Acceptability of Brazzein-Sweetened Ice Cream as a Sugar-Reduction Strategy in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Double-Blind Randomized Crossover Sensory Study

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 25%–30% of adults globally. Dietary sugar reduction is one of the key therapeutic targets, but elimination of sugar-sweetened foods may compromise adherence to calorie-restricted diets. Brazzein, a natural sweet protein that is 500–2000 times sweeter than sucrose, offers a promising substitute, yet clinical data in patients with MASLD are lacking. In a double-blind, randomized, two-period crossover trial, 103 adults with MASLD tasted iso-sweet vanilla ice cream sweetened with either brazzein or sucrose on two consecutive days. Overall impression and sensory attributes (appearance, color, aroma, flavor, and texture) were rated on 5-point hedonic scales, and the percentage of the 100 g portion consumed was recorded. Brazzein-sweetened ice cream met the prespecified criteria for both non-inferiority and equivalence versus sucrose for overall impression. Top-2 box acceptance (ratings ≥4) was extremely high and nearly identical (96.1% for brazzein and 98.1% for sucrose). Mean consumption exceeded 98% of the portion for both products, with no significant difference between sweeteners. Secondary sensory ratings were closely similar, and multivariate analyses indicated highly overlapping sensory profiles. Exploratory subgroup analyses suggested consistent findings across most demographic and clinical characteristics, although participants with advanced liver fibrosis (LSM ≥9.6 kPa) showed numerically higher ratings for sucrose. Liver stiffness was the only significant predictor of consumption, with slightly lower intake at higher stiffness values. This study provides the first evidence that brazzein-sweetened ice cream maintains consumer acceptability comparable to a conventional sucrose-sweetened product in a clinically relevant population, supporting its potential integration into dietary management strategies for MASLD.