Artificially sweet success at curbing childhood weight gain

Substituting sugar-sweetened drinks with artificially sweetened alternatives could help reduce weight gain in schoolchildren, research suggests.

The authors of a large, double-blind study, published online in The New England Journal of Medicine, found that children given sugar-free drinks gained less weight and body fat than those who drank regular sugar-containing drinks.

The study included 641 Dutch schoolchildren aged between 4 years 10 months and 11 years 11 months who already regularly drank soft drinks. They received one can per day of a drink that was sweetened either with sucrose 26 g, or with sucralose 34 mg and acesulfame potassium 12 mg. The study lasted 18 months and, on average, the children were followed up for 541 days.

The mean increase in body mass index (BMI) z score was significantly greater in the sugar drink group at 0.15 standard deviation (SD) units compared with 0.02 SD units in the sugar-free drink group.

Children given sugar-free drinks also gained more body fat. For example, at 18 months, they had gained 5.5 mm in the sum thickness of four skinfolds, compared with 3.2 mm in the sugar-free group. They also had significantly smaller decreases in waist-to-height ratio and greater measures of fat mass by electrical impedance.

The mean weight increased by 6.35 kg in the sugar-free drink group compared with 7.37 kg in the sugar drink group. Of this significant difference, the authors approximate that 0.5 kg is due to fat mass, 0.3 kg due to changes in lean mass, and 0.2 kg due to height growth.

Janne de Ruyter (VU University, Amsterdam, the Netherlands) and colleagues say this is one of the most robust studies of artificially sweetened drinks to date, which previously have been hampered by small study sizes and confounding factors. "The double-blind design eliminated the effects of psychological cues and socially desirable behavior and allowed testing of biologic mechanisms alone," they explain.

The authors also employed several adherence measures, including urine testing for sucralose.

They say their findings help dispel the idea that artificial sweeteners lead to weight gain. "A plausible explanation for the observed reduction in body fat is that the removal of liquid sugar was not sensed by satiating mechanisms and was incompletely compensated for by the increased consumption of other foods."

However, they add that the results would probably be replicable with water or other noncaloric drinks.

Writing in an accompanying editorial, Sonia Caprio (Yale University, New Haven, Connecticut, USA) goes further to say that the findings should encourage public health efforts targeting sweetened drink consumption. "The time has come to take action and strongly support and implement the recommendations from the Institute of Medicine, the American Heart Association, the Obesity Society, and many other organizations to reduce consumption of sugar-sweetened beverages in both children and adults."

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