title: Chronic Low-Calorie Sweetener Use and Risk of Abdominal Obesity among Older Adults: A Cohort Study.
abstract: BACKGROUND
  Low-calorie sweetener use for weight control has come under increasing scrutiny as obesity, especially abdominal obesity, remain entrenched despite substantial low-calorie sweetener use. We evaluated whether chronic low-calorie sweetener use is a risk factor for abdominal obesity.
  
  
  METHODS
  We used 8268 anthropometric measurements and 3096 food diary records with detailed information on low-calorie sweetener consumption in all food products, from 1454 participants (741 men, 713 women) in the Baltimore Longitudinal Study of Aging collected from 1984 to 2012 with median follow-up of 10 years (range: 0-28 years). At baseline, 785 were low-calorie sweetener non-users (51.7% men) and 669 participants were low-calorie sweetener users (50.1% men). Time-varying low-calorie sweetener use was operationalized as the proportion of visits since baseline at which low-calorie sweetener use was reported. We used marginal structural models to determine the association between baseline and time-varying low-calorie sweetener use with longitudinal outcomes-body mass index, waist circumference, obesity and abdominal obesity-with outcome status assessed at the visit following low-calorie sweetener ascertainment to minimize the potential for reverse causality. All models were adjusted for year of visit, age, sex, age by sex interaction, race, current smoking status, dietary intake (caffeine, fructose, protein, carbohydrate, and fat), physical activity, diabetes status, and Dietary Approaches to Stop Hypertension score as confounders.
  
  
  RESULTS
  With median follow-up of 10 years, low-calorie sweetener users had 0.80 kg/m2 higher body mass index (95% confidence interval [CI], 0.17-1.44), 2.6 cm larger waist circumference (95% CI, 0.71-4.39), 36.7% higher prevalence (prevalence ratio = 1.37; 95% CI, 1.10-1.69) and 53% higher incidence (hazard ratio = 1.53; 95% CI 1.10-2.12) of abdominal obesity than low-calorie sweetener non-users.
  
  
  CONCLUSIONS
  Low-calorie sweetener use is independently associated with heavier relative weight, a larger waist, and a higher prevalence and incidence of abdominal obesity suggesting that low-calorie sweetener use may not be an effective means of weight control.
authors.affiliation: Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America.
authors.forename: Chee W
authors.initials: CW
authors.lastname: Chia
authors.affiliation: Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America.
authors.forename: Michelle
authors.initials: M
authors.lastname: Shardell
authors.affiliation: Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America.
authors.forename: Toshiko
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America.
authors.forename: David D
authors.initials: DD
authors.lastname: Liu
authors.affiliation: Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America.
authors.forename: Kristofer S
authors.initials: KS
authors.lastname: Gravenstein
authors.affiliation: Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America.
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Simonsick
authors.affiliation: Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America.
authors.forename: Josephine M
authors.initials: JM
authors.lastname: Egan
authors.affiliation: Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002149:Energy Intake / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D012737:Sex Factors; D013549:Sweetening Agents / Q000008:administration & dosage*
chemical_list: D013549:Sweetening Agents