Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies

Paige E Miller, Vanessa Perez, Paige E Miller, Vanessa Perez

Abstract

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.

© 2014 American Society for Nutrition.

Figures

FIGURE 1.
FIGURE 1.
Study selection process. http://www.ncbi.nlm.nih.gov/pubmed. LCS, low-calorie sweetener; RCT, randomized controlled trial.
FIGURE 2.
FIGURE 2.
Forest plots derived from random-effects models depicting the effect of LCS on body weight in RCTs among all subjects (A) and by age (B), sex (C), and source of LCS (D). Squares represent mean change in body weight within the individual studies; 95% CIs are represented by horizontal lines. Square size is proportional to the weight of each study. Diamonds represent the WGMD. *P < 0.05. LCS, low-calorie sweetener; RCT, randomized controlled trial; ref, reference; WGMD, weighted group mean difference.
FIGURE 3.
FIGURE 3.
Forest plots derived from random-effects models depicting the effects of LCS on BMI (A), fat mass (B), and waist circumference (C) in RCTs. Squares represent mean change within the individual studies; 95% CIs are represented by horizontal lines. Square size is proportional to the weight of each study. Diamonds represent the WGMD. *P < 0.05. LCS, low-calorie sweeteners; RCT, randomized controlled trial; ref, reference; WGMD, weighted group mean difference.
FIGURE 4.
FIGURE 4.
Forest plots derived from random effects models summarizing results from the meta-analysis of prospective cohort studies that examined LCS intake and change in BMI (A) or body weight (B). The squares represent the mean correlation within each study, with 95% CIs represented by horizontal lines. Square size is proportional to the weight of each study. Diamonds represent the WGMC. Reference numbers are shown in parentheses. *P < 0.05. LCS, low-calorie sweetener; ref, reference; WGMC, weighted group mean correlation.
FIGURE 5.
FIGURE 5.
Funnel plots for the detection of publication bias among RCTs that examined body weight (A) and prospective cohort studies that examined BMI (B). The x axis represents the effect size of each RCT (A) or the Fisher-transformed correlation value of each prospective cohort study (B). The y axis represents the SE of the effect size (A) or the correlation value (B) of the corresponding study. The solid vertical line is the pooled summary estimate from the meta-analysis. RCT, randomized controlled trial.

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