Abstract
Background: Whether habitually consuming artificially sweetened beverages (ASBs) in place of sugar-sweetened beverages (SSBs) is associated with weight changes is unclear.
Objectives: To evaluate the association of increasing ASBs or water, as SSBs replacements, with changes in weight/body mass index (BMI).
Methods: We analyzed data from the Nurses’ Health Study (NHS), NHS II, and Health Professionals Follow-up Study. Adults aged 26–65 y were followed for 24–32 y with biennial questionnaires updating medical, lifestyle, and anthropometric data. Multivariable-adjusted linear models estimated associations between changes in ASB intake, substitution of SSBs with ASBs or water, and 4-y weight and BMI changes. Latent class growth models and multinomial logistic models estimated the odds of weight-trajectory membership based on beverage intake.
Results: Among 143,409 participants (median follow-up 28 y), the mean weight gain per 4-y interval was 1.3 kg (5th–95th percentile: −6.3 to 9.1 kg). Each 3-serving/wk increase in ASB was associated with –0.18 kg weight change [95% confidence interval (CI): –0.26 kg, –0.11 kg] and –0.06 kg/m2 BMI change (95% CI: –0.09 kg/m2, –0.03 kg/m2) over 4-y intervals, with stronger inverse associations among adults with overweight/obesity and higher SSB intake. Replacing 3 SSB servings/wk with ASB was associated with lower weight (–1.39 kg, 95% CI: –1.50 kg, –1.28 kg) and BMI gains (–0.50 kg/m2 95% CI: –0.54 kg/m2, –0.45 kg/m2), with larger SSB-to-ASB replacements associated with progressively less gains. Similar estimates were observed when replacing SSB with water (–1.39 kg, 95% CI: –1.48 kg, –1.30 kg and –0.49 kg/m2, 95% CI: –0.53 kg/m2, –0.46 kg/m2). Replacing ASB with water was associated with modest reductions in weight (–0.11 kg, 95% CI: –0.19 kg, –0.03 kg) and BMI gains (–0.04 kg/m2, 95% CI: –0.08 kg/m2, –0.01 kg/m2). Higher ASB or water intake were inversely associated with unhealthy weight trajectories.
Conclusions: Increases in ASB intake were inversely associated with weight/BMI gains over time, particularly among adults with overweight/obesity and higher SSB intake. Replacing SSBs with ASBs—or ideally water—was associated with decreases in weight/BMI changes in a dose-dependent manner.
Summary:
This study by Espinosa et al., used data from three large U.S. prospective cohort studies to examine the relationship between low/no calorie sweeteners beverage (LNCSB) consumption and long-term weight change.
A total of 143,409 adults aged 26–65 yeas were followed for 24–32 years with repeated assessments of diet, lifestyle, and body weight. The results showed that increasing LNCSB consumption by three servings per week was associated with slightly less weight and less BMI gain over time, particularly among individuals with overweight or obesity, and that substituting sugar-sweetened beverages (SSBs) with LNCSB or water was associated with larger reductions in weight gain. Replacing three servings of SSBs per week with LNCSB or water was linked to about 1.39 kg less weight gain and lower BMI increase over four years, while replacing LNCSB with water produced smaller additional benefits. Overall, the findings indicate that increasing LNCSB intake is associated with less weight gain over time, especially when it replaces SSB.