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Declining erythritol levels during weight loss correlate with lower 2-year ASCVD risk estimatesLower erythritol levels linked to lower heart disease risk

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Key Takeaway
Note that declining erythritol levels during weight loss are associated with lower 2-year ASCVD risk estimates.

This observational analysis of an RCT evaluated the relationship between plasma polyol levels and cardiovascular risk in 802 to 805 adults with overweight or obesity. The study assessed 10-year ASCVD risk estimates and cholesterol in lipoprotein subfractions over a 2-year follow-up period.

At baseline, higher levels of erythritol (beta 1.1%), arabitol/xylitol (beta 1.3%), and mannitol/sorbitol (beta 1.1%) per 1 SD were associated with higher ASCVD risk estimates (P < 0.001). At 6 months, greater decreases in erythritol (but not other polyols) were associated with reductions in ASCVD risk estimates (beta: -0.16% per 1 SD reduction, P = 0.023).

At 2 years, initial 6-month declines in plasma erythritol were associated with long-term improvements in ASCVD risk (beta: -0.26%, P = 0.016). These early declines in erythritol were also associated with reductions in cholesterol in VLDL + LDL containing apoC-III. No safety or tolerability data were reported.

Because this is an observational analysis of an RCT, the results indicate associations rather than direct causation. The findings suggest that erythritol may serve as a marker for cardiovascular risk improvements during weight-loss interventions, but further prospective data are needed to establish clinical utility.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in the management of overweight and obesity by identifying a specific metabolic marker, erythritol, associated with cardiovascular risk. While prior coverage noted that specific serum biomarkers like CRP and Vitamin D show associations with sarcopenia and sarcopenic obesity, this study provides new data on erythritol as a potential indicator of cardiovascular risk during weight-loss interventions.

If you are managing weight or trying to improve your heart health, the ingredients in your diet might matter more than you think. Researchers looked at how certain sugar substitutes, called polyols, relate to heart health in adults with overweight or obesity. They specifically looked at erythritol, a common sugar substitute.

The study found that people with higher initial levels of erythritol had higher estimates for heart disease risk. However, when participants followed a weight-loss diet, those who saw a drop in erythritol levels also saw a decrease in their heart disease risk estimates. This drop in erythritol was also linked to lower levels of certain types of cholesterol that can harm your arteries.

It is important to remember that this was an observational look at a trial, not a direct test of the substance itself. While the link between lower erythritol and better heart health is promising, the study shows an association rather than a direct cause. Talk to your doctor about how these findings might affect your specific health goals.

What this means for you:
Lower levels of the sugar substitute erythritol are linked to lower heart disease risk and better cholesterol.

Common questions

What is erythritol?

Erythritol is a type of sugar substitute known as a polyol. This study looked at how its levels in the body relate to heart health risk and cholesterol in adults who are overweight or obese.

How does erythritol affect heart health?

The study found that higher initial levels of erythritol were linked to higher heart disease risk. However, when people followed a weight-loss diet and their erythritol levels dropped, their heart disease risk estimates also went down.

Does this mean erythritol causes heart problems?

This study was an observational analysis, which means it shows a link between erythritol and heart health, but it does not prove that one causes the other. You should speak with a healthcare provider about your specific diet.

Study Details

Study typeRct
Sample sizen = 802
EvidenceLevel 2
PublishedNov 2026
View Original Abstract ↓
BACKGROUND: High circulating concentrations of sugar alcohols (polyols) have recently been linked to increased risks of cardiovascular events. OBJECTIVES: We investigated whether temporal changes in plasma concentrations of erythritol and other isomeric polyols (arabitol/xylitol and mannitol/sorbitol) in response to weight-loss dietary interventions were associated with improvements in atherosclerotic cardiovascular disease (ASCVD) risk estimates and atherogenic lipid profiles among adults with overweight or obesity. METHODS: We performed an observational analysis using data from adults with overweight or obesity who participated in the 2-y Preventing Overweight Using Novel Dietary Strategies trial. Plasma erythritol, arabitol/xylitol, and mannitol/sorbitol were measured at baseline (n = 802, n = 805, and n = 803, respectively) and at 6 mo. Temporal changes were calculated among participants with measurements at both time points (n = 664, n = 669, and n = 668, respectively). The primary outcome was the 10-y ASCVD risk estimated using the validated pooled cohort equations. Two-year changes in cholesterol in lipoprotein subfractions with or without apolipoprotein C-III (apoC-III) were analyzed as secondary outcomes. RESULTS: Higher baseline levels of erythritol [β per 1 standard deviation (SD): 1.1%; standard error (SE): 0.2%], arabitol/xylitol (β: 1.3%; SE: 0.2%), and mannitol/sorbitol (β: 1.1%; SE: 0.2%) were associated with higher ASCVD risk estimates (P < 0.001 for all). Greater decreases in erythritol, but not the other polyols, were significantly associated with reductions in ASCVD risk estimates at 6 mo (β: -0.16%; SE: 0.07% per 1 SD reduction; P = 0.023). Initial (6-mo) declines in plasma erythritol were associated with long-term (2-y) improvements in ASCVD risk (β: -0.26%; SE: 0.11%; P = 0.016) and reductions in cholesterol in very-low-density lipoprotein + low-density lipoprotein containing apoC-III. CONCLUSIONS: Declines in plasma erythritol concentrations in response to weight-loss dietary interventions are associated with improvements in ASCVD risk estimates and atherogenic lipid subtypes containing apoC-III. These findings highlight the potential role of changes in plasma erythritol concentrations in relation to improvements in cardiometabolic risk among adults with overweight or obesity. This trial was registered at clinicaltrials.gov as NCT00072995.
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