Substitution of sugar‐sweetened beverages with non‐caloric alternatives and weight change: A systematic review of randomized trials and meta‐analysis

Summary Background Intake of sugar‐sweetened beverages has been associated with weight gain. It is uncertain if replacing an existing use of sugar‐sweetened beverages with non‐caloric beverages results in long‐term reduction in body weight. Objective The objective of this study is to explore if a long‐term reduction in body weight can be achieved by replacing an existing intake of sugar‐sweetened beverages with non‐caloric beverages. Methods Systematic review and meta‐analysis of randomized clinical trials in accordance with PRISMA guidelines. PubMed and EMBASE were searched for literature. Studies with a “substitution” design were included, that is, studies where subjects substituted an existing intake of sugar‐sweetened beverages with either artificially sweetened beverages or unsweetened beverages/water. Studies with 6 months or longer follow‐up of weight change were included. Results Six trials with a total of 1729 participants were included in the meta‐analysis. Replacing an existing intake of sugar‐sweetened beverages with a non‐caloric beverage resulted in a long‐term BMI reduction of 0.31 kg/m 2 compared with the sugar‐sweetened beverage‐group (95% CI; 0.17–0.44). One study with 1 year's intervention and 2 years follow‐up showed a regression towards baseline BMI after the intervention had ended. Conclusion Replacing an existing use of sugar‐sweetened beverages with artificially sweetened beverages or unsweetened beverages resulted in a long‐term 0.31 kg/m 2 reduction in BMI equivalent to 0.5–1 kg in children and adults, respectively, as long as the interventions lasted.