Scoping review and evidence map on the relation 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: 11/1/2022
Citation: Higgins, K.A., Rawal, R., Baer, D.J., O'Connor, L.E., Appleton, K.M. 2022. Scoping review and evidence map on the relation between exposure to dietary sweetness and body weight-related outcomes in adults. Advances in Nutrition. 13(6):2341-2356. https://doi.org/10.1093/advances/nmac090.
DOI: https://doi.org/10.1093/advances/nmac090

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 obesity. Some organizations further recommend avoiding dietary sweetness, regardless of the source. A scoping review and evidence map were completed to characterize the research that investigated associations between dietary sweetness and body weight. The aimwas to identify and map published studies that have investigated total dietary sweetness, sweet food/beverages, sugar, or sweetener intake, and body weight–related outcomes and/or energy intake. Using preregistered search terms (osf.io/my7pb), 36,779 publications (duplicates removed) were identified from PubMed, Cochrane Library, and Scopus and screened for inclusion. Eligible studies were clinical trials, longitudinal cohorts, case–control studies, cross-sectional studies, and systematic reviews conducted among adults (age =18 y), which were performed to investigate associations between dietary sweetness, sweet foods/beverages, sugar, or sweetener (energetic or nonenergetic) intake and body weight, BMI, adiposity, and/or energy intake. A total of 833 eligible publications were identified, detailing 804 studies. Only 7 studies (0.9% of included studies; 2 clinical trials, 4 cross-sectional studies, and 1with another design type) investigated associations between total dietary sweetness and body weightrelated outcome and/or energy intake. An additional 608 (75.6%) studies investigated intakes of sweet foods/beverages, sugar, or sweetener, and body weight-related outcomes and/or energy intake, including 225 clinical trials, 81 longitudinal cohorts, 4 case–control studies, and 280 crosssectional studies. Most studies (90.6%) did not measure the sweetness of the diet or individual foods consumed. Ninety-two (11.4%) publications reported data fromstudies on dietary patterns that included sweet foods/beverages alongside other dietary components and 97 (12.1%) systematic reviews addressed different but related research questions. Although there is a breadth of evidence fromstudies that have investigated associations between intakes of sweet foods and beverages, sugars, and sweeteners and body weight, there is a limited depth of evidence on the association between total dietary sweetness and body weight.