Nutritional and Health Aspects of Sweeteners - Sweeteners: Nutritional Aspects, Applications, and Production Technology - page 347

lipid-modifying medications added during the study ( P < 0.001). Signiicant improvements in body
weight and high-density lipoprotein cholesterol in this pilot study suggest that d-tag may be a poten-
tially useful adjunct in the management of patients with type 2 DM (Donner et al. 2010).
Strategies to reverse the upward trend in obesity rates need to focus on both reducing energy
intake and increasing energy expenditure. The provision of low- or reduced-energy-dense foods is
one way of helping people to reduce their energy intake and therefore enable weight maintenance or
weight loss to occur. The use of intense sweeteners as a substitute for sucrose potentially offers one
way of helping people to reduce the energy density of their diet without any loss of palatability. de la
Hunty et al. (2006) reviewed the evidence for the effect of aspartame on weight loss, weight mainte-
nance, and energy intake in adults and addresses the question of how much energy is compensated
for and whether the use of aspartame-sweetened foods and drinks is an effective way of losing
weight. They identiied all studies that examined the effect of substituting sugar with either aspar-
tame alone or aspartame in combination with other intense sweeteners on energy intake or body
weight. Studies that were not randomized controlled trials in healthy adults, and studies that did not
measure energy intake for at least 24 h (for those with energy intake as an outcome measure) were
excluded from the analysis. A minimum of 24-h energy intake data was set as the cutoff to ensure
that the full extent of any compensatory effects was seen. A total of 16 studies were included in the
analysis. Of these 16 studies, 15 had energy intake as an outcome measure. The studies that used
soft drinks as the vehicle for aspartame used between 500 and about 2000 mL, which is equivalent
to about two to six cans or bottles of soft drinks every day. A signiicant reduction in energy intake
was seen with aspartame compared with all types of control, except when aspartame was compared
with nonsucrose controls such as water. In addition, de la Hunty et al. (2006) reported that using
foods and drinks sweetened with aspartame instead of those sweetened with sucrose is an effective
way of maintaining and losing weight without reducing the palatability of the diet. The decrease
in energy intake and the rate of weight loss that can reasonably be achieved is low but meaningful
and, on a population basis, more than suficient to counteract the current average rate of weight
gain of around 0.007 kg/week. On an individual basis, it provides a useful adjunct to other weight
loss regimes. Some compensation for the substituted energy does occur, but this is only about one-
third of the energy replaced and is probably less when using soft drinks sweetened with aspartame.
Nevertheless, these compensation values are derived from short-term studies. More data is needed
over the longer term to determine whether a tolerance to the effects is acquired. To achieve the aver-
age rate of weight loss seen in these studies of 0.2 kg/week will require around a 220-kcal (0.93-MJ)
deicit per day based on an energy value for obese tissue of 7500 kcal/kg. Assuming the higher rate
of compensation (32%), this would require the substitution of around 330 kcal/day (1.4 MJ/day) from
sucrose with aspartame (which is equivalent to around 88 g of sucrose). Using the lower estimated
rate of compensation for soft drinks alone (15.5%) would require the substitution of about 260 kcal/
day (1.1 MJ/day) from sucrose with aspartame. This is equivalent to 70 g of sucrose or about two
cans of soft drinks every day.
11.5.5 artiicial Sweeteners and energy
Aspartame increased subjective hunger ratings compared to glucose or water (Blundell and
Hill 1986). Glucose preload reduced the perceived pleasantness of sucrose, but aspartame did not,
according to the same authors. In another study, aspartame, acesulfame potassium (Ace K), and
saccharin were all associated with a heightened motivation to eat and more items selected on a food
preference list (Rogers et al. 1988). Aspartame had the most pronounced effect, possibly due to its
nonbitter aftertaste. Artiicial sweetener preloads either had no effect (Black et al. 1993; Rogers et
al. 1988) or increased subsequent energy intake (Lavin et al. 1997; King et al. 1999) unlike glucose
or sucrose, which decreased the energy intake at the test meal. Moreover, Rolls (1991) reported on
the sweet taste of aspartame, saccharin, and Ace K, and they found it to increase ratings of hunger