A randomized controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesity

Effects of stevia consumption on appetite in adults: A systematic review and dose-response meta-analysis of randomized controlled trials

Stevia is an intense, calorie-free sweetener that is frequently used to reduce energy intake; however, studies examining its effects on appetite and energy intake have produced mixed results, indicating that a definitive consensus has not yet been reached. This systematic review and meta-analysis aimed to determine the impact of stevia on appetite and energy intake in adults. The PROSPERO registration number for this research is CRD42023414411. The databases PubMed (MEDLINE), Scopus, Web of Science, and Google Scholar were systematically searched. In addition, the reference lists of extracted articles and pertinent reviews were examined. Two evaluators performed screening, quality assessment, and data extraction independently. Furthermore, the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was employed to systematically assess the certainty level of the evidence presented in our study. Eleven clinical trials with a total of 428 participants were included. We found no significant changes in any appetite scores following stevia consumption (very low to moderate certainty of the evidence). Moreover, subgroup analyses demonstrated the scores of desires to eat increased significantly in the oral intake of stevia and not enteral intake subgroup (WMD: 0.45; 95% CI: 0.009, 0.89; P = 0.046). In addition, the number of studies reporting energy intake was limited, preventing a meta-analysis of this variable. In conclusion, stevia consumption has no significant effect on appetite scores in adults but it seems that more long-term clinical trials are needed to obtain more accurate results. PRACTITIONER POINT: Stevia, as a non-nutritive sweetener, has no significant effect on appetite scores in adults.

The Effects of Aspartame on Glucose, Insulin, and Appetite-Regulating Hormone Responses in Humans: Systematic Review and Meta-Analyses

Aspartame (L-α-aspartyl-L-phenylalanine methyl ester) has been implicated in increased risk of several chronic health conditions, yet underlying mechanisms remain unclear. The objective of this work was to systematically identify and summarize all controlled intervention studies investigating the effects of aspartame consumption on glucose, insulin, and appetite-related hormone responses. Five academic databases, 4 trial registries, and additional resources were searched until June 2024. Search hits were screened, in duplicate, for intervention studies of aspartame compared with comparator, which assessed glucose, insulin, and/or any other appetite-regulating hormone. Results were tabulated, and meta-analyses run where ≥10 studies with similar methodology were found. Risk of bias (RoB) was assessed using RoB-2. Certainty of the evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. One hundred one articles were identified, detailing 100 experiments: 79 acute (≤1 d), 8 medium term (2-30 d), and 13 long term (>30 d). Experiments involved healthy adults, individuals with aspartame sensitivity, and individuals with compromised glucose metabolism, varied widely in aspartame provision and comparator/s, and although almost all assessed glucose and/or insulin responses, few experiments investigated other appetite-regulating hormones. Meta-analyses (acute cross-over studies) revealed few effects of aspartame on blood glucose/insulin compared with vehicle or low-calorie sweeteners (LCS), and lower blood glucose/insulin concentrations compared with sugars, other carbohydrates, or other nutritive elements. Over the medium term and longterm, few effects of aspartame were found, and high heterogeneity between studies remained. Similar effects were found in other populations, and other outcomes, with few adverse events. RoB assessments suggested "some concerns" for the majority of studies. The certainty of the evidence for all outcomes in all populations was judged to be "very low." Our findings suggest little to no effects of aspartame consumption on glucose metabolism over the short term or the long term. Further studies over the long term, assessing a range of appetite-regulating hormones and comparing aspartame with other LCS, would be of value. This study was registered in PROSPERO as CRD42024540781 on April 29, 2024.

Low- or No-Energy Sweeteners and Body Weight Management: Dissecting a "Minor" Effect

Nonnutritive sweeteners were introduced on the market over a century ago to displace the calories of added sugars in foods and beverages and, therefore, facilitate weight loss. In spite of their widespread use, obesity has reached epidemic proportions. The present paper addresses this apparent paradox. Low- or no-energy sweeteners (LNES) are a small group of widely different substances that can be used to modify one single aspect of energy intake, i.e., consumption of added sugars. Their potential benefits for weight management can be predicted by energy balance equations. Decades of research confirm that LNES affect weight via a purely nutritional mechanism, in proportion of their actual displacement of sugar energy. LNES allow a substantial decrease in energy density of beverages (as opposed to solid foods) and can be maximally effective in consumers of sugar-containing drinks. Their average effect is robust but modest (1-2-kg weight loss) compared to comprehensive weight-loss programs (±5 kg), medication, or surgery (+10% of initial weight). Other benefits of LNES include sensory-specific satiety for sweet foods, improved diet adherence, and facilitation of weight-loss maintenance. Whether these effects are considered minor or major benefits in the present obesogenic context is a matter of individual definition.

Artificially sweetened beverages do not influence metabolic risk factors: a systematic review and meta-analysis

Introduction

The influence of artificially sweetened beverages (ASBs) on metabolic risk factors for non-communicable diseases (NCDs) remains unclear. This study aimed to systematically review the literature concerning whether the effects of ASBs on body weight and metabolic risk factors are equivalent to those of unsweetened beverages (USBs).

Methods

We searched PubMed, Embase, Web of Science, and Cochrane Library databases from their establishment until March 3, 2025. Only randomized controlled trials (RCTs) comparing ASBs and USBs were included. Literature screening, data extraction, and bias evaluations were performed. Statistical analyses were performed using Review Manager 5.4 and Stata 15.0 software.

Results

Nine RCTs involving 1,457 individuals were included. Meta-analysis findings indicated no statistically significant differences between ASB and USB groups in terms of weight, waist circumference, fasting blood glucose, glycated hemoglobin, homeostatic model assessment for insulin resistance, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure (all p > 0.05).

Conclusion

The study findings do not support the hypothesis that ASBs pose significant risks or benefits in terms of metabolic risk factors for NCDs. However, given this study applied a heterogeneous ASB formula, it could not adequately consider the role of specific artificial sweeteners. Further research is needed to evaluate the potential effect of different artificial sweeteners and their doses on health.

Systematic review registration

https://www.crd.york.ac.uk, identifier CRD420251027794.

Health Impact Database Development for Sweeteners and Sweetness Enhancers: The SWEET Project

Sweeteners and sweetness enhancers (S&SEs) are ingredients used in foods and beverages to reduce sugar while providing the sweetness of sugar with little to no calories. Although S&SEs have global regulatory approval and acceptance, questions remain regarding their overall safety and efficacy. Information on the effects of S&SEs in regard to health and efficacy can be found in randomised controlled trials (RCTs) that exist in peer-reviewed literature. With the large number of RCT publications on various S&SEs, a need exists to organise and collect each of the published studies in a useful database. Currently, a database containing human clinical information on S&SEs does not exist and so The SWEET project has created a publicly available and comprehensive Health Impact Database that includes available human clinical information on sweeteners. This paper describes the process and development of a database that collects comprehensive information on published human clinical studies evaluating S&SEs between the years January 2000 and September 2024. Ovid Medline was used to search for RCT publications from the year 2000 to 2024. The search produced 1538 publications, of which 257 complied with the predetermined eligibility criteria. There was a large variability in the number of studies that fit the inclusion criteria. For example, some S&SEs had numerous studies (i.e., sucralose, n = 63 eligible publications) and some S&SEs had no publications that fit the criteria (aspartame-acesulfame K salt and neohesperidine DC). The Health Impact Database is located at https://sweetproject.eu/HIdatabase and is contained in Microsoft Excel spreadsheets which are organised by health impact criteria. This database will be a useful tool for researchers as it provides comprehensive information on human clinical studies on S&SEs that can be leveraged as a general resource and for systematic reviews and meta-analyses.

Rediscovering Sweetness: The Evolution and Impact of Non-Nutritive and Natural Sweeteners

PURPOSE OF THE REVIEW

The escalating incidence of obesity and metabolic syndromes has catalyzed a critical evaluation of dietary sugars, leading to an increased interest in non-nutritive and natural sweeteners as viable alternatives. This manuscript reviews the historical developments, safety profiles, and health-related consequences of these sweeteners, tracing the evolution from early discoveries such as saccharin and cyclamate to contemporary compounds like aspartame, sucralose, and plant-derived sweeteners.

RECENT FINDINGS

We explore the physiological mechanisms underpinning sweet taste perception, including the roles of T1R and T2R receptors, and the neurochemical pathways involving dopamine in mediating the rewarding effects of sugar consumption. The review underscores the adverse health impacts associated with excessive intake of added sugars, which correlate positively with conditions such as obesity, type 2 diabetes, and cardiovascular diseases. Attention is given to the contrasting profiles of non-nutritive sweeteners and natural sweetener alternatives, with an emphasis on emerging concerns regarding the safety and long-term ramifications of synthetic sweeteners. The regulatory context surrounding the approval and utilization of sweeteners varies significantly across different jurisdictions, warranting careful consideration. As consumer inclination shifts towards healthier dietary choices, a nuanced understanding of the implications of sweetener selection on public health is imperative.

Comparative effects of different beverages on weight loss in adults: a systematic review and network meta-analysis of randomized trials

BACKGROUND

There is a lack of clarity on the comparative effects of different beverages on weight loss in adults.

OBJECTIVE

This study aimed at quantifying and ranking the effects of different beverages on weight loss.

METHODS

We searched PubMed, Scopus, and Web of Science up to January 2023. We included randomized trials evaluating the comparative effects of two or more beverages, or compared a beverage against a control group (water, no intervention), for weight loss in adults. We conducted a random-effects network meta-analysis (NMA) with a Bayesian framework to estimate mean difference [MD] and 95% credible interval [CrI].

RESULTS

In total, 78 randomized trials with 4168 participants were eligible. Low/no-calorie sweetened beverages (LNCSB) was effective for weight loss compared with water (MD: -0.79 kg, 95% CrI: -1.35, -0.18), milk (MD: -0.80 kg, 95% CrI: -1.59, -0.01), fruit juice (MD: -0.83 kg, 95% CrI: -1.47, -0.13), sugar-sweetened beverages (SSB) (MD: -1.08 kg, 95% CrI: -1.65, -0.50), and no intervention (MD: -1.19 kg, 95% CrI: -1.93, -0.41). However, in sensitivity analyses, no significant effect was seen in trials with a low risk of bias and those that implemented calorie restriction. LNCSB drinking was effective for waist circumference reduction compared with water (MD: -1.85 cm, 95% CrI: -3.47, -0.22). The certainty of evidence from most comparisons was rated low.

CONCLUSIONS

This study suggested evidence of low certainty that intake of LNCSBs can result in a small weight loss when used as a substitute for other beverages. Considering the low certainty of evidence, more research is needed to compare the effects of different beverages on body weight.

TRIAL REGISTRATION

Not applicable, but the protocol of this systematic review was registered at PROSPERO (registration number: CRD42023407937).

Urinary excretion of low- and no-calorie sweeteners (LNCS) and associated food sources, as observed in the German cross-sectional KarMeN-study

PURPOSE

We aimed to quantify urinary excretion of LNCS (Low- and No-Calorie Sweeteners) and to identify LNCS-associated food consumption in Germany, with special emphasis on exposure to combinations of different LNCS.

METHODS

UPLC-MS/MS was used to quantify LNCS metabolites in 24-hour urine samples of 301 participants from the cross-sectional KarMeN (Karlsruhe Metabolomics and Nutrition) study. Dietary data were assessed via 24 h recall. Spearman rank correlation analysis and multiple linear regression models were used to investigate food groups that contribute to LNCS exposure.

RESULTS

Based on the number of samples with quantifiable urinary concentrations and the absolute excretion within a day, cyclamate (88% of samples), saccharin (44%), acesulfame (35%), and aspartame (32%) were most commonly consumed. The consumption of specific food groups, such as table sweeteners, light soft drinks, Radler, protein shakes, and stevia sweeteners, accounted for significant variations in urinary concentrations. Specific combinations of LNCS were observed for these food groups, as well as a considerable exploitation of LNCS-specific ADI (acceptable daily intake).

CONCLUSION

Individuals who consume high amounts of specific LNCS-containing, processed foods are exposed to a notable mix of various LNCS. Since data on associations between mixed LNCS exposure and health are lacking, it is an urgent issue to evaluate the potential risks of consuming combinations of diverse LNCS rather than conducting risk assessments of single LNCS.

Cross-sectional associations between consumption of non-nutritive sweeteners and diet quality among United States adults in the Cancer Prevention Study-3

BACKGROUND

Non-nutritive sweeteners (NNS) are used to replace added sugar, yet whether NNS consumers have better or worse diet quality compared to nonconsumers is unclear.

OBJECTIVE

To investigate cross-sectional associations between NNS consumption and diet quality.

METHODS

Data from participants in the American Cancer Society (ACS) Cancer Prevention Study-3 cohort were used for this analysis. NNS intake was estimated using self-reported consumption of NNS-containing beverages, packets, and yogurt from a validated food frequency questionnaire. Participants were categorized into nonconsumers, <1 serving, 1 to <2 servings and ≥2 servings per day. Diet quality was assessed using the ACS diet score (2020) and Healthy Eating Index (HEI-2015). Analysis of variance was used to compare diet quality scores across NNS consumption groups, and multivariable linear regression was used to examine associations between NNS consumption and diet quality. Multivariable logistic regression was used to evaluate the odds of low diet quality across NNS consumption groups.

RESULTS

Data from 163,679 participants [median age 53 y (IQR 45-60), 78.9% females, mean NNS intake 1.0 ± 1.5 servings/d, mean HEI-2015 score 75.4 ± 10.2] were included. NNS consumers had lower diet quality for ACS diet score (6.8 ± 0.03 among nonconsumers compared with 6.5 ± 0.03, 6.3 ± 0.03, and 6.1± 0.03 for consumers of <1 serving, 1 to <2 servings, and ≥2 servings of NNS per day, respectively, P-trend < 0.0001) and HEI-2015 (76.3 ± 0.1 among nonconsumers compared with 76.7 ± 0.1, 75.6 ± 0.2, and 72.7± 0.2 for consumers of <1 serving, 1 to <2 servings, and ≥2 servings of NNS per day, respectively, P-trend < 0.0001). Odds of low diet quality were higher among NNS consumers and were higher with higher NNS consumption (3%, 17%, and 43% higher odds of low diet quality among those who consumed <1 serving, 1 to <2 servings and ≥2 servings of NNS per day).

CONCLUSIONS

NNS consumers have lower diet quality in a large cohort of adults in the United States.

Non-caloric sweetener effects on brain appetite regulation in individuals across varying body weights

Sucralose, a widely used non-caloric sweetener, provides sweet taste without calories. Some studies suggest that non-caloric sweeteners stimulate appetite, possibly owing to the delivery of a sweet taste without the post-ingestive metabolic signals that normally communicate with the hypothalamus to suppress hunger. In a randomized crossover trial (ClinicalTrials.gov identifier: NCT02945475 ), 75 young adults (healthy weight, overweight or with obesity) consumed a drink containing sucralose, sweetness-matched sucrose or water. We show that acute consumption of sucralose versus sucrose stimulates hypothalamic blood flow (P < 0.018) and greater hunger responses (P < 0.001). Sucralose versus water also increases hypothalamic blood flow (P < 0.019) but produces no difference in hunger ratings. Sucrose, but not sucralose, increases peripheral glucose levels, which are associated with reductions in medial hypothalamic blood flow (P < 0.007). Sucralose, compared to sucrose and water, results in increased functional connections between the hypothalamus and brain regions involved in motivation and somatosensory processing. These findings suggest that non-caloric sweeteners could affect key mechanisms in the hypothalamus responsible for appetite regulation.

Secondary Analysis of Sweetness Liking from Pilot Study Replacing Sugar Sweetened Soda with Flavored, Unsweetened Sparkling Water

OBJECTIVE

This study aimed to evaluate changes in sensory ratings (liking, sweetness intensity, "just about right" (JAR) level of sweetness) of 0-10.7% w/w sugar in soda after 1 and 2 wk of replacing sugar-sweetened soda consumption with unsweetened, flavored, sparkling water.

METHODS

Consumers of sugar-sweetened sodas (17 men and women, average age 28 years) replaced their sodas with unsweetened, flavored sparkling waters for 2 wk. Changes in sensory ratings were evaluated for sodas ranging from 0-10.7% w/w added sugar. In a secondary analysis, cluster analysis identified "Sweet Likers" (liking increased with sugar concentration) and "Sweet Moderates" (liking peaked in the middle of the concentration range) in the baseline ratings, and models for changes in sensory ratings were reevaluated by sweet-liking group.

RESULTS

The primary analyses showed no significant effects of the intervention on sweetness intensity or liking ratings. However, the secondary analysis showed that Sweet Likers reduced liking ratings for all sodas, but particularly for the highest concentration (p = 0.0021) after the intervention. Sweet Moderates, however, increased liking ratings after the intervention, driven by an increase in liking for the lower concentrations of sugar (p = 0.0058). Additionally, Sweet Moderates increased their overall ratings for sweetness intensity in sodas (p = 0.00074).

CONCLUSION

These results suggest that the intervention may have been more successful in shifting sensory perception and acceptance of less-sweet sodas for Sweet Moderates than for Sweet Likers. These results should be verified in a larger sample that intentionally recruits by sweet liker status, to see if initial liking for sweetness may be a critical factor in interventions aiming to improve liking of less sweet beverages.

An Overview of Reviews on the Association of Low Calorie Sweetener Consumption With Body Weight and Adiposity

BACKGROUND

Numerous systematic reviews (SR) and meta-analyses (MA) on low calorie sweeteners (LCS) have been published in recent years, concluding that LCS have beneficial, neutral, or detrimental effects on various health outcomes, depending on the review.

OBJECTIVES

The objective of this overview of reviews was to determine how the methodologies of SR investigating the association between LCS consumption and body weight (BW) influence their findings and whether MA results can provide a consistent estimated effect.

METHODS

Systematic searches of PubMed, Scopus, and Cochrane Library were conducted in November 2022 to identify SR of randomized controlled trials (RCT) or non-randomized studies (NRS) investigating the association between LCS consumption and BW. The methods, MA results, and conclusions were extracted from each eligible SR.

RESULTS

Of the 985 search results, 20 SR evaluated the association between LCS and BW, drawing from publications of 75 RCT, 42 prospective cohort studies, and 10 cross-sectional studies. There was a considerable lack of overlap of studies included within each SR attributed, in part, to the inclusion of studies based on design; thus, each SR synthesized results from distinctly different studies. Evidence synthesis methods were heterogeneous and often opaque, making it difficult to determine why results from certain studies were excluded or why disparate results were observed between SR.

CONCLUSIONS

SR investigating the effect of LCS on BW implement different methodologies to answer allegedly the same question, drawing from a different set of heterogeneous studies, ignoring the basic assumptions required for MA, resulting in disparate results and conclusions. Previous MA show the large effects of study design, which results in inconsistent estimates of the effect of LCS on BW between MA of RCT and NRS. Given the availability of long-term RCT, these studies should be the basis of determining causal relationships (or lack thereof) between LCS and BW. This trial was registered at PROSPERO as CRD42022351200.

The Presence of Added Sugars and Other Sweeteners in Food and Beverage Products Advertised on Television in the United States, 2022

BACKGROUND/OBJECTIVES

The Dietary Guidelines for Americans recommend consuming less than 10% of total calories from added sugars. Low-calorie sweeteners, sugar alcohols, and natural low-calorie sweeteners are used to reduce added sugar intake, but there are concerns about their long-term health impacts, especially for children. This paper describes the food and beverage television advertising landscape as it pertains to sweeteners.

METHODS

This cross-sectional study uses television ratings data licensed from The Nielsen Company for the United States in 2022. Nutrition facts panels and ingredient lists were collected for food and beverage product advertisements seen on television and assessed for the presence of added sugars, low-calorie sweeteners, sugar alcohols, and natural low-calorie sweeteners (forms of stevia and monk fruit), as well as whether products were high in added sugars based on federal Interagency Working Group guidelines for advertising to children.

RESULTS

Of the sweeteners examined, added sugars were most commonly found in food and beverage product advertisements seen on television (60-68% of advertisements seen across age groups), followed by low-calorie sweeteners (6-10%), sugar alcohols (2-4%), and natural low-calorie sweeteners (2%). About one-third (32-33%) of advertisements seen by 2-5- and 6-11-year-olds were high in added sugars, similar to the percentage seen by 12-17- and 18+-year-olds (34-35%). Advertisements seen for cereal (86-95%) and sweets (92-93%) were most likely to have added sugars, while those for sweets (89-90%) were most likely to be high in added sugars.

CONCLUSIONS

Sweeteners are common in food and beverage product advertisements seen on television, including alternatives to added sugars for which there are concerns about long-term impacts on health. Continued monitoring and additional research on other advertising media platforms used by food and beverage companies (e.g., digital media) is needed.

The effects of non-nutritive sweeteners on energy and macronutrients intake in adults: a grade-assessed systematic review and meta-analyses of randomized controlled trials

Objectives

The effect of non-nutritive sweeteners (NNSs) on long-term satiety is not well understood. This systematic review and meta-analysis were performed to investigate the effect of NNSs on long-term total energy and macronutrients intake.

Methods

Online databases including Scopus, PubMed, ISI Web of Science, and Google Scholar were searched up to September 2024 to find relevant randomized control trials (RCTs). A random effects model was used for estimating the overall effects.

Results

The results showed a reducing effect of NNSs consumption vs. sugar on total energy intake [total energy intake change = -175.26 kcal/day, 95% confidence interval (CI): -296.47 to -54.06, I2 = 61.19%] and carbohydrate intake [Hedges' g = -0.35, 95% CI: -0.63 to -0.06, I2 = 58.99%]. While, NNSs intake vs. water was not associated with significant change in total energy intake [total energy intake change = 29.94 kcal/day, 95% CI: -70.37 to 130.24, I2 = 34.98%] and carbohydrate intake [Hedges' g = 0.28, 95% CI: -0.02 to 0.58, I2 = 65.26%]. The Consumption of NNSs compared to the either sugar or water did not have a significant effect on fat intake [Hedges' g sugar = 0.08, 95% CI: -0.10 to 0.26, I2 = 8.73%/ fat intake change water = 0.20 g/day, 95% CI: -3.48 to 3.88, I2 = 0%] and Protein intake [Hedges' g sugar = 0.16, 95% CI: -0.11 to 0.42, I 2  = 50.83%/Hedges' g water = 0.00, 95% CI: -0.15 to 0.16, I2 = 0%].

Conclusion

In summary, our findings suggest that NNSs consumption may be effective in reducing total energy and carbohydrate intake compared to sugar.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=432816, CRD42023432816.

Associations of saccharin intake with all-cause, cardiovascular and cancer mortality risk in USA adults

Saccharin is a widely used sugar substitute, but little is known about the long-term health effects of saccharin intake. Our study aimed to examine the association between saccharin intake and mortality in diabetic and pre-diabetic population and overweight population from NHANES 1988-1994. Cox proportional hazard models were used to evaluate the association between saccharin intake and CVD, cancer and all-cause mortality. After multivariable adjustment, increased absolute saccharin intake was associated with the risk of all-cause mortality (hazard ratio (HR): 1·41, 95 % CI: 1·05, 1·90), CVD mortality (HR: 1·93, 95 % CI: 1·15, 3·25) and cancer mortality (HR: 2·26, 95 % CI: 1·10, 4·45) in diabetic and pre-diabetic population. Among overweight population, higher absolute saccharin intake was associated with the risk of cancer mortality (HR: 7·369, 95 % CI: 2·122, 25·592). Replacing absolute saccharin intake with total sugar significantly reduced all-cause mortality by 12·5 % and CVD mortality by 49·7 % in an equivalent substitution analysis in the diabetic and pre-diabetic population. Aspartame substitution reduced all-cause mortality by 29·2 % and cancer mortality by 30·2 %. Notably, the relative daily intake of saccharin also had similar effects as the absolute intake on all-cause, cardiovascular and cancer mortality in all analyses. This was despite the fact that the relative daily intake in our study was below the Food and Drug Administration limit of 15 mg/kg. In conclusion, our study showed a considerable risk of increased saccharin intake on the all-cause, CVD mortality and cancer mortality.

Impacts of food additives on gut microbiota and host health

The rapidly expanding food industry necessitates the use of food additives to achieve specific purposes. However, this raises new concerns in food safety due to the reported negative impacts of food additives on gut microbiota and host health, particularly in the context of continuous worldwide urbanization. This review summarizes the existing studies on the effects of different types of commonly used food additives on gut microbiota alteration, intestinal barrier disruption, metabolism disorder, and neurobehavior changes. These food additives, including emulsifiers, low-calorie sweeteners, inorganic nanoparticles, and preservatives, have been found to exert multifaceted impacts, primarily adverse effects, highlighting the potential risks associated with food additive exposure in various chronic diseases. Further research is warranted to elucidate the specific mechanisms, determine the relevance of these findings to humans, and clarify the suitability of certain food additives for vulnerable populations. It is crucial to note that natural food additives are not inherently superior to synthetic ones in terms of safety. Rigorous evaluation is still warranted before their widespread application in the food industry. Additionally, the potential synergistic effects of commonly used food additives combination in specific food categories on gut microbiota and host metabolism should be investigated to understand their relevance in real-world scenarios.

EFSA Panel on Food Additives and Flavourings (FAF), Castle L, Andreassen M, Aquilina G, Bastos ML, Boon P, Fallico B, FitzGerald R, Frutos Fernandez MJ, Grasl‐Kraupp B, Gundert‐Remy U, Gürtler R, Houdeau E, Kurek M, Louro H, Morales P, Passamonti S, Batke M, Bruzell E, Chipman J, Cheyns K, Crebelli R, Fortes C, Fürst P, Halldorsson T, LeBlanc J, Mirat M, Lindtner O, Mortensen A, Ntzani E, Shah R, Wallace H, Wright M, Barmaz S, Civitella C, Georgelova P, Lodi F, Mazzoli E, Rasinger J, Maria Rincon A, Tard A, Zakidou P, Younes M. Re-evaluation of saccharin and its sodium, potassium and calcium salts (E 954) as food additives

This opinion deals with the re-evaluation of saccharin and its sodium, potassium and calcium salts (E 954) as food additives. Saccharin is the chemically manufactured compound 1,2-benzisothiazol-3(2H)-one-1,1-dioxide. Along with its sodium (Na), potassium (K) and calcium (Ca) salts, they are authorised as sweeteners (E 954). E 954 can be produced by two manufacturing methods i.e. Remsen-Fahlberg and Maumee. No analytical data on potential impurities were provided for products manufactured with the Maumee process; therefore, the Panel could only evaluate saccharins (E 954) manufactured with the Remsen-Fahlberg process. The Panel concluded that the newly available studies do not raise a concern for genotoxicity of E 954 and the saccharins impurities associated with the Remsen-Fahlberg manufacturing process. For the potential impurities associated with the Maumee process, a concern for genotoxicity was identified. The data set evaluated consisted of animals and human studies. The Panel considered appropriate to set a numerical acceptable daily intake (ADI) and considered the decrease in body weight in animal studies as the relevant endpoint for the derivation of a reference point. An ADI of 9 mg/kg body weight (bw) per day, expressed as free imide, was derived for saccharins (E 954). This ADI replaces the ADI of 5 mg /kg bw per day (expressed as sodium saccharin, corresponding to 3.8 mg /kg bw per day saccharin as free imide) established by the Scientific Committee on Food. The Panel considered the refined brand-loyal exposure assessment scenario the most appropriate exposure scenario for the risk assessment. The Panel noted that the P95 exposure estimates for chronic exposure to saccharins (E 954) were below the ADI. The Panel recommended the European Commission to consider the revision of the EU specifications of saccharin and its sodium, potassium and calcium salts (E 954).

Effects of Sucralose Supplementation on Glycemic Response, Appetite, and Gut Microbiota in Subjects with Overweight or Obesity: A Randomized Crossover Study Protocol

Sucralose stands as the most common non-nutritive sweetener; however, its metabolic effects have sparked significant controversy over the years. We aim to examine the effects of sucralose daily intake on glycemia, subjective appetite, and gut microbiota (GM) changes in subjects with overweight or obesity. In this randomized, crossover, and controlled trial, 23 participants with a body mass index between 25 kg/m2 and 39.9 kg/m2 will be assigned to one of two interventions to receive either sucralose (2 mg/kg/day equivalent to 40% of the acceptable daily intake) or glucose (control) for 4 weeks, each phase separated by a 4-week washout period. The glycemic response will be determined during a meal tolerance test, subjective appetite will be evaluated using a visual analog scale, and GM changes will be analyzed by next-generation sequencing of the bacterial rRNA 16S gene from fecal samples. All measures will be performed before and after intervention periods. We hypothesize that sucralose supplementation induces changes in glycemic response, subjective appetite, and gut microbiota in overweight and obese participants. This protocol was approved by the Ethics Committee of the UJAT (No. 0721) and was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12621001531808).

Long-term metabolic effects of non-nutritive sweeteners

OBJECTIVE

Excessive consumption of added sugars has been linked to the rise in obesity and associated metabolic abnormalities. Non-nutritive sweeteners (NNSs) offer a potential solution to reduce sugar intake, yet their metabolic safety remains debated. This study aimed to systematically assess the long-term metabolic effects of commonly used NNSs under both normal and obesogenic conditions.

METHODS

To ensure consistent sweetness level and controlling for the acceptable daily intake (ADI), eight weeks old C57BL/6 male mice were administered with acesulfame K (ace K, 535.25 mg/L), aspartame (411.75 mg/L), sucralose (179.5 mg/L), saccharin (80 mg/L), or steviol glycoside (Reb M, 536.25 mg/L) in the drinking water, on the background of either regular or high-fat diets (in high fat diet 60% of calories from fat). Water or fructose-sweetened water (82.3.gr/L), were used as controls. Anthropometric and metabolic parameters, as well as microbiome composition, were analyzed following 20-weeks of exposure.

RESULTS

Under a regular chow diet, chronic NNS consumption did not significantly affect body weight, fat mass, or glucose metabolism as compared to water consumption, with aspartame demonstrating decreased glucose tolerance. In diet-induced obesity, NNS exposure did not increase body weight or alter food intake. Exposure to sucralose and Reb M led to improved insulin sensitivity and decreased weight gain. Reb M specifically was associated with increased prevalence of colonic Lachnospiracea bacteria.

CONCLUSIONS

Long-term consumption of commonly used NNSs does not induce adverse metabolic effects, with Reb M demonstrating a mild improvement in metabolic abnormalities. These findings provide valuable insights into the metabolic impact of different NNSs, aiding in the development of strategies to combat obesity and related metabolic disorders.

Effect of Replacing Sucrose in Beverages with Nonnutritive Sweetener Sucralose on Cardiometabolic Risk Factors Among Asian Indian Adults with Type 2 Diabetes: A 12-Week Randomized Controlled Trial

INTRODUCTION

Country-specific evidence-based research is crucial for understanding the role of nonnutritive sweeteners (NNS) in managing type 2 diabetes (T2D). The main aim of this study was to explore the effect of replacing sucrose with sucralose in coffee/tea in Asian Indians with type 2 diabetes (T2D).

METHODS

This 12-week, parallel-arm randomized controlled trial included 210 participants with T2D, assigned to the intervention group, where sugar/sucrose in coffee or tea was substituted with sucralose, or the control group, where sugar/sucrose was continued. Lifestyle factors remained unchanged. The primary outcome was change in HbA1c. Secondary outcomes were changes in body weight (BW), body mass index (BMI), waist circumference (WC), lipid profiles, and inflammatory markers.

RESULTS

At the end of 12 weeks, no change was observed in HbA1c, fasting plasma glucose, lipid profile, and inflammatory markers between or within groups. There was a small but significant reduction in BW (- 0.5 kg [95% CI - 1.0, - 0.1]; p = 0.02), BMI (- 0.2 kg/m2 [- 0.4, 0.0]; p = 0.03), and WC (- 0.8 cm [- 1.4, - 0.3]; p = 0.002) in the intervention group. Improvements were also observed in lipid accumulation product (p = 0.01), visceral adiposity index (p = 0.04), triglyceride/glucose index (p = 0.04), total energy intake (p = 0.04), and carbohydrate intake (p < 0.0001).

CONCLUSIONS

In Asian Indians with T2D, replacing about 60 kcal of added sucrose with sucralose in coffee/ tea had no benefit on glycemia but resulted in a small reduction in body weight, body mass index, and waist circumference.

TRIAL REGISTRATION

Clinical Trials Registry of India (CTRI/2021/04/032686).

The Bittersweet Reality: The Cardiovascular Risk of Artificial Sweeteners

Artificial sweeteners are increasingly popular as alternatives to sugar. Approximately 41% of the American adult population reports regular consumption of low-calorie sweeteners. People are not even aware they are ingesting artificial sweeteners as they are now in chewing gum, toothpaste, various food products, baked goods, and even pharmaceutical products. Some of these sweeteners are sweeter than sugar, some less sweet than sugar, and some are natural sweeteners. With the goal of increasing palatability, many products have multiple additives to create the perfect taste. Despite their widespread use and perceived benefits, there is increasing concern in the academic community about the long-term safety of these artificial sweeteners and their role in increasing the burden of cardiovascular diseases, including coronary heart disease, stroke, and heart failure. There is general agreement about the cardiovascular risk of added sugars to a diet. Public health authorities have recommended limiting added sugar consumption. Replacing sugar with these artificial sweeteners has become increasingly popular, but safety remains a question. While multiple well-designed randomized clinical trials are needed for the conclusion, review of the current literature gives us pause about the cardiovascular risk and long-term safety of these additives.

Effect of stevia on blood glucose and HbA1C: A meta-analysis

BACKGROUND

The study investigates substituting non-nutritive sweeteners (NNS) for sugar to address health concerns related to excess sugar intake. It specifically examines how stevia affects insulin and blood glucose levels. The systematic review and meta-analysis aim to evaluate stevia's impact on glycemic indices.

METHODS

We conducted a systematic review and meta-analysis following PRISMA guidelines, including 26 studies with 1439 participants. The PROSPERO registration number for this research is CRD42023414411. We systematically searched PubMed (MEDLINE), Scopus, Web of Science, and Google Scholar. Additionally, we thoroughly reviewed the reference lists of the articles we extracted and relevant reviews. Two evaluators independently carried out screening, quality assessment, and data extraction. The GRADE (grading of recommendations, assessment, development, and evaluation) approach was utilized to evaluate the certainty of the evidence.

RESULTS

Stevia consumption was associated with significantly reducing blood glucose levels (WMD: -3.84; 95 % CI: -7.15, -0.53; P = 0.02, low certainty), especially in individuals with higher BMI, diabetes, and hypertension. Dose-response analysis revealed a decrease in blood glucose for ≥3342 mg/day of stevia consumption. Stevia consumption has been shown to reduce blood glucose levels within 1-4 months, as evidenced by dose-response analysis (less than 120 days) and subgroup analysis (more than four weeks). However, stevia did not significantly affect insulin concentration or HbA1C levels (very low and low certainty, respectively).

CONCLUSIONS

Low certainty evidence showed that stevia improved blood glucose control, especially when consumed for less than 120 days. However, more randomized trials with higher stevia dosages are required.

Could Insulin Be a Better Regulator of Appetite/Satiety Balance and Body Weight Maintenance in Response to Glucose Exposure Compared to Sucrose Substitutes? Unraveling Current Knowledge and Searching for More Appropriate Choices

BACKGROUND

Insulin exerts a crucial impact on glucose control, cellular growing, function, and metabolism. It is partially modulated by nutrients, especially as a response to the intake of foods, including carbohydrates. Moreover, insulin can exert an anorexigenic effect when inserted into the hypothalamus of the brain, in which a complex network of an appetite/hunger control system occurs. The current literature review aims at thoroughly summarizing and scrutinizing whether insulin release in response to glucose exposure may be a better choice to control body weight gain and related diseases compared to the use of sucrose substitutes (SSs) in combination with a long-term, well-balanced diet.

METHODS

This is a comprehensive literature review, which was performed through searching in-depth for the most accurate scientific databases and applying effective and relevant keywords.

RESULTS

The insulin action can be inserted into the hypothalamic orexigenic/anorexigenic complex system, activating several anorexigenic peptides, increasing the hedonic aspect of food intake, and effectively controlling the human body weight. In contrast, SSs appear not to affect the orexigenic/anorexigenic complex system, resulting in more cases of uncontrolled body weight maintenance while also increasing the risk of developing related diseases.

CONCLUSIONS

Most evidence, mainly derived from in vitro and in vivo animal studies, has reinforced the insulin anorexigenic action in the hypothalamus of the brain. Simultaneously, most available clinical studies showed that SSs during a well-balanced diet either maintain or even increase body weight, which may indirectly be ascribed to the fact that they cannot cover the hedonic aspect of food intake. However, there is a strong demand for long-term longitudinal surveys to effectively specify the impact of SSs on human metabolic health.

Activation and inhibition of the sweet taste receptor TAS1R2-TAS1R3 differentially affect glucose tolerance in humans

The sweet taste receptor, TAS1R2-TAS1R3, is expressed in taste bud cells, where it conveys sweetness, and also in intestinal enteroendocrine cells, where it may facilitate glucose absorption and assimilation. In the present study, our objective was to determine whether TAS1R2-TAS1R3 influences glucose metabolism bidirectionally via hyperactivation with 5 mM sucralose (n = 12) and inhibition with 2 mM sodium lactisole (n = 10) in mixture with 75 g glucose loads during oral glucose tolerance tests (OGTTs) in healthy humans. Plasma glucose, insulin, and glucagon were measured before, during, and after OGTTs up to 120 minutes post-prandially. We also assessed individual participants' sweet taste responses to sucralose and their sensitivities to lactisole sweetness inhibition. The addition of sucralose to glucose elevated plasma insulin responses to the OGTT (F(1, 11) = 4.55, p = 0.056). Sucralose sweetness ratings were correlated with early increases in plasma glucose (R2 = 0.41, p<0.05), as well as increases in plasma insulin (R2 = 0.38, p<0.05) when sucralose was added to the OGTT (15 minute AUC). Sensitivity to lactisole sweetness inhibition was correlated with decreased plasma glucose (R2 = 0.84, p<0.01) when lactisole was added to the OGTT over the whole test (120 minute AUC). In summary, stimulation and inhibition of the TAS1R2-TAS1R3 receptor demonstrates that TAS1R2-TAS1R3 helps regulate glucose metabolism in humans and may have translational implications for metabolic disease risk.

Stevioside Ameliorates Palmitic Acid-Induced Abnormal Glucose Uptake via the PDK4/AMPK/TBC1D1 Pathway in C2C12 Myotubes

BACKGROUND

Stevioside (SV) with minimal calories is widely used as a natural sweetener in beverages due to its high sweetness and safety. However, the effects of SV on glucose uptake and the pyruvate dehydrogenase kinase isoenzyme (PDK4) as an important protein in the regulation of glucose metabolism, remain largely unexplored. In this study, we used C2C12 skeletal muscle cells that was induced by palmitic acid (PA) to assess the effects and mechanisms of SV on glucose uptake and PDK4.

METHODS

The glucose uptake of C2C12 cells was determined by 2-NBDG; expression of the Pdk4 gene was measured by quantitative real-time PCR; and expression of the proteins PDK4, p-AMPK, TBC1D1 and GLUT4 was assessed by Western blotting.

RESULTS

In PA-induced C2C12 myotubes, SV could significantly promote cellular glucose uptake by decreasing PDK4 levels and increasing p-AMPK and TBC1D1 levels. SV could promote the translocation of GLUT4 from the cytoplasm to the cell membrane in cells. Moreover, in Pdk4-overexpressing C2C12 myotubes, SV decreased the level of PDK4 and increased the levels of p-AMPK and TBC1D1.

CONCLUSION

SV was found to ameliorate PA-induced abnormal glucose uptake via the PDK4/AMPK/TBC1D1 pathway in C2C12 myotubes. Although these results warranted further investigation for validation, they may provide some evidence of SV as a safe natural sweetener for its use in sugar-free beverages to prevent and control T2DM.

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

BACKGROUND

Sweeteners and sweetness enhancers (S&SE) are used to replace energy yielding sugars and maintain sweet taste in a wide range of products, but controversy exists about their effects on appetite and endocrine responses in reduced or no added sugar solid foods. The aim of the current study was to evaluate the acute (1 day) and repeated (two-week daily) ingestive effects of 2 S&SE vs. sucrose formulations of biscuit with fruit filling on appetite and endocrine responses in adults with overweight and obesity.

METHODS

In a randomised crossover trial, 53 healthy adults (33 female, 20 male) with overweight/obesity in England and France consumed biscuits with fruit filling containing 1) sucrose, or reformulated with either 2) Stevia Rebaudioside M (StRebM) or 3) Neotame daily during three, two-week intervention periods with a two-week washout. The primary outcome was composite appetite score defined as [desire to eat + hunger + (100 - fullness) + prospective consumption]/4.

FINDINGS

Each formulation elicited a similar reduction in appetite sensations (3-h postprandial net iAUC). Postprandial insulin (2-h iAUC) was lower after Neotame (95% CI (0.093, 0.166); p < 0.001; d = -0.71) and StRebM (95% CI (0.133, 0.205); p < 0.001; d = -1.01) compared to sucrose, and glucose was lower after StRebM (95% CI (0.023, 0.171); p < 0.05; d = -0.39) but not after Neotame (95% CI (-0.007, 0.145); p = 0.074; d = -0.25) compared to sucrose. There were no differences between S&SE or sucrose formulations on ghrelin, glucagon-like peptide 1 or pancreatic polypeptide iAUCs. No clinically meaningful differences between acute vs. two-weeks of daily consumption were found.

INTERPRETATION

In conclusion, biscuits reformulated to replace sugar using StRebM or Neotame showed no differences in appetite or endocrine responses, acutely or after a two-week exposure, but can reduce postprandial insulin and glucose response in adults with overweight or obesity.

FUNDING

The present study was funded by the Horizon 2020 program: Sweeteners and sweetness enhancers: Impact on health, obesity, safety and sustainability (acronym: SWEET, grant no: 774293).

Comparison of a Daily Steviol Glycoside Beverage compared with a Sucrose Beverage for Four Weeks on Gut Microbiome in Healthy Adults

BACKGROUND

Recent studies suggest that some nonnutritive sweeteners (NNS) have deleterious effects on the human gut microbiome (HGM). The effect of steviol glycosides on the HGM has not been well studied.

OBJECTIVE

We aimed to evaluate the effects of stevia- compared with sucrose-sweetened beverages on the HGM and fecal short-chain fatty acid (SCFA) profiles.

METHODS

Using a randomized, double-blinded, parallel-design study, n = 59 healthy adults [female/male, n = 36/23, aged 31±9 y, body mass index (BMI): 22.6±1.7 kg/m2] consumed 16 oz of a beverage containing either 25% of the acceptable daily intake (ADI) of stevia or 30 g of sucrose daily for 4 weeks followed by a 4-week washout. At weeks 0 (baseline), 4, and 8, the HGM was characterized via shotgun sequencing, fecal SCFA concentrations were measured using ultra-high performance liquid chromatography-tandem mass spectrometry and anthropometric measurements, fasting serum glucose, insulin and lipids, blood pressure, pulse, and 3-d diet records were obtained.

RESULTS

There were no significant differences in the HGM or fecal SCFA between the stevia and sucrose groups at baseline (P > 0.05). At week 4 (after intervention), there were no significant differences in the HGM at the phylum, family, genus, or species level between the stevia and sucrose groups and no significant differences in fecal SCFA. At week 4, BMI had increased by 0.3 kg/m2 (P = 0.013) in sucrose compared with stevia, but all other anthropometric and cardiometabolic measures and food intake did not differ significantly (P > 0.05). At week 8 (after washout), there were no significant differences in the HGM, fecal SFCA, or any anthropometric or cardiometabolic measure between the stevia and sucrose groups (P > 0.05).

CONCLUSIONS

Daily consumption of a beverage sweetened with 25% of the ADI of stevia for 4 weeks had no significant effects on the HGM, fecal SCFA, or fasting cardiometabolic measures, compared with daily consumption of a beverage sweetened with 30 g of sucrose.

TRIAL REGISTRATION

clinicaltrials.gov as NCT05264636.

Metabolic Effects of Selected Conventional and Alternative Sweeteners: A Narrative Review

Sugar consumption is known to be associated with a whole range of adverse health effects, including overweight status and type II diabetes mellitus. In 2015, the World Health Organization issued a guideline recommending the reduction of sugar intake. In this context, alternative sweeteners have gained interest as sugar substitutes to achieve this goal without loss of the sweet taste. This review aims to provide an overview of the scientific literature and establish a reference tool for selected conventional sweeteners (sucrose, glucose, and fructose) and alternative sweeteners (sucralose, xylitol, erythritol, and D-allulose), specifically focusing on their important metabolic effects. The results show that alternative sweeteners constitute a diverse group, and each substance exhibits one or more metabolic effects. Therefore, no sweetener can be considered to be inert. Additionally, xylitol, erythritol, and D-allulose seem promising as alternative sweeteners due to favorable metabolic outcomes. These alternative sweeteners replicate the benefits of sugars (e.g., sweetness and gastrointestinal hormone release) while circumventing the detrimental effects of these substances on human health.

Substitution of sugar-sweetened beverages with non-caloric alternatives and weight change: A systematic review of randomized trials and meta-analysis

BACKGROUND

Intake of sugar-sweetened beverages has been associated with weight gain. It is uncertain if replacing an existing use of sugar-sweetened beverages with non-caloric beverages results in long-term reduction in body weight.

OBJECTIVE

The objective of this study is to explore if a long-term reduction in body weight can be achieved by replacing an existing intake of sugar-sweetened beverages with non-caloric beverages.

METHODS

Systematic review and meta-analysis of randomized clinical trials in accordance with PRISMA guidelines. PubMed and EMBASE were searched for literature. Studies with a "substitution" design were included, that is, studies where subjects substituted an existing intake of sugar-sweetened beverages with either artificially sweetened beverages or unsweetened beverages/water. Studies with 6 months or longer follow-up of weight change were included.

RESULTS

Six trials with a total of 1729 participants were included in the meta-analysis. Replacing an existing intake of sugar-sweetened beverages with a non-caloric beverage resulted in a long-term BMI reduction of 0.31 kg/m2 compared with the sugar-sweetened beverage-group (95% CI; 0.17-0.44). One study with 1 year's intervention and 2 years follow-up showed a regression towards baseline BMI after the intervention had ended.

CONCLUSION

Replacing an existing use of sugar-sweetened beverages with artificially sweetened beverages or unsweetened beverages resulted in a long-term 0.31 kg/m2 reduction in BMI equivalent to 0.5-1 kg in children and adults, respectively, as long as the interventions lasted.

Association between consumption of sweeteners and endometrial cancer risk: a systematic review and meta-analysis of observational studies

The purpose of this study is to further investigate the relationship between sweetener exposure and the risk of endometrial cancer (EC). Up until December 2022, a literature search in an electronic database was carried out utilizing PubMed, Web of Science, Ovid, and Scopus. The odds ratio (OR) and 95 % confidence interval (CI) were used to evaluate the results. Sweeteners were divided into nutritional sweeteners (generally refers to sugar, such as sucrose and glucose) and non-nutritional sweeteners (generally refers to artificial sweeteners, such saccharin and aspartame). Ten cohort studies and two case-control studies were eventually included. The study found that in 12 studies, compared with the non-exposed group, the incidence rate of EC in the sweetener exposed group was higher (OR = 1·15, 95 % CI = [1·07, 1·24]). Subgroup analysis showed that in 11 studies, the incidence rate of EC in the nutritional sweetener exposed group was higher than that in the non-exposed group (OR = 1·25, 95 % CI = [1·14, 1·38]). In 4 studies, there was no difference in the incidence rate of EC between individuals exposed to non-nutritional sweeteners and those who were not exposed to non-nutritional sweeteners (OR = 0·90, 95 % CI = [0·81, 1·01]). This study reported that the consumption of nutritional sweeteners may increase the risk of EC, whereas there was no significant relationship between the exposure of non-nutritional sweeteners and the incidence of EC. Based on the results of this study, it is recommended to reduce the intake of nutritional sweeteners, but it is uncertain whether use of on-nutritional sweeteners instead of nutritional sweetener.

Online commentaries of the sugar-sweetened beverages tax in Malaysia: Content analysis

INTRODUCTION

Implementing taxes on sugary drinks, or SSBs, has been a controversial topic in many countries, including Malaysia. This study aimed to examine how Malaysian Facebook users responded to the announcement and implementation of the SSBs tax through netnography.

METHODS

This cross-sectional study employed qualitative and quantitative methods and used an inductive approach and thematic content analysis to analyze online commentaries on news articles published on popular online news portals from November 2018 to August 2019. Data was collected by downloading the commentaries onto Microsoft Word and importing them into NVivo.

RESULTS

Of the commentaries analyzed, 60.9% rejected the SSBs tax, and 39.1% favored it. No association was found between the online news articles and the slants of the commentaries.

CONCLUSION

The results of this study demonstrate a clear divide in public opinion regarding the SSBs tax in Malaysia, with many online readers expressing opposition to the tax despite evidence of the harmful effects of sugar presented in the articles they are commenting on. These findings have implications for policymakers and public health advocates seeking to implement similar taxes in the future.

EFSA Panel on Food Additives and Flavourings (FAF), Younes M, Aquilina G, Degen G, Engel K, Fowler P, Frutos Fernandez MJ, Fürst P, Gundert‐Remy U, Gürtler R, Husøy T, Manco M, Mennes W, Passamonti S, Moldeus P, Shah R, Waalkens‐Berendsen I, Wright M, Barat Baviera JM, Gott D, Herman L, Leblanc J, Wölfle D, Entrena JA, Consuelo C, Mech A, Multari S, Palaniappan V, Ruggeri L, Smeraldi C, Tard A, Castle L. Safety evaluation of the food additive steviol glycosides, predominantly Rebaudioside M, produced by fermentation using Yarrowia lipolyticaVRM

The EFSA Panel on Food Additive and Flavourings (FAF Panel) provides a scientific opinion on the safety of a new process to produce steviol glycosides by fermentation of simple sugars using a genetically modified strain of Yarrowia lipolytica (named Y. lipolytica VRM). The manufacturing process may result in impurities different from those that may be present in the other steviol glycosides E 960a-d, therefore the Panel concluded that separate specifications are required for the food additive produced as described in the current application. Viable cells and DNA from the production strain are not present in the final product. The Panel considered that the demonstration of the absence of kaurenoic acid in the proposed food additive, using a method with a limit of detection (LOD) of 0.3 mg/kg, is adequate to dispel the concerns for potential genotoxicity. Given that all steviol glycosides follow the same metabolic pathways, the Panel considered that the current steviol glycosides would fall within the same group of substances. Therefore, the Panel considered that the already existing data on rebaudioside M and structurally related steviol glycosides are sufficient, and a similar metabolic fate and toxicity is expected for the food additive. The results from the bacterial reverse mutation assay and the in vitro micronucleus assay were negative and indicated absence of genotoxicity from the food additive. The existing acceptable daily intake (ADI) of 4 mg/kg body weight (bw) per day, expressed as steviol equivalents, was considered to be applicable to the proposed food additive. The Panel concluded that there is no safety concern for steviol glycosides, predominantly Rebaudioside M, produced by fermentation using Y. lipolytica VRM, to be used as a food additive at the proposed uses and use levels.

Sugar and low/no-calorie-sweetened beverage consumption and associations with body weight and waist circumference changes in five European cohort studies: the SWEET project

PURPOSE

Results of prospective studies investigating associations between low/no-calorie sweeteners (LNCS) and body weight-related outcomes are inconclusive. We conducted dose-response and theoretical replacement individual patient data meta-analyses using harmonised prospective data to evaluate associations between sugar-sweetened beverage (SSB) consumption, low/no-calorie sweetened beverage (LNCB) consumption, and changes in body weight and waist circumference.

METHODS

Individual participant data were obtained from five European studies, i.e., Lifelines Cohort Study, NQplus study, Alpha Omega Cohort, Predimed-Plus study, and Feel4diabetes study, including 82,719 adults aged 18-89 with follow-up between 1 and 9 years. Consumption of SSB and LNCB was assessed using food-frequency questionnaires. Multiple regression analyses adjusting for major confounders and including substitution models were conducted to quantify associations in individual cohorts; random-effects meta-analyses were performed to pool individual estimates.

RESULTS

Overall, pooled results showed weak adverse associations between SSB consumption and changes in body weight (+ 0.02 kg/y, 95%CI 0.00; 0.04) and waist circumference (+ 0.03 cm/y, 95%CI 0.01; 0.05). LNCB consumption was associated with higher weight gain (+ 0.06 kg/y, 95%CI 0.04; 0.08) but not with waist circumference. No clear associations were observed for any theoretical replacements, i.e., LNCB or water for SSB or water for LNCB.

CONCLUSION

In conclusion, this analysis of five European studies found a weak positive association between SSB consumption and weight and waist change, whilst LNCB consumption was associated with weight change only. Theoretical substitutions did not show any clear association. Thus, the benefit of LNCBs as an alternative to SSBs remains unclear.

Classification of Food Additives Using UV Spectroscopy and One-Dimensional Convolutional Neural Network

Food additives are utilized in countless food products available for sale. They enhance or obtain a specific flavor, extend the storage time, or obtain a desired texture. This paper presents an automatic classification system for five food additives based on their absorbance in the ultraviolet domain. Solutions with different concentrations were created by dissolving a measured additive mass into distilled water. The analyzed samples were either simple (one additive solution) or mixed (two additive solutions). The substances presented absorbance peaks between 190 nm and 360 nm. Each substance presents a certain number of absorbance peaks at specific wavelengths (e.g., acesulfame potassium presents an absorbance peak at 226 nm, whereas the peak associated with potassium sorbate is at 254 nm). Therefore, each additive has a distinctive spectrum that can be used for classification. The sample classification was performed using deep learning techniques. The samples were associated with numerical labels and divided into three datasets (training, validation, and testing). The best classification results were obtained using CNN (convolutional neural network) models. The classification of the 404 spectra with a CNN model with three convolutional layers obtained a mean testing accuracy of 92.38% ± 1.48%, whereas the mean validation accuracy was 93.43% ± 2.01%.

Non-sugar sweeteners and health outcomes in adults without diabetes: deciphering the WHO recommendations in the Indian context

BACKGROUND AND AIMS

A systematic review and meta-analysis conducted by the World Health Organization (WHO) assessed the health outcomes of non-sugar sweeteners (NSS) in randomized controlled trials (RCTs) and prospective cohort studies (PCSs) and reported conflicting findings. We aim to decipher these conflicting findings in RCTs and PCSs by critically reviewing their results, comparing them with previous meta-analyses, and providing a simplified interpretation including the Indian perspective.

METHODS

We critically reviewed the 210-page dossier of WHO including the full text of most of the key studies of NSS included in this meta-analysis and subsequently compared it with previous meta-analyses to identify similarities and differences to address a few key questions pertaining to health outcomes associated with NSS use in adults.

RESULTS

Poor health outcomes are often associated with excess sugar intake. While NSS are typically consumed as a sugar replacement, benefits are conflicting. While RCTs found some benefits in the short term, PCSs found harm associated with NSS use in the long term.

CONCLUSION

The 2022 WHO meta-analysis that assessed the health outcomes of NSS is the most robust and critically analyzed document available to date. Despite the absence of any strong conclusion that suggests NSS consumption increases the risk of cardio-metabolic disorders, no firm evidence also rejects this statement. NSS could be an attractive replacement for sugar in overweight/obese people in the short term, but long-term harm cannot be fully ruled out. We suggest avoiding consuming sugar and restricting NSS intake wherever possible until long-term studies confirm or refute these findings.

Assessing the impact of non-nutritive sweeteners on anthropometric indices and leptin levels in adults: A GRADE-assessed systematic review, meta-analysis, and meta-regression of randomized clinical trials

In today's world, non-nutritive sweeteners (NNSs) are recognized as substitutes for sugar or other high-calorie sweeteners, and their consumption is increasing dramatically. However, there is ongoing debate regarding the impact of NNSs on anthropometric indices. To fill this gap in knowledge, the current GRADE-assessed systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the effects of artificial- and stevia-based sweeteners consumption on anthropometric indices and serum leptin level which is known as an appetite-regulating hormone. A comprehensive search was conducted on the Scopus, PubMed, and Embase databases up to November 2022 to identify randomized controlled trials (RCTs) investigating the effects of NNSs on anthropometric indices and serum leptin levels. Data extraction from qualified studies was performed independently by two researchers. A random- or fixed-effects model was used to estimate weighted mean differences (WMDs) and 95% confidence intervals (CIs) for anthropometric indices such as body weight (BW), body mass index (BMI), fat mass (FM), fat-free mass (FFM), waist circumference (WC) and serum leptin level. Heterogeneity between studies was assessed using Cochran's Q test and quantified using the I2 statistic. From a pool of 3212 studies initially identified, 20 studies with a total sample size of 2158 subjects were included in the analysis. Results of the pooled analysis showed that NNSs consumption had a significant reducing effect on BW (WMD: -1.02, 95% CI: -1.57, -0.46 Kg), FM (WMD: -1.09, 95% CI: -1.90, -0.29), and FFM (WMD: -0.83, 95% CI: -1.42, -0.23), but did not have any significant effect on BMI (WMD: -0.16, 95% CI: -0.35, 0.02), WC (WMD: -1.03, 95% CI: -2.77, 0.72), or serum leptin level (WMD: -2.17, 95% CI: -4.98, 0.65). The findings of this study indicate that the consumption of artificial- and stevia-based sweeteners may lead to a reduction in body weight, fat mass, and free fat mass.

Ultraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms

Epidemiologic evidence supports a positive association between ultraprocessed food (UPF) consumption and body mass index. This has led to recommendations to avoid UPFs despite very limited evidence establishing causality. Many mechanisms have been proposed, and this review critically aimed to evaluate selected possibilities for specificity, clarity, and consistency related to food choice (i.e., low cost, shelf-life, food packaging, hyperpalatability, and stimulation of hunger/suppression of fullness); food composition (i.e., macronutrients, food texture, added sugar, fat and salt, energy density, low-calorie sweeteners, and additives); and digestive processes (i.e., oral processing/eating rate, gastric emptying time, gastrointestinal transit time, and microbiome). For some purported mechanisms (e.g., fiber content, texture, gastric emptying, and intestinal transit time), data directly contrasting the effects of UPF and non-UPF intake on the indices of appetite, food intake, and adiposity are available and do not support a unique contribution of UPFs. In other instances, data are not available (e.g., microbiome and food additives) or are insufficient (e.g., packaging, food cost, shelf-life, macronutrient intake, and appetite stimulation) to judge the benefits versus the risks of UPF avoidance. There are yet other evoked mechanisms in which the preponderance of evidence indicates ingredients in UPFs actually moderate body weight (e.g., low-calorie sweetener use for weight management; beverage consumption as it dilutes energy density; and higher fat content because it reduces glycemic responses). Because avoidance of UPFs holds potential adverse effects (e.g., reduced diet quality, increased risk of food poisoning, and food wastage), it is imprudent to make recommendations regarding their role in diets before causality and plausible mechanisms have been verified.

Long-Term Consumption of Sucralose Induces Hepatic Insulin Resistance through an Extracellular Signal-Regulated Kinase 1/2-Dependent Pathway

Sugar substitutes have been recommended to be used for weight and glycemic control. However, numerous studies indicate that consumption of artificial sweeteners exerts adverse effects on glycemic homeostasis. Although sucralose is among the most extensively utilized sweeteners in food products, the effects and detailed mechanisms of sucralose on insulin sensitivity remain ambiguous. In this study, we found that bolus administration of sucralose by oral gavage enhanced insulin secretion to decrease plasma glucose levels in mice. In addition, mice were randomly allocated into three groups, chow diet, high-fat diet (HFD), and HFD supplemented with sucralose (HFSUC), to investigate the effects of long-term consumption of sucralose on glucose homeostasis. In contrast to the effects of sucralose with bolus administration, the supplement of sucralose augmented HFD-induced insulin resistance and glucose intolerance, determined by glucose and insulin tolerance tests. In addition, we found that administration of extracellular signal-regulated kinase (ERK)-1/2 inhibitor reversed the effects of sucralose on glucose intolerance and insulin resistance in mice. Moreover, blockade of taste receptor type 1 member 3 (T1R3) by lactisole or pretreatment of endoplasmic reticulum stress inhibitors diminished sucralose-induced insulin resistance in HepG2 cells. Taken together, sucralose augmented HFD-induced insulin resistance in mice, and interrupted insulin signals through a T1R3-ERK1/2-dependent pathway in the liver.

Effects of Nonnutritive Sweeteners on Body Composition Changes during Pubertal Growth

The effects of consuming specific types of nonnutritive sweeteners (NNSs) on adiposity changes in children have remained inconsistent. In this study, we aimed to investigate the effects of the intake of different kinds of NNSs on long-term adiposity changes during pubertal growth. Furthermore, we examined the above relationships among different sexes, pubertal stages, and levels of obesity. A total of 1893 6-15-year-old adults were recruited and followed-up every 3 months. The NNS-FFQ (Food Frequency Questionnaire) was conducted and urine samples were collected to investigate the effects of the selected sweeteners, which included acesulfame potassium, aspartame, sucralose, glycyrrhizin, steviol glycosides, and sorbitol. Multivariate linear mixed-effects models were used to examine the relationship between NNS intake and body composition. The consumption of aspartame, sucralose, glycyrrhizin, stevioside, and sorbitol was associated with decreased fat mass and increased fat-free mass. In the highest tertile group, the effects of NNS consumption on fat mass corresponded to values of -1.21 (95% CI: -2.04 to -0.38) for aspartame, -0.62 (95% CI: -1.42 to 0.19) for sucralose, -1.26 (95% CI: -2.05 to -0.47) for glycyrrhizin, -0.90 (95% CI: -2.28 to 0.48) for stevioside, and -0.87 (95% CI: -1.67 to -0.08) for sorbitol, while the effects on fat-free mass corresponded to values of 1.20 (95% CI: 0.36 to -0.38) for aspartame, 0.62 (95% CI: -0.19 to 1.43) for sucralose, 1.27 (95% CI: 0.48 to 2.06) for glycyrrhizin, 0.85 (95% CI: -0.53 to 2.23) for stevioside, and 0.87 (95% CI: 0.08 to 1.67) for sorbitol. Particularly, aspartame and sorbitol revealed a dose-responsiveness effect. The above finding was more prominent among girls than boys. Moreover, fat mass was significantly reduced in normal-weight children who consumed a moderate amount of aspartame and a large amount of glycyrrhizin and sorbitol compared with obese children. In conclusion, the NNS-specific and sex-specific effects of long-term NNS consumption revealed associations of decreasing fat mass and increasing fat-free mass for children undergoing pubertal growth.

Impact of acute consumption of beverages containing plant-based or alternative sweetener blends on postprandial appetite, food intake, metabolism, and gastro-intestinal symptoms: Results of the SWEET beverages trial

Project SWEET examined the barriers and facilitators to the use of non-nutritive sweeteners and sweetness enhancers (hereafter "S&SE") alongside potential risks/benefits for health and sustainability. The Beverages trial was a double-blind multi-centre, randomised crossover trial within SWEET evaluating the acute impact of three S&SE blends (plant-based and alternatives) vs. a sucrose control on glycaemic response, food intake, appetite sensations and safety after a carbohydrate-rich breakfast meal. The blends were: mogroside V and stevia RebM; stevia RebA and thaumatin; and sucralose and acesulfame-potassium (ace-K). At each 4 h visit, 60 healthy volunteers (53% male; all with overweight/obesity) consumed a 330 mL beverage with either an S&SE blend (0 kJ) or 8% sucrose (26 g, 442 kJ), shortly followed by a standardised breakfast (∼2600 or 1800 kJ with 77 or 51 g carbohydrates, depending on sex). All blends reduced the 2-h incremental area-under-the-curve (iAUC) for blood insulin (p < 0.001 in mixed-effects models), while the stevia RebA and sucralose blends reduced the glucose iAUC (p < 0.05) compared with sucrose. Post-prandial levels of triglycerides plus hepatic transaminases did not differ across conditions (p > 0.05 for all). Compared with sucrose, there was a 3% increase in LDL-cholesterol after stevia RebA-thaumatin (p < 0.001 in adjusted models); and a 2% decrease in HDL-cholesterol after sucralose-ace-K (p < 0.01). There was an impact of blend on fullness and desire to eat ratings (both p < 0.05) and sucralose-acesulfame K induced higher prospective intake vs sucrose (p < 0.001 in adjusted models), but changes were of a small magnitude and did not translate into energy intake differences over the next 24 h. Gastro-intestinal symptoms for all beverages were mostly mild. In general, responses to a carbohydrate-rich meal following consumption of S&SE blends with stevia or sucralose were similar to sucrose.

Important food sources of fructose-containing sugars and adiposity: A systematic review and meta-analysis of controlled feeding trials

BACKGROUND

Sugar-sweetened beverages (SSBs) providing excess energy increase adiposity. The effect of other food sources of sugars at different energy control levels is unclear.

OBJECTIVES

To determine the effect of food sources of fructose-containing sugars by energy control on adiposity.

METHODS

In this systematic review and meta-analysis, MEDLINE, Embase, and Cochrane Library were searched through April 2022 for controlled trials ≥2 wk. We prespecified 4 trial designs by energy control: substitution (energy-matched replacement of sugars), addition (energy from sugars added), subtraction (energy from sugars subtracted), and ad libitum (energy from sugars freely replaced). Independent authors extracted data. The primary outcome was body weight. Secondary outcomes included other adiposity measures. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence.

RESULTS

We included 169 trials (255 trial comparisons, n = 10,357) assessing 14 food sources at 4 energy control levels over a median 12 wk. Total fructose-containing sugars increased body weight (MD: 0.28 kg; 95% CI: 0.06, 0.50 kg; P_MD = 0.011) in addition trials and decreased body weight (MD: -0.96 kg; 95% CI: -1.78, -0.14 kg; P_MD = 0.022) in subtraction trials with no effect in substitution or ad libitum trials. There was interaction/influence by food sources on body weight: substitution trials [fruits decreased; added nutritive sweeteners and mixed sources (with SSBs) increased]; addition trials [dried fruits, honey, fruits (≤10%E), and 100% fruit juice (≤10%E) decreased; SSBs, fruit drink, and mixed sources (with SSBs) increased]; subtraction trials [removal of mixed sources (with SSBs) decreased]; and ad libitum trials [mixed sources (with/without SSBs) increased]. GRADE scores were generally moderate. Results were similar across secondary outcomes.

CONCLUSIONS

Energy control and food sources mediate the effect of fructose-containing sugars on adiposity. The evidence provides a good indication that excess energy from sugars (particularly SSBs at high doses ≥20%E or 100 g/d) increase adiposity, whereas their removal decrease adiposity. Most other food sources had no effect, with some showing decreases (particularly fruits at lower doses ≤10%E or 50 g/d). This trial was registered at clinicaltrials.gov as NCT02558920 (https://clinicaltrials.gov/ct2/show/NCT02558920).

The Impact of Free Sugar on Human Health-A Narrative Review

The importance of nutrition in human health has been understood for over a century. However, debate is ongoing regarding the role of added and free sugars in physiological and neurological health. In this narrative review, we have addressed several key issues around this debate and the major health conditions previously associated with sugar. We aim to determine the current evidence regarding the role of free sugars in human health, specifically obesity, diabetes, cardiovascular diseases, cognition, and mood. We also present some predominant theories on mechanisms of action. The findings suggest a negative effect of excessive added sugar consumption on human health and wellbeing. Specific class and source of carbohydrate appears to greatly influence the impact of these macronutrients on health. Further research into individual effects of carbohydrate forms in diverse populations is needed to understand the complex relationship between sugar and health.

The effect of regular consumption of four low- or no-calorie sweeteners on glycemic response in healthy women: A randomized controlled trial

OBJECTIVES

The aim of this study was to determine the effects of regular exposure to certain low- or no-calorie sweeteners (LNCS) on glucose tolerance and glucagon-like peptide 1 (GLP-1) release in healthy individuals.

METHODS

It was designed as a randomized, single-blinded, controlled study. Healthy and normoglycemic adults who did not have regular consumption of LNCS were recruited. Participants underwent a 75-g oral glucose tolerance test (OGTT) at baseline and were randomly assigned to consume 330 mL water sweetened with saccharine, sucralose, or aspartame + acesulfame-K (Asp+Ace-K), or plain water for the control group, daily for 4 wk. Fasting plasma glucose, insulin, GLP-1, and glycated hemoglobin A_1c (HbA_1c) levels and 1-h, 2-h, and 3-h plasma glucose and insulin levels during OGTT were obtained at baseline. The change in insulin sensitivity was assessed by both the Homeostatic Model Assessment Insulin Resistance (HOMA-IR) Index and the Matsuda Index. Anthropometric measurements and dietary intakes were determined at baseline. Baseline measurements were repeated at week 4.

RESULTS

Of the participants enrolled in the study, 42 (age, 21.24 ± 2.26 y; body mass index, 20.65 ± 2.88 kg/m²) completed the 4-wk intervention period. There were no differences for glucose, insulin, GLP-1, or HbA_1c levels or HOMA-IR scores at baseline or at week 4 when compared with the control group. The area under the curve of mean glucose and insulin values during OGTT were also found to be similar between groups at baseline and week 4. There were also no effects of LNCS intake on body weight, body composition, and waist circumference.

CONCLUSIONS

These results suggest that regular consumption of LNCS-sweetened water similar to doses consumed in daily life over 4 wk had no significant effect on glycemic response, insulin sensitivity, GLP-1 release, and body weight in healthy individuals. This trial was registered at www.

CLINICALTRIALS

gov as NCT04904133.

Sugar-Sweetened and Artificially Sweetened Beverages Consumption and Risk of Cardiovascular Health

INTRODUCTION

Sugar-sweetened and artificially sweetened beverages are routinely consumed worldwide. Given their popularity, there has been much debate about the effect that these beverages have on cardiovascular health. We sought to determine the exact relationship between sugar-sweetened and artificially sweetened beverages consumption on cardiovascular health.

METHODS

All studies that reported an association between sugar-sweetened/artificially sweetened beverages consumption and cardiovascular health were extracted from database inception to September 2022 using keywords from several databases. We used the DerSimonian & Laird random-effects method for the analysis.

RESULTS

Of the total 16 prospective studies, 1,405,375 individuals were followed for a median follow-up of 14.8 years. Compared with low sugar-sweetened and artificially sweetened beverage consumption, a higher consumption of sugar-sweetened and artificially sweetened beverages was associated with greater cardiovascular outcomes (hazard ratio [HR] of 1.27, 95% confidence interval [CI] of 1.16-1.40 and risk ratios of 1.16, 95% CI of 1.02-1.33). Similarly, compared with low artificially sweetened beverages consumption, a higher consumption of artificially sweetened beverages was associated with greater cardiovascular outcomes (HR of 1.32, 95% CI of 1.12-1.57). Likewise, compared with low sugar-sweetened beverages consumption, a higher consumption of sugar-sweetened beverages was associated with greater cardiovascular outcomes (HR of 1.21, 95% CI of 1.07-1.37 and risk ratios of 1.22, 95% CI of 1.09-1.35).

CONCLUSIONS

Increasing consumption of sugar-sweetened and artificially sweetened beverages may be correlated with an increased risk of developing cardiovascular/vascular complications and mortality, albeit without causality of cardiovascular/vascular morbidity.

Sugar-sweetened beverage consumption and weight gain in children and adults: a systematic review and meta-analysis of prospective cohort studies and randomized controlled trials

BACKGROUND

Sugar-sweetened beverages (SSBs) have been implicated in fueling the obesity epidemic.

OBJECTIVES

This study aimed to update a synthesis of the evidence on SSBs and weight gain in children and adults.

METHODS

MEDLINE, Embase, and Cochrane databases were searched through September 8, 2022, for prospective cohort studies and randomized controlled trials (RCTs) that evaluated intake of SSBs in relation to BMI and body weight in children and adults, respectively. Eligible interventions were compared against a noncaloric control. Study-level estimates were pooled using random-effects meta-analysis and presented as β-coefficients with 95% CIs for cohorts and weighted mean differences (MDs) with 95% CIs for RCTs.

RESULTS

We identified 85 articles including 48 in children (40 cohorts, n = 91,713; 8 RCTs, n = 2783) and 37 in adults (21 cohorts, n = 448,661; 16 RCTs, n = 1343). Among cohort studies, each serving/day increase in SSB intake was associated with a 0.07-kg/m² (95% CI: 0.04 kg/m², 0.10 kg/m²) higher BMI in children and a 0.42-kg (95% CI: 0.26 kg, 0.58 kg) higher body weight in adults. RCTs in children indicated less BMI gain with SSB reduction interventions compared with control (MD: -0.21 kg/m²; 95% CI: -0.40 kg/m², -0.01 kg/m²). In adults, randomization to addition of SSBs to the diet led to greater body weight gain (MD: 0.83 kg; 95% CI: 0.47 kg, 1.19 kg), and subtraction of SSBs led to weight loss (MD: -0.49 kg; 95% CI: -0.66 kg, -0.32 kg) compared with the control groups. A positive linear dose-response association between SSB consumption and weight gain was found in all outcomes assessed.

CONCLUSIONS

Our updated systematic review and meta-analysis expands on prior evidence to confirm that SSB consumption promotes higher BMI and body weight in both children and adults, underscoring the importance of dietary guidance and public policy strategies to limit intake. This meta-analysis was registered at the International Prospective Register of Systematic Reviews as CRD42020209915.

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

INTRODUCTION

Intake of free sugars in European countries is high and attempts to reduce sugar intake have been mostly ineffective. Non-nutritive sweeteners and sweetness enhancers (S&SEs) can maintain sweet taste in the absence of energy, but little is known about the impact of acute and repeated consumption of S&SE in foods on appetite. This study aims to evaluate the effect of acute and repeated consumption of two individual S&SEs and two S&SE blends in semisolid and solid foods on appetite and related behavioural, metabolic and health outcomes.

METHODS AND ANALYSIS

A work package of the SWEET Project; this study consists of five double-blind randomised cross-over trials which will be carried out at five sites across four European countries, aiming to have n=213. Five food matrices will be tested across three formulations (sucrose-sweetened control vs two reformulated products with S&SE blends and no added sugar). Participants (body mass index 25-35 kg/m²; aged 18-60 years) will consume each formulation for 14 days. The primary endpoint is composite appetite score (hunger, inverse of fullness, desire to eat and prospective food consumption) over a 3-hour postprandial incremental area under the curve during clinical investigation days on days 1 and 14.

ETHICS AND DISSEMINATION

The trial has been approved by national ethical committees and will be conducted in accordance with the Declaration of Helsinki. Results will be published in international peer-reviewed open-access scientific journals. Research data from the trial will be deposited in an open-access online research data archive.

TRIAL REGISTRATION NUMBER

NCT04633681.

Mapping the Homeostatic and Hedonic Brain Responses to Stevia Compared to Caloric Sweeteners and Water: A Double-Blind Randomised Controlled Crossover Trial in Healthy Adults

Non-nutritive sweeteners have potential effects on brain function. We investigated neural correlates of responses to beverages differing in sweetness and calories. Healthy participants completed 4 randomised sessions: water vs. water with stevia, glucose, or maltodextrin. Blood-oxygenation level-dependent (BOLD) contrast was monitored for 30 min post-ingestion by functional Magnetic Resonance Imaging. A food visual probe task at baseline was repeated at 30 min. A significant interaction of taste-by-calories-by-time was demonstrated mainly in motor, frontal, and insula cortices. Consumption of the stevia-sweetened beverage resulted in greater BOLD decrease, especially in the 20-30 min period, compared to other beverages. There was a significant interaction of taste-by-time in BOLD response in gustatory and reward areas; sweet beverages induced greater reduction in BOLD compared to non-sweet. The interaction calories-by-time showed significantly greater incremental area under the curve in thalamic, visual, frontal, and parietal areas for glucose and maltodextrin 10-20 min post-consumption only, compared to water. In the visual cue task, the water demonstrated an increased response in the visual cortex to food images post-consumption; however, no difference was observed for the three sweet/caloric beverages. In conclusion, both sweet taste and calories exert modulatory effects, but stevia showed a more robust and prolonged effect.