dose-Response · doi:10.1177/1559325821996955 · Cited by 12
“Body weight is highly sensitive variable in toxicity studies and taken into consideration when noxious effects of several drugs are going to be determined.(25) The treatment of animals with test chalcone analogues showed a substantial increase in body weight which reflected the improvement in general health conditions…”
Background
An Overview of Reviews on the Association of Low Calorie Sweetener Consumption With Body Weight and Adiposity
Higgins, K., Rawal, R., Kramer, M., Baer, D. J., Yerke, A. M., & Klurfeld, D. M. (2024) · Advances in Nutrition · doi:10.1016/j.advnut.2024.100239 · Cited by 12
“…only RCT [19,32,36,38,44 – 46]; 3 included only prospective cohorts and/or case – control studies [20,47,48]; and 10 included RCT and NRS (including prospective cohorts, retrospective cohorts, case – control, cross-sectional, and non-randomized clinical trials) [11,30,31,34,35,37,39,49 – 51].”
Influential
Effects of Nonnutritive Sweeteners on the BMI of Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies
Espinosa, A., Mendoza, K., Laviada‐Molina, H., Rangel-Méndez, J. A., Molina-Seguí, F., Sun, Q., Tobias, D. K., Willett, W. C., & Mattei, J. (2024) · Advances in Nutrition · doi:10.1016/j.advnut.2024.100292 · Cited by 13
Effects of artificial and natural sweeteners on host metabolic health: A double-edged sword
Xue, H., Kang, X., Hong, K., Gao, Y., Tang, Y., Lin, Y., Liu, X., Huang, W., Zhan, J., & You, Y. (2025) · Food Research International · doi:10.1016/j.foodres.2025.117158 · Cited by 14
Do low-calorie sweeteners promote weight gain in rodents?
Glendinning, J. I. (2016) · Physiology & Behavior · doi:10.1016/j.physbeh.2016.01.043 · Cited by 11
The Effects of Different High-Protein Low-Carbohydrates Proprietary Foods on Blood Sugar in Healthy Subjects
Lodi, A., Karsten, B., Bosco, G., López, M. G., Brandão, P. P., Bianco, A., & Paoli, A. (2016) · Journal of Medicinal Food · doi:10.1089/jmf.2016.0072 · Cited by 13
“However, more studies are required to confirm these negative suggestions, since a recent review shows that there is no evidence for a limitation of their use to reduce energy intake.(70) The same author states that our congenitally liking for sweetness implies that the reward value from sugar and low-calorie sweetener…”
Energy Expenditure, Carbohydrate Oxidation and Appetitive Responses to Sucrose or Sucralose in Humans: A Pilot Study
Chern, C., & Tan, S. (2019) · Nutrients · doi:10.3390/nu11081782 · Cited by 11
“Our observations were consistent with a systematic review of observational and short-term interventional trials, where NNS use did not increase appetite, food intake or weight gain in humans [52].”
Result
Maternal intake of fructose or artificial sweetener during pregnancy and lactation has persistent effects on metabolic and reproductive health of dams post-weaning
Bridge-Comer, P. E., Vickers, M. H., Morton-Jones, J., Spada, A., Rong, J., & Reynolds, C. M. (2022) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s2040174422000022 · Cited by 11
Scoping Review and Evidence Map of the Relation between Exposure to Dietary Sweetness and Body Weight-Related Outcomes in Adults
Higgins, K., Rawal, R., Baer, D. J., O’Connor, L. E., & Appleton, K. M. (2022) · Advances in Nutrition · doi:10.1093/advances/nmac090 · Cited by 11
From biology to behavior: a cross‐disciplinary seminar series surrounding added sugar and low‐calorie sweetener consumption
Sylvetsky, A. C., Hiedacavage, A., Shah, N., Pokorney, P. E., Baldauf, S., Merrigan, K., Smith, V., Long, M. W., Black, R., Robien, K., et al. (2019) · Obesity Science & Practice · doi:10.1002/osp4.334 · Cited by 10
“The majority of RCTs show that replacement of SSBs with LCS reduces body weight (71).”
BackgroundInfluential
A Single 48 mg Sucralose Sip Unbalances Monocyte Subpopulations and Stimulates Insulin Secretion in Healthy Young Adults
Gómez-Arauz, A. Y., Bueno-Hernández, N., Palomera, L. F., Alcántara-Suárez, R., León, K. L. D., Méndez-García, L. A., Carrero-Aguirre, M., Manjarrez‐Reyna, A. N., Martínez‐Reyes, C. P., Esquivel‐Velázquez, M., et al. (2019) · Journal of Immunology Research · doi:10.1155/2019/6105059 · Cited by 11
Changes in nutrient and calorie intake, adipose mass, triglycerides and TNF-α concentrations after non-caloric sweetener intake: A pilot study
Sánchez‐Delgado, M., Estrada, J. A., Cervantes, V. P., Kaufer‐Horwitz, M., & Contreras, I. (2019) · International Journal for Vitamin and Nutrition Research · doi:10.1024/0300-9831/a000611 · Cited by 13
Artificial Sweeteners: Perceptions and Realities
Samreen, H., & Dhaneshwar, S. S. (2022) · Current Diabetes Reviews · doi:10.2174/1573399818666220429083052 · Cited by 10

Authors: Rogers, P. J., Hogenkamp, P. S., de Graaf, C., Higgs, S., Lluch, A., Ness, A. R., Penfold, C., Perry, R., Putz, P., Yeomans, M. R., & Mela, D. J.
Affiliations: University of Bristol (GB)
Uppsala University (SE)
University of Birmingham (GB)
Danone (France) (FR)
University Hospitals Bristol NHS Foundation Trust (GB)
University of Sussex (GB)
Unilever Research and Development Vlaardingen (NL)
ORCID: Rogers, P J
Higgs, S
Ness, A R
Penfold, C
Perry, R
Yeomans, M R
Mela, D J
Venue: International Journal of Obesity
Publisher: Springer Science and Business Media LLC
Published: 2015-09-14
Volume: 40
Issue: 3
Pages: 381-394
ISSN: 0307-0565 (ISSN-L)
1476-5497
DOI: 10.1038/ijo.2015.177
PMC: PMC4786736
OpenAlex: W2171131656
Cited by: 358
References: 210
Citations by year: 2026: 16 · 2025: 19 · 2024: 24 · 2023: 29 · 2022: 33 · 2021: 26 · 2020: 53 · 2019: 34 · 2018: 46 · 2017: 44 · 2016: 31 · 2015: 2
FWCI: 5.26
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (tdm)
creativecommons.org/licenses/by/4.0 (vor)
Locations: International Journal of Obesity (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Explore Bristol Research (publishedVersion, cc-by)
Socio-Environmental Systems Modeling (acceptedVersion, cc-by)
Figshare (submittedVersion, cc-by)
Bristol Research (University of Bristol) (submittedVersion, cc-by)
Sussex Research Online (University of Sussex) (submittedVersion, cc-by)
KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by)
Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
Funders: University Hospitals Bristol NHS Foundation Trust
National Institute for Health and Care Research (NF-SI-0513-10083)
European Commission (607310)
University of Bristol
Wageningen University and Research
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Biochemical Analysis and Sensing Techniques
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
Keywords: energy intake, body weight, body mass index, sugar-sweetened beverages, ad libitum feeding, energy density, weight gain, reverse causality, animal studies, prospective cohort, randomized controlled trials
MeSH terms: Animals, Body Weight, Energy Intake, Humans, Obesity, Sweetening Agents, Reproducibility of Results, Weight Gain, Body Mass Index, Randomized Controlled Trials as Topic, Evidence-Based Medicine, Models, Animal, Non-Nutritive Sweeteners, Observational Studies as Topic

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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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