Abstract
Stevia is an intense, calorie-free sweetener that is frequently used to reduce energy intake; however, studies examining its effects on appetite and energy intake have produced mixed results, indicating that a definitive consensus has not yet been reached. This systematic review and meta-analysis aimed to determine the impact of stevia on appetite and energy intake in adults. The PROSPERO registration number for this research is CRD42023414411. The databases PubMed (MEDLINE), Scopus, Web of Science, and Google Scholar were systematically searched. In addition, the reference lists of extracted articles and pertinent reviews were examined. Two evaluators performed screening, quality assessment, and data extraction independently. Furthermore, the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was employed to systematically assess the certainty level of the evidence presented in our study. Eleven clinical trials with a total of 428 participants were included. We found no significant changes in any appetite scores following stevia consumption (very low to moderate certainty of the evidence). Moreover, subgroup analyses demonstrated the scores of desires to eat increased significantly in the oral intake of stevia and not enteral intake subgroup (WMD: 0.45; 95% CI: 0.009, 0.89; P = 0.046). In addition, the number of studies reporting energy intake was limited, preventing a meta-analysis of this variable. In conclusion, stevia consumption has no significant effect on appetite scores in adults but it seems that more long-term clinical trials are needed to obtain more accurate results.
Summary
The aim of this comprehensive systematic review was to determine the impact of steviol glycosides on appetite and energy intake in adults. Following a systematic search of the literature following PRISMA guidelines, 11 randomized controlled trials (RCTs) involving 428 participants were included as the evidence base. A meta-analysis was performed on 10 out of the 11 papers as, due to the lack of the appropriate number of effect sizes, one study on energy intake could not be included in the meta-analysis.
The results found no significant effects of stevia on appetite scores, including hunger, fullness, desire to eat, and prospective consumption, with the certainty of evidence rated as very low to moderate. Subgroup analysis based on feeding type, study design, blindness type, sex, country, BMI status, health condition, intervention type, control type, duration of study, time of measurement, and study quality revealed a significant increase in desire to eat in adults following oral stevia intake but not after enteral administration.