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Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies

Identifieur interne : 000144 ( Pmc/Checkpoint ); précédent : 000143; suivant : 000145

Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies

Auteurs : P J Rogers [Royaume-Uni] ; P S Hogenkamp [Suède] ; C. De Graaf ; S. Higgs [Royaume-Uni] ; A. Lluch [France] ; A R Ness [Royaume-Uni] ; C. Penfold [Royaume-Uni] ; R. Perry [Royaume-Uni] ; P. Putz [Belgique] ; M R Yeomans [Royaume-Uni] ; D J Mela

Source :

RBID : PMC:4786736

Abstract

By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that LES exposure (versus sugars or unsweetened alternatives) has no effect on EI or BW, we conducted a systematic review of relevant studies in animals and humans consuming LES with ad libitum access to food energy. In 62 of 90 animal studies exposure to LES did not affect or decreased BW. Of 28 reporting increased BW, 19 compared LES with glucose exposure using a specific ‘learning' paradigm. Twelve prospective cohort studies in humans reported inconsistent associations between LES use and body mass index (−0.002 kg m2 per year, 95% confidence interval (CI) −0.009 to 0.005). Meta-analysis of short-term randomized controlled trials (129 comparisons) showed reduced total EI for LES versus sugar-sweetened food or beverage consumption before an ad libitum meal (−94 kcal, 95% CI −122 to −66), with no difference versus water (−2 kcal, 95% CI −30 to 26). This was consistent with EI results from sustained intervention randomized controlled trials (10 comparisons). Meta-analysis of sustained intervention randomized controlled trials (4 weeks to 40 months) showed that consumption of LES versus sugar led to relatively reduced BW (nine comparisons; −1.35 kg, 95% CI –2.28 to −0.42), and a similar relative reduction in BW versus water (three comparisons; −1.24 kg, 95% CI –2.22 to −0.26). Most animal studies did not mimic LES consumption by humans, and reverse causation may influence the results of prospective cohort studies. The preponderance of evidence from all human randomized controlled trials indicates that LES do not increase EI or BW, whether compared with caloric or non-caloric (for example, water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water.


Url:
DOI: 10.1038/ijo.2015.177
PubMed: 26365102
PubMed Central: 4786736


Affiliations:


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PMC:4786736

Le document en format XML

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<p>By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that LES exposure (versus sugars or unsweetened alternatives) has no effect on EI or BW, we conducted a systematic review of relevant studies in animals and humans consuming LES with
<italic>ad libitum</italic>
access to food energy. In 62 of 90 animal studies exposure to LES did not affect or decreased BW. Of 28 reporting increased BW, 19 compared LES with glucose exposure using a specific ‘learning' paradigm. Twelve prospective cohort studies in humans reported inconsistent associations between LES use and body mass index (−0.002 kg m
<sup></sup>
<sup>2</sup>
per year, 95% confidence interval (CI) −0.009 to 0.005). Meta-analysis of short-term randomized controlled trials (129 comparisons) showed reduced total EI for LES versus sugar-sweetened food or beverage consumption before an
<italic>ad libitum</italic>
meal (−94 kcal, 95% CI −122 to −66), with no difference versus water (−2 kcal, 95% CI −30 to 26). This was consistent with EI results from sustained intervention randomized controlled trials (10 comparisons). Meta-analysis of sustained intervention randomized controlled trials (4 weeks to 40 months) showed that consumption of LES versus sugar led to relatively reduced BW (nine comparisons; −1.35 kg, 95% CI –2.28 to −0.42), and a similar relative reduction in BW versus water (three comparisons; −1.24 kg, 95% CI –2.22 to −0.26). Most animal studies did not mimic LES consumption by humans, and reverse causation may influence the results of prospective cohort studies. The preponderance of evidence from all human randomized controlled trials indicates that LES do not increase EI or BW, whether compared with caloric or non-caloric (for example, water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water.</p>
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<journal-id journal-id-type="iso-abbrev">Int J Obes (Lond)</journal-id>
<journal-title-group>
<journal-title>International Journal of Obesity (2005)</journal-title>
</journal-title-group>
<issn pub-type="ppub">0307-0565</issn>
<issn pub-type="epub">1476-5497</issn>
<publisher>
<publisher-name>Nature Publishing Group</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">26365102</article-id>
<article-id pub-id-type="pmc">4786736</article-id>
<article-id pub-id-type="pii">ijo2015177</article-id>
<article-id pub-id-type="doi">10.1038/ijo.2015.177</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Review</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies</article-title>
<alt-title alt-title-type="running">Low-energy sweeteners systematic review</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Rogers</surname>
<given-names>P J</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Hogenkamp</surname>
<given-names>P S</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>de Graaf</surname>
<given-names>C</given-names>
</name>
<xref ref-type="aff" rid="aff3">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Higgs</surname>
<given-names>S</given-names>
</name>
<xref ref-type="aff" rid="aff4">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lluch</surname>
<given-names>A</given-names>
</name>
<xref ref-type="aff" rid="aff5">5</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ness</surname>
<given-names>A R</given-names>
</name>
<xref ref-type="aff" rid="aff6">6</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Penfold</surname>
<given-names>C</given-names>
</name>
<xref ref-type="aff" rid="aff6">6</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Perry</surname>
<given-names>R</given-names>
</name>
<xref ref-type="aff" rid="aff6">6</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Putz</surname>
<given-names>P</given-names>
</name>
<xref ref-type="aff" rid="aff7">7</xref>
<xref ref-type="corresp" rid="caf1">*</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Yeomans</surname>
<given-names>M R</given-names>
</name>
<xref ref-type="aff" rid="aff8">8</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Mela</surname>
<given-names>D J</given-names>
</name>
<xref ref-type="aff" rid="aff9">9</xref>
</contrib>
<aff id="aff1">
<label>1</label>
<institution>School of Experimental Psychology, University of Bristol</institution>
, Bristol,
<country>UK</country>
</aff>
<aff id="aff2">
<label>2</label>
<institution>Department of Neuroscience, Uppsala University</institution>
, Uppsala,
<country>Sweden</country>
</aff>
<aff id="aff3">
<label>3</label>
<institution>Division of Human Nutrition, Wageningen University</institution>
, Wageningen,
<country>the Netherlands</country>
</aff>
<aff id="aff4">
<label>4</label>
<institution>The School of Psychology, University of Birmingham</institution>
, Birmingham,
<country>UK</country>
</aff>
<aff id="aff5">
<label>5</label>
<institution>Danone Research, Centre Daniel Carasso, RD</institution>
, Palaiseau Cedex,
<country>France</country>
</aff>
<aff id="aff6">
<label>6</label>
<institution>National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Level 3, University Hospitals Bristol Education Centre</institution>
, Bristol,
<country>UK</country>
</aff>
<aff id="aff7">
<label>7</label>
<institution>European Branch, ILSI Europe a.i.s.b.l.</institution>
, Brussels,
<country>Belgium</country>
</aff>
<aff id="aff8">
<label>8</label>
<institution>School of Psychology, University of Sussex</institution>
, Brighton,
<country>UK</country>
</aff>
<aff id="aff9">
<label>9</label>
<institution>Unilever R&D Vlaardingen</institution>
, Vlaardingen,
<country>the Netherlands</country>
</aff>
</contrib-group>
<author-notes>
<corresp id="caf1">
<label>*</label>
<institution>European Branch, ILSI Europe a.i.s.b.l.</institution>
, Avenue E. Mounier 83, Box 6, Brussels B-1200,
<country>Belgium</country>
. E-mail:
<email>publications@ilsieurope.be</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub">
<month>03</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epreprint">
<day>14</day>
<month>09</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="epub">
<day>10</day>
<month>11</month>
<year>2015</year>
</pub-date>
<volume>40</volume>
<issue>3</issue>
<fpage>381</fpage>
<lpage>394</lpage>
<history>
<date date-type="received">
<day>13</day>
<month>11</month>
<year>2014</year>
</date>
<date date-type="rev-recd">
<day>28</day>
<month>08</month>
<year>2015</year>
</date>
<date date-type="accepted">
<day>28</day>
<month>08</month>
<year>2015</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright © 2016 Macmillan Publishers Limited</copyright-statement>
<copyright-year>2016</copyright-year>
<copyright-holder>Macmillan Publishers Limited</copyright-holder>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
<pmc-comment>author-paid</pmc-comment>
<license-p>This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article#amp;#x02019;s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
</license-p>
</license>
</permissions>
<abstract>
<p>By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that LES exposure (versus sugars or unsweetened alternatives) has no effect on EI or BW, we conducted a systematic review of relevant studies in animals and humans consuming LES with
<italic>ad libitum</italic>
access to food energy. In 62 of 90 animal studies exposure to LES did not affect or decreased BW. Of 28 reporting increased BW, 19 compared LES with glucose exposure using a specific ‘learning' paradigm. Twelve prospective cohort studies in humans reported inconsistent associations between LES use and body mass index (−0.002 kg m
<sup></sup>
<sup>2</sup>
per year, 95% confidence interval (CI) −0.009 to 0.005). Meta-analysis of short-term randomized controlled trials (129 comparisons) showed reduced total EI for LES versus sugar-sweetened food or beverage consumption before an
<italic>ad libitum</italic>
meal (−94 kcal, 95% CI −122 to −66), with no difference versus water (−2 kcal, 95% CI −30 to 26). This was consistent with EI results from sustained intervention randomized controlled trials (10 comparisons). Meta-analysis of sustained intervention randomized controlled trials (4 weeks to 40 months) showed that consumption of LES versus sugar led to relatively reduced BW (nine comparisons; −1.35 kg, 95% CI –2.28 to −0.42), and a similar relative reduction in BW versus water (three comparisons; −1.24 kg, 95% CI –2.22 to −0.26). Most animal studies did not mimic LES consumption by humans, and reverse causation may influence the results of prospective cohort studies. The preponderance of evidence from all human randomized controlled trials indicates that LES do not increase EI or BW, whether compared with caloric or non-caloric (for example, water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water.</p>
</abstract>
</article-meta>
</front>
<floats-group>
<fig id="fig1">
<label>Figure 1</label>
<caption>
<p>Flow of information through the different phases of the systematic review.</p>
</caption>
<graphic xlink:href="ijo2015177f1"></graphic>
</fig>
<fig id="fig2">
<label>Figure 2</label>
<caption>
<p>Forest plot showing individual and combined effect sizes for prospective cohort studies reporting the association between LES consumption and change in BMI over the follow-up period. Effect sizes have been standardised to a 1 year follow-up period. Negative scores favour LES consumption (BMI decrease). Squares represent change in BMI per year for the individual studies; square size is proportional to the weight of each study; horizontal lines represent 95% CIs. Diamonds represent the summary estimates and 95% CIs from random effects models for associations in adults and children separately, and in adults and children combined. BMI, Body Mass Index; LES, low-energy sweetener.</p>
</caption>
<graphic xlink:href="ijo2015177f2"></graphic>
</fig>
<fig id="fig3">
<label>Figure 3</label>
<caption>
<p>Summary of outcomes of meta-analyses of short-term intervention studies comparing the effects on EI of LES versus sugar (for adults and children separately and combined), LES versus unsweetened products, LES versus water, LES versus nothing and LES in capsules versus placebo capsules. EI difference is the difference in cumulative EI (total of preload plus test meal EI) for the LES condition minus the comparison condition. Negative scores favour LES (that is, lower cumulative intake with LES). Filled diamonds represent the summary estimates and associated 95% CIs from random effects models of all studies included in the comparison. Unfilled diamonds represent the summary random effects estimates and 95% CIs for studies of adults and children separately. Many of the included studies reported multiple results for the same participants within the same comparison (for example, LES versus several different sugars). Treating these multiple results as independent potentially biases estimates of the variance of the summary effect sizes (see
<xref ref-type="supplementary-material" rid="sup1">Supplementary Information</xref>
methods section). Therefore, only the first set of results reported from each study was analysed. Accordingly, the total number of comparisons analysed (129) is less than the total recorded (218). EI, energy intake; LES, low-energy sweetener.</p>
</caption>
<graphic xlink:href="ijo2015177f3"></graphic>
</fig>
<fig id="fig4">
<label>Figure 4</label>
<caption>
<p>Forest plots showing individual and combined effect sizes for sustained intervention studies comparing the effects on BW of LES versus sugar (upper panel) and LES versus water (lower panel). Mean difference is weight change (end point minus baseline) in the LES condition minus weight change in the sugar condition over the intervention period (a negative score favours LES). Squares represent mean difference in BW for the individual comparisons; square size is proportional to the weight of each comparison; horizontal lines represent 95% CIs; diamonds represent the summary estimates and 95% CIs from random effects models for comparisons in adults for LES versus sugar, adults and children for LES versus sugar, and adults for LES versus water. BW, body weight; LES, low-energy sweetener.</p>
</caption>
<graphic xlink:href="ijo2015177f4"></graphic>
</fig>
<table-wrap id="tbl1">
<label>Table 1</label>
<caption>
<title>Outcomes of rodent studies providing information on effect of compulsory consumption of LES on BW</title>
</caption>
<table frame="hsides" rules="groups" border="1">
<colgroup>
<col align="left"></col>
<col align="char" char="."></col>
<col align="char" char="."></col>
<col align="char" char="."></col>
</colgroup>
<thead valign="bottom">
<tr>
<th align="left" valign="top" charoff="50"> </th>
<th colspan="3" align="center" valign="top" char="." charoff="50">
<italic>Change in BW relative to controls</italic>
<hr></hr>
</th>
</tr>
<tr>
<th align="left" valign="top" charoff="50"> </th>
<th align="center" valign="top" char="." charoff="50">
<italic>Decrease</italic>
</th>
<th align="center" valign="top" char="." charoff="50">
<italic>No difference</italic>
</th>
<th align="center" valign="top" char="." charoff="50">
<italic>Increase</italic>
</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left" valign="top" charoff="50">At any dose (47)
<xref ref-type="fn" rid="t1-fn3">a</xref>
</td>
<td align="char" valign="top" char="." charoff="50">22</td>
<td align="char" valign="top" char="." charoff="50">21</td>
<td align="char" valign="top" char="." charoff="50">4</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">Lower LES doses (37)
<xref ref-type="fn" rid="t1-fn4">b</xref>
</td>
<td align="char" valign="top" char="." charoff="50">4</td>
<td align="char" valign="top" char="." charoff="50">32</td>
<td align="char" valign="top" char="." charoff="50">1</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">Higher LES doses (
<xref ref-type="bibr" rid="bib34">34</xref>
)
<xref ref-type="fn" rid="t1-fn5">c</xref>
</td>
<td align="char" valign="top" char="." charoff="50">18</td>
<td align="char" valign="top" char="." charoff="50">13</td>
<td align="char" valign="top" char="." charoff="50">3</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="t1-fn1">
<p>Abbreviations: BW, body weight; LES, low-energy sweetener.</p>
</fn>
<fn id="t1-fn2">
<p>Figures are numbers of studies reporting no difference or a significant change (increase or decrease) in BW relative to controls, with total numbers of relevant studies in brackets. Where a study used multiple LES doses (in some studies including doses both below and above 2% of vehicle), if the change in BW for any dose was significantly increased or decreased relative to placebo, that result was counted as the effect of the LES overall.</p>
</fn>
<fn id="t1-fn3">
<label>a</label>
<p>All studies included in the count.</p>
</fn>
<fn id="t1-fn4">
<label>b</label>
<p>Lower LES doses, ⩽2% of vehicle (diet or fluid source), only included in the count.</p>
</fn>
<fn id="t1-fn5">
<label>c</label>
<p>Higher LES doses, >2% of vehicle (diet or fluid source), only included in the count.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tbl2">
<label>Table 2</label>
<caption>
<title>Summary of the results of the review</title>
</caption>
<table frame="hsides" rules="groups" border="1">
<colgroup>
<col align="left"></col>
<col align="left"></col>
</colgroup>
<thead valign="bottom">
<tr>
<th align="left" valign="top" charoff="50">
<italic>Type and number of studies (or number of comparisons)</italic>
<xref ref-type="fn" rid="t2-fn3">a</xref>
</th>
<th align="left" valign="top" charoff="50">
<italic>Results</italic>
</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left" valign="top" charoff="50">Animal studies, 90</td>
<td align="left" valign="top" charoff="50">BW gain when LES added to food or drink compulsorily or voluntarily consumed compared with BW gain on the food or drink without LES: 22↓ 37→ 9↑</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50">BW gain when LES added to a dietary supplement compared with BW gain when glucose added to the same dietary supplement: 0↓ 3→ 19↑</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">Prospective cohort studies, 12</td>
<td align="left" valign="top" charoff="50">No overall association of LES consumption with BMI</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">Short-term intervention studies (129 comparisons analysed
<xref ref-type="fn" rid="t2-fn4">b</xref>
)</td>
<td align="left" valign="top" charoff="50">EI from preload plus
<italic>ad libitum</italic>
meal when preload was LES versus sugar, unsweetened food, water, nothing or placebo capsule: LES</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">Sustained intervention studies, EI (10 comparisons)</td>
<td align="left" valign="top" charoff="50">In all cases the absolute value for total or change in EI was lower for LES: LES versus sugar −75 to −514 kcal per day (nine comparisons) LES versus water −126 kcal per day (one comparison)</td>
</tr>
<tr>
<td align="left" valign="top" charoff="50">Sustained intervention studies ⩾4 weeks in duration, BW (12 comparisons)</td>
<td align="left" valign="top" charoff="50">Difference in weight loss or weight gain favoured LES: LES versus sugar −1.41 kg (adults, eight comparisons) LES versus sugar −1.02 kg (children, one comparison) LES versus water −1.24 kg (adults, three comparisons)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="t2-fn1">
<p>Abbreviations: BMI, body mass index; BW, body weight; EI, energy intake; LES, low-energy sweeteners.</p>
</fn>
<fn id="t2-fn2">
<p>↓ decrease; → no difference; ↑ increase.</p>
</fn>
<fn id="t2-fn3">
<label>a</label>
<p>Some studies had more than one relevant comparison, for example LES versus sugar and LES versus water, or LES versus sugar in lean participants and LES versus sugar in overweight participants reported separately.</p>
</fn>
<fn id="t2-fn4">
<label>b</label>
<p>See caption to
<xref ref-type="fig" rid="fig3">Figure 3</xref>
.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations>
<list>
<country>
<li>Belgique</li>
<li>France</li>
<li>Royaume-Uni</li>
<li>Suède</li>
</country>
</list>
<tree>
<noCountry>
<name sortKey="De Graaf, C" sort="De Graaf, C" uniqKey="De Graaf C" first="C" last="De Graaf">C. De Graaf</name>
<name sortKey="Mela, D J" sort="Mela, D J" uniqKey="Mela D" first="D J" last="Mela">D J Mela</name>
</noCountry>
<country name="Royaume-Uni">
<noRegion>
<name sortKey="Rogers, P J" sort="Rogers, P J" uniqKey="Rogers P" first="P J" last="Rogers">P J Rogers</name>
</noRegion>
<name sortKey="Higgs, S" sort="Higgs, S" uniqKey="Higgs S" first="S" last="Higgs">S. Higgs</name>
<name sortKey="Ness, A R" sort="Ness, A R" uniqKey="Ness A" first="A R" last="Ness">A R Ness</name>
<name sortKey="Penfold, C" sort="Penfold, C" uniqKey="Penfold C" first="C" last="Penfold">C. Penfold</name>
<name sortKey="Perry, R" sort="Perry, R" uniqKey="Perry R" first="R" last="Perry">R. Perry</name>
<name sortKey="Yeomans, M R" sort="Yeomans, M R" uniqKey="Yeomans M" first="M R" last="Yeomans">M R Yeomans</name>
</country>
<country name="Suède">
<noRegion>
<name sortKey="Hogenkamp, P S" sort="Hogenkamp, P S" uniqKey="Hogenkamp P" first="P S" last="Hogenkamp">P S Hogenkamp</name>
</noRegion>
</country>
<country name="France">
<noRegion>
<name sortKey="Lluch, A" sort="Lluch, A" uniqKey="Lluch A" first="A" last="Lluch">A. Lluch</name>
</noRegion>
</country>
<country name="Belgique">
<noRegion>
<name sortKey="Putz, P" sort="Putz, P" uniqKey="Putz P" first="P" last="Putz">P. Putz</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

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