Low calorie sweeteners not associated to increased risk of mortality

Posted: 18 March 2019

ISA statement in response to the study by Malik et al.

There is no evidence that low calorie sweeteners could increase the risk of mortality, based on an overwhelming body of robust scientific evidence. Commenting on a new paper by Malik et al.1, the International Sweeteners Association (ISA) would like to highlight that low calorie sweeteners are amongst the most thoroughly researched ingredients worldwide. The safety of approved low calorie sweeteners has been repeatedly confirmed by regulatory authorities around the world such as the Joint Food and Agriculture Organization (FAO)/ World Health Organization (WHO) Expert Committee on Food Additives (JECFA), the US Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA).2,3,4

In this paper by Malik et al., the analyses of two observational prospective cohort US studies found that artificially-sweetened beverages (ASBs) consumption – only in the highest intake category of >4servings/ day – was associated with total and CVD (cardiovascular disease)-caused mortality only in the one study in women (Nurses’ Health Study), but not in men (Health Professionals’ Follow-up Study). Importantly, no association with cancer-caused mortality was found in neither study. Furthermore, and commenting on the clinical implication of their study, the authors state: “ASBs could be used to replace SSBs [sugar-sweetened beverages] among habitual SSB consumers but higher consumption of ASBs should be discouraged.”

It is important to highlight however that after adjusting for co-variates such as hypertension, hypercholesterolemia, type 2 diabetes mellitus, coronary heart disease, and stroke during follow-up, the association between ASBs and total mortality in women was attenuated, which indicates that reverse causation and confounding factors may well explain the observed association seen only for very high daily intake of ASBs (>4servings/day) and CVD in women, but not in men. Interestingly, this study further found that replacing 1 serving/d of SSB with 1 serving/d of ASB was associated with a 4% lower risk of total mortality, 5% lower risk of CVD mortality, and 4% lower risk of cancer mortality. This finding indeed suggests that replacing SSBs with ASBs may bring health benefits.

Used in foods, beverages and tabletop sweeteners, low calorie sweeteners can provide people with a wide choice of sweet-tasting options with low or no calories. Therefore, they can be a useful tool, when used in place of sugar and as part of a balanced diet, in helping reduce overall sugar and calorie intake, as well as manage blood glucose levels. Low calorie sweeteners are also non-cariogenic, which means that they do not contribute to tooth decay.


  1. Malik et al. Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. 2019;139:00–00. DOI: 10.1161/CIRCULATIONAHA.118.037401
  2. http://www.fao.org/food/food-safety-quality/scientific-advice/jecfa/en/
  3. http://www.fda.gov