Nutritional and Health Aspects of Sweeteners - Sweeteners: Nutritional Aspects, Applications, and Production Technology - page 346

The American Cancer Society Study conducted in the early 1980s included 78,694 women who
were highly homogeneous with regard to age, ethnicity, socioeconomic status, and lack of preexist-
ing conditions (Stellman and Garinkel 1986, 1988). At 1-year follow-up, 2.7%-7.1% more regular
artiicial sweetener users gained weight compared to nonusers matched by initial weight. The differ-
ence in the amount gained between the two groups was less than 2 lb., albeit statistically signiicant.
Saccharin use was also associated with 8-year weight gain in 31,940 women from the Nurses'
Health Study conducted in the 1970s, as described by Colditz et al. (1990).
Phelan et al. (2009) compared the dietary strategies and the use of fat- and sugar-modiied foods
and beverages in a weight loss maintainer group (WLM) and an always-normal weight group (NW).
WLM reported consuming a diet that was lower in fat (28.7% versus 32.6%; P < 0.0001) and used
more fat modiication strategies than NW. WLM also consumed a signiicantly greater percentage
of modiied dairy (60% versus 49%; P = 0.002) and modiied dressings and sauces (55% vs. 44%;
P = 0.006) than NW. WLM reported consuming three times more daily servings of artiicially
sweetened soft drinks (0.91% versus 0.37%; P = 0.003), signiicantly fewer daily servings of sugar-
sweetened soft drinks (0.07% versus 0.16%; P = 0.03), and more daily servings of water (4.72%
versus 3.48%; P = 0.002) than NW. These indings suggest that WLM used more dietary strategies
to accomplish their weight loss maintenance, including greater restriction on fat intake, use of fat-
and sugar-modiied foods, reduced consumption of SSBs, and increased consumption of artiicially
sweetened beverages. Ways of promoting the use of fat-modiied foods and artiicial sweeteners
merits further research in both prevention- and treatment-controlled trials.
Vermunt et al. (2003) have evaluated whether the replacement of dietary (added) sugar by low-
energy sweeteners or complex carbohydrates contributes to weight reduction. In two experimental
studies, no short-term differences in weight loss were observed after the use of aspartame compared
to sugar in obese subjects following a controlled energy-restricted diet. However, the consumption
of aspartame was associated with improved weight maintenance after a year. In two short-term
studies in which energy intake was not restricted, the substitution of sucrose by artiicial sweeteners,
investigated mostly in beverages, resulted in lower energy intake and lower body weight. Similarly,
two short-term studies comparing the effect of sucrose and starch on weight loss in obese subjects
did not ind differences when the total energy intake was equal and reduced. An ad libitum diet with
complex carbohydrates resulted in lower energy intake compared to high-sugar diets. In two out of
three studies, this was relected in lower body weight in subjects consuming the complex carbohy-
drate diet. In conclusion, a limited number of relatively short-term studies suggest that replacing
(added) sugar by low-energy sweeteners or by complex carbohydrates in an ad libitum diet might
result in lower energy intake and reduced body weight. In the long term, this might be beneicial for
weight maintenance. However, the number of studies is small, and overall conclusions, in particular
for the long term, cannot be drawn (Vermunt et al. 2003).
Donner et al. (2010) explored the metabolic effects of oral d-tagatose (d-tag) given daily to
eight human subjects with type 2 diabetes mellitus (DM) for 1 year. Oral d-tag attenuates the rise
in plasma glucose during an oral glucose tolerance test in subjects with type 2 DM and reduces
food intake in healthy human subjects. In addition, a reduction in food consumption and less weight
gain has been observed in rats fed on tagatose. Donner et al. (2010) hypothesized that the treatment
period would lead to weight loss and improvements in glycated hemoglobin and the lipid proile. A
2-month run-in period was followed by a 12-month treatment period when 15 g of oral d-tag was
taken three times daily with food. No serious adverse effects were seen during the 12-month treat-
ment period. Ten of the initially 12 recruited subjects experienced gastrointestinal side effects that
tended to be mild and transient. When three subjects who had oral diabetes, medications added,
and/or dosages increased during the study were excluded, the mean (SD) body weight declined from
108.4 (9.0) to 103.3 (7.3) kg ( P = 0.001). Glycated hemoglobin fell nonsigniicantly from 10.6% ±
1.9% to 9.6% ± 2.3% ( P = 0.08). High-density lipoprotein cholesterol progressively rose from a
baseline level of 30.5 ± 15.8 to 41.7 ± 12.1 mg/dL at month 12 in the six subjects who did not have