International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2–4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.
Low calorie sweetened foods and beverages could be included in dietary guidelines as alternatives to sugar and sugar-sweetened products, as low calorie sweeteners are safe ingredients that provide sweet taste with low or no calories and with no glycaemic effects, and thus with potential benefits for weight management and glucose control in diabetes. These are some key conclusions of an international panel of more than 60 scientific experts who met in a scientific event in Lisbon on 2-4 July 2017 organised by the Spanish Nutritional Research Foundation (FIN) in collaboration of the Lusófona University of Lisbon, and with the support of 43 organisations and foundations specialised in nutrition and dietetics, medical societies, universities and research centres in Europe and Latin America.
The scientific experts of the Lisbon Consensus discussed and evaluated the evidence in relation to the safety and regulation of low calorie sweeteners, their role in sugar reduction, weight management, glucose control and dental health, as well as other nutritional aspects of their use in foods and beverages and reached the below conclusions:
- Low calorie sweeteners are some of the most extensively evaluated substances in the human food chain. The safety of approved low calorie sweeteners has been reviewed and confirmed by health regulatory agencies globally, such as the WHO-FAO JECFA, FDA and EFSA.
- Consumer education about low calorie sweeteners must be strengthened in a rigorous, objective way, based on the best scientific evidence and regulatory processes.
- The use of low calorie sweeteners in place of sugar in weight reduction programmes may favour the reduction of excess weight and maintenance of weight loss in the context of structured diet plans. Furthermore, the use of low calorie sweeteners instead of sugar in diabetes control programme may contribute to a better glycaemic control. They also provide dental health benefits.
- It is suggested that foods and beverages with low calorie sweeteners are included as alternative options to sugar use in dietary guidelines.
- Health professionals are an important source of scientific information for both the general population and patients on issues related to food and health; therefore, continuing education on the safety, use and benefits of low calorie sweeteners to this group is necessary.