The effect of non-caloric sweeteners on cognition, choice, and post-consumption satisfaction Effect of Replacing Sugar with Non-Caloric Sweeteners in Beverages on the Reward Value after Repeated Exposure Effects of aspartame-, monk fruit-, stevia- and sucrose-sweetened beverages on postprandial glucose, insulin and energy intake Consumption of caloric and non-caloric versions of a soft drink differentially affects brain activation during tasting Effect of non-sucrose sweet tasting solution on neonatal heel prick responses. The effects of water and non‐nutritive sweetened beverages on weight loss and weight maintenance: A randomized clinical trial Cephalic phase responses to sweet taste. Sugar-sweetened product consumption alters glucose homeostasis compared with dairy product consumption in men and women at risk of type 2 diabetes mellitus. The relative reinforcing value of sweet versus savory snack foods after consumption of sugar- or non-nutritive sweetened beverages Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial. Sucrose compared with artificial sweeteners: a clinical intervention study of effects on energy intake, appetite, and energy expenditure after 10 wk of supplementation in overweight subjects. A randomized control trial for reduction of caloric and non-caloric sweetened beverages in young adults: effects in weight, body composition and blood pressure. Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol Reducing sugar-sweetened beverage consumption by providing caloric information: how Black adolescents alter their purchases and whether the effects persist. Hormonal responses to non-nutritive sweeteners in water and diet soda Turku sugar studies. V. Final report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man. The impact of ‘on-pack’ pictorial health warning labels and calorie information labels on drink choice: A laboratory experiment
Consumers often turn to non-caloric sweeteners ( NCS ) as a means of promoting a healthy body weight . However , several studies have now linked their long-term use to increased weight gain , raising the question of whether these products produce unintended psychological , physiological , or behavioral changes that have implication s for weight management goals . In the following , we present the results of three experiments bearing on this issue , testing whether NCS-consumption influences how  individuals think about and respond to food .  Participants in each of our three experiments were r and omly assigned to consume a sugar-sweetened beverage , an unsweetened beverage , or a beverage sweetened with NCS . We then measured their cognition ( Experiment 1 ) , product choice ( Experiment 2 ) , and subjective responses to a sugar-sweetened food ( Experiment 3 ) . Results revealed that consuming NCS-sweetened beverages influences psychological processes in ways that - over time - may increase calorie intake Background The reward value of food is partly dependent on learned associations . It is not yet known whether replacing sugar with non-caloric sweeteners in food is affecting long-term acceptance . Objective To determine the effect of replacing sugar with non-caloric sweeteners in a nutrient-empty drink ( soft drink ) versus nutrient-rich drink ( yoghurt drink ) on reward value after repeated exposure . Design We used a r and omized crossover design whereby forty subjects ( 15 men , 25 women ) with a mean±SD age of 21±2 y and BMI of 21.5±1.7 kg/m2 consumed a fixed portion of a non-caloric sweetened ( NS ) and sugar sweetened ( SS ) versions of either a soft drink or a yoghurt drink ( counterbalanced ) for breakfast which were distinguishable by means of colored labels . Each version of a drink was offered 10 times in semi-r and om order . Before and after conditioning the reward value of the drinks was assessed using behavioral tasks on wanting , liking , and expected satiety . In a subgroup ( n=18 ) fMRI was performed to assess brain reward responses to the drinks . Results Outcomes of both the behavioral tasks and fMRI showed that conditioning did not affect the reward value of the NS and SS versions of the drinks significantly . Overall , subjects preferred the yoghurt drinks to the soft drinks and the ss drinks to the NS drinks . In addition , they expected the yoghurt drinks to be more satiating , they reduced hunger more , and delayed the first eating episode more . Conditioning did not influence these effects . Conclusion Our study showed that repeated consumption of a non-caloric sweetened beverage , instead of a sugar sweetened version , appears not to result in changes in the reward value . It can not be ruled out that learned associations between sensory attributes and food satiating capacity which developed preceding the conditioning period , during lifetime , affected the reward value of the drinks Background : Substituting sweeteners with non-nutritive sweeteners ( NNS ) may aid in glycaemic control and body weight management . Limited studies have investigated energy compensation , glycaemic and insulinaemic responses to artificial and natural NNS . Objectives : This study compared the effects of consuming NNS ( artificial versus natural ) and sucrose ( 65 g ) on energy intake , blood glucose and insulin responses . Methods : Thirty healthy male subjects took part in this r and omised , crossover study with four treatments : aspartame- , monk fruit- , stevia- and sucrose-sweetened beverages . On each test day , participants were asked to consume a st and ardised breakfast in the morning , and they were provided with test beverage as a preload in mid-morning and ad libitum lunch was provided an hour after test beverage consumption . Blood glucose and insulin concentrations were measured every 15 min within the first hour of preload consumption and every 30 min for the subsequent 2 h. Participants left the study site 3 h after preload consumption and completed a food diary for the rest of the day . Results : Ad libitum lunch intake was significantly higher for the NNS treatments compared with sucrose ( P=0.010 ) . The energy ' saved ' from replacing sucrose with NNS was fully compensated for at subsequent meals ; hence , no difference in total daily energy intake was found between the treatments ( P=0.831 ) . The sucrose-sweetened beverage led to large spikes in blood glucose and insulin responses within the first hour , whereas these responses were higher for all three NNS beverages following the test lunch . Thus , there were no differences in total area under the curve ( AUC ) for glucose ( P=0.960 ) and insulin ( P=0.216 ) over 3 h between the four test beverages . Conclusions : The consumption of calorie-free beverages sweetened with artificial and natural NNS have minimal influences on total daily energy intake , postpr and ial glucose and insulin compared with a sucrose-sweetened beverage Sensory-specific satiety , which is defined as a relative decrease in pleasantness , is increased by greater oro-sensory stimulation . Both sensory-specific satiety and pleasantness affect taste activation in the orbitofrontal cortex . In contrast , metabolic satiety , which results from energy intake , is expected to modulate taste activation in reward areas . The aim of this study was to determine the effects of the amount of oro-sensory stimulation and energy content on consumption-induced changes in taste activation .  Ten men participated in a 2 × 2 r and omized crossover study . Subjects were scanned twice using functional magnetic resonance imaging : after fasting for at least 2h and after treatment , on four occasions . Treatment consisted of the ingestion of 450 mL of orangeade ( sweetened with 10 % sucrose or non-caloric sweeteners ) at 150 mL/min , with either small ( 5 mL ) or large ( 20 mL ) sips . During scanning , subjects alternately tasted orangeade , milk and tomato juice and rated its pleasantness . Before and after the scans , subjects rated pleasantness , prospect i ve consumption , desire to eat and sweetness for all tastants . Main findings were that , before treatment , the amygdala was activated more by non-caloric than by caloric orangeade . Caloric orangeade activated part of the striatum before , but not after treatment . We observed no main effects of sip size on taste activation and no interaction between sip size and caloric content . In conclusion , the brain responds differentially to caloric and non-caloric versions of a sweet drink and consumption of calories can modulate taste activation in the striatum . Further research is needed to confirm that the observed differences are due to caloric content and not to ( subliminal ) differences in the sensory profile . In addition , implication s for the effectiveness of non-caloric sweeteners in decreasing energy intake need to be established A substance commercially described as ' sugar free , ' used as a sweetener for paracetamol suspension , was evaluated on measures of  neonatal pain . Sixty infants were r and omly allocated to receive one of four solutions before heel stab blood sampling : sterile water ( placebo ) ; 25 or 50 % sucrose ( weight/volume ) ; and the commercial sweet-tasting solution . There was a significant reduction in crying time and pain score 3 minutes after the painful stimulus in all groups compared with the controls . It is concluded that this sweet-tasting solution has analgesic effects as potent as those of concentrated sucrose solutions Objective To evaluate the effects of water versus beverages sweetened with non‐nutritive sweeteners ( NNS ) on body weight in subjects enrolled in a year‐long behavioral weight loss treatment program . Methods The study used a r and omized equivalence design with NNS or water beverages as the main factor in a trial among 303 weight‐stable people with overweight and obesity . All participants participated in a weight loss program plus assignment to consume 24 ounces ( 710 ml ) of water or NNS beverages daily for 1 year . Results NNS and water treatments were non‐equivalent , with NNS treatment  showing greater weight loss at the end of 1 year . At 1 year subjects receiving water had maintained a 2.45 ± 5.59 kg weight loss while those receiving NNS beverages maintained a loss of 6.21 ± 7.65 kg ( P < 0.001 for difference ) . Conclusions Water and NNS beverages were not equivalent for weight loss and maintenance during a 1‐year behavioral treatment program . NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users  of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program . These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program The sweet taste of nonnutritive sweeteners has been reported to increase hunger and food intake through the mechanism of cephalic-phase insulin release ( CPIR ) . We investigated the effect of oral sensation of sweetness on CPIR and other indexes associated with glucose metabolism using nutritive and nonnutritive sweetened tablets as stimuli . At lunchtime , 12 normal-weight men sucked for 5 min a sucrose , an aspartame-polydextrose , or an unsweetened polydextrose tablet ( 3 g ) with no added flavor . The three stimuli were administered in a counterbalanced order , each on a separate day at 1-wk intervals . Blood was drawn continuously for 45 min before and 25 min after the beginning of sucking and sample s were collected at 1-min intervals . Spontaneous oscillations in glucose , insulin , and glucagon concentrations were assessed as were increments ( slopes ) of fatty acid concentrations during the baseline period . The nature of the baseline ( oscillations : glucose , insulin , and glucagon ; and slopes : fatty acids ) was taken into account in the analyses of postexposure events . No CPIR and no significant effect on plasma glucagon or fatty acid concentrations were observed after the three stimuli . However , there was a significant decrease in plasma glucose and insulin after all three stimuli . Only the consumption of the sucrose tablet was followed by a postabsorptive increase in plasma glucose and insulin concentrations starting 17 and 19 min , respectively , after the beginning of sucking . In conclusion , this study suggested that oral stimulation provided by sweet nonflavored tablets is not sufficient for inducing CPIR BACKGROUND Dietary patterns characterized by high intakes of fruits and vegetables , whole grains , low-fat dairy products , and low glycemic load have been associated with lower type 2 diabetes mellitus ( T2DM ) risk . In contrast , dietary patterns that include high intakes of refined grains , processed meats , and high amounts of added sugars have been associated with increased T2DM risk . OBJECTIVE This r and omized , 2-period crossover trial compared the effects of dairy and sugar-sweetened product ( SSP ) consumption on insulin sensitivity and pancreatic β-cell function in men and women at risk of the development of T2DM who habitually consume sugar-sweetened beverages . METHODS In a r and omized , controlled crossover trial , participants consumed dairy products ( 474 mL/d 2 % milk and 170 g/d low-fat yogurt ) and SSPs ( 710 mL/d nondiet soda and 108 g/d nondairy pudding ) , each for 6 wk , with a 2-wk washout between treatments . A liquid meal tolerance test ( LMTT ) was administered at baseline and the end of each period . RESULTS Participants were 50 % female with a mean age and body mass index of 53.8 y and 32.2 kg/m(2 ) , respectively . Changes from baseline were significantly different between dairy product and SSP conditions for median homeostasis model assessment 2-insulin sensitivity ( HOMA2-%S ) ( 1.3 vs. -21.3 % , respectively , P = 0.009 ; baseline = 118 % ) , mean LMTT disposition index ( -0.03 vs. -0.36 , respectively , P = 0.011 ; baseline = 2.59 ) , mean HDL cholesterol ( 0.8 vs. -4.2 % , respectively , P = 0.015 ; baseline = 44.3 mg/dL ) , and mean serum 25-hydroxyvitamin D [ 25(OH)D ] ( 11.7 vs. -3.3 , respectively , P = 0.022 ; baseline = 24.5 μg/L ) . Changes from baseline in LMTT Matsuda insulin sensitivity index ( -0.10 vs. -0.49 , respectively ; baseline = 4.16 ) and mean HOMA2-β-cell function ( -2.0 vs. 5.3 % , respectively ; baseline = 72.6 % ) did not differ significantly between treatments . CONCLUSION These results suggest that SSP consumption is associated with less favorable values for HOMA2-%S , LMTT disposition index , HDL cholesterol , and serum 25(OH)D in men and women at risk of T2DM vs. baseline values and values during dairy product consumption . This trial was registered at clinical trials.gov as NCT01936935 The effects of sugar-sweetened ( SSB ) and non-nutritive sweetened ( NSB ) beverages on the regulation of appetite , energy intake and body weight regulation remain controversial . Using a behavioral choice paradigm , we sought to determine the effects of consuming a SSB or NSB on appetite and the reinforcing value of sweet relative to salty/savory snack foods . In a r and omized crossover study , 21 healthy weight adults consumed 360 ml of SSB ( sucrose ; 31 g ) or NSB ( sucralose ; 4 g ) with a st and ardized meal . Hedonic ratings for the sweet and salty/savory snack foods used for the reinforcement task were assessed prior to the start of the study . Satiety and the desire to eat foods with a specific taste profile were assessed before and every 30 min post-meal for 4 h. The relative reinforcing value of the snack foods was assessed using a computer-based choice task ( operant responding with concurrent schedules of reinforcement ) 4 h post-meal . Hedonic ratings did not differ between the most highly liked sweet and salty/savory snack foods . Beverage type did not influence measures of satiety or the desire to eat foods with a specific taste . However , sweet snacks were more ( p < 0.05 ) reinforcing relative to salty/savory snack foods after consuming a NSB than after a SSB . In conclusion , this is the first study to demonstrate that NSB can increase the motivation to gain access to sweet snacks relative to salty/savory snack foods later in the day BACKGROUND Consumption of liquid calories from beverages has increased in parallel with the obesity epidemic in the US population , but their causal relation remains unclear . OBJECTIVE The objective of this study was to examine how changes in beverage consumption affect  weight change among adults . DESIGN This was a prospect i ve study of 810 adults participating in the PREMIER trial , an 18-mo r and omized , controlled , behavioral intervention trial .  Measurements ( weight , height , and 24-h dietary recall ) were made at baseline , 6 mo , and 18 mo . RESULTS Baseline mean intake of liquid calories was 356 kcal/d ( 19 % of total energy intake ) . After potential confounders and intervention assignment were controlled for , a reduction in liquid calorie intake of 100 kcal/d was associated with a weight loss of 0.25 kg ( 95 % CI : 0.11 , 0.39 ; P < 0.001 ) at 6 mo and of 0.24 kg ( 95 % CI : 0.06 , 0.41 ; P = 0.008 ) at 18 mo . A reduction in liquid calorie intake had a stronger effect than did a reduction in solid calorie intake on weight loss . Of the individual beverages , only intake of sugar-sweetened beverages ( SSBs ) was significantly associated with weight change . A reduction in SSB intake of 1 serving/d was associated with a weight loss of 0.49 kg ( 95 % CI : 0.11 , 0.82 ; P = 0.006 ) at 6 mo and of 0.65 kg ( 95 % CI : 0.22 , 1.09 ; P = 0.003 ) at 18 mo . CONCLUSIONS These data support recommendations to limit liquid calorie intake among adults and to reduce SSB consumption as a means to accomplish weight loss or avoid excess weight gain . This trial was registered at clinical trials.gov as NCT00000616 BACKGROUND There is a lack of appetite studies in free-living subjects supplying the habitual diet with either sucrose or artificially sweetened beverages and foods . Furthermore , the focus of artificial sweeteners has only been on the energy intake ( EI ) side of the energy-balance equation . The data are from a subgroup from a 10-wk study , which was previously published . OBJECTIVE The objective was to investigate changes in EI and energy expenditure ( EE ) as possible reasons for the changes in body weight during 10 wk of supplementation of either sucrose or artificial sweeteners in overweight subjects . DESIGN Supplements of sucrose-sweetened beverages and foods ( 2 g/kg body weight ; n = 12 ) or similar amounts containing artificial sweeteners ( n = 10 ) were given single-blind in a 10-wk parallel design . Beverages accounted for 80 % and solid foods for 20 % by weight of the supplements . The rest of the diet was free choice . Indirect 24-h whole-body calorimetry was performed at weeks 0 and 10 . At week 0 the diet was a weight-maintaining st and ardized diet . At week 10 the diet consisted of the supplements and ad libitum choice of foods .  Visual analog scales were used to record appetite . RESULTS Body weight increased in the sucrose group and decreased in the sweetener group during the intervention . The sucrose group had a 3.3-MJ higher EI but felt less full and had higher ratings of prospect i ve food consumption than did the sweetener group at week 10 . Basal metabolic rate was increased in the sucrose group , whereas 24-h EE was increased in both groups at week 10 . Energy balance in the sucrose group was more positive than in the sweetener group at the stay at week 10 . CONCLUSION The changes in body weight in the 2 groups during the 10-wk intervention seem to be attributable to changes in EI rather than to changes in EE INTRODUCTION Recently has been documented that the consumption of sweetened non-caloric beverages has increased as an option to weight control , however r and omized control trials have demonstrated a modest weight loss . OBJECTIVE To evaluate the effect of reducing consumption of beverage with caloric and non-caloric sweeteners on weight , body composition and blood pressure  in young Mexican adults . METHODS In an experimental study 148 nursing students were r and omly assigned to one of 3 groups : 1 ) no sweetened beverages were permitted , only plain water , tea or coffee without sugar ; 2 ) consumption of beverages with non-caloric sweeteners was allowed ; and 3 ) no restriction of sweetened beverages was imposed . All groups were given individualized isocaloric diets monitored by a 24-hour record of consumption and food frequency question naire and blood pressure , weight , waist circumference and body composition by tetrapolar bioelectric impedance were taken at the beginning of the study and three and six months later . RESULTS Differences between groups were found in body mass index at 3 months that decrease in group 1 and 2 and increase in group 3 ( -1.75 vs.-0.61 vs.0.54 % of change , p < 0.001 ) . At six months there were also statistical differences in waist circumference ( -4.07 vs.-1.23 vs. 0.62 % of change , p < 0.001 ) and sugar consumption ( -62.0 vs.-54.61 vs.11.08 % of change , p < 0.001 ) in groups 1 , 2 and 3 respectively . CONCLUSIONS The reduction in consumption of both caloric and non-caloric sweetened beverages contributes to signifi ca nt body mass index loss and waist circumference Background Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide . Most chronic diseases are associated with underlying preventable risk factors , such as elevated blood pressure , high blood glucose or glucose intolerance , high lipid levels , physical inactivity , excessive sedentary behaviours , and overweight/obesity . The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood . Sugar-sweetened beverages are known to be significant sources of additional caloric intake , and given recent attention to their contribution in the development of chronic diseases , a systematic review is warranted . We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are . Methods / Design Of interest are studies addressing sugar-sweetened beverage consumption , taking a broad perspective . Both direct consumption studies as well as those evaluating interventions that influence consumption ( e.g. school policy , educational ) will be relevant . Non-specific or multi-faceted behavioural , educational , or policy interventions may also be included subject to the level of evidence that exists for the other interventions /exposures . Comparisons of interest and endpoints of interest are pre-specified . We will include r and omized controlled trials , controlled clinical trials , interrupted time series studies , controlled before-after studies , prospect i ve and retrospective comparative cohort studies , case – control studies , and nested case – control design s. The MEDLINE ® , Embase , The Cochrane Library , CINAHL , ERIC , and PsycINFO ® data bases and grey literature sources will be search ed . The processes for selecting studies , abstract ing data , and resolving conflicts are described . We will assess risk of bias using design -specific tools . To determine sets of confounding variables that should be adjusted for , we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessment s. Meta- analysis will be conducted where appropriate ; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach will be used to determine the quality of evidence for outcomes . Systematic review registration PROSPERO CRD42014009641 OBJECTIVES We examined the ways in which adolescents altered the type and size of their purchases of  sugar-sweetened beverages ( SSBs ) , together with whether the effects persisted after removing caloric information signs in stores . METHODS We used a case-crossover design with 6 stores located in low-income Black neighborhoods in Baltimore , Maryl and , from 2012 to 2013 . The intervention used 1 of 4 r and omly posted signs with caloric information : absolute calories , number of teaspoons of sugar , and number of minutes of running or miles of walking necessary to burn off a beverage . We collected data for 4516 purchases by Black adolescents , including both baseline and postintervention periods with no signs posted . RESULTS We found that providing caloric information significantly reduced the number of total beverage calories purchased , the likelihood of buying an SSB , and the likelihood of buying an SSB greater than 16 ounces ( P < .05 ) . After removing the signs , the quantity , volume , and number of calories from SSB purchases remained lower than baseline ( P < .05 ) . CONCLUSIONS Providing caloric information was associated with purchasing a smaller SSB , switching to a beverage with no calories , or opting to not purchase a beverage ; there was a persistent effect on reducing SSB purchases after signs were removed Background Non-nutritive sweeteners ( NNS ) , especially in form of diet soda , have been linked to metabolic derangements ( e.g. obesity and diabetes ) in epidemiologic studies . We aim ed to test acute metabolic effects of NNS in isolation ( water or seltzer ) and in diet sodas . Methods We conducted a four-period , cross-over study at the National Institutes of Health Clinical Center ( Bethesda , Maryl and ) . Thirty healthy adults consumed 355 mL water with 0 mg , 68 mg , 170 mg , and 250 mg sucralose , and 31 individuals consumed 355 mL caffeine-free Diet Rite Cola ™ , Diet Mountain Dew ™ ( 18 mg sucralose , 18 mg acesulfame-potassium , 57 mg aspartame ) , and seltzer water with NNS ( 68 mg sucralose and 41 mg acesulfame-potassium , equivalent to Diet Rite Cola ™ ) in r and omized order , prior to oral glucose tolerance tests . Blood sample s were collected serially for 130 min . Measures included GLP-1 , GIP , glucose , insulin , C-peptide , glucose absorption , gastric emptying , and subjective hunger and satiety ratings . Results Diet sodas  augmented active GLP-1 ( Diet Rite Cola ™ vs. seltzer water , AUC , p = 0.039 ; Diet Mountain Dew ™ vs. seltzer water , AUC , p = 0.07 ) , but gastric emptying and satiety were unaffected . Insulin concentrations were nominally higher following all NNS conditions without altering glycemia . Sucralose alone ( at any concentration ) did not affect metabolic outcomes . Conclusions Diet sodas but not NNS in water augmented GLP-1 responses to oral glucose . Whether the trends toward higher insulin concentrations after NNS are of clinical importance remains to be determined . Our findings emphasize the need to test metabolic effects of NNS after chronic consumption . Trial registration The data for this manuscript were gathered from clinical trial # NCT01200940 The purpose was to study differences in the  caries increment rate  as influenced by various sugars . The trial involved almost complete substitution of sucrose ( S ) by fructose ( F ) or xylitol ( X ) during a period of 2 years . There were no significant initial differences as to caries status between the prospect i ve sugar groups ; 35 subjects in the S-group , 38 in the F-group , and 52 in the X-group . During the entire study 10 subjects discontinued or were excluded . The clinical and radiographical observer error was reported and discussed . After 2 years the mean increment of decayed , missed and filled tooth surfaces was 7.2 in the S-group , 3.8 in the F-group , and 0.0 in the X-group . The weakness of the DMFS-index in not showing the development of new secondary caries and the increase in size of the lesions was overcome by expressing the caries activity in terms of indices showing the total quantitative and qualitative development . The results showed a massive reduction of the caries increment in relation to xylitol consumption . Fructose was found to be less cariogenic than sucrose . It was suggested that the non- and anticariogenic properties of xylitol principally depend on its lack of suitability for microbial metabolism and physico-chemical effects in plaque and saliva Sugar-sweetened beverages ( SSBs ) are one of the largest added sugar sources to diets in the UK and USA . Health warning labels reduce hypothetical selection of SSBs in online studies but uncertainty surrounds their impact on selection of drinks for consumption . Calorie information labels are also promising but their impact on SSB selection is unclear . This laboratory study assessed the impact on SSB selection of ' on-pack ' labels placed directly on physical products : i.a pictorial health warning label depicting an adverse health consequence of excess sugar consumption ; and ii.calorie information labels . Potential moderation of any effects by socio-economic position ( SEP ) was also examined . Participants - 401 adults , resident in Engl and , approximately half of whom were of lower SEP and half of higher SEP , were asked to select a drink from a range of two non-SSBs and four SSBs ( subsequent to completing a separate study assessing the effects of food availability on snack selection ) . The drinks included ' on-pack ' labels according to r and omisation : Group 1:pictorial health warning label on SSBs ; Group 2:calorie information label on all drinks ; Group 3:no additional label . The primary outcome was the proportion of participants selecting an SSB . Compared to not having additional labels ( 39 % ) , neither the pictorial health warning label ( 40 % ) nor calorie information labels ( 43 % ) affected the proportion of participants selecting an SSB . Lower SEP participants ( 45 % ) were more likely to select an SSB compared to those of higher SEP ( 35 % ) , but SEP did not moderate the impact of labels on drink selection . In conclusion , pictorial health warning labels may be less effective in reducing SSB selection in lab-based compared with online setting s , or depending on label design and placement . Findings suggest that effects might be absent when choosing from real products with actual ' on-pack ' labels , positioned in a ' realistic ' manner . Field studies are needed to further assess the impact of ' on-pack ' SSB warning labels in real-world setting s to rule out the possible contribution of study design factors
In healthy subjects , appetite and short term food intake , risk of cancer , risk of diabetes , risk of dental caries , weight gain and risk of obesity are the most investigated health outcomes .
Overall there is no conclusive evidence for beneficial and harmful effects on those outcomes .
In subjects with diabetes and hypertension , the evidence regarding health outcomes of NNS use is also inconsistent .
Background Food products containing non-nutritive sweeteners ( NNSs ) instead of sugar have become increasingly popular in the last decades .
Their appeal is obviously related to their calorie-free sweet taste .
However , with the dramatic increase in their consumption , it is reasonable and timely to evaluate their potential health benefits and , more importantly , potential adverse effects .
The main aim of this scoping review was to map the evidence about health outcomes possibly associated with regular NNS consumption by examining the extent , range , and nature of research activity in this area .