(P25-007-25) Non-nutritive-Sweetened Beverages Are Similar to Water in SSBs Reduction: Strategies to Oppose Sugars With Non-nutritive Sweeteners or Water (STOP Sugars NOW) Trial

Objectives: Major health authorities recommend against the use of non-nutritive sweetened beverages (NSB) as a replacement for sugars-sweetened beverages (SSB). We aim to assesses the effect of NSBs versus water for SSBs reduction on concerns related to the microbiome, glucose tolerance, and related risk factors.

Methods: We conducted a pragmatic, open-label, crossover, randomized trial in adult consumers of SSB (≥1 serving/day) with obesity (high BMI + waist circumference [WC]). Participants were randomized to 3 4-wk interventions (SSB, NSB, water) separated by ≥4-wk washouts. We prespecified 3 substitutions: NSB for SSB (intended), water for SSB (standard of care), and NSB for SSB (reference). Primary outcomes were gut microbiota beta diversity by 16S rRNA (weighted UniFrac distance) and glucose tolerance (75g oral glucose tolerance test incremental area under the curve [iAUC]). Other outcomes included related markers of adiposity, glucose-insulin regulation, lipids, and blood pressure (BP). Urinary biomarkers assessed adherence to SSB (fructose, sucrose) and NSB (acesulfame-potassium, sucralose). Prespecified analyses were by intention-to-treat (ITT; primary), completers (C), and per protocol (PP).

Results: Of 80 randomized participants (51% female; mean [SD] age, 42 y [13]; BMI, 33.7 kg/m² [6.8]; WC, 109 cm [13.5]; SSB intake, 1.9 servings/d [range, 1-5]), 66 (83%) completed and 52 (65%) followed the protocol. There were no differences in the 2 primary outcomes across the prespecified analyses. Substituting NSB for SSB improved WC (PP), fasting triglycerides (ITT, C, PP), and HDL-C (C), while water for SSB improved insulin sensitivity (C, PP), insulin iAUC (C, PP), fasting C-peptide (PP), triglycerides (ITT, C, PP), HDL-C (C, PP), and diastolic BP (ITT, C, PP) (p < 0.05). NSB and water were not different for any outcome. Urinary biomarkers confirmed adherence to the interventions. Adverse events were low with no differences.

Conclusions: In participants with obesity, NSB or water for SSB reduction did not affect glucose tolerance or gut microbiota with advantages for other cardiometabolic risk factors. Stronger adherence resulted in greater reductions, requiring consideration in SSBs reduction programs.

Funding Sources: Canadian Institute for Health Research (CIHR)