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To evaluate whether the replacement of dietary (added) sugar by low-energy sweeteners or complex carbohydrates contributes to weight reduction. The regulation of food intake with respect to appetite, satiety and energy intake as well as adaptation of eating habits is briefly discussed.

• Published data from Medline (National Library of Medicine, Bethesda, MD) dated from 1980 onwards on role of sugars, CCHO and sweeteners in human body weight maintenace
• Search words: Simple or complex carbohydrates, sugar or sucrose, body weight, BMI (body mass index), sweeteners, obesity, energy intake and starch articles
• Only in English limitation
• Up to 35 publications.

Fat discussion.

Review of articles on sugar intake targeting non-nutritive sweeteners and body weight.

Four key studies on sweeteners and body weight and a general overview on appetite.

Four key studies that compared subjects, period, design, experimental groups, products and body weight results.

Experimental Studies; Effects of Sugar Relative to Sweeteners in Relation to Body Weight

Reference	Kanders et al, 1988	Blackburn et al, 1997	Raben et al, 2002	Tordoff, Alleva, 1990
Subjects	59 obese subjects		41 obese subjects	30 healthy-weight subjects
Men	13		Six	21
Women	46	163 obese women	35	Nine
Period	12 weeks	19 weeks; one year weight maintenance; two-year follow-up	10 weeks	3x3 weeks
Design	Parallel	Parallel	Parallel	Cross-over
Experimental Groups	1. Energy-restricted diet: 4.2MJ for women and 5.0MJ for men plus aspartame-containing products 2. Energy-restricted diet: 4.2MJ for women and 5.0MJ for men plus no aspartame-containing products. Both combined with an exercise program	1. Energy-restricted diet: 4.2MJ plus aspartame-containing products 2. Energy-restricted diet: 4.2MJ plus no aspartame-containing products Both combined with an exercise program	1. Ad libitum diet with artificial sweetener-containing products (1.1MJ) 2. Ad libitum diet with sucrose-containing products (3.4MJ)	1. 1,150g asparatame-sweetened soda (12.6KJ) 2. 1,150g high-fructose corn syrup (2.2MJ) 3. No aspartame-sweetened soda (control)
Products	1. Milk products, drinks, sweeteners	1. Milk products, drinks, sweeteners 2. Sugar and honey	One and two drinks and solid foods (yogurt, marmalade, ice cream, stewed fruits)	1. Soda 2. Syrup
Results (Body Weight)	1. Decrease of 7.4kg (7.5%) in women and 10.4kg (9.5%) in men 2. Decrease of 5.8kg (5.8%) in women and 12.2kg (11.7%) in men No difference between the groups	1. Decrease of 9.9kg (P<0.0001) 2. Decrease of 9.8kg (P<0.0001) No differnce between the groups; better weight maintenance for the aspartame group (P<0.05), a regain of 2.6kg vs. 5.4kg	1. Decrease of 1.0kg 2. Increase of 1.6kg Significant difference between the groups (P<0.001)	1. Decrease of 0.11kg in women and 0.35kg in men 2. Increase of 0.61kg in women and 0.64kg in men 3. Decrease of 0.36kg in women and 0.12kg in men Significant difference between groups (P<0.01)

• Kanders et al: The weight loss seen in the experimental group after the active weight-loss phase, compared to the control group, might indicate that compliance with reduced energy intake was facilitated for subjects allowed to use low-energy sweetened products.
• Blackburn et al: A later study by same group, during a 19-week weight-loss program, may also indicate that compliance with a weight -maintenace program seems to be facilitated with the use of low-energy sweeteners.
• Raben et al: After 10 weeks, a decrease in body weight was found in those consuming the artificially-sweetened supplements (1kg), in contrast to the increase in those supplemented with sucrose. The main difference in body weight was found to be the difference in energy intake coming from experimental fluids. DiMeglio and Mattes have reported that energy intake is less accurate with fluids than with solid foods.
• Tordoff, Alleva: After three weeks of high-fructose corn syrup, body weight was significantly increased, compared to consumption of aspartame-sweetened soda and no soda. It may be that reducing total sugar intake by replacing consumption of larger volumes of high-fructose-containing soda by aspartame drinks may be helpful in body weight control.

Other Findings

• Appetite, satiety and energy intake: Drewnowski et al, 1994, Rolls et al, 1998, King et al, 1999, Holt et al and Lavin et al have found that sweeteners, as compared to sucrose, did not have any effect on feelings of hunger.
• Eating habits: Porikos et al investigated the change in energy intake when sucrose-containing products were replaced by comparable products sweetened with aspartame in six healthy-weight men. During the first three days, no change in food intake was observed, but after four to six days, about 40% of the missed sucrose calories in the aspartame diet was compensated.

• A limited number of relatively short-term studies suggest that replacing added sugar by low-energy sweeteners in an ad libitum diet might result in lower energy intake and reduced body weight. In the long term, this may be beneficial for weight maintenance.
• However, the number of studies is small and overall conclusions for long-term effects cannot be drawn. Conflicting results from short-term studies may be due to differences in designs, study populations and other parameters. Different carbohydrates and sweeteners may have other effects on appetite, satiety and food intake.

Other:

‘Suikerstichting Nederland’ (the Netherlands)

Nice review of four studies on sweeteners and body weight. Selected criteria was 35 articles, but it is not known how they were selected.