Abstract
Background: Sweeteners and sweetness enhancers (S&SE) are used to replace energy yielding sugars and maintain sweet taste in a wide range of products, but controversy exists about their effects on appetite and endocrine responses in reduced or no added sugar solid foods. The aim of the current study was to evaluate the acute (1 day) and repeated (two-week daily) ingestive effects of 2 S&SE vs. sucrose formulations of biscuit with fruit filling on appetite and endocrine responses in adults with overweight and obesity.
Methods: In a randomised crossover trial, 53 healthy adults (33 female, 20 male) with overweight/obesity in England and France consumed biscuits with fruit filling containing 1) sucrose, or reformulated with either 2) Stevia Rebaudioside M (StRebM) or 3) Neotame daily during three, two-week intervention periods with a two-week washout. The primary outcome was composite appetite score defined as [desire to eat + hunger + (100 – fullness) + prospective consumption]/4.
Findings: Each formulation elicited a similar reduction in appetite sensations (3-h postprandial net iAUC). Postprandial insulin (2-h iAUC) was lower after Neotame (95% CI (0.093, 0.166); p < 0.001; d = -0.71) and StRebM (95% CI (0.133, 0.205); p < 0.001; d = -1.01) compared to sucrose, and glucose was lower after StRebM (95% CI (0.023, 0.171); p < 0.05; d = -0.39) but not after Neotame (95% CI (-0.007, 0.145); p = 0.074; d = -0.25) compared to sucrose. There were no differences between S&SE or sucrose formulations on ghrelin, glucagon-like peptide 1 or pancreatic polypeptide iAUCs. No clinically meaningful differences between acute vs. two-weeks of daily consumption were found.
Interpretation: In conclusion, biscuits reformulated to replace sugar using StRebM or Neotame showed no differences in appetite or endocrine responses, acutely or after a two-week exposure, but can reduce postprandial insulin and glucose response in adults with overweight or obesity.
Summary
This randomised crossover controlled trial sought to evaluate the acute (1 day) and repeated (two week daily) ingestive effects derived from the consumption of two biscuit formulations containing a fruit filling sweetened with either neotame or stevia rebaudioside M, in comparison to a sucrose sweetened control, on appetite and endocrine responses in 53 adults with overweight and obesity.
The primary outcome was the difference in incremental area under the curve (iAUC) for the 180-min composite appetite score based on hunger, fullness, desire to eat and prospective food consumption from acute compared to repeated exposure (2-weeks). Secondary outcomes included other subjective sensations (appetite for savoury and sweet, thirst, nausea and bloating), food preferences (liking and wanting for fatty or sweet foods) and glyceamic and endocrine responses (glucose, insulin, ghrelin, GLP-1 and pancreatic polypeptide) from acute compared to repeated exposure.
Results showed no overall effect of LNCS formulations, with similar iAUC composite appetite scores between sucrose, stevia rebaudioside M and Neotame. Insulin responses were lower after the stevia rebaudioside M and Neotame formulations compared to sucrose and glucose responses were lower after stevia rebaudioside M compared to sucrose, but not after Neotame compared to sucrose. There were no differences between LNCS or sucrose formulations on ghrelin, GLP-1 or pancreatic polypeptide iAUCs. Secondary findings on food preferences revealed no differences in pre-to post-intake changes in explicit liking or implicit wanting for high fat vs. low fat, or sweet relative to savoury foods, and no differences after acute vs. repeated exposure.
Overall, the results suggest there are no acute or repeated differences between Neotame, stevia rebaudioside M or sucrose on appetite or satiety-related endocrine responses when consumed in a solid food matrix.