ISA comments in response to a review paper by Sylvetsky et al
Having reviewed the publication by Sylvetsky et al.1 about the potential implications for low calorie sweetener use in children, the International Sweeteners Association (ISA) would like to point out the lack of evidence to support any negative effects of low calorie sweeteners’ use during pregnancy, lactation or in early life on preference for sweetness, adiposity and other metabolic outcomes in children.
While we would welcome new high-quality research around low calorie sweeteners’ benefits, a need highlighted in the conclusions of the review work by Sylvetsky et al, it is also important to remark on the biased and unjustified presumptions supported in this publication, as current evidence doesn’t support that low calorie sweeteners may encourage a “sweet tooth”2. Importantly, clinical studies have shown that the replacement of sugary products with low calorie sweetened alternatives can help reduce weight gain and fat accumulation in children and adolescents.3, 4
In fact, research shows that there is no consistent association between low calorie sweetener intake and a heightened appetite for sugar or sweet products in children, while, in many instances, low calorie sweeteners’ use is associated with a lower intake of sweet tasting substances, suggesting that they may help to satisfy a desire for sweetness.2 Of course, when it comes to managing sweetness overall, it is critical that children are exposed to different tastes and introduced to a variety of healthy foods during early childhood to help them adopt overall healthy and balanced eating behaviours.
Similarly, when it comes to the use of low calorie sweeteners by pregnant and lactating women, there is no evidence supporting any negative impact on adiposity or other metabolic outcomes in infancy, childhood or later in adult life, despite the misleading assertions illustrated in a figure presenting potential effects of maternal non-nutritive sweeteners consumption during pregnancy (fig. 4 in Sylvetsky et al paper). In fact, while the role of maternal diet on adiposity and overall metabolic health is an area of high scientific interest, there is no human intervention study suggesting any negative effect of low calorie sweetener use on these outcomes.
Following an overall balanced diet during pregnancy and lactation as well as encouraging healthy eating behaviours early in childhood are recognised as some of the most critical aspects of reducing an individual’s risk of obesity and lifestyle-related diseases. Being mindful of the special nutritional needs in childhood, the use of low calorie sweetened foods and drinks within the context of an overall balanced diet can be helpful in managing a “sweet tooth” and childhood adiposity.