1. This systematic review and meta-analysis demonstrated that low- and no-calorie sweetened beverages (LNCSBs) are associated with significant improvements in adiposity without changes in glycemia, blood lipids, and blood pressure as a substitute for sugar-sweetened beverages (SSBs).

2. LNCSBs have demonstrated reasonable evidence to recommend as a replacement strategy in the short-to-moderate term for SSBs in overweight adults.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Sugar intake is a major public health concern, with sugar-sweetened beverages (SSBs) remaining as a modifiable target. Low- and no-calorie sweetened beverages (LNCSBs) have emerged as a replacement for SSBs; however, dietary guidelines continue to recommend water rather than LNCSBs as the primary substitution for SSBs. It is unclear whether replacing SSBs for LNCSBs results in the intended benefits, such as reduced body weight and improvements in glycemic control, blood lipids, cholesterol, and blood pressure. This systematic review and meta-analysis of randomized controlled trials sought to summarize the evidence regarding the associations of LNCSBs with body weight and other cardiometabolic factors. Three prespecified substitutions were used: LNCSBs for SSBs (intended substitution of LNCSB), water for SSBs (current recommendation), and LNCSBs for water (comparison of substitution options). The primary outcome was body weight, and secondary outcomes included other adiposity measurements, glycemic control, blood lipids, and blood pressure. Seventeen studies were included in the analysis. LNCSBs as a substitute for SSBs was associated with reduced body weight (mean difference [MD]: -1.06 kg [95% CI: -1.71 to -0.41]); no significant differences were found with regards to measurements of glycemic control, blood lipids, or blood pressure. Furthermore, the substitution of water for SSBs was not associated with reduced body weight (MD: 0.01 kg [95% CI: -0.95 to 0.98]). Similarly, there were no significant differences in measurements of glycemic control, blood lipids, or blood pressure. Lastly, upon comparing LNCSBs with water, LNCSBs demonstrated a significant reduction in body weight (MD: -1.07 kg [95% CI: -1.95 to -0.19]) and systolic blood pressure. However, water was associated with significantly decreased HbA1C %. Overall, substituting LNCSBs for SSBs demonstrated significantly reduced body weight; substituting SSBs with water or LNCSBs did not demonstrate significant changes in other cardiometabolic factors besides adiposity. One limitation of the study, however, is that despite the exclusive use of randomized controlled trials, most outcomes had low-to-moderate certainty of evidence.

Click to read the study in JAMA Network Open

Relevant Reading: Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies

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