Replacing Sugar-Sweetened With Unsweetened Beverages May Not Improve Triglyceride to HDL-C Ratio

Long-term replacement of sugar-sweetened- with artificially sweetened or unsweetened beverages was not found to improve the triglyceride to high-density lipoprotein cholesterol ratio in adults usually consuming these beverages, according to a study published in the Journal of the American Heart Association.

Adults who consumed ≥1 serving/day of sugar-sweetened beverages and had a body mass index between 18.5 and 40.0 kg/m² were enrolled in the study, which was conducted at the Boston Children’s Hospital. Participants were randomly assigned to receive sugar-sweetened beverages (n=67), artificially sweetened beverages (n=67), or unsweetened beverages (n=69), all of which were delivered to participants’ homes for 12 months. Beverages were continually delivered to ensure replacement for sugar-sweetened beverages consumed at baseline.

Study outcomes were changes in serum triglyceride to high-density lipoprotein cholesterol ratio, body weight, and sweet taste preference, which were assessed after a 12-hour overnight fast at baseline and 12 months.

At 12 months, the serum triglyceride to high-density lipoprotein cholesterol ratio was comparable between the 3 groups (P =.65), with mean changes of 3.2±5.7 in the sugar-sweetened (P =.56), −2.4±5.4 in the artificially sweetened (P =.65), and −3.2±5.1 in the unsweetened (P =.52) beverages group.

In participants with the most trunk fat, weight gain was greater in those consuming sugar-sweetened vs artificially sweetened or unsweetened beverages (4.4±1.0 vs 0.5±0.9 and -0.2±0.9 kg, respectively; P =.002).

Sweet taste preference was assessed with 10 samples of sucrose solutions (sucrose concentration range, 0-18%). Sweetness threshold and favorite concentration) were reduced in the unsweetened beverage group (–1.0±0.2% m/v; P =.005 and –2.3±0.4% m/v; P <.0001, respectively), but were unchanged in the sugar-sweetened beverage group. Favorite concentration was lower in the artificially sweetened beverage group (–1.1±0.5% m/v; P =.02). The change in sweetness threshold favored the unsweetened over the artificially sweetened beverage group (P =.015).

Limitations of the study include its single-site design, the inability to mask participants to interventions, and the use of self-reported assessments for dietary intake.

“[T]he benefits of eliminating consumption of sugar-sweetened beverages and the differential effects of artificially sweetened beverages and unsweetened beverages on cardiometabolic risk factors may require longer periods of study for the general population,” noted the study authors.

Reference

Ebbeling CB, Feldman HA, Steltz SK, Quinn NL, Robinson LM, Ludwig DS. Effects of sugar-sweetened, artificially sweetened, and unsweetened beverages on cardiometabolic risk factors, body composition, and sweet taste preference: A randomized controlled trial [published online July 22, 2020]. J Am Heart Assoc. doi:10.1161/JAHA.119.015668