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.
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 m(-)(2) 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.
authors.affiliation: School of Experimental Psychology, University of Bristol, Bristol, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Rogers
authors.affiliation: Department of Neuroscience, Uppsala University, Uppsala, Sweden.
authors.forename: P S
authors.initials: PS
authors.lastname: Hogenkamp
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: de Graaf
authors.affiliation: The School of Psychology, University of Birmingham, Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Higgs
authors.affiliation: Danone Research, Centre Daniel Carasso, RD, Palaiseau Cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Lluch
authors.affiliation: 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, Bristol, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Ness
authors.affiliation: 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, Bristol, UK.
authors.forename: C
authors.initials: C
authors.lastname: Penfold
authors.affiliation: 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, Bristol, UK.
authors.forename: R
authors.initials: R
authors.lastname: Perry
authors.affiliation: European Branch, ILSI Europe a.i.s.b.l., Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Putz
authors.affiliation: School of Psychology, University of Sussex, Brighton, UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Yeomans
authors.affiliation: Unilever R&D Vlaardingen, Vlaardingen, the Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: Mela
mesh_terms: D000818:Animals; D015992:Body Mass Index; D001835:Body Weight; D002149:Energy Intake / Q000187:drug effects*; D019317:Evidence-Based Medicine; D006801:Humans; D023421:Models, Animal; D064306:Non-Nutritive Sweeteners / Q000494:pharmacology*; D009765:Obesity / Q000517:prevention & control*; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D013549:Sweetening Agents / Q000494:pharmacology; D015430:Weight Gain
chemical_list: D064306:Non-Nutritive Sweeteners; D013549:Sweetening Agents