Scoping review and evidence map on the relationship between exposure to dietary sweetness and body weight-related outcomes in adults

Authors: Higgins, Kelly; RAWAL, RITA - University Of Maryland; Baer, David; O'Connor, Lauren; APPLETON, KATHERINE - Bournemouth University

Submitted to: Advances in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/19/2022
Publication Date: N/A
Citation: N/A

Interpretive Summary: Dietary recommendations from numerous governmental and public health organizations recommend reduced intake of added sugars due to the health risks associated with energy intake from sugars, including the increased risk of overweight and obesity. This recommendation is based on the hypothesis that reduced exposure to dietary sweetness will reduce the preference and desire for sweet foods/beverages, similar to the changes in preference observed with reductions in dietary salt and fat. A scoping review was completed to identify and map studies that investigate the association between total dietary sweetness and body weight outcomes among healthy adults. As a secondary aim, this review aimed to identify and map the availability of studies that investigate sweet food/beverage, sugar, or sweetener intakes and body weight outcomes. A total of 36,779 publications (duplicates removed) were recovered in the literature searches. Of these, 33,569 publications were excluded during the title and abstract screening. An additional 2,377 publications were excluded during the full text review. Therefore, 833 publications summarizing results from 804 studies were determined to meet the inclusion criteria. While 225 clinical trials and 383 observational studies have investigated intake of various dietary sources of sweetness on body weight-related outcomes, few aimed to evaluate the sweetness of the entire diet. Only 7 studies were identified that evaluated the sweetness of the entire diet. These studies were predominantly cross-sectional or short in duration (=24 hr) except for one clinical trial that studied sweetness exposures for 24 wk. Some studies (n=46) were identified in this evidence map that measured the sweetness of individual foods/beverages consumed, a secondary level of evidence. Yet these studies were also largely acute in duration (=24 hr) and measured energy intake only. Thus, the bulk of the available evidence on sweetness exposures focuses on the intake of individual sweet foods/beverages assumed to be sweet or the level of sugars or sweeteners, not total dietary sweetness. While there is a breadth of evidence from studies that investigate sweet food/beverage, sugar, and sweetener intake and body weight, there is limited evidence on the association between total dietary sweetness and body weight.

Technical Abstract: Numerous governmental and health organizations recommend reduced intake of added sugars due to the health risks associated with excess intake, including the risk of overweight and obesity. Some organizations further recommend avoiding dietary sweetness, regardless of the source. A scoping review and evidence map were completed to characterize the published research investigating dietary sweetness and body weight. The aim was to identify and map studies that investigate total dietary sweetness, sweet food/beverage, sugar, or sweetener intakes, and body weight-related outcomes. Using pre-registered search terms (https://osf.io/my7pb), 33,603 publications (duplicates removed) from PubMed, Cochrane Library, and Scopus were identified and screened for inclusion. Eligible studies were clinical trials, longitudinal cohorts, case-control studies, cross-sectional studies, and systematic reviews conducted among adults (=18 years) which investigated the associations between dietary sweetness, sweet food/beverage, sugar, or sweetener (energetic or non-energetic) intake on body weight, body mass index, adiposity, and energy intake. A total of 833 eligible publications were identified, detailing 804 studies. Two clinical trials, 4 cross-sectional studies, and 1 study of other design type investigated the associations between total dietary sweetness and a body weight-related outcome. An additional 608 studies were identified that investigated sweet food/beverage, sugar, or sweetener intake and body weight-related outcomes, including 225 clinical trials, 81 longitudinal cohorts, 4 case-control studies, and 280 cross-sectional studies. Most studies (90.6%) did not measure the sweetness of the diet or individual foods consumed. Ninety-two publications reported on dietary patterns that included sweet foods/beverages alongside other dietary components. Additionally, 97 systematic reviews addressed research questions related to various sweetness exposure and body weight-related outcomes. While there is a breadth of evidence from studies that investigate sweet food/beverage, sugar, and sweetener intake, and body weight, there is limited evidence on the association between total dietary sweetness and body weight.