Effects of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Beverages on Cardiometabolic Risk Factors, Body Composition, and Sweet Taste Preference: A Randomized Controlled Trial

Cara B Ebbeling, Henry A Feldman, Sarah K Steltz, Nicolle L Quinn, Lisa M Robinson, David S Ludwig, Cara B Ebbeling, Henry A Feldman, Sarah K Steltz, Nicolle L Quinn, Lisa M Robinson, David S Ludwig

Abstract

Background A 2018 American Heart Association science advisory indicated that, pending further research, artificially sweetened beverages (ASBs) may be an appropriate initial replacement for sugar-sweetened beverages (SSBs) during transition to unsweetened beverages (USBs). Methods and Results We randomly assigned 203 adults (121 males, 82 females; 91.6% retention), who habitually consumed SSBs, to 3 groups and delivered free SSBs, ASBs, or USBs to their homes for 12 months. Outcomes included serum triglyceride to high-density lipoprotein cholesterol ratio (primary), body weight, and sweet taste preference (experimental assessment, 0%-18% sucrose solutions). Change in serum triglyceride to high-density lipoprotein cholesterol ratio was not different between groups. Although overall change in weight also was not different between groups, we found effect modification (P=0.006) by central adiposity. Among participants in the highest tertile of baseline trunk fat but not other tertiles, weight gain was greater (P=0.002) for the SSB (4.4±1.0 kg, estimate±SE) compared with ASB (0.5±0.9 kg) or USB (-0.2±0.9 kg) group. Both sweetness threshold (-1.0±0.2% m/v; P=0.005) and favorite concentration (-2.3±0.4% m/v; P<0.0001) decreased in the USB group; neither changed in the SSB group. In the ASB group, sweetness threshold did not change, and favorite concentration decreased (-1.1±0.5% m/v; P=0.02). Pairwise comparison between the ASB and USB groups indicated a difference in sweetness threshold (P=0.015). Conclusions Replacing SSBs with noncaloric beverages for 12 months did not affect serum triglyceride to high-density lipoprotein cholesterol ratio. Among individuals with central adiposity, replacing SSBs with either ASBs or USBs lowered body weight. However, USBs may have the most favorable effect on sweet taste preference. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT01295671.

Keywords: beverages; body weight; diet; dyslipidemia; sweet taste preference.

Conflict of interest statement

Dr Ludwig received royalties for books on obesity and nutrition that recommend a low‐glycemic‐load diet. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1
Participant flow. ASB indicates artificially sweetened beverage; SSB, sugar‐sweetened beverage; and USB, unsweetened beverage.
Figure 2
Figure 2
Effect modification by baseline trunk fat for changes in body weight and fat mass. Each bar indicates 12‐month mean change±standard error, from repeated‐measures analysis of variance, adjusted for prespecified covariates (sex, ethnicity, race, age). Within each tertile of trunk fat, P (bottom) tests for difference in mean change across beverage groups. Interaction P (top) tests for difference in beverage effect across tertiles. ASB indicates artificially sweetened beverage; SSB, sugar‐sweetened beverage; and USB, unsweetened beverage.
Figure 3
Figure 3
Changes in sweet taste preference. Robust (outlier‐resistant) regression analysis provided 12‐month mean change±standard error and P values testing for difference in mean change between groups (top) and within groups (bottom). ASB indicates artificially sweetened beverage; SSB, sugar‐sweetened beverage; and USB, unsweetened beverage.

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