Scoping Review and Evidence Map of the Relation between Exposure to Dietary Sweetness and Body Weight-Related Outcomes in Adults

Abstract

Numerous governmental and health organizations recommend reduced intake of added sugars due to the health risks associated with excess intake, including the risk of obesity. Some organizations further recommend avoiding dietary sweetness, regardless of the source. A scoping review and evidence map were completed to characterize the research that investigated associations between dietary sweetness and body weight. The aim was to identify and map published studies that have investigated total dietary sweetness, sweet food/beverages, sugar, or sweetener intake, and body weight-related outcomes and/or energy intake. Using preregistered search terms (osf.io/my7pb), 36,779 publications (duplicates removed) were identified from PubMed, Cochrane Library, and Scopus and screened for inclusion. Eligible studies were clinical trials, longitudinal cohorts, case-control studies, cross-sectional studies, and systematic reviews conducted among adults (age ≥18 y), which were performed to investigate associations between dietary sweetness, sweet foods/beverages, sugar, or sweetener (energetic or nonenergetic) intake and body weight, BMI, adiposity, and/or energy intake. A total of 833 eligible publications were identified, detailing 804 studies. Only 7 studies (0.9% of included studies; 2 clinical trials, 4 cross-sectional studies, and 1 with another design type) investigated associations between total dietary sweetness and body weight-related outcome and/or energy intake. An additional 608 (75.6%) studies investigated intakes of sweet foods/beverages, sugar, or sweetener, and body weight-related outcomes and/or energy intake, including 225 clinical trials, 81 longitudinal cohorts, 4 case-control studies, and 280 cross-sectional studies. Most studies (90.6%) did not measure the sweetness of the diet or individual foods consumed. Ninety-two (11.4%) publications reported data from studies on dietary patterns that included sweet foods/beverages alongside other dietary components and 97 (12.1%) systematic reviews addressed different but related research questions. Although there is a breadth of evidence from studies that have investigated associations between intakes of sweet foods and beverages, sugars, and sweeteners and body weight, there is a limited depth of evidence on the association between total dietary sweetness and body weight.

Keywords: body composition; evidence map; ingestive behavior; scoping review; sensory; sugars; sweeteners; sweetness.

FIGURE 1

Categories and definitions of dietary sweetness exposures included in the scoping review and evidence map.

FIGURE 2

PRISMA flow diagram of studies that investigated the association between dietary sweetness and body weight-related outcomes among adults included in the scoping review and evidence map. ¹Duplicates removed not captured by EndNote. ²Automation tools described in Supplemental Methods.

FIGURE 3

Heat maps of specific outcomes reported in studies that investigated the association between dietary sweetness and body weight-related outcomes among adults by study design type and sweetness exposure. Number of studies that measured BW and/or BMI (A). B, Number of studies that measured energy intake (B). Number of studies that measured fat mass and/or body fat percentage (C). Number of studies that measured WC and/or W:H ratio (D). The different colors represent the different numbers of studies that reported each outcome by study design type and sweetness exposure.