Background: The roles of low-and no-calorie sweeteners (LNCS) and sugars in obesity remain debated, partly due to the limitations of self-reported dietary intakes.
Objective: To examine cross-sectional associations between urinary LNCS and sugar concentrations and body mass index (BMI) and waist-to-height (WHtR) z-scores in Dutch children and adolescents.
Methods: We used data and urine samples of 500 participants aged 8-17 years sampled from the Lifelines Cohort. LNCS and sugar concentrations were measured from timed overnight urine samples using UPLC-MS/MS. Multivariable linear regression models assessed associations of urinary LNCS and sugars (mg/mL or log-transformed urinary biomarker-to-creatinine ratio [UBCR]) with BMI and WHtR z-scores, adjusting for age, sex, screen time hours, and fruit and vegetable frequencies of use.
Results: The median age of the study population was 14 years, and 50% (n = 249) were girls. Mean BMI z-score amounted to 0.10 (SD: 1.0) and WHtR z-score was 0.16 (SD: 1.0). Urinary saccharin was independently associated with BMI z-score (βmg/mL: 51.59 [95% CI: 7.96, 95.21]), and urinary sucralose with both BMI z-score (βmg/mL: 291.29 [95% CI: 98.01, 484.58]) and WHtR z-score (βmg/mL: 238.75 [95% CI: 44.53, 432.98]). Inverse associations with BMI z-score were observed for urinary sugar concentrations: total sugar, fructose, glucose, and similarly for WHtR z-score. BMI and WHtR z-scores were not significantly associated with urinary sucrose, total urinary LNCS, acesulfame, cyclamate and steviol.
Conclusions: Urinary saccharin and sucralose were positively associated with indicators of general and abdominal obesity in children and adolescents, while total urinary sugar, glucose, and fructose showed inverse associations. These findings likely reflect differences in dietary patterns of children and adolescents according to weight status, as misreporting can be excluded due to the use of biomarkers.
Keywords: biomarkers; childhood obesity; metabolic health; sugars; sweeteners.