Abstract
Background:Low-calorie sweeteners (LCSs) are said to be a risk factor for obesity and diabetes. Reverse causality may be an alternative explanation.Methods:Data on LCS use, from a single 24-h dietary recall, for a representative sample of 22 231 adults were obtained from 5 cycles of the National Health and Nutrition Examination Survey (1999–2008 NHANES). Retrospective data on intent to lose or maintain weight during the prior 12-months and 10-year weight history were obtained from the weight history questionnaire. Objectively measured heights and weights were obtained from the examination. Primary analyses evaluated the association between intent to lose/maintain weight and use of LCSs and specific LCS product types using survey-weighted generalized linear models. We further evaluated whether body mass index (BMI) may mediate the association between weight loss intent and use of LCSs. The association between 10-year weight history and current LCS use was evaluated using restricted cubic splines.Results:In cross-sectional analyses, LCS use was associated with a higher prevalence of obesity and diabetes. Adults who tried to lose weight during the previous 12 months were more likely to consume LCS beverages (prevalence ratio=1.64, 95% confidence interval (CI) 1.54–1.75), tabletop LCS (prevalence ratio=1.68, 95% CI 1.47–1.91) and LCS foods (prevalence ratio=1.93, 95% CI 1.60–2.33) as compared with those who did not. In mediation analyses, BMI only partially mediated the association between weight control history and the use of LCS beverages, tabletop LCS, but not LCS foods. Current LCS use was further associated with a history of prior weight change (for example, weight loss and gain).Conclusions:LCS use was associated with self-reported intent to lose weight during the previous 12 months. This association was only partially mediated by differences in BMI. Any inference of causality between attempts at weight control and LCS use is tempered by the cross-sectional nature of these data and retrospective self-reports of prior weight loss/maintenance intent.
Highlights
People use low-calorie sweeteners (LCSs) to reduce dietary calories and manage body weight, with numerous randomized studies suggesting that their use can result in weight loss.[1,2,3,4,5,6] A position statement from the American Diabetes Association has included low-calorie sweetener. aModel 1 (LCS) use under nutrition recommendations and interventions for the management of diabetes.[4]
Overall, LCSs of any type were consumed by 30.1% of adults, with
Others suggest reverse causality, such that overweight and obese people turn to LCSs to manage body weight.[31]
Summary
People use low-calorie sweeteners (LCSs) to reduce dietary calories and manage body weight, with numerous randomized studies suggesting that their use can result in weight loss.[1,2,3,4,5,6] A position statement from the American Diabetes Association has included LCS use under nutrition recommendations and interventions for the management of diabetes.[4] Systematic reviews of animal and human trials suggest that LCSs do not increase body weight or energy intake, and that in place of sugar, use of LCS leads to reduced energy intake and body weight.[7,8] Paradoxically some observational studies have reported that regular LCS use may lead to obesity, diabetes and the metabolic syndrome,[9,10,11,12] the data were not always consistent.[13,14,15] Missing from most studies evaluating the relation between LCS and deleterious outcomes was any information on past weight history or disease status, or the motivation to lose weight. Any inference of causality between attempts at weight control and LCS use is tempered by the cross-sectional nature of these data and retrospective self-reports of prior weight loss/maintenance intent
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