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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
Open accessAbstract
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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“There is mixed evidence from systematic reviews and meta-analyses for nonnutritive sweetener use with regard to weight management, with some finding benefit in weight loss (233-235) while other research suggests an association with weight gain (236,237).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [234]
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“18 In contrast to this, two meta-analyses have reported that no clear and significant evidence exists between the use of ASs and BW. 19,20 Hence this umbrella meta-analysis was conducted to overcome this conflict and provide clear evidence on the effect of ASs on BW, BMI, and energy intake and…”
BackgroundMethodResultInfluentialNutritional Recommendations for People with Type 1 Diabetes Mellitus
Rubin, D., Bosy‐Westphal, A., Kabisch, S., Kronsbein, P., Müssig, K., Simon, M., Tombek, A., Weber, K. S., & Skurk, T. (2025) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-2500-0477 · Cited by 2
“Regarding the effect of sweet - eners on appetite, intervention studies show that beverages containing sweeteners have an effect similar to water on appetite and energy intake [43, 45–47].”
Pacheco-Sánchez, B., Melgar‐Locatelli, S., López-Merchán, R., Benítez-Marín, M. J., Alonso, M. B., González‐Mesa, E., Tovar, R., Rubio, P., Suárez, J., Sanjuan, C., et al. (2025) · Biology of Sex Differences · doi:10.1186/s13293-025-00724-5 · Cited by 3
“…in the use of NNS to prevent excessive weight gain since observational studies showed a positive correlation between NNS consumption and body weight gain [4, 5]; however, other studies indicate that replacing sugars with NNS induces weight loss, especially in people with excess body weight [6, 7].”
Balachandran, K. (2018) · Journal of Social Health and Diabetes · doi:10.4103/jshd.jshd_20_17 · Cited by 2
Empfehlungen zur Ernährung von Personen mit Typ-1-Diabetes mellitus
Rubin, D., Bosy‐Westphal, A., Kabisch, S., Kronsbein, P., Simon, M., Tombek, A., Weber, K. S., Skurk, T., & für den Ausschuss Ernährung der, D. D. G. (2022) · Diabetologie und Stoffwechsel · doi:10.1055/a-1908-0685 · Cited by 2
Hassan, M. I. (2016) · doi:10.12691/jfnr-4-3-4 · Cited by 2
The impact of artificial sweeteners on the metabolic syndrome
Czyżewski, F., Baranowska, A., Baranowska, K., Filipek, K., Kawka, J., Muciek, M., Mrugała, S., Mrugała, W., Skierkowski, B., & Zalewska, N. (2024) · Journal of Education Health and Sport · doi:10.12775/jehs.2024.66.013 · Cited by 2
Verlangen nach Süßem: Eine Evaluation der Suchtperspektive auf Zucker- und Süßstoffkonsum
Meule, A. (2017) · Pädiatrie & Pädologie · doi:10.1007/s00608-017-0489-6 · Cited by 2
Non-caloric sweeteners in women of reproductive age – A consensus document
Laviada‐Molina, H., Uriza, R. B., Méndez, J. A. A., Cavagnari, B. M., Celis-González, C., Tellez, R. C., Brambila, J. C., Espinosa‐Marrón, A., Plascencia, J. L., Alarcón, M. G. L., et al. (2020) · Nutrición Hospitalaria · doi:10.20960/nh.02870 · Cited by 2
“Tal es el caso del metaanálisis realizado por Rogers en 2016 (48), en el cual se agruparon estudios de intervención (adultos y niños), encontrándose que en los grupos con ENC (comparando contra otros comparadores) se apreciaron los valores más bajos de ingesta energética.”
BackgroundTherapeutic Management of Obesity
Bray, G. A. (2020) · Contemporary cardiology · doi:10.1007/978-3-030-56514-5_17 · Cited by 3
Flynn, A. N., Rogers, P. J., Hall, K. D., Courville, A. B., & Brunstrom, J. M. (2023) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2022.10.009 · Cited by 2
Can aspartame-sweetened products safely help with weight loss?
Wojcieszonek, A., Szpyt, J., Pajor, K., & Hawryłkowicz, V. (2020) · Journal of Education Health and Sport · doi:10.12775/jehs.2020.10.09.039 · Cited by 1
“348 The reason for this may be the fact that a person consuming a drink based on aspartame or other sweetener does not want to reach for high-calorie snacks as often as the person consuming water alone [13].”
BackgroundWie sinnvoll ist eine Zuckersteuer?
Dippel, F.-W. (2023) · Ernährung & Medizin · doi:10.1055/a-1834-6138 · Cited by 1
“Eine Metaanalyse beobachtete sogar eine Gewichtszunahme unter dem Konsum von süßstoffhaltigen Getränken bei Kindern sowie im Tierversuch [8].”
BackgroundEmpfehlungen zur Ernährung von Personen mit Typ-1-Diabetes mellitus
Rubin, D., Bosy‐Westphal, A., Kabisch, S., Kronsbein, P., Simon, M., Tombek, A., Weber, K. S., & Skurk, T. (2023) · Die Diabetologie · doi:10.1007/s11428-023-01040-5 · Cited by 1
“Bezüglich eines Effekts von Süßstoffen auf den Appetit zeigen Interventionsstudien, dass süßstoffhaltige Getränke eine ähnliche Wirkung auf Appetit und Energiezufuhr haben wie Wasser [62, 64, 65].”
de Lima, R. C., Silva, G. B. E., Mendonça, V. S., Malhão, T. A., Diógenes, M. E. L., & Huguenin, G. V. B. (2024) · Nutrition Reviews · doi:10.1093/nutrit/nuae110 · Cited by 1
Smeets, P. A. M., Veit, R., Oosterink, E., Meijboom, S., Risso, D. S., Preissl, H. T., & Kullmann, S. (2026) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2026.101401 · Cited by 1
“A wealth of evidence in humans suggests that overall nonnutritive-sweetened drinks are equivalent to water, in terms of their acute metabolic effects and their effects on energy intake and weight [6,7].”
Aiestarán-Zelaia, I., Sánchez-Guisado, M. J., Beraza, M., López-Arandia, L., Plaza‐García, S., Fernández-Folgueral, I., de Molina-Iracheta, A., Holt, I. J., & Ruı́z-Cabello, J. (2025) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2025.118891 · Cited by 1
Artificial Sweeteners and Cardiovascular Disease: Systematic Review and Meta-analysis
Gimeno-Ruiz, S., Belanche, C. T., Muñoz-Cabrejas, A., Morales-Suárez-Varela, M., Guallar‐Castillón, P., & Moreno‐Franco, B. (2025) · Nutrition Reviews · doi:10.1093/nutrit/nuaf298 · Cited by 1
Xu, B., Kang, X., Zhang, H., Huang, L., Magnuson, J. T., Wang, M., Walther, G., Duan, G., & Qiu, W. (2026) · Trends in Food Science & Technology · doi:10.1016/j.tifs.2026.105631 · Cited by 1
Wang, L., Chang, T., 賈文康, Chen, J., Li, L., Zhang, T., Wang, B., Dong, C., Cui, Y., & Liao, X. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1894194 · Cited by 1
Gupta, G., Yograj, S., Gupta, A. K., Langer, B., Goni, M., & Kalsotra, L. (2017) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20170926 · Cited by 1
“On the contrary, Rogers et al have found beneficial effect on weight with use of artificial sweeteners.(18) The health benefits of artificial sweeteners are inconclusive, with research showing mixed findings.”
BackgroundNutritional Recommendations for People with Type 1 Diabetes Mellitus
Rubin, D., Bosy‐Westphal, A., Kabisch, S., Kronsbein, P., Simon, M., Tombek, A., Weber, K. S., & Skurk, T. (2023) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-1946-3753 · Cited by 1
“Regarding the effect of sweeteners on appetite, intervention studies show that beverages containing sweeteners have an effect similar to water on appetite and energy intake [63, 65, 66].”
BackgroundThe review: Effects of acesulfame K on human health
Xu, X. (2024) · International journal of agriculture and food sciences research. · doi:10.62051/ijafsr.v1n1.07 · Cited by 1
“Switching to ACK-added foods from regular foods with sugar can assist in weight loss and blood sugar control [9; 25, 26].”
BackgroundAspartame: A review of functional properties and physiology impacts of aspartame
Zhang, Y. (2024) · Theoretical and Natural Science · doi:10.54254/2753-8818/45/20240521 · Cited by 1
Nolden, A. A., & Makame, J. (2024) · Nutrients · doi:10.3390/nu17010032 · Cited by 1
Hsiao, D., Kruger, R., Diako, C., Nelson, I., Stice, E. M., & Ali, A. (2025) · Appetite · doi:10.1016/j.appet.2025.107871 · Cited by 1
Pyrogianni, V. (2018) · Nutrition Reviews · doi:10.1093/nutrit/nuy051 · Cited by 3
Le goût sucré dans la tourmente. Entre suspicions et réalités
Schlienger, J.-L. (2020) · Médecine des Maladies Métaboliques · doi:10.1016/j.mmm.2020.01.012 · Cited by 1
Nutritional Recommendations for People with Type 1 Diabetes Mellitus
Rubin, D., Bosy‐Westphal, A., Kabisch, S., Kronsbein, P., Simon, M., Tombek, A., Weber, K. S., & Skurk, T. (2020) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-1284-6036 · Cited by 2
Habib, F. A., Putra, B. A. W., & Setyono, B. (2020) · Jurnal Edukasi · doi:10.19184/jukasi.v7i3.21602 · Cited by 1
Fantino, M., Fantino, A., Matray, M., & Mistretta, F. (2018) · Appetite · doi:10.1016/j.appet.2018.06.036 · Cited by 1
Metadata
- 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)
- Venue
- International Journal of Obesity
- Published
- 2015-09-14
- Volume
- 40
- Issue
- 3
- Pages
- 381-394
- ISSN
- 0307-0565 (ISSN-L)
- 1476-5497
- 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
- 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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