Children can safely use low/no calorie sweeteners

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ISA statement in response to new policy statement by American Academy of Pediatrics

Brussels, 28th October 2019: Following the publication today of a new statement by the American Academy of Pediatrics on the use of low/no calorie sweeteners in children1, the International Sweeteners Association (ISA) acknowledges the importance of a healthy diet which provides the required amount of energy and nutrients to support children’s development. The ISA would want, however, to reassure the public on the safety of all approved low/no calorie sweeteners for both adults and children, as consistently confirmed by international regulatory authorities, such as FDA2, JECFA3 and EFSA4.

As part of the safety evaluation process, the risk assessment experts of these food safety agencies establish an Acceptable Daily Intake (ADI) for approved low/no calorie sweeteners, that represents the daily amount that can be safely consumed over a lifetime without any health risk, including by high-use consumers and children. The ADI is a scientific basis for establishing the legal maximum levels of low/no calorie sweeteners in different food categories, also those intended for children. Food safety agencies monitor intake of approved low/no calorie sweeteners, and research at global level confirms that low/no calorie sweeteners’ intake remains well below the individual sweetener Acceptable Daily Intake (ADI) among the general population, in both children and adults.5,6,7 Accordingly, the safety of consumers, including children, is assured by said agencies and the permitted maximum levels of low/no calorie sweeteners based on their scientific advice.

Of course, it is important to keep in mind that children, particularly young children, need ample calories for rapid growth and development, so choosing a wide variety of nutritious foods in the right amounts will allow a child to grow into a healthy weight. For instance, in the European Union, low/no calorie sweeteners, like any food additive, are not generally approved for use in foods intended for infants and young children under the age of three.

Also, the ISA would highlight the fact that consumers worldwide, including in the US, are informed about the presence of low/no calorie sweeteners in a particular product through the list of ingredients, where sweeteners are indicated by their name, as any other food ingredient.

At a time when obesity and non-communicable diseases including diabetes and oral diseases remain major global health challenges, and in light of current recommendations to reduce overall sugar intake including in children,8 low/no calorie sweeteners can be safely consumed by both adults and children, and within the context of a balanced diet and a healthy lifestyle they allow people to meet their innate desire for sweetness while helping them to reduce their calorie and sugar intake, and thereby help them manage their body weight.9,10,11,12,13 In their new statement, the AAP also recognises that: “When substituted for caloric-sweetened foods or beverages, NNSs [nonnutritive sweeteners] can reduce weight gain or promote small amounts of weight loss (+-1 kg) in children (and adults)”. Low/no calorie sweeteners can further be a useful tool in the management of blood glucose levels and the prevention of type 2 diabetes,14,15 and contribute to dental health,14 as also supported by food safety authorities and health organisations worldwide.5,16 In line with its mission to inform on the most up-to-date scientific information on the safety and utility of low/no calorie sweeteners, the ISA encourages consumer education on the benefits of a healthy and balanced diet and information on the role of low/no calorie sweeteners in the diet.17

Looking at appetite for sweetness specifically, controlled intervention studies in children with a duration of up to 18 months have shown that consumption of low/no calorie sweetened beverage tended to reduce rather than increase the intake of sugar-containing foods. Therefore, their use was associated with a lower intake of sweet tasting foods,18 which suggests that low/no calorie sweeteners do not encourage a “sweet tooth”, and may, on the contrary, help satisfy desire for sweetness.19

Used in foods, beverages and tabletop sweeteners, low/no calorie sweeteners can provide people, including children,20 with a wide choice of sweet-tasting options with low or no calories, and thus 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 in managing blood glucose levels. Low calorie sweeteners are also non-cariogenic, which means that they do not contribute to tooth decay.

  1. Baker-Smith CM, de Ferranti SD, Cochran WJ, AAP COMMITTEE ON NUTRITION, SECTION ON GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION. The Use of Nonnutritive Sweeteners in Children. Pediatrics. 2019;144(5):e20192765
  5. Martyn D, Darch M, Roberts A et al. Low-/No-Calorie Sweeteners: A Review of Global Intakes. Nutrients 2018, 10(3), 357
  6. David R. Tennant (2019) Estimation of exposures to non-nutritive sweeteners from consumption of tabletop sweetener products: a review, Food Additives & Contaminants: Part A, 36:3, 359-365
  7. David R. Tennant, A. Vlachou (2019) Potential consumer exposures to low/no calorie sweeteners: a refined assessment based upon market intelligence on use frequency, and consideration of niche applications, Food Additives & Contaminants: Part A, 36:8, 1173-1183
  8. WHO guidelines on ‘Sugars intake for adults and children’. 2015:
  9. Rogers PJ, Hogenkamp PS, de Graaf K, et al. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Int J Obes 2016; 40(3): 381-94
  10. de Ruyter, JC., Olthof, MR., Seidell, JC., & Katan, MB.. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med 2012;367(15):1397–1406
  11. de Ruyter, JC., Olthof, MR., Seidell, JC., & Katan, MB.. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med 2012;367(15):1397–1406
  12. Ebbeling CB, Feldman HA, Chomitz VR, Antonelli TA, Gortmaker SL, Osganian SK et al. A randomized trial of sugar-sweetened beverages and adolescent body weight. N Engl J Med 2012; 367: 1407–1416
  13. Katan MB, de Ruyter JC, Kuijper LD, Chow CC, Hall KD, Olthof MR. Impact of Masked Replacement of Sugar- Sweetened with Sugar-Free Beverages on Body Weight Increases with Initial BMI: Secondary Analysis of Data from an 18 Month Double–Blind Trial in Children. PLoS ONE. 2016; 11(7): e0159771
  14. EFSA Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA 2011 Journal 9(6): 2229, and 9(4): 2076.
  15. Nichol AD, Holle MJ, An R. Glycemic impact of non-nutritive sweeteners: a systematic review and meta-analysis of randomized controlled trials. Eur J Clin Nutr 2018; 72: 796-804
  16. Renwick AG. The intake of intense sweeteners – an update review. Food Addit Contam 2006 Apr; 23: 327-38
  18. de Ruyter, J. C., Katan, M. B., Kuijper, L. D., Liem, D. G., & Olthof, M. R. (2013). The effect of sugar-free versus sugar-sweetened beverages on satiety, liking and wanting: An 18 month randomized double-blind trial in children. PlosOne, 8(10), e78039.
  19. Bellisle F. Intense Sweeteners, Appetite for the Sweet Taste, and Relationship to Weight Management. Curr Obes Rep 2015; 4(1): 106-110
  20. Wakida-Kuzunoki GH, Aguiñaga-Villaseñor RG, Avilés-Cobián R, et al. Edulcorantes no calóricos en la edad pediátrica: análisis de la evidencia científica [Low calroie sweeteners in childhood: analysis of the scientific evidence]. Revista Mexicana de Pediatría 2017; 84(suppl 1): S3-S23 (in Spanish)