Low-calorie sweeteners in the human diet: scientific evidence, recommendations, challenges and future needs. A symposium report from the FENS 2019 conference.

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Autore(i): Gallagher AM, Ashwell M, Halford JCG, Hardman CA, Maloney NG and Raben A.
Publication name: Journal on Nutritional Science 2021; 10:E7. doi:10.1017/jns.2020.59
Publication year: 2021

Abstract

Overconsumption of free sugars, particularly from sugar-sweetened beverages (SSB), has potential negative health impacts. Implementation of a range of public health strategies is needed to reduce intakes of free sugars, including reducing portion sizes, promoting healthier dietary choices and reformulating foods and beverages. Although low-calorie sweeteners (LCS) are a useful tool for reducing energy intake and control glucose response when consuming sweet foods and drinks, several opinions persist about the adverse health effects of LCS, many of which are based on poor, little or no scientific evidence. This symposium report summarises key messages of the presentations and related discussions delivered at a scientific symposium at the 13th European Nutrition Conference (FENS 2019). These presentations considered the scientific evidence and current recommendations about the use and potential benefits of LCS for human health, with a particular focus on current evidence in relation to body weight and glycaemic control. Many of the studies to date on LCS have focused on low-calorie sweetened beverages (LCSB); however, the psychological and behavioural factors influencing consumer beliefs and consumption of LCSB need to be further explored. Current recommendations for LCS use are described, including the conclusions from a recent expert consensus report identifying the challenges that remain with LCS research. Finally, existing knowledge gaps and future actions are described, as well as two large ongoing research projects: SWITCH and SWEET.

Summary

The present symposium report summarises key learnings from the presentations and related discussions delivered at a scientific symposium at the 13th European Nutrition Conference (FENS 2019) regarding the scientific evidence and recommendations for the use of low/no calorie sweeteners. The scientific symposium at FENS 2019 was supported by the International Sweeteners Association (ISA).

The balance of evidence from systematic reviews and meta-analyses of randomised controlled trials (RCTs), which rank at the highest level of the “evidence hierarchy”, indicates potential benefit of low/no calorie sweeteners use, when substituting sugar, in reduced energy intake and body weight. Similarly, higher-quality evidence from systematic reviews and meta-analyses of RCTs shows that the ingestion of low/no calorie sweeteners does not affect postprandial levels of glucose or insulin, compared with a control such as water or placebo. It is also widely recognised that low/no calorie sweeteners cause a lower spike in blood glucose levels compared to sugars.

The paper also discussed existing knowledge gaps and two ongoing research projects, the SWITCH study and SWEET project. The authors conclude that, given the current public health interest on the impact of free sugars on human health and the potential benefits of low/no calorie sweeteners in helping achieve current recommendations for intakes of free sugars, it is important that the research findings from projects such as SWITCH and SWEET are translated into the public health space.

Finally, the authors discuss the importance of evidence-based policies and communications. It is noted that even with a well-developed evidence base, translation of any benefit of low/no calorie sweeteners into wider public health benefits will ultimately be hampered if scepticism surrounding sweeteners’ use persists. The authors state that: “Countering misinformation, where appropriate, is needed to ensure a balanced reporting of the public health relevance of the totality of the research evidence base”. They call for better risk-benefit communication to support wider public health strategies aimed at reducing excessive intakes of free sugars and thereby result in positive impacts on human health.

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