Cited by 115Biochemical Analysis and Sensing TechniquesDiet, Metabolism, and DiseaseRegulation of Appetite and Obesity

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Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: systematic review and meta-analysis

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Laviada‐Molina, Hugo, Molina‐Segui, Fernanda, Pérez‐Gaxiola, Giordano, Cuello‐García, Carlos, Arjona‐Villicaña, Ruy, Espinosa‐Marrón, Alan, Martinez‐Portilla, Raigam Jafet·2020·Obesity Reviews

DOI 10.1111/obr.13020

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Abstract

There is an ongoing debate about the possible influences of nonnutritive sweeteners (NNS) on body weight. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) with NNS to assess their impact on body weight. We systematically searched for RCTs at least 4 weeks in duration, evaluating the effect of NNS on body weight, both in subjects with healthy weight and in subjects with overweight/obesity at any age, and compared the effects of NNS vs caloric and noncaloric comparators. The primary outcome was the difference in body weight between NNS and comparators. Twenty studies were eligible (n = 2914). Participants consuming NNS showed significant weight/BMI differences favouring NNS compared with nonusers. Grouping by nature of comparator revealed that NNS vs placebo/no intervention and NNS vs water produced no effect. When comparing NNS vs sucrose, significant weight/BMI differences appeared favouring NNS. Consumption of NNS led to significantly negative weight/BMI differences in unrestricted energy diets, but not in weight-reduction diets. Participants with overweight/obesity and adults showed significant favourable weight/BMI differences with NNS. Data suggest that replacing sugar with NNS leads to weight reduction, particularly in participants with overweight/obesity under an unrestricted diet, information that could be utilized for evidence-based public policy decisions.

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“A meta-analysis of 20 randomised clinical trials showed that study participants consuming products with intense sweeteners showed significantly lower body weight compared to people not consuming this type of products [85].”
Potential actions for preventing high consumption of Non-Nutritive Sweeteners among Chilean children and adolescents: recommendations from a panel of relevant actors
Marcela Reyes, J., León, C. P., Ortega, A., Pemjean, I., Corvalán, C., & Garmendia, M. L. (2024) · Public Health Nutrition · doi:10.1017/s1368980024001745 · Cited by 5
“Although results are still inconclusive (9,10) , some health associations such as the Institute of Medicine of the United States (IOM-USA) and the American Academy of Pediatrics have concluded that consumption of NNS in children should not be promoted until all its potential health effects are…”
Result
Human body weight, nutrients, and foods: a scoping review
Hjelmesaeth, J. S., & Sjöberg, A. (2022) · Food & Nutrition Research · doi:10.29219/fnr.v66.8814 · Cited by 5
“Non-nutritive sweeteners One recent SR and MA of 20 randomised controlled trial (RCTs) (15) including 2,914 participants with the duration of 4–77 weeks showed that participants consuming NNS showed small but significant weight/body mass index (BMI) differences favoring NNS compared with non-users (–1.”
Background
Effects of Non-Nutritive Sweeteners on Weight Loss and Maintenance, Metabolic Improvement, and Appetite Regulation in Weight Management Programs: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Wen, J., Wu, Q., Li, S., Liu, Y., & Wen, D. (2025) · Nutrition Reviews · doi:10.1093/nutrit/nuaf094 · Cited by 4
Reconciling conflicting evidence on low- and no-calorie sweeteners and cardiometabolic outcomes: an umbrella review using naïve and bias-adjusted methods
Ayoub‐Charette, S., Kavanagh, M. E., Khan, T. A., & Sievenpiper, J. L. (2025) · Applied Physiology Nutrition and Metabolism · doi:10.1139/apnm-2025-0068 · Cited by 4
Human neural synergy when combining stevia with a flavour modifier and the neural effects of sucrose vs stevia
Ko, H.-K., Shi, J., Eidenberger, T., Shi, W., & McCabe, C. (2025) · NeuroImage · doi:10.1016/j.neuroimage.2025.121552 · Cited by 4
Sweeteners: Sensory properties, digestion, consumption trends, and health effects
Mattes, R. D., Tan, S., & Tucker, R. M. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-821848-8.00014-7 · Cited by 6
Non-nutritive sweeteners and body weight management: another brick in the wall of evidence
Rogers, P. J. (2023) · International Journal of Obesity · doi:10.1038/s41366-023-01419-w · Cited by 4
“This result sits comfortably within the range of results identi ﬁ ed in meta-analyses [4, 5] of previous RCTs making this comparison, which collectively show no difference for body weight between NNS beverages and water.”
Enteroendocrine hormonal response after the ingestion of cola beverages with sucrose and non-nutritive sweeteners in healthy adults: A randomized crossover trial
Galicia-Ayala, C., Klünder‐Klünder, M., Vilchis-Ordóñez, A., López-Martı́nez, B., & Miranda‐Lora, A. L. (2025) · Nutrition · doi:10.1016/j.nut.2025.112938 · Cited by 3
Differential effects of nutritive and non-nutritive sweet mouth rinsing on appetite in adults with obesity
Cogan, B., & Cooper, J. A. (2023) · Appetite · doi:10.1016/j.appet.2023.107133 · Cited by 3
The effect of sweeteners on carbohydrate metabolism, metabolic parameters and intestinal microbiota
Silina, N. V., Mazurina, N. V., Ershova, E. V., & Komshilova, K. A. (2024) · Obesity and metabolism · doi:10.14341/omet13020 · Cited by 3
Low‐ or No‐Energy Sweeteners and Body Weight Management: Dissecting a “Minor” Effect
Bellisle, F. (2025) · Obesity Reviews · doi:10.1111/obr.13937 · Cited by 2
“Although an early RCT suggested that aspartame administered in capsules could decrease later food intake [68], LNES delivered in capsules had no effect on weight [36, 37] or glycemia [69].”
Human brain responses to the artificial sweetener sucralose and sucrose in the presence of flavour modifier
Ko, H.-K., Shi, J., Eidenberger, T., Shi, W., & McCabe, C. (2025) · Nutritional Neuroscience · doi:10.1080/1028415x.2025.2508772 · Cited by 4
“A recent meta-analysis finds that replacing sugar with non-nutrient sweeteners leads to weight reduction, particularly in participants overweight/obese under an unrestricted diet [5].”
The Effect of Non‐Nutritive Sweeteners' Consumption on Body Weight: A Randomized‐Controlled Trial
Daher, M. I., Darazi, E. E., Kacim, M., Hobeika, M., & Sacre, Y. (2025) · Food Science & Nutrition · doi:10.1002/fsn3.70691 · Cited by 3
Artificial Sweeteners Perturbed Liver Enzymes in Rat Model
Dawood, M. N., Jasim, S. A. H., Fadel, M. A., & Thanoon, I. A.-J. (2022) · Pharmacognosy Journal · doi:10.5530/pj.2022.14.135 · Cited by 3
Sucralose Targets the Insulin Signaling Pathway in the SH-SY5Y Neuroblastoma Cell Line
Čović, M., Zjalić, M., Mihajlović, L., Pap, M., Wagner, J., Mandić, D., Debeljak, Ž., & Heffer, M. (2023) · Metabolites · doi:10.3390/metabo13070817 · Cited by 3
Sweet Talk: A Qualitative Study Exploring Attitudes towards Sugar, Sweeteners and Sweet-Tasting Foods in the United Kingdom
Tang, C. S., Mars, M., James, J., de Graaf, K. C., & Appleton, K. M. (2021) · Foods · doi:10.3390/foods10061172 · Cited by 3
“Consistent with work demonstrating benefits for weight management [27,28], LNCS use continues to be predominantly associated with concerns over bodyweight [14,16,29-31].”
Background
A Review of Low- and No-Calorie Sweetener Safety and Weight Management Efficacy
Mattes, R. D., Rivera, B. N., Rutigliani, G., Rogers, S., Mendoza, I. D., Wang, L., Beckemeier, K., & Wikoff, D. S. (2024) · Nutrition Today · doi:10.1097/nt.0000000000000723 · Cited by 2
The Effects of Aspartame on Glucose, Insulin, and Appetite-Regulating Hormone Responses in Humans: Systematic Review and Meta-Analyses
Boxall, L. R., Eskandari, F., Wallis, J., Bielat, A. D., & Appleton, K. M. (2025) · Advances in Nutrition · doi:10.1016/j.advnut.2025.100449 · Cited by 2
“LCS are commonly recognized as safe [10,11], widely used within the food industry [10,11], and recent reviews suggest bene ﬁ ts for reducing energy intake and body weight (BW), when compared with the consumption of sugar [12 – 14].”
The effects of non-nutritive sweeteners on lipid profile in adults: a systematic review and meta-analysis of randomized controlled clinical trials
Najafi, A., Moghtaderi, F., Seyedjafari, B., Rostampour, K., & Salehi‐Abargouei, A. (2025) · Scientific Reports · doi:10.1038/s41598-025-00612-3 · Cited by 3
The effects of artificial sweeteners on body weight, body fat, and energy intake: A meta-analysis of meta-analyses
Hamedi, F., Asemani, S., Prabahar, K., Jourabchi‐Ghadim, N., & Ostadrahimi, A. (2024) · BioSocial Health Journal. · doi:10.34172/bshj.22 · Cited by 2
“26 The selection of studies based on the inclusion criteria differs among each study, which would have contributed to this variation in results.”
Background
Public Health Impact and Environmental Sustainability of Low/No Calorie Sweeteners’ Use as Food and Beverage Reformulation Tools
Pyrogianni, V. (2025) · Food Science and Nutrition Cases · doi:10.1079/fsncases.2025.0008 · Cited by 1
Beyond Added Sugar Reduction: A Narrative Review of Policies to Address Nonsugar Sweeteners
Krieger, J. W., Davis, J. N., Ng, S. W., Nguyen, M., Zimová, A., Hedrick, V. E., Malik, V., Taillie, L. S., Sylvetsky, A. C., & Falbe, J. (2026) · Journal of Nutrition · doi:10.1016/j.tjnut.2026.101479 · Cited by 1
Effectiveness of obesity interventions among South Korean children and adolescents and importance of the type of intervention component: a meta-analysis
Choe, S., Sa, J., Chaput, J., & Kim, D. (2021) · Korean Journal of Pediatrics · doi:10.3345/cep.2021.00409 · Cited by 1
USE OF LOW-CALORIE SWEETENERS IN TREATING OBESITY
Reimisz, P. (2023) · Health Problems of Civilization · doi:10.5114/hpc.2023.128034 · Cited by 1
Cardiovascular Therapeutics from Natural Sources
Sreedevi, K., & Sandeep, P. M. (2024) · Springer eBooks · doi:10.1007/978-981-99-9183-9_17 · Cited by 2
Aspartame: 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
Educational Intervention Boosts Dietitians’ Knowledge of the Safety and Approval of Low- and No-Calorie Sweeteners
Nolden, A. A., & Makame, J. (2024) · Nutrients · doi:10.3390/nu17010032 · Cited by 1
“In a meta-analysis of 20 studies, Laviada-Molina and colleagues (2020) concluded that using LNCSs was associated with a significant reduction in body weight and BMI among overweight and obese consumers [20].”
Assessing Occupational Health and Safety Management: A Multi-Center Study of 30 in Primary Health Centers in Indonesia
Siswanto, S. (2025) · Journal of Applied Nursing and Health · doi:10.55018/janh.v7i1.288 · Cited by 2
Gain of Body Fat and Intake of Energy in Rats with Low Dose of Caloric and Non-Caloric Sweeteners Used in Reformulation Beverage in Mexico
Rodríguez, G. L., Galván, M., Galván-Valencia, O., & Castillo, J. G. (2025) · Beverages · doi:10.3390/beverages11030069 · Cited by 1
Effects of non‐nutritive sweeteners on diabetes: Comments on a Cochrane review
Laviada‐Molina, H., Espinosa‐Marrón, A., Martinez-Portilla, R. J., & Molina-Seguí, F. (2021) · Diabetic Medicine · doi:10.1111/dme.14520 · Cited by 1
Gut microbiota response to sucralose or rebaudioside A in rats under two dietary conditionsPreprint
Ramos-García, M., Mendoza, A. D. G., García-Vázquez, C., Martínez‐Magaña, J. J., Olvera‐Hernández, V., Martínez‐López, M. C., Díaz-Zagoya, J. C., Álvarez-Villagómez, C. S., Juárez-Rojop, I. E., Nicolini, H., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2802760/v1 · Cited by 1
Letter to the editor in response to article “Consumption patterns of nonnutritive sweeteners among university students at a Caribbean Institute”
Pyrogianni, V. (2020) · Journal of American College Health · doi:10.1080/07448481.2020.1767114
“While there has been much conversation regarding the potential for NNSs to cause weight gain, such an effect has been refuted by collective evidence from randomized controlled trials (RCTs) – the most reliable type of research for evaluation of proposed effects.(5,6) Webb et al(1) cite a recently conducted scoping rev…”
BackgroundResult
Effects of non‐nutritive sweeteners on diabetes: Reply to Laviada‐Molina et al.
Lohner, S., de Gaudry, D. K., Toews, I., Ferenci, T., & Meerpohl, J. J. (2021) · Diabetic Medicine · doi:10.1111/dme.14589
Non-nutritive Sweetened Beverages and Cardiometabolic Risk
McGlynn, N. D. (2020) · TSpace (University of Toronto)
The defamation of low-energy sweeteners: Crop circles, zombies, and zebrasPreprint
Mela, D. J. (2022) · doi:10.31219/osf.io/nh6ay
Is consumption of artificially sweetened beverages associated with obesity in adults?
Raetz, J., Veltri, K., Stine-Rowe, A., & Buck, L. (2022) · Evidence-Based Practice · doi:10.1097/ebp.0000000000001672
Kardiyovasküler Sağlığı İyileştirmeye Yönelik Diyet Yaklaşımları
Dedeler, E., AYHAN, Z., TOYMAN, E., & Kaner, G. (2023) · İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi · doi:10.61399/ikcusbfd.1206442
Sucralose or rebaudioside A at recommended doses did not alter the gut microbiota composition in rats under two dietary conditionsPreprint
Ramos-García, M., Mendoza, A. D. G., García-Vázquez, C., Martínez‐Magaña, J. J., Olvera‐Hernández, V., Martínez‐López, M. C., Díaz-Zagoya, J. C., Álvarez-Villagómez, C. S., Juárez‐Rojop, I. E., Nicolini, H., et al. (2024) · Research Square · doi:10.21203/rs.3.rs-2802760/v2
Dietary sucrose, sucralose and probiotic sweetener isomaltooligosaccharide divergently affect exercise induced weight loss and its associated skeletal muscle metabolismPreprint
Shi, L. S., Liu, Y., Duan, Y., Liu, T., Zhang, B., Zhu, W., Kang, J., & Zhang, K.-R. (2024) · Research Square · doi:10.21203/rs.3.rs-3867242/v1
Süßstoffe und ihre Wirkung auf das Körpergewicht
Kabisch, S. (2024) · Adipositas - Ursachen Folgeerkrankungen Therapie · doi:10.1055/a-2227-4357
“Es zeigt sich, dass diejenigen Gruppen mit Süßstoffexposition konsistent eine besse - re Gewichtsentwicklung aufweisen, bei Erwachsenen [20] und bei Kindern bzw.”
Background
Assessment of Knowledge and Perceptions of Pakistani Adults about Non-nutritive Sweeteners
Naveed, A., Khan, B., Asghar, K., Noor, M., Arshad, M., Sultan, T., & Mazhar, M. (2024) · DIET FACTOR (Journal of Nutritional & Food Sciences) · doi:10.54393/df.v5i01.104
Süßstoffe und ihre Wirkung auf das Körpergewicht
Kabisch, S. (2024) · Diabetes aktuell · doi:10.1055/a-2329-5194
肥満症の食事療法
小林, 俊. (2024) · Nihon Ika Daigaku Igakkai Zasshi · doi:10.1272/manms.20.261

Authors: Laviada‐Molina, H., Molina‐Segui, F., Pérez‐Gaxiola, G., Cuello‐García, C., Arjona‐Villicaña, R., Espinosa‐Marrón, A., & Martinez‐Portilla, R. J.
Affiliations: Universidad Marista de Mérida (MX)
Department of Human Nutrition and Metabolism Research, Health Sciences School Universidad Marista de Merida Mérida Mexico
Pediatric Hospital of Sinaloa (MX)
McMaster University (CA)
Endocrinology Service Hospital Regional de Alta Especialidad de la Peninsula de Yucatan Merida Mexico
Nuffield Department of Primary Health Sciences, Radcliffe Observatory Quarter University of Oxford Centre for Evidence‐Based Medicine Oxford UK
ORCID: Laviada‐Molina, Hugo
Molina‐Segui, Fernanda
Pérez‐Gaxiola, Giordano
Cuello‐García, Carlos
Arjona‐Villicaña, Ruy
Espinosa‐Marrón, Alan
Martinez‐Portilla, Raigam Jafet
Venue: Obesity Reviews
Publisher: Wiley
Published: 2020-03-25
Volume: 21
Issue: 7
Pages: e13020-e13020
ISSN: 1467-7881 (ISSN-L)
1467-789X
DOI: 10.1111/obr.13020
OpenAlex: W3014022032
Cited by: 115
References: 44
Citations by year: 2026: 12 · 2025: 23 · 2024: 25 · 2023: 16 · 2022: 19 · 2021: 13 · 2020: 7
FWCI: 1.69
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Obesity Reviews (publishedVersion)
PubMed (publishedVersion)
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: artificial sweeteners, body weight, body mass index, obesity, overweight, sucrose replacement, weight loss diet, sugar consumption
MeSH terms: Body Weight, Diet, Humans, Obesity, Body Mass Index, Non-Nutritive Sweeteners

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Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: systematic review and meta-analysis

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