Abstract
Background: Excess intake of added sugars contributes to obesity, type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and premature mortality. Sugar-sweetened beverages (SSBs), the main source of added sugars, are consistently linked to adverse outcomes. Artificially sweetened beverages (ASBs) have been suggested as short-term substitutes, but evidence regarding benefits and harms remains inconclusive, and guidance is lacking.
Methods: This consensus statement draws on a structured evidence review combining two approaches: an updated meta-analysis of randomized controlled trials (RCTs) assessing short- to intermediate-term effects of replacing SSBs with ASBs on weight and metabolic outcomes; and an umbrella review of systematic reviews of cohort studies evaluating long-term associations of SSBs and ASBs with major outcomes, including mortality, CVD, and T2DM.
Results: In 14 RCTs (3–76 weeks), replacing SSBs with ASBs produced modest reductions in body weight (−0.73 kg) and body fat (−0.72%), with inconsistent effects on glycemic and cardiometabolic markers. Evidence from 20 systematic reviews of cohorts (up to 34 years follow-up) showed that higher intake of both SSBs and ASBs was associated with increased risks of T2DM, CVD, and mortality, with relative risks for ASBs similar to those for SSBs.
Conclusion: ASBs may serve as a short-term substitution for individuals with high SSB intake, particularly those at elevated metabolic risk. However, regular or long-term use is not recommended due to uncertain safety and potential reinforcement of sweet preference. Public health strategies should emphasize reducing both SSBs and ASBs, prioritizing water and unsweetened beverages as the ultimate goal.
Summary
The Korean Diabetes Association and the Korean Nutrition Society recommend the consumption of beverages with low/no calorie sweeteners as a temporary replacement for sugar-sweetened beverages (SSBs), particularly for individuals with high sugar intake or elevated metabolic risk. However, water should remain the preferred long-term public health goal.
This consensus statement integrates findings from an updated meta-analysis of randomized controlled trials (RCTs) and an umbrella review of systematic reviews of prospective cohort studies. The meta-analysis of RCTs assessing short- to intermediate-term substitution of SSBs with low/no calorie sweetened beverages shows modest reductions in body weight and body fat, suggesting that beverages with low/no calorie sweeteners may support short-term weight management when replacing SSBs.
In contrast, observational evidence indicates that long-term consumption of low/no calorie sweetened beverages is modestly associated with increased risk of type 2 diabetes, cardiovascular disease, and all-cause mortality. However, these findings cannot establish causality due to the potential influence of confounding and reverse causation.