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Low‐calorie sweeteners and body weight and composition: a meta‐analysis of randomized controlled trials and prospective cohorts (391.1)

Findings from randomized controlled trials (RCTs) and prospective cohorts investigating the relationship between low‐calorie sweeteners (LCS) and body weight and composition have been mixed and use of LCS as part of weight loss efforts remains controversial. The purpose of this study was to systematically review and quantitatively summarize results from RCTs and separately from prospective cohorts. Meta‐analyses evaluated weighted mean change in body weight and composition values between the LCS intervention and placebo groups among the 15 RCTs, and weighted mean correlations for LCS intake and body weight and composition parameters among the 9 prospective cohorts. Compared to placebo, LCS from food, beverages, or supplements significantly reduced body weight (‐0.74 kg, 95% CI: ‐1.10, ‐0.38), fat mass (‐1.18 kg, 95% CI: ‐1.75, ‐0.60), and waist circumference (‐0.93 cm, 95% CI: ‐1.74, ‐0.12), with no effect on BMI. In contrast, the meta‐analysis of cohorts showed that LCS intake was weakly but significantly associated with increased BMI (0.034, 95% CI: 0.009, 0.060), and nonsignificantly associated with increased body weight (0.024, 95% CI: ‐0.010, 0.058) and fat mass (0.035, 95% CI: ‐0.026, 0.096). Overall, available evidence from RCTs indicates that LCS may help reduce body weight, fat mass, and waist circumference, although this conclusion is not supported by results from prospective cohort studies.