The effect of sugar-free versus sugar-sweetened beverages on satiety, liking and wanting: an 18 month randomized double-blind trial in children

Abstract

Background: Substituting sugar-free for sugar-sweetened beverages reduces weight gain. A possible explanation is that sugar-containing and sugar-free beverages cause the same degree of satiety. However, this has not been tested in long-term trials.

Methods: We randomized 203 children aged 7-11 years to receive 250 mL per day of an artificially sweetened sugar-free beverage or a similarly looking and tasting sugar-sweetened beverage. We measured satiety on a 5-point scale by questionnaire at 0, 6, 12 and 18 months. We calculated the change in satiety from before intake to 1 minute after intake and 15 minutes after intake. We then calculated the odds ratio that satiety increased by 1 point in the sugar-group versus the sugar-free group. We also investigated how much the children liked and wanted the beverages.

Results: 146 children or 72% completed the study. We found no statistically significant difference in satiety between the sugar-free and sugar-sweetened group; the adjusted odds ratio for a 1 point increase in satiety in the sugar group versus the sugar-free group was 0.77 at 1 minute (95% confidence interval, 0.46 to 1.29), and 1.44 at 15 minutes after intake (95% CI, 0.86 to 2.40). The sugar-group liked and wanted their beverage slightly more than the sugar-free group, adjusted odds ratio 1.63 (95% CI 1.05 to 2.54) and 1.65 (95% CI 1.07 to 2.55), respectively.

Conclusions: Sugar-sweetened and sugar-free beverages produced similar satiety. Therefore when children are given sugar-free instead of sugar-containing drinks they might not make up the missing calories from other sources. This may explain our previous observation that children in the sugar-free group accumulated less body fat than those in the sugar group.

Trial registration: ClinicalTrials.gov NCT00893529 http://clinicaltrials.gov/show/NCT00893529.

Figure 1. Randomization and follow-up of the study participants.

In the sugar-free group, allergy was reported as an adverse event for one child. In the sugar-group, allergy was reported as an adverse event for one child, and weight increase was reported as an adverse event for one child.

Figure 2. Time schedule for filling out the questionnaire.

The timeline is indicative because each school had its own timing of the morning break.

Figure 3. Satiety after intake minus satiety before intake of the beverages at 18 months in 146 children.

Satiety was scored from 1 (not full at all) to 5 (very full). Bars indicate the shift in satiety from before to after intake of the beverages. Panel A shows satiety 1 minute after intake; Panel B, 15 minutes after intake. An increase of 1 means any increase of 1 point on the 5-point scale.

Figure 4. Arithmetic mean scores for satiety, liking, and wanting over the course of the trial.

Dashed lines, sugar group; solid lines, sugar-free group. T bars indicate one standard deviation