Urinary Sweeteners and Sugars in Relation to Childhood Obesity: The SWEET Project

Background The roles of low-and no-calorie sweeteners (LNCS) and sugars in obesity remain debated, partly because of the limitations of self-reported dietary intakes. Objectives To examine cross-sectional associations between urinary LNCS and sugar concentrations and 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 y sampled from the Lifelines Cohort. LNCS and sugar concentrations were measured from timed overnight urine samples using ultra-pressure liquid chromatography coupled to tandem mass spectrometry. Multivariable linear regression models assessed associations of urinary LNCS and sugars (mg/mL or log-transformed urinary biomarker-to-creatinine ratio) 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 y, 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% confidence interval (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, whereas 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 because of the use of biomarkers.