title: Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies.
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.
  
  
  METHODS
  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.
authors.affiliation: From the Center for Epidemiology, Biostatistics, and Computational Biology, Exponent Inc, Chicago, IL.
authors.forename: Paige E
authors.initials: PE
authors.lastname: Miller
authors.affiliation: From the Center for Epidemiology, Biostatistics, and Computational Biology, Exponent Inc, Chicago, IL.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Perez
mesh_terms: D050154:Adiposity; D015992:Body Mass Index; D015331:Cohort Studies; D004038:Diet, Reducing; D002149:Energy Intake; D019317:Evidence-Based Medicine; D006801:Humans; D064306:Non-Nutritive Sweeteners / Q000009:adverse effects / Q000627:therapeutic use*; D064427:Nutritive Sweeteners / Q000009:adverse effects / Q000627:therapeutic use*; D050177:Overweight / Q000178:diet therapy* / Q000517:prevention & control; D010349:Patient Compliance; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015203:Reproducibility of Results; D015431:Weight Loss
chemical_list: D064306:Non-Nutritive Sweeteners; D064427:Nutritive Sweeteners