(OR37-06-24) Long-Term Weight and BMI Changes From Artificially Sweetened Beverages: Three Large Prospective Cohort Studies Coupled With a Systematic Review and Meta-Analysis

Objectives: Evaluate long-term changes in artificially-sweetened beverage (ASB) intake in relation to changes in weight/body mass index (BMI) and when replacing sugar-sweetened beverages (SSB) with ASB or water.

Methods: Prospective cohort data from the Nurses’ Health Study I (NHS I) & II (NHS II) and Health Professionals Follow-up Study (HPFS) were used. Participants were U.S. women and men, assessed every 4 years (1986-2010, NHS I, 1991-2019, NHS II, and 1986-2018, HPFS). Food-frequency questionnaires evaluated food and beverage intake (12 oz serving/day). Questionnaires collected medical, lifestyle, and anthropometric data. Persons with major baseline diseases and pregnant/lactating women were excluded; those reaching 65 years were censored. Lag time analyses addressed reverse causation. Multivariate-adjusted models evaluated changes in ASB intake in relation to weight/BMI changes over 4-year intervals. Substitution models examined replacing SSB with ASB/water or ASB with water in relation to weight/BMI change. Mediation analysis evaluated energy intake’s role. Results were complemented with a systematic review and meta-analysis.

Results: Among 143,413 participants (median follow-up 28 years), a one-serving/day increase of ASB was associated with -0.068 kg weight change (95%CI: -0.094, -0.043) and -0.024 kg/m² BMI change (95%CI: -0.034, -0.013) over 4-year intervals. The association was primarily mediated by reducing energy intake. Substituting SSB with ASB was inversely associated with weight change (β=-0.499 kg, 95%CI: -0.539, -0.459) and BMI change (β=-0.183 kg/m² 95%CI: -0.199, -0.167). Similar estimates were observed when replacing SSB with water (β=-0.534 kg, 95%CI: -0.567, -0.501 and β=-0.197 kg/m², 95%CI: -0.210, -0.84). Substituting ASB with water was also inversely associated with weight change (β=-0.034 kg, 95%CI: -0.060, -0.008) and BMI change (β=-0.014 kg/m², 95%CI: -0.025, -0.004). Meta-analysis of five prospective cohort studies confirmed findings.

Conclusions: A one serving/day increase in ASB was associated with a modest weight/BMI decrease by reducing energy intake. Substituting SSB with ASB or water, and substituting ASB with water, were both associated with favorable weight/BMI changes. Findings support water as the recommended alternative.

Funding Sources: None