(P19-013-25) Effect of Replacing Added Sugars With Sucralose on Gut Microbiome Composition Among Asian Indian Adults in Two 12-Week Randomized Controlled Trials

Objectives: Replacing added sugars with non-nutritive sweeteners, such as sucralose, may help reduce weight gain in adults over time. Because sucralose is primarily excreted in the stool, its consumption could lead to changes in the gut microbiome. Current evidence supporting this hypothesis is mixed. We aimed to explore whether replacing sucrose with sucralose led to changes in gut microbiome composition among Asian Indian adults with obesity (BMI ≥25 kg/m²) or type 2 diabetes (T2D).

Methods: In two analogous sub-studies nested within 12-week, parallel-arm randomized controlled trials, adults with T2D (trial 1) or obesity (trial 2) were instructed to replace sucrose in their daily coffee and tea with sucralose (n=25 or 23, respectively) or to continue their use of sucrose (n=24 or 25, respectively). Gut microbiome composition was profiled using 16S rRNA sequencing of the V3-V4 region in stool samples collected before and after the 12-week interventions. The false discovery rate (FDR) was controlled using the Benjamini-Hochberg method.

Results: Compared with the control group, the sucralose intervention increased α diversity (p=0.02 for Shannon Index) and β diversity (p=0.005) in the gut microbiome communities of adults with T2D. The Firmicutes: Bacteroides ratio increased in the T2D intervention group [β (SD): 2.19 (2.08); p< 0.0001] but not in the T2D control group [β (SD): 0.98 (3.22); p=0.15] (between-group difference: p=0.13). Among 591 species detected in the T2D study, relative abundances of 11 sugar-fermenting or short-chain fatty-acid-producing species were reduced, and one species (Enterococcus) was increased after the intervention compared with the control (FDR < 0.20). There was no evidence that changes in gut microbial species mediated the observed reductions in body weight or waist circumference in the intervention group among adults with T2D. In the trial among adults with obesity, no significant differences in changes in overall gut microbiome composition were observed in the intervention versus control group.

Conclusions: Among Asian Indian adults with T2D replacing daily sucrose added to coffee and tea with sucralose resulted in changes in gut microbiome composition, primarily driven by reductions in sugar-fermenting bacteria.

Funding Sources: M/S Zydus Wellness and NIH