Brussels, 08 July 2026: The International Sweeteners Association (ISA) notes the publication of a new narrative review with a meta-analysis by Wang et al. examining the effects of low/no calorie sweeteners (LNCS) on cardiometabolic health. These findings do not alter the overall evidence base supporting LNCS as alternatives to sugar and should be interpreted cautiously given the very small magnitude of the reported effects and several important methodological considerations.
The authors’ conclusions rely largely on statistically significant increases in fasting insulin and HbA1c. However, the reported increase in HbA1c was only 0.07%, a difference that is unlikely to be clinically meaningful and is below the level generally considered relevant for glycaemic management. Moreover, fasting insulin is a surrogate biomarker that is difficult to interpret in isolation, particularly in the absence of consistent effects across other measures of glucose metabolism and insulin sensitivity. All other markers of cardiometabolic health including blood glucose, insulin sensitivity, blood pressure and lipid profile did not differ significantly between LNCS and placebo or water, while no comparison was made with sugars or other caloric comparators.
Furthermore, the review’s assessment of observational evidence does not adequately account for important sources of bias, including reverse causality and the effects of substituting sugars with LNCS. Recent studies that have explicitly considered these factors have generally found evidence consistent with neutral or beneficial effects of LNCS on body weight and cardiometabolic outcomes.
Notably, the review focused on comparisons of LNCS with non-caloric controls, such as water, rather than on their intended use as substitutes for sugar. From a public health perspective, the most relevant question is whether replacing sugar with LNCS delivers a net health benefit. Evidence from substitution studies shows that, as part of an overall healthy diet and lifestyle, low/no calorie sweeteners can be used to support public health objectives to reduce sugar intake and ultimately assist in weight and diabetes management, as well as with dental health.