Low- and no-calorie sweetened beverages as good as water in maintaining body weight: JAMA

Canada: In a new study it was found that using low- and no-calorie sweetened drinks (LNCSBs) as an intended alternative for sugar-sweetened beverages (SSBs) resulted in minor reductions in cardiometabolic risk variables and body weight with no indication of harm and had a similar direction of effect as water substitution. The findings of this study were published in the Journal of American Medical Association.

There are concerns that LNCSBs lack documented advantages, with major dietary guidelines advocating water rather than LNCSBs as a replacement for SSBs. It is unknown if LNCSB, as a substitute for SSBs, may produce comparable benefits in cardiometabolic risk factors compared to water. As a result, Néma D. McGlynn and colleagues did this research. To investigate the relationship between LNCSBs and body weight and cardiometabolic risk factors in persons with and without diabetes.

Embase, Medline, and the Cochrane Central Register of Controlled Trials were searched for this study from commencement to December 26, 2021. RCTs with at least 2 weeks of intervention comparing LNCSBs, SSBs, and/or water were considered. Two independent reviewers extracted the data and assessed the possibility of bias. A network meta-analysis was carried out using data represented as mean difference (MD) or standardized mean difference (SMD) with 95 percent confidence intervals (CIs). The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to evaluate the evidence's certainty. Bodyweight was the major result. Other indicators of glycemic control, obesity, blood lipids, nonalcoholic fatty liver disease, blood pressure, and uric acid were secondary results.

The key findings of this study were as follow:

1. A total of 17 randomized controlled trials (RCTs) with 24 trial comparisons were included, involving 1733 individuals who were overweight or obese and were at risk of or had diabetes.

2. Overall, LNCSBs were used as a substitute for SSBs in 12 RCTs, water was used as a substitute for SSBs in 3 RCTs (n = 429), and LNCSBs were used as a substitute for water in 9 RCTs (n = 974).

3. The substitution of LNCSBs for SSBs was related to lower body weight, BMI, percentage of body fat, and intrahepatic lipid. Substituting water for SSBs had no effect on the outcome.

4. Except for glycated hemoglobin A1c and systolic blood pressure, there was no correlation between substituting LNCSBs for water.

5. The evidence's certainty was moderate to low for body weight and moderate to low for all other outcomes across all replacements.

In conclusion, The data points to the advantages of LNCSBs as an alternate replacement approach for SSBs in people with overweight or obesity who are at risk of or have diabetes over the long run.

Reference:

McGlynn, N. D., Khan, T. A., Wang, L., Zhang, R., Chiavaroli, L., Au-Yeung, F., Lee, J. J., Noronha, J. C., Comelli, E. M., Blanco Mejia, S., Ahmed, A., Malik, V. S., Hill, J. O., Leiter, L. A., Agarwal, A., Jeppesen, P. B., (2022). Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk. In JAMA Network Open, https://doi.org/10.1001/jamanetworkopen.2022.2092

Keywords: low calorie, cardiovascular, metabolic risk, beverages, sugar, sweetened drinks, water, obesity, body mass index, body fat, JAMA, weight loss