Abstract
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, I2 = 50.83%/Hedges’ g water = 0.00, 95% CI: −0.15 to 0.16, I2 = 0%].
Summary
The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) was to investigate the effect of low-and no-calorie sweeteners (LNCS) on long-term total energy and macronutrient intake.
A systematic literature search was conducted in accordance with PRISMA guidelines, and a total of 21 RCTs in adults were included in the review. All studies had a duration of at least four weeks and were published up to September 2024.The meta-analysis was conducted separately based on the type of control group, which was either sugar or water.
Thirteen publications assessed the effect of LNCS consumption on total energy intake compared to sugar, while eight studies used water as comparator. For carbohydrate intake, 11 studies evaluated the effects of LNCS in comparison with sugar, and seven with water. Finally, regarding sugar intake, eight studies examined the effects of LNCS compared to sugar, and 3 studies compared to water.
The results showed that, when compared to sugar, LNCS consumption significantly reduced total energy intake, as well as carbohydrate and sugar intake. In subgroup analyses for LNCS vs. sugar, the result indicated that among different types of LNCS as intervention, only combined LNCS significantly decreased total energy intake. Consumption of LNCS compared to either sugar or water did not have a significant effect on fat, protein and fiber intake.