The Use of Low-Calorie Sweeteners by Children: Implications for Weight Management123 Artificial sweetener use and one-year weight change among women. Chronic Consumption of Artificial Sweetener in Packets or Tablets and Type 2 Diabetes Risk: Evidence from the E3N-European Prospective Investigation into Cancer and Nutrition Study The effect of non-caloric sweeteners on cognition, choice, and post-consumption satisfaction Predictors of weight gain in a Mediterranean cohort: the Seguimiento Universidad de Navarra Study 1. 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. Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol Replacing sugary drinks with milk is inversely associated with weight gain among young obesity-predisposed children. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis School randomised trial on prevention of excessive weight gain by discouraging students from drinking sodas. Sugar-sweetened beverage consumption and central and total adiposity in older children: a prospective study accounting for dietary reporting errors. Artificial sweeteners and absence of bladder cancer risk in Copenhagen. Longitudinal associations between key dietary behaviors and weight gain over time: transitions through the adolescent years. A randomized trial of sugar-sweetened beverages and adolescent body weight. Consumption of sucrose-sweetened soft drinks increases plasma levels of uric acid in overweight and obese subjects: a 6-month randomised controlled trial Fruit Juice Intake Predicts Increased Adiposity Gain in Children From Low-Income Families: Weight Status-by-Environment Interaction Effect of drinking soda sweetened with aspartame or high-fructose corn syrup on food intake and body weight.
The rise in pediatric obesity since the 1970s has been well established in the United States and is becoming a major concern worldwide . As a potential means to help slow the obesity epidemic , low-calorie sweeteners ( LCS ) have gained attention as dietary tools to assist in adherence to weight loss plans or prevention of excess weight gain . Observational studies tend to show positive correlations between LCS consumption and weight gain in children and adolescents . Although the data are intriguing , these epidemiologic studies do not establish that LCS cause weight gain , because there are likely many lifestyle and genetic differences between children and families who choose to consume LCS and those who do not . Short-term r and omized controlled trials have shown LCS use to be BMI neutral or to have modest weight-reducing effects in overweight and obese adolescents . The long-term effects of LCS in children and adolescents are unknown . Some compelling research is currently underway and may provide needed insight into the potential role of LCS in weight management . The paucity of data regarding the effects of LCS use in children and adolescents creates challenges in decision-making for health care providers and parents Weight change over a 1-year period was examined in a highly homogeneous group of 78,694 women ages 50 - 69 enrolled in a prospect i ve mortality study .  Artificial sweetener usage increased with relative weight and decreased with age . Users were significantly more likely than nonusers to gain weight , regardless of initial weight . Average weight gains or losses by artificial sweetener users differed by less than 2 pounds from gains or losses among nonusers . These results were not explicable by differences in food consumption patterns . The data do not support the hypothesis that long-term artificial sweetener use either helps weight loss or prevents weight gain Background : The influence of artificial sweeteners on metabolic diseases is controversial . Artificially sweetened beverages have been associated with an increased risk of type 2 diabetes ( T2D ) but biases and reverse causation have been suspected to have influenced the observed association . In addition , it has been suggested that investigation into the relationship between the frequency and duration of the consumption of packet or tablet artificial sweeteners and T2D risk is necessary . Methods : We used data from 61,440 women in the prospect i ve E3N-European Prospect i ve Investigation into Cancer and Nutrition study , conducted between 1993 and 2011 . We estimated hazards ratios ( HRs ) and 95 % CIs of T2D risk associated with both the frequency and the duration of use of artificial sweeteners consumed in packets or tablets . Results : Compared to “ never or rare ” consumers of artificial sweeteners , those using them “ always or almost always ” had an increased risk of T2D ( HR = 1.83 [ 95 % CI 1.66 - 2.02 ] in the multivariate model [ MM ] , HR = 1.33 [ 95 % CI 1.20 - 1.47 ] when further adjusted for body mass index , BMI ) . Women consuming artificial sweeteners in packets or tablets for more than 10 years also had an increased risk of T2D compared to never or rare users ( HR = 2.10 [ 95 % CI 1.83 - 2.40 ] in the MM and HR = 1.15 [ 95 % CI 1.00 - 1.33 ] when adjusted for BMI , respectively ) . Conclusions : Our data suggest that both a higher frequency and a longer consumption of artificial sweeteners in packets or tablets was associated with T2D risk , independently of major T2D risk factors , but partially mediated by adiposity . A pre caution ary principle should be applied to the promotion of these products that are still largely recommended as healthy sugar substitutes 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 High consumption of sugar-sweetened drinks has been associated with  weight gain and obesity in the United States . This trend may also be affecting population s with different eating patterns who increasingly are adopting typical US dietary patterns . OBJECTIVE We assessed whether the consumption of sweetened drinks and other food items increased the likelihood of weight gain in a Mediterranean population . DESIGN This was a prospect i ve cohort analysis of 7194 men and women with a mean age of 41 y who were followed-up for a median of 28.5 mo with mailed question naires . Dietary exposure was assessed with a previously vali date d semiquantitative food-frequency question naire . RESULTS During follow-up , we observed that 49.5 % of the participants increased their weight ( x weight gain : 0.64 kg ; 95 % CI : 0.55 , 0.73 kg ) . In the participants who had gained > or =3 kg in the 5 y before baseline , the adjusted odds ratio of subsequent weight gain for the fifth quintile compared with the first quintile of sugar-sweetened soft drink consumption was 1.6 ( 95 % CI : 1.2 , 2.1 ; P for trend = 0.02 ) . This association was absent in the participants who had not gained weight in the 5-y period before baseline . The consumption of hamburgers , pizza , and sausages ( as a proxy for fast-food consumption ) was also independently associated with weight gain ( adjusted odds ratio for the fifth compared with the first quintile = 1.2 ; 95 % CI : 1.0 , 1.4 ; P for trend = 0.05 ) . We also found a significant , but weaker , association between weight gain and both red meat and sweetened fruit juice consumption . CONCLUSION In a Mediterranean cohort , particularly in the participants who had already gained weight , an increased consumption of sugar-sweetened soft drinks and of hamburgers , pizza , and sausages was associated with a higher risk of additional subsequent weight gain 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 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 The aim of the present study was to examine the associations of sugary drink consumption and its substitution with alternative beverages with body weight gain  among young children predisposed to future weight gain . Secondary analysis of the Healthy Start Study , a 1·5-year r and omised controlled trial design ed to prevent overweight among Danish children aged 2 - 6 years ( n 366 ) , was carried out . Multivariate linear regression models were used to investigate the associations of beverage consumption with change in body weight ( Δweight ) or BMI ( Δ BMI ) z-score . Substitution models were used to extrapolate the influence of replacing sugary drinks with alternative beverages ( water , milk and diet drinks ) on Δweight or Δ BMI z-score .  Sugary drink intake at baseline and substitution of sugary drinks with milk were associated with both Δweight and Δ BMI z-score . Every 100 g/d increase in sugary drink intake was associated with 0·10 kg and 0·06 unit increases in body weight ( P=0·048 ) and BMI z-score ( P=0·04 ) , respectively . Substitution of 100 g/d sugary drinks with 100 g/d milk was inversely associated with Δweight ( β=-0·16 kg ; P=0·045 ) and Δ BMI z-score ( β=-0·07 units ; P=0·04 ) . The results of this study suggest that sugary drink consumption was associated with body weight gain  among young children with high predisposition for future overweight . In line with the current recommendations , sugary drinks , whether high in added or natural sugar , should be discouraged to help prevent childhood obesity . Milk may be a good alternative to sugary drinks with regard to weight management among young obesity-predisposed children BACKGROUND The rising prevalence of obesity in children has been linked in part to the consumption of sugar-sweetened drinks . Our aim was to examine this relation . METHODS We enrolled 548 ethnically diverse schoolchildren ( age 11.7 years , SD 0.8 ) from public schools in four Massachusetts communities , and studied them prospect ively for 19 months from October , 1995 , to May , 1997 . We examined the association between baseline and change in consumption of sugar-sweetened drinks ( the independent variables ) , and difference in measures of obesity , with linear and logistic regression analyses adjusted for potentially confounding variables and clustering of results within schools . FINDINGS For each additional serving of sugar-sweetened drink consumed , both body mass index ( BMI ) ( mean 0.24 kg/m2 ; 95 % CI 0.10 - 0.39 ; p=0.03 ) and frequency of obesity ( odds ratio 1.60 ; 95 % CI 1.14 - 2.24 ; p=0.02 ) increased after adjustment for anthropometric , demographic , dietary , and lifestyle variables . Baseline consumption of sugar-sweetened drinks was also independently associated with change in BMI ( mean 0.18 kg/m2 for each daily serving ; 95 % CI 0.09 - 0.27 ; p=0.02 ) . INTERPRETATION Consumption of sugar-sweetened drinks is associated with obesity in children OBJECTIVE To determine whether an educational programme aim ed at discouraging students from drinking sugar-sweetened beverages could prevent excessive weight gain . DESIGN Forty-seven classes in twenty-two schools were r and omised as intervention or control . SUBJECTS Participants were 1140 , 9 - 12-year-old fourth grade rs ( 435 in the intervention group and 608 in the control group ) .  Sugar-sweetened beverages and juice intake were measured through one 24 h recall at baseline and another at the end of the trial . The main outcome was the change in BMI ( BMI = weight (kg)/height ( m2 ) ) , measured at the beginning and at the end of the school year . Intention-to-treat analysis was performed taking into account the cluster ( classes ) effect . RESULTS A statistically significant decrease in the daily consumption of carbonated drinks in the intervention compared to control ( mean difference = -56 ml ; 95 % CI -119 , -7 ml ) was followed by a non-significant overall reduction in BMI , P = 0.33 . However , among those students overweight at baseline , the intervention group showed greater BMI reduction ( -0.4 kg/m2 compared with -0.2 kg/m2 in the control group ( P = 0.11 ) ) , and this difference was statistically significant among girls ( P = 0.009 ) . Fruit juice consumption was slightly increased in the intervention group ( P = 0.08 ) , but not among girls . CONCLUSION Decreasing sugar-sweetened beverages intake significantly reduced BMI  among overweight children , and mainly among girls . Efforts to reduce energy intake through liquids need to emphasise overall sweetened beverages and addition of sugar on juices OBJECTIVE To determine the prospect i ve relationship between changes in sugar-sweetened beverage ( SSB ) intake and central adiposity in older children . DESIGN Dietary intakes of children were obtained by 3 d food records at ages 10 and 13 years . Waist circumference ( WC ) and weight and height to determine BMI were measured at 10 and 13 years and total body fat mass ( TBFM ) at 13 years by dual-energy X-ray absorptiometry . Analyses were conducted using multivariable linear regression . Reporting errors were measured and participants were categorized as under- , plausible and over-reporters of dietary intakes . SETTING Community-based British cohort of children participating in the Avon Longitudinal Study of Parents and Children . RESULTS Among 2455 older children , increased SSB  consumption from ages 10 to 13 years was associated with higher WC ( st and ardized β=0.020 , P=0.19 ) , BMI ( β=0.028 , P=0.03 ) and TBFM ( β=0.017 , P=0.20 ) at 13 years . Effects were strengthened among plausible dietary reporters ( n 1059 ) : WC ( β=0.097 , P<0.001 ) , BMI ( β=0.074 , P<0.001 ) and TBFM ( β=0.065 , P=0.003 ) . The association between change in SSB and WC was weakened , but remained statistically significant after accounting for BMI ( β=0.042 , P=0.02 ) and TBFM ( β=0.048 , P=0.01 ) . CONCLUSIONS Higher consumption of SSB from ages 10 to 13 years was associated with a larger WC at age 13 years independent of differences in total adiposity . Accounting for dietary reporting errors strengthened associations . Our findings further support recommendations to limit intakes of SSB to reduce excess weight gain in children and suggest that SSB have an additional deleterious effect on central adiposity During the years 1979 to 1981 a population -based case-control study of bladder cancer including papillomas was performed in Greater Copenhagen . After exclusions some 388 patients ( 290 males ; 98 females ) and an age- and sex-matched group of 787 controls ( 592 males ; 195 females ) remained for analysis . Controls were selected at r and om from the general population of the study area . All persons were interviewed concerning use of artificial sweeteners in addition to their exposure to a number of other known or suspected risk factors for bladder cancer . Fifty-five male bladder cancer patients ( 19.4 % ) and 150 controls ( 25.7 % ) had at some time used artificial sweeteners regularly . Among females 27.1 % of cases and 25.9 % of controls regularly used sweeteners . In neither sex was the relative risk significantly increased in users compared with non-users of artificial sweeteners . The relative risk of 0.78 in the two sexes combined was not significantly different from 1.0 ( 95 % C.I. : 0.58 - 1.05 ) . There was no indication of a regular increase in risk with increasing daily consumption of table-top sweeteners nor was there any indication of an increase in risk with a duration of regular use of artificial sweeteners . Taking into account a possible latency period between first regular use and bladder cancer development did not change the finding of an absence of association between use of artificial sweeteners and the risk of bladder cancer . Neither saccharine nor cyclamate users had an increased risk of bladder cancer . This population -based case-control investigation provides further evidence that it is highly unlikely that the consumption of artificial sweeteners has contributed to current bladder cancer rates in man Previous studies have yielded inconsistent results when documenting the association between key dietary factors and adolescent weight change over time . The purpose of this study was to examine the extent to which changes in adolescent sugar-sweetened beverage ( SSB ) , diet soda , breakfast , and fast-food consumption were associated with changes in BMI and percent body fat ( PBF ) . This study analyzed data from a sample of 693 Minnesota adolescents followed over 2 years . R and om coefficient models were used to examine the relationship between  dietary intake and BMI and PBF and to separate cross-sectional and longitudinal associations . Adjusting for total physical activity , total energy intake , puberty , race , socioeconomic status , and age , cross-sectional findings indicated that for both males and females , breakfast consumption was significantly and inversely associated with BMI and PBF , and diet soda intake was significantly and positively associated with BMI and PBF among females . In longitudinal analyses , however , there were fewer significant associations . Among males there was evidence of a significant longitudinal association between SSB consumption and PBF ; after adjustment for energy intake , an increase of one serving of SSB per day was associated with an increase of 0.7 units of PBF among males . This study adds to previous research through its method ological strengths , including adjustment for physical activity and energy intake assessed using state-of-the-art methods ( i.e. , accelerometers and 24-h dietary recalls ) , as well as its evaluation of both BMI and PBF . Additional research is needed to better underst and the complex constellation of factors that contribute to adolescent weight gain over time BACKGROUND Consumption of sugar-sweetened beverages may cause excessive weight gain . We aim ed to assess the effect on weight gain of an intervention that included the provision of noncaloric beverages at home for overweight and obese adolescents . METHODS We r and omly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups . The experimental group received a 1-year intervention design ed to decrease consumption of sugar-sweetened beverages , with follow-up for an additional year without intervention . We hypothesized that the experimental group would gain weight at a slower rate than the control group . RESULTS Retention rates were 97 % at 1 year and 93 % at 2 years . Reported consumption of sugar-sweetened beverages was similar at baseline in the experimental and control groups ( 1.7 servings per day ) , declined to nearly 0 in the experimental group at 1 year , and remained lower in the experimental group than in the control group at 2 years . The primary outcome , the change in mean body-mass index ( BMI , the weight in kilograms divided by the square of the height in meters ) at 2 years , did not differ significantly between the two groups ( change in experimental group minus change in control group , -0.3 ; P=0.46 ) . At 1 year , however , there were significant between-group differences for changes in BMI ( -0.57 , P=0.045 ) and weight ( -1.9 kg , P=0.04 ) . We found evidence of effect modification according to ethnic group at 1 year ( P=0.04 ) and 2 years ( P=0.01 ) . In a prespecified analysis according to ethnic group , among Hispanic participants ( 27 in the experimental group and 19 in the control group ) , there was a significant between-group difference in the change in BMI at 1 year ( -1.79 , P=0.007 ) and 2 years ( -2.35 , P=0.01 ) , but not among non-Hispanic participants ( P>0.35 at years 1 and 2 ) . The change in body fat as a percentage of total weight did not differ significantly between groups at 2 years ( -0.5 % , P=0.40 ) . There were no adverse events related to study participation . CONCLUSIONS Among overweight and obese adolescents , the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention design ed to reduce consumption of sugar-sweetened beverages , but not at the 2-year follow-up ( the prespecified primary outcome ) . ( Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others ; Clinical Trials.gov number , NCT00381160 . ) Background / Objectives : Sucrose-sweetened soft drinks ( SSSDs ) are associated with the development of metabolic disorders . Fructose is a major component of SSSDs and is demonstrated to induce uric acid ( UA ) production and stimulate fat accumulation independent of excess caloric intake . UA induce insulin resistance and low- grade inflammation , suggesting that UA may have a causal role in the development of metabolic complications . The objective of this study is to investigate the long-term effects of consuming SSSDs on circulating levels of UA in overweight and obese subjects . Subjects/ Methods : Using a previously published study , circulating UA levels were assessed at baseline and after 6 months using chromogenic enzymatic absorptiometry . The study included 47 overweight and obese subjects without diabetes , r and omised to consume 1 l daily of either SSSD ( regular cola ) , isocaloric semi-skimmed milk , diet cola or water for 6 months . Results : Circulating UA levels increased ~15 % ( P=0.02 ) after the 6-month intervention in the SSSD group with no change in the other groups . In the SSSD  group , circulating UA levels increased significantly after the intervention in both absolute ( P=0.005 ) and relative values ( P=0.004 ) . The change in UA after the intervention correlated with changes in liver fat ( P=0.005 ) , triglycerides ( P=0.02 ) and insulin ( P=0.002 ) . Conclusions : In this secondary analysis daily intake of 1 l SSSD for 6 months was found to increase circulating UA levels compared with isocaloric milk , diet cola and water . Thus , a high daily intake of SSSDs in overweight and obese subjects without overt diabetes may increase the risk of developing metabolic complications through the elevation of UA . This trial is registered at Clinical Trials.gov as NCT00777647 OBJECTIVE . Our goal was to test the hypothesis that increased fruit juice intake and parental restriction of children 's eating are associated with increased adiposity gain and whether exposure to nutritional counseling predicted reduced adiposity gain among children . PATIENTS AND METHODS . A sample of parents or guardians of children aged 1 to 4 years who attended 1 of 49 Special Supplemental Nutrition Program for Women , Infants , and Children agencies in New York State were surveyed in 1999 or 2000 ( N = 2801 ) . The survey addressed children 's dietary intake , parental feeding practice s , and parental exposure to nutritional counseling messages to increase fruit , vegetable , and low-fat milk intakes .  Each child 's height and weight were measured approximately every 6 months for up to 48 months . A prospect i ve cohort design was used in which survey variables were the predictors and the outcome was change in children 's adiposity , defined as change in age- and gender-st and ardized BMI per month ( ie , BMI z-score slope ) . RESULTS . Controlling for gender and ethnicity , the relationship between juice intake and adiposity gain depended on children 's initial overweight status . Among children who were initially either at risk for overweight or overweight , increased fruit juice intake was associated with excess adiposity gain , whereas parental offerings of whole fruits were associated with reduced adiposity gain . Each additional daily serving of fruit juice was associated with an excess adiposity gain of 0.009 SD per month . Feeding restriction was greater among parents whose children were initially at risk for overweight or overweight compared with those at a healthy weight . Parental exposure to nutritional messages was not associated with reduced child adiposity gain . CONCLUSION . This study supports the Institute of Medicine recommendations to reduce fruit juice intake as a strategy for overweight prevention in high-risk children To examine whether artificial sweeteners aid in the control of long-term food intake and body weight , we gave free-living , normal-weight subjects 1150 g soda sweetened with aspartame ( APM ) or high-fructose corn syrup ( HFCS ) per day . Relative to when no soda was given , drinking APM-sweetened soda for 3 wk significantly reduced calorie intake of both females ( n = 9 ) and males ( n = 21 ) and decreased the body weight of males but not of females . However , drinking HFCS-sweetened soda for 3 wk significantly increased the calorie intake and body weight of both sexes . Ingesting either type of soda reduced intake of sugar from the diet without affecting intake of other nutrients . Drinking large volumes of APM-sweetened soda , in contrast to drinking HFCS-sweetened soda , reduces sugar intake and thus may facilitate the control of calorie intake and body weight
Data from large , epidemiologic studies support the existence of an association between  artificially-sweetened beverage  consumption and weight gain in children .
Epidemiological data have demonstrated an association between artificial sweetener use and  weight gain .
Evidence of a causal relationship linking artificial sweetener use to weight gain and other metabolic health effects is limited .
However , recent animal studies provide intriguing information that supports an active metabolic role of artificial sweeteners .
This systematic review examines the current literature on  artificial sweetener consumption in children and its health effects .