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Low-calorie sweeteners: are they all created equal?

This clinical trial explored how four low-calories sweeteners affect bodyweight, body composition, and more.

Study under review: A randomized controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesity.

Introduction

Overweight and obesity raise the risk of numerous health conditions[1], including type 2 diabetes, cancer, and cardiovascular disease, and pose a severe financial burden to the healthcare system[2]. As an excessive energy intake is a fundamental cause of overweight and obesity, changes in dietary habits are a cornerstone of bodyweight control.

One recommended dietary modification to help manage bodyweight is the reduction of added sugar consumption. The main rationale for this recommendation is that added sugars, especially in liquid form (i.e. as commonly found in sodas, fruit juices, sports drinks, and energy drinks), contribute calories without suppressing appetite[3], thereby contributing to weight gain by promoting a positive energy balance[4].

A common strategy to help reduce sugar intake is to replace sugary drinks with drinks that are sweetened with low-calorie sweeteners (LCSs). These substances have a sweetening potency several hundred times greater than that of sucrose, and can, therefore, deliver sweetness with minimal or no associated energy. Some of the more common LCSs, along with their brand names and their relative sweetness compared to sugar, are shown in Figure 1. However, while some research[5] suggests that using LCSs in place of sugar may lead to reduced bodyweight, other research[6] has reported neutral effects.

One reason for the inconsistent experimental research results could be that different LCSs[7] may differentially affect appetite, brain reward activation, the gut microbiome, and metabolism. However, before investigating the mechanisms by which different LCSs may differentially affect bodyweight, it should first be established that they do, in fact, lead to differential outcomes in bodyweight when chronically consumed.

The study under review aimed to investigate whether LCSs affect bodyweight differently by evaluating the effects of the consumption of four commonly consumed LCSs: aspartame, saccharin, rebaudioside A (often simply referred to as ‘stevia’), and sucralose, as well as sucrose on bodyweight, body composition, energy intake and expenditure, appetite, and glycemia over a 12-week period in adults with overweight or obesity.

A common dietary strategy to help manage bodyweight is the replacement of sugary drinks with drinks that are sweetened with low-calorie sweeteners (LCSs). However, the research investigating the effects of LCSs on bodyweight has found mixed results, which may be partly due to the unique chemical structure of each LCS. To establish whether different LCSs differentially affect bodyweight, the study under review examined the effects of four LCSs (aspartame, saccharin, rebaudioside A, and sucralose) and sucrose on bodyweight, body composition, energy intake and expenditure, appetite, and glycemia in adults with overweight or obesity.

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