Declines in plasma erythritol levels and improvements in insulin sensitivity and glucose metabolism: POUNDS lost trial
4 affiliations
- 1Department of Epidemiology, Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA USA
- 2Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
- 3Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA USA
- 4Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
Abstract
Background: Erythritol is a non-nutritive sweetener that is also endogenously produced from glucose. We investigated whether declines in plasma erythritol and other sugar alcohols (polyols) in response to weight-loss dietary interventions were significantly associated with long-term improvements in glucose metabolism and insulin sensitivity.
Methods: Plasma erythritol, mannitol/sorbitol, and arabitol/xylitol were repeatedly measured among adults with overweight or obesity who participated in the POUNDS Lost trial (n = 802 at baseline and n = 664 at 6 months). We analyzed associations of changes in erythritol, mannitol/sorbitol, and arabitol/xylitol from baseline to 6 months with changes in homeostasis model assessment of insulin resistance (HOMA-IR), fasting insulin, fasting glucose, and HbA1c at 6 months and 2 years of intervention.
Results: Plasma erythritol levels were positively related to HOMA-IR, fasting insulin, and glycemic markers at baseline. Greater declines in plasma erythritol in response to the interventions were associated with greater reductions in HOMA-IR (p < 0.001) and fasting insulin (p < 0.001) at 6 months. Similar associations were found for changes in arabitol/xylitol, but not for mannitol/sorbitol. Every 1 SD reduction in plasma erythritol during the initial 6-month period was related to long-term (2-year) decreases in log-transformed HOMA-IR (β [SE] –0.07 [0.02], p = 0.008) and glycemic markers (β –1.0 [0.44] mg/dL, p = 0.025 for fasting glucose; β –0.05% [0.02%], p = 0.019 for HbA1c).
Conclusion: Declines in plasma erythritol may be related to long-term improvements in insulin sensitivity and glycemic status during weight-loss dietary interventions in adults with overweight or obesity.
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BibTeX
@article{heianza2026declines,
title = {{Declines in plasma erythritol levels and improvements in insulin sensitivity and glucose metabolism: POUNDS lost trial}},
author = {Yoriko Heianza and Jennifer C. Rood and Catherine M. Champagne and Frank B. Hu and George A. Bray and Frank M. Sacks and Lu Qi},
journal = {International Journal of Obesity (2005)},
year = {2026},
month = jul,
doi = {10.1038/s41366-026-02152-w},
url = {https://doi.org/10.1038/s41366-026-02152-w},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Declines in plasma erythritol levels and improvements in insulin sensitivity and glucose metabolism: POUNDS lost trial
AU - Yoriko Heianza
AU - Jennifer C. Rood
AU - Catherine M. Champagne
AU - Frank B. Hu
AU - George A. Bray
AU - Frank M. Sacks
AU - Lu Qi
PY - 2026
DA - 2026/07/21
JO - International Journal of Obesity (2005)
DO - 10.1038/s41366-026-02152-w
UR - https://doi.org/10.1038/s41366-026-02152-w
AB - Background: Erythritol is a non-nutritive sweetener that is also endogenously produced from glucose. We investigated whether declines in plasma erythritol and other sugar alcohols (polyols) in response to weight-loss dietary interventions were significantly associated with long-term improvements in glucose metabolism and insulin sensitivity. Methods: Plasma erythritol, mannitol/sorbitol, and arabitol/xylitol were repeatedly measured among adults with overweight or obesity who participated in the POUNDS Lost trial (n = 802 at baseline and n = 664 at 6 months). We analyzed associations of changes in erythritol, mannitol/sorbitol, and arabitol/xylitol from baseline to 6 months with changes in homeostasis model assessment of insulin resistance (HOMA-IR), fasting insulin, fasting glucose, and HbA1c at 6 months and 2 years of intervention. Results: Plasma erythritol levels were positively related to HOMA-IR, fasting insulin, and glycemic markers at baseline. Greater declines in plasma erythritol in response to the interventions were associated with greater reductions in HOMA-IR (p < 0.001) and fasting insulin (p < 0.001) at 6 months. Similar associations were found for changes in arabitol/xylitol, but not for mannitol/sorbitol. Every 1 SD reduction in plasma erythritol during the initial 6-month period was related to long-term (2-year) decreases in log-transformed HOMA-IR (β [SE] –0.07 [0.02], p = 0.008) and glycemic markers (β –1.0 [0.44] mg/dL, p = 0.025 for fasting glucose; β –0.05% [0.02%], p = 0.019 for HbA1c). Conclusion: Declines in plasma erythritol may be related to long-term improvements in insulin sensitivity and glycemic status during weight-loss dietary interventions in adults with overweight or obesity.
SN - 0307-0565
SN - 1476-5497
ER -