By Vicky Pyrogianni, Dietitian – Nutritionist, MSc*, Nutrition Science Director, International Sweeteners Association (ISA)
* Vicky Pyrogianni is a Dietitian – Nutritionist registered in Greece with a master’s degree in sports nutrition and more than twenty years of experience in both dietetic practice and nutrition science communication. Vicky has been a consultant to the International Sweeteners Association (ISA) since 2016, holding the role of the Nutrition Science Director. She is also currently a member of the Communications Committee of the International Confederation of Dietetic Associations (ICDA, 2021-present) and has served three times as member of the Board of the Hellenic Dietetic Association.
A year after the publication of the WHO guideline on the use of non-sugar sweeteners which questioned their role in weight control and non-communicable diseases and called for more research, new studies presented at the 31st European Congress on Obesity (ECO 2024) showed benefits of low/no calorie sweeteners’ use in blood glucose control and in longer-term weight loss management, and no adverse effect on appetite or cardiometabolic health outcomes.
What research was presented at ECO 2024?
In a symposium organised by SWEET, a European Commission Horizon 2020 funded project, scientists of the 29-partner research consortium presented the results of a series of acute, medium- and long-term randomised controlled trials (RCTs) conducted as part of the SWEET project and discussed these findings in the context of the available literature.
Sweeteners do not increase appetite and can help in blood glucose control, acute and medium-term trials show
While there are numerous studies that have examined the impact of low/no calorie sweetened beverages on eating behaviour and health outcomes, few studies have looked at effects of solid foods sweetened with sugar substitutes. What makes the medium-term study of the SWEET project the first of its kind is that it evaluated the effect of acute and repeated consumption of five different solid and semisolid food matrices with low/no calorie sweeteners on appetite and related behavioural and metabolic responses in participants with overweight or obesity.1
Gibbons et al. published the results of the first out of five trials in April 2024.2
In an RCT of crossover design, 53 participants were asked to consume daily for two weeks biscuits containing either sugar or two different low/no calorie sweeteners, namely stevia rebaudioside M or neotame. The results showed no differences in appetite, hunger or endocrine responses compared to sugar, and some benefit of low/no calorie sweeteners in blood glucose control. Insulin levels measured over two hours after eating were reduced in both sweetener groups, as were blood glucose levels in the stevia group, which may confer a benefit for blood glucose control, for example in individuals at risk of developing type 2 diabetes.
Preliminary findings of the other trials were presented at ECO 2024, showing a similar pattern. Sweeteners or sweetener blends (sucralose-acesulfame-K, stevia-mongroside, neotame, stevia reb M) in semisolid and solid foods including yoghurt, cereals, chocolate and cake, did not generally affect hunger or appetite responses differently compared to sugar, while -with the exception of chocolate- low/no calorie sweetened foods had a beneficial impact on blood glucose control.
Including low/no calorie sweetened products in a healthy diet can improve longer-term weight loss maintenance, two longer-term trials find
The modest benefit of low/no calorie sweeteners’ use in weight control, which is consistently shown in systematic reviews of RCTs including a review by the WHO,3-6 was also confirmed by the 1-year multicentre RCT of the SWEET project.8
The study included 341 adults with overweight or obesity from Denmark, Spain, Greece, and The Netherlands. Adult participants followed an initial 2-month period of weight loss, followed by a 10-month intervention where participants were permitted to consume low/no calorie sweetened products or not (control), as part of a healthy ad libitum diet with <10% energy from added sugars.7
Results presented at ECO 2024 showed that adults in the sweetener group had modestly better weight loss maintenance compared with participants in the control group (1.6±0.7kg),8 which may be due to greater diet satisfaction, increased positive mood, and lower craving for sweet food.9
Appetite-related outcomes were not influenced by the intervention, and risk markers for type 2 diabetes and cardiovascular disease were not different between groups.8
The findings of the SWEET 1-year RCT are consistent with the results of another long-term study, the SWITCH trial, that was published last year by Harrold and colleagues.10
This parallel design RCT in 493 adults with overweight or obesity investigated the effects of daily drinking of two servings of low/no calorie sweetened beverages or water on body weight over a 12-week phase of active weight loss, followed by a 40-week period of assisted weight maintenance, and finally a second year of voluntary, unassisted maintenance extension phase. At the end of the first year, participants in the sweeteners group lost 7.5kg versus 6.1kg for those who drank water.10
Nearly all other results linked to weight also improved in both groups: reductions in blood pressure, LDL cholesterol and better liver function were reported in both groups. As presented at the congress, the results of the second year of voluntary, unassisted weight maintenance will be published soon.
New research in line with the conclusions of the roundtable “Low/no calorie sweeteners: your questions answered”
The new research presented at ECO 2024 adds new evidence on the role of low/no calorie sweeteners in long-term weight control, indicating that sweeteners may help individuals living with overweight or obesity to keep the lost weight off more efficiently after a weight loss effort. While low/no calorie sweeteners do not have weight loss properties by themselves and can assist modestly with weight control when used in place of sugars and as part of an overall healthy diet, the new evidence is particularly important given that weight maintenance following weight loss is frequently the most challenging goal of weight management efforts.
A panel of experts who participated in a roundtable on low/no calorie sweeteners organised by MyNutriWeb last year reached similar conclusions regarding the potential benefit of low/no calorie sweeteners in weight control and stressed that: “To have pleasure from food, it is important to take a balanced approach. Although simply including LNCS in the diet will not help improve health, they may have a role in a stepwise approach to reducing sugar intake and potentially also intake of sweet foods on a way to achieving a healthier dietary pattern.”
References:
- Gibbons C, O’Hara B, O’Connor D, et al. Acute and repeated impact of sweeteners and sweetness enhancers in solid and semi-solid foods on appetite: protocol for a multicentre, cross-over, RCT in people with overweight/obesity – the SWEET Project. BMJ Open. 2022 Dec 23;12(12):e063903. doi: 10.1136/bmjopen-2022-063903
- Gibbons C, Beaulieu K, Almiron-Roig E, et al. Acute and two-week effects of neotame, stevia rebaudioside M and sucrose-sweetened biscuits on postprandial appetite and endocrine response in adults with overweight/obesity-a randomised crossover trial from the SWEET consortium. EBioMedicine. 2024 Apr;102:105005. doi: 10.1016/j.ebiom.2024.105005
- Laviada-Molina H, Molina-Segui F, Pérez-Gaxiola G, et al. Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: Systematic review and meta-analysis. Obes Rev. 2020;21(7):e13020
- Rogers PJ, Appleton KM. The effects of low-calorie sweeteners on energy intake and body weight: a systematic review and meta-analyses of sustained intervention studies. Int J Obes (Lond). 2021;45(3):464-478
- McGlynn ND, Khan TA, Wang L, Zhang R, Chiavaroli L, Au-Yeung F, et al. Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk: A Systematic Review and Metaanalysis. JAMA Netw Open. 2022;5(3):e222092
- Rios-Leyvraz M, Montez J. Health effects of the use of non-sugar sweeteners: a systematic review and meta-analysis. World Health Organization (WHO) 2022. https://iris.who.int/handle/10665/353064 License: CC BY-NC-SA 3.0 IGO
- Kjølbæk L, Manios Y, Blaak EE, et al. Protocol for a multicentre, parallel, randomised, controlled trial on the effect of sweeteners and sweetness enhancers on health, obesity and safety in overweight adults and children: the SWEET project. BMJ Open. 2022 Oct 12;12(10):e061075. doi: 10.1136/bmjopen-2022-061075
- Raben A, Kjølbæk L, Andersen SS, et al. Effect of sweeteners and sweetness enhancers on weight loss maintenance in adults and children with overweight or obesity – results from the SWEET multicentre, randomised, controlled, trial. Obes Facts 2024;17(suppl 1):7–515 (pp 464). doi: 10.1159/000538577
- Dakin C, Beaulieu K, Halford J, et al. The impact of sweeteners on eating behaviours during a weight maintenance RCT in adults and children with overweight: SWEET project. Obes Facts 2024;17(suppl 1):7–515 (pp 355). doi: 10.1159/000538577
- Harrold JA, Hill S, Radu C, et al. Non-nutritive sweetened beverages versus water after a 52-week weight management programme: a randomised controlled trial. Int J Obes (Lond). 2024;48(1):83-93
Disclaimer: This blog has been written in collaboration with the nutrition team at International Sweeteners Association and reviewed by the MyNutriWeb nutrition and dietetic team. Approval of each sponsor and activity is carefully assessed for suitability on a case by case basis. Sponsorship does not imply any endorsement of the brand by MyNutriWeb, its organisers, its moderators or any participating healthcare professional, or their association. Sponsorship funds are reinvested into the creation and promotion of professional development opportunities on MyNutriWeb.
YOU MAY ALSO BE INTERESTED IN:
