Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Cardiometabolic risk factors are unchanged in a 12-month randomized controlled trial examining sugar-sweetened, artificially sweetened, and unsweetened beverages.

2. Sweet preference is decreased most after switching from sugar-sweetened to unsweetened beverages.

Evidence Rating Level: 1 (Excellent)

Consuming sugar-sweetened beverages (SSBs) has long been associated with negative health outcomes, such as obesity, Type II diabetes mellitus, and cardiovascular disease. However, there have been mixed results in associating artificially sweetened beverages (ASBs) to these outcomes. A particular concern is that consuming ASBs may contribute to a stronger preference for consuming sugary foods. Reducing refined sugar consumption is correlated with lower ratios of serum triglyceride to high-density lipoprotein cholesterol (TG:HDL-C). Low TG:HDL-C also predicts cardiometabolic outcomes such as insulin resistance, coronary atherosclerosis, and myocardial infarction. In this randomized controlled trial aimed, researchers sought to determine the effect of SSB, ASB, and USB consumption on TG:HDL-C, body weight, and sweet preference. Two hundred and three individuals who regularly consumed at least one sugary beverage daily were assigned to either have free SSBs, ASBs, or USBs delivered to their homes for 12 months, and asked to consume these beverages at the same frequency as they previously did with sugary beverages. The change in TG:HDL-C was the same among all 3 groups: The adjusted mean change±SE was 3.2±5.7 for SSBs, -2.4±5.4 for ASBs, and -3.2±5.1 for USBs (p = 0.65). Body weight (p = 0.66) and fat mass (p = 0.27) were also the same. However, participants in the highest tertile of trunk fat had a significant body weight increase (p = 0.002) in the SSB group (4.4±1.0 kg) compared to ASB (0.5±0.9 kg) and USB (-0.2±0.9 kg). Finally, sweetness threshold (the concentration rated as being of medium sweetness) was decreased in USBs but unchanged in ASBs (p = 0.0001 and p = 0.02 respectively). Participants’ favourite sugar concentrations were decreased in both USBs and ASBs (-2.3±0.4% m/v, p < 0.0001 and -1.1±0.5% m/v, p = 0.02 respectively). At least on a relatively short term basis of one year, study findings did not provide evidence of SSB substitutes conferring significant health benefits in terms of TG:HDL-C ratio, although both ASBs and USBs were found to lower body weight in individuals with central adiposity. USBs do appear to be the most beneficial substitute of the two however, as they were found to have the most favourable effect on altering sweet taste preference overtime.

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