TOPLINE:
Substituting added sugars with sweeteners and sweetness enhancers (S&SEs) as part of a healthy diet for 1 year modestly supports weight loss maintenance and promotes favorable gut microbiota composition changes in adults with overweight or obesity, without adversely affecting cardiometabolic markers.
METHODOLOGY:
- Researchers conducted a randomized trial to evaluate the long-term effects of S&SE use on weight-loss maintenance, cardiometabolic risk factors, and gut microbiota composition in 325 adults (median age, 47 years; 71% women) and 36 children (median age, 10 years; 61% girls) with overweight or obesity.
- The trial included a 2-month initial phase during which children had to achieve weight stability and adults had to lose ≥ 5% of their initial weight and maintain it, followed by a 10‑month healthy ad libitum intervention for weight loss maintenance.
- Participants were randomly assigned to one of two diets providing < 10% of energy from sugars: a diet replacing sugar‑rich products with S&SEs (S&SE group) or the same diet without S&SEs (sugar group).
- Gut microbiota composition was analyzed in a subgroup of 137 adults who completed the study.
- Primary outcomes were 1‑year changes in body weight and gut microbiota composition in adults. Secondary outcomes included 1-year changes in type 2 diabetes and cardiovascular disease risk factors, BMI‑for‑age z scores in children, and adverse events occurrence.
TAKEAWAY:
- At 1 year, the S&SE group maintained greater weight loss than the sugar group (mean difference, 1.6 kg; P = .03).
- The S&SE group also demonstrated distinct shifts in gut microbiota, with increased abundance of short-chain fatty acid-producing and methane-producing bacteria.
- Compared with the sugar group, the S&SE group had greater reductions in BMI and several cholesterol measures at 6 months and in hip circumference at 1 year; in children, BMI-for-age z scores did not significantly differ between groups at 1 year.
- The S&SE group reported more adverse events, mainly gastrointestinal symptoms such as abdominal pain, loose stools, and excess intestinal gas.
IN PRACTICE:
“S&SEs improve weight control and gut microbiota composition while having neutral effects on metabolic health,” the lead author commented in an accompanying research highlight.
SOURCE:
The study was led by Michelle D. Pang, BSc, Institute for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Netherlands. It was published online in Nature Metabolism.
LIMITATIONS:
The trial had a higher-than-expected dropout rate (40% vs 30%), reducing statistical power. Energy intake may have been underestimated, with baseline consumption about 25% below the estimated energy requirements. Results for children should be interpreted cautiously due to limited sample size and suboptimal compliance. The absence of direct short-chain fatty acid measurements and detailed metagenomic-enabled functional analyses limited interpretation of the metabolic implications of microbiota changes.
DISCLOSURES:
The study was funded by the Horizon 2020 programme. One author disclosed receiving honoraria from Nestlé, Unilever, and the International Sweeteners Association, and employment by Novo Nordisk. Other authors disclosed receiving project funding, travel supporting, consultancy fees, and other ties with various organizations.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.