Nutritional and Health Aspects of Sweeteners - Sweeteners: Nutritional Aspects, Applications, and Production Technology - page 345

11.5.3 Interventional Studies of artiicial Sweeteners and Weight Gain in Children
Three small interventional studies that manipulated artiicial sweetener intake have been conducted
in children and did not show any metabolic effects. Shortly after the approval of aspartame by the
FDA, its effects during active weight reduction and its role in glucoregulatory hormone changes
were studied in 55 overweight children and young adults, aged 10-21, during a 13-week 1000-kcal/
day diet (Knopp et al. 1976). There were no differences in weight loss for subjects receiving 2.7 g/
day of encapsulated aspartame versus placebo.
A randomized, controlled pilot study of 103 adolescents, aged 13-18 years, examined the effect
of replacing sugar-sweetened drinks with artiicially sweetened beverages or water during a 25-week
period (Ebbeling et al. 2006). Changes in BMI for intervention versus control (no replacement of
sugar-sweetened drinks) were not signiicant for the entire group, although an exploratory post hoc
analysis showed that the intervention made the greatest difference in the heaviest subjects, whose
BMIs declined by 0.63 ± 0.23 kg/m 2 , compared with a 0.12 ± 0.26 kg/m 2 gain in the control group.
However, the authors of this study could not isolate the effect of artiicial sweeteners.
In a randomized, controlled trial by Williams et al. (2007), girls aged 11-15 years consumed
a 1500-kcal/day diet for 12 weeks. In one group, sugar-sweetened soda was permitted as a snack,
whereas in the other group, only diet sodas were permitted. There were no differences between
groups for BMI change, and it was reported that the intake of either sugar-sweetened or artiicially
sweetened soda did not affect BMI change.
Rodearmel et al. (2007) worked on a family-intervention study where the America on the Move
small-changes approach for weight gain prevention was evaluated in families with at least one child
(7-14 years old) who was overweight or at risk for overweight. These children were the primary
target of the intervention, and parents were the secondary target. Families were randomly assigned
to either the America on the Move group ( n = 100) or the self-monitor-only group ( n = 92). Families
who were assigned to the America on the Move group were asked to make two small lifestyle
changes: (1) to walk an additional 2000 steps per day above baseline as measured by pedometers
and (2) to eliminate 420 kJ/day (100 kcal/day) from their typical diet by replacing dietary sugar with
a noncaloric sweetener. Families who were assigned to the self-monitor group were asked to use
pedometers to record physical activity but were not asked to change their diet or physical activity
level. The results showed that, during a 6-month period, both groups of children showed signiicant
decreases in BMI for age. However, the America on the Move group, compared with the self-monitor
group, had a signiicantly higher percentage of target children who maintained or reduced their BMI for
age and, consistently, a signiicantly lower percentage who increased their BMI for age. There was
no signiicant weight gain during the 6-month intervention in parents of either group. Rodearmel et
al. (2007) suggested that the small-changes approach advocated by America on the Move could be
useful for addressing childhood obesity by preventing excess weight gain in families.
11.5.4 Do artiicial Sweeteners help reduce Weight?
When sugar was covertly switched to aspartame in a metabolic ward, a 25% immediate reduc-
tion in energy intake was achieved, promoting weight loss in rats (Porikos et al. 1977; Porikos and
Koopmans 1988). Conversely, knowingly ingesting aspartame was associated with a high total energy
intake, suggesting overcompensation for the expected caloric reduction (Mattes 1990). Vigilant moni-
toring, caloric restriction, and exercise were most likely involved in the weight loss seen in different
programs associating artiicial sweeteners (Rodearmel et al. 2007; Blackburn et al. 1997).
The San Antonio Heart Study examined 3682 adults over a 7- to 8-year period in the 1980s and
found a positive correlation between artiicial sweetener use and weight gain (Fowler et al. 2008).
When matched for initial BMI, gender, ethnicity, and diet, drinkers of artiicially sweetened beverages
consistently had higher BMIs at the follow-up, with dose dependence on the amount of consumption.