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

Obes Rev. 2024 Feb;25(2):e13652. doi: 10.1111/obr.13652. Epub 2023 Oct 25.

Abstract

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.

Keywords: BMI; sugar-sweetened beverages; systematic review; weight change.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Adult
  • Beverages
  • Body Weight
  • Child
  • Humans
  • Randomized Controlled Trials as Topic
  • Sugar-Sweetened Beverages*
  • Sweetening Agents

Substances

  • Sweetening Agents