Acute and two-week effects of neotame, stevia rebaudioside M and sucrose-sweetened biscuits on postprandial appetite and endocrine response in adults with overweight/obesity-a randomised crossover trial from the SWEET consortium

Background Sweeteners and sweetness enhancers (S&SE) are used to replace energy yielding sugars and maintainsweet taste in a wide range of products, but controversy exists about their effects on appetite and endocrine responsesin reduced or no added sugar solid foods. The aim of the current study was to evaluate the acute (1 day) and repeated(two-week daily) ingestive effects of 2 S&SE vs. sucrose formulations of biscuit with fruitfilling on appetite andendocrine responses in adults with overweight and obesity. Methods In a randomised crossover trial, 53 healthy adults (33 female, 20 male) with overweight/obesity in England andFrance consumed biscuits with fruitfilling containing 1) sucrose, or reformulated with either 2) Stevia Rebaudioside M(StRebM) or 3) Neotame daily during three, two-week intervention periods with a two-week washout. The primary outcomewas composite appetite score defined as [desire to eat + hunger + (100-fullness) + prospective consumption]/4. Findings Each formulation elicited a similar reduction in appetite sensations (3-h postprandial net iAUC).Postprandial insulin (2-h iAUC) was lower after Neotame (95% CI (0.093, 0.166); p < 0.001; d =-0.71) andStRebM (95% CI (0.133, 0.205); p < 0.001; d =-1.01) compared to sucrose, and glucose was lower after StRebM(95% CI (0.023, 0.171); p < 0.05; d =-0.39) but not after Neotame (95% CI (-0.007, 0.145); p = 0.074; d =-0.25)compared to sucrose. There were no differences between S&SE or sucrose formulations on ghrelin, glucagon-likepeptide 1 or pancreatic polypeptide iAUCs. No clinically meaningful differences between acute vs. two-weeks ofdaily consumption were found. Interpretation In conclusion, biscuits reformulated to replace sugar using StRebM or Neotame showed no differences in appetite or endocrine responses, acutely or after a two-week exposure, but can reduce postprandial insulin andglucose response in adults with overweight or obesity.