Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies
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Background Replacement of caloric sweeteners with lower- or no-calorie alternatives may facilitate weight loss or weight maintenance by helping to reduce energy intake; however, past research examining low-calorie sweeteners (LCSs) and body weight has produced mixed results.Objective The objective was to systematically review and quantitatively evaluate randomized controlled trials (RCTs) and prospective cohort studies, separately, that examined the relation between LCSs and body weight and composition.Design A systematic literature search identified 15 RCTs and 9 prospective cohort studies that examined LCSs from foods or beverages or LCSs consumed as tabletop sweeteners. Meta-analyses generated weighted mean differences in body weight and composition values between the LCS and control groups among RCTs and weighted mean correlations for LCS intake and these parameters among prospective cohort studies.Results In RCTs, LCSs modestly but significantly reduced all outcomes examined, including body weight (-0.80 kg; 95% CI: -1.17, -0.43), body mass index [BMI (in kg/m²): -0.24; 95% CI: -0.41, -0.07], fat mass (-1.10 kg; 95% CI: -1.77, -0.44), and waist circumference (-0.83 cm; 95% CI: -1.29, -0.37). Among prospective cohort studies, LCS intake was not associated with body weight or fat mass, but was significantly associated with slightly higher BMI (0.03; 95% CI: 0.01, 0.06).Conclusions The current meta-analysis provides a rigorous evaluation of the scientific evidence on LCSs and body weight and composition. Findings from observational studies showed no association between LCS intake and body weight or fat mass and a small positive association with BMI; however, data from RCTs, which provide the highest quality of evidence for examining the potentially causal effects of LCS intake, indicate that substituting LCS options for their regular-calorie versions results in a modest weight loss and may be a useful dietary tool to improve compliance with weight loss or weight maintenance plans.
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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 while other research suggests an association with weight gain.
“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:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [233]
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- Authors
- Miller, P. E., & Perez, V.
- ORCID
- Miller, Paige E
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2014-09
- Volume
- 100
- Issue
- 3
- Pages
- 765-777
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC4135487
- OpenAlex
- W1963564461
- Cited by
- 313
- References
- 61
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 21 · 2023: 23 · 2022: 21 · 2021: 20 · 2020: 34 · 2019: 31 · 2018: 40 · 2017: 30 · 2016: 32 · 2015: 24 · 2014: 7
- FWCI
- 3.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed Central (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 composition, body mass index, fat mass, waist circumference, weight loss, weight maintenance, energy intake
- MeSH terms
- Energy Intake, Diet, Reducing, Humans, Patient Compliance, Prospective Studies, Recurrence, Reproducibility of Results, Cohort Studies, Weight Loss, Body Mass Index, Randomized Controlled Trials as Topic, Evidence-Based Medicine, Adiposity, Overweight, Non-Nutritive Sweeteners, Nutritive Sweeteners
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