Low- and No-Calorie Sweeteners as a Sugar-Reduction Tool: Insights from Robust Evidence Synthesis

Conflicting guidelines on low- and no-calorie sweeteners (LNCS) stem largely from how evidence is analyzed. This umbrella review evaluated whether analytical approach influences conclusions on LNCS and cardiometabolic health. Across randomized trials, LNCS consistently reduced energy intake, body weight, and body fat. Bias-adjusted analyses also showed reductions in BMI and systolic blood pressure, with modest effects on HbA1c compared with water. In observational cohorts, naïve analyses linked LNCS to higher cardiometabolic risk, whereas bias-adjusted analyses showed the opposite pattern, associating LNCS with lower body weight, waist circumference, obesity, coronary heart disease, and cardiovascular and all-cause mortality. Evidence certainty was moderate for trials and low for cohorts. Overall, analyses that appropriately account for substitution and reverse causality support LNCS as a beneficial sugar-reduction strategy with favorable cardiometabolic outcomes.

Source : https://pubmed.ncbi.nlm.nih.gov/41428417/