Did replacing sugary drinks with sugar-free drinks reduce children’s weight gain?

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Sugary beverage consumption is associated with overweight, possibly because liquid sugars do not produce a sense of satiety and therefore do not reduce consumption of other foods. Evidence was lacking on whether replacing sugary beverages with noncaloric ones reduces weight gain.

Researchers conducted an 18-month trial involving 641 primarily normal-weight children aged 4 years 10 months to 11 years 11 months. Children were randomly assigned to receive 250 ml (8 oz) daily of either a sugar-free, artificially sweetened beverage or a similar sugar-containing beverage providing 104 kcal. The beverages were distributed through schools. At 18 months, 26% of the children had stopped consuming the beverages, and data for children who did not complete the study were imputed.

The BMI z score increased by an average of 0.02 standard deviation units in the sugar-free group and 0.15 in the sugar group; the 95% confidence interval for the difference was -0.21 to -0.05. BMI is weight in kilograms divided by height in meters squared. Weight increased by 6.35 kg in the sugar-free group versus 7.37 kg in the sugar group, with a 95% confidence interval for the difference of -1.54 to -0.48 kg. Skinfold-thickness measurements, waist-to-height ratio, and fat mass also increased significantly less in the sugar-free group. Adverse events were minor.

When researchers combined 18-month measurements from 136 children who had discontinued the study with those from 477 who completed it, BMI z scores increased by 0.06 standard deviation units in the sugar-free group and 0.12 in the sugar group (P=0.06). The researchers concluded that masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children. The study was funded by the Netherlands Organization for Health Research and Development and others and registered as DRINK, ClinicalTrials.gov NCT00893529.