Science-based public health decision-making increases consumers’ confidence

Science news from the webinar organised by ISA and hosted by the National Food and Nutrition Institute (INAN)



  • Independent food safety agencies worldwide examine and assess the best available scientific evidence and, on that basis, confirm the safety of low/no calorie sweeteners.
  • A study by the Chilean Food Safety and Quality Agency (ACHIPIA) found that the intake of the most commonly consumed low/no calorie sweeteners is well below their Acceptable Daily Intakes (ADIs).
  • Low/no calorie sweeteners do have a role to play in weight and glucose control, but they are only part of the solution among a pool of dietary strategies.


At a webinar organised by the International Sweeteners Association (ISA) and hosted by the National Food and Nutrition Institute (INAN) of Paraguay, a technical body under the Ministry of Public Health and Social Wellbeing, three international experts were invited to talk about the safety of low/no calorie sweeteners, their intake levels and their role in weight control and diabetes.

From safety assessment to evidence about sweeteners’ efficacy, all topics discussed at this webinar are important for public health. And speakers agreed that public health and regulatory decisions should be based on the best available scientific evidence to reassure and increase consumers’ confidence.

How is the safety of low/no calorie sweeteners reassured?

Even if low/no calorie sweeteners have been approved and safely used for decades, there are still misconceptions about their safety assessment. Dr Rebeca López-García, an independent consultant and toxicologist from Mexico, explained that the safety of all food additives, including low/no calorie sweeteners, is assessed by food safety agencies around the world such as the Joint Expert Committee on Food Additives (JECFA) of FAO and WHO, but also by regional and national agencies. The stringent evaluations by food safety bodies, which may require many years to be completed, examine all the best available scientific evidence individually for each sweetener, as the characteristics and metabolism of these compounds vary greatly.

During the safety assessment and approval process by the food safety agencies and regulatory authorities, an Acceptable Daily Intake (ADI) is set for each individual sweetener. The ADI is the amount of a food additive (e.g. a sweetener) that can be safely consumed on a daily basis during a person’s entire lifetime without any appreciable health risk. The ADI takes into account all population groups, including more vulnerable ones, such as children and pregnant women.

Are individuals at risk of exceeding the acceptable daily intake of approved low/no calorie sweeteners?

With the safety of all approved low/no calorie sweeteners confirmed by global and regional food safety bodies, the next key question is if their intake from the diet is within the ADI that has been set for each sweetener. That was in fact the scope of a recent study that was presented at the webinar by Lic. Constanza Miranda, on behalf of the Chilean Food Safety and Quality Agency (ACHIPIA)1, who conducted this study upon a request from the local Ministry of Health, to examine whether the intake of sweeteners in Chile remains within their respective ADIs.

The study, performed by ACHIPIA with the support of the European Food Safety Authority (EFSA) and the German Federal Institute for Risk Assessment (BfR), aimed at assessing the chronic dietary exposure of the Chilean population to four commonly consumed low/no calorie sweeteners: acesulfame potassium, aspartame, sucralose, and steviol glycosides. ACHIPIA experts analysed intake data from the Chilean National Food Consumption Survey and also used analytical data from the Surveillance Programme for Food Additives carried out by the Ministry of Health of Chile between 2018 and 2019. The results showed that none of the sweeteners assessed exceeded its respective ADI in any of the exposure scenarios evaluated in the study, or in any of the age groups (including children). In fact, the intake of all four sweeteners was well below the ADI, even in the most conservative high-exposure scenarios. Based on these results, ACHIPIA experts concluded that the likelihood of exceeding the ADI of the four sweeteners through the consumption of the foods evaluated in the study is very low.1 The outcomes of this study are important in informing science-based decisions on the regulation and nutrition recommendations regarding low/no calorie sweeteners’ use and consumption in Chile.

Do low/no calorie sweeteners have a useful role in obesity, diabetes and overall in public health?

Beyond their confirmed safety, people also want to know if low/no calorie sweeteners could help them reduce free sugars intake, manage their calorie intake, lose weight or control their blood glucose. To answer this question, Prof. Alison Gallagher, Professor of Public Health Nutrition at Ulster University in Northern Ireland (UK), presented the latest evidence about the role of low/no calorie sweeteners in weight control and diabetes.

The evidence from systematic reviews of human controlled studies (i.e. randomised controlled trials or RCTs), which provide the most reliable causal evidence of how sweeteners may affect body weight or glucose control, shows that:

  • consuming low/no calorie sweeteners in place of sugars can have a beneficial effect on reducing sugars and energy (calorie) intake and assisting with weight control2-5
  • low/no calorie sweeteners do not affect glycaemic control and cause a lower blood glucose rise after food consumption when used instead of sugars6-9


These assertions have also been confirmed in a systematic review and meta-analysis of RCTs that was conducted recently by the WHO.10 Conclusions from RCTs are contrasted by findings of observational studies, which, however, are at high risk of bias from residual confounding and reverse causation. This means that a positive association between sweeteners’ intake and obesity or diabetes is likely observed because people turn to low/no calorie sweeteners as a means to help them reduce sugars intake, and in turn to manage their health condition, rather than the other way around.

Concluding remarks

At a discussion session, moderated by Lic. Marizela Lopez Cattebeke of the National Food and Nutrition Institute (INAN), the experts talked about the importance of science-based public health decision making and further clarified the nature and role of low/no calorie sweeteners in the diet. Low/no calorie sweeteners are food additives; hence, they do not have pharmacological (e.g., weight loss/ glucose lowering) properties. The contribution of low/no calorie sweeteners to weight loss is modest and depends on the amount of sugar (and calories) replaced in the diet. They should not be expected to be the solution to a complex problem such as obesity, but they can complement the overall toolbox of dietary strategies in order to help people reduce their sugars and calorie intake, and in turn manage their body weight and/ or blood glucose control. In conclusion, a short answer to the question if low/no calorie sweeteners could have a role to play in obesity and diabetes management is: “Yes, they do, but they are only part of the solution.”

You may watch the webinar on demand by clicking here.  

  1. Agencia Chilena para la Inocuidad y Calidad Alimantaria – ACHIPIA (Chilean Food Safety and Quality Agency). Chronic dietary exposure assessment on sweeteners in food consumed by the Chilean population. ACHIPIA 2021. Available at:
  2. Rogers PJ, Hogenkamp PS, de Graaf C, 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
  3. Rogers PJ and Appleton KM.The effects of low-calorie sweeteners on energy intake and body weight: a systematic review and meta-analyses of sustained intervention studies. Int J Obes 2021; 45(3): 464-478
  4. McGlynn ND, Khan TA, Wang L, et al. Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk: A Systematic Review and Meta-analysis. JAMA Network Open 2022;5(3):e222092
  5. Laviada-Molina H, Molina-Segui F, Pérez-Gaxiola G, et al. Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: Systematic review and meta-analysis. Obesity Reviews 2020; 21(7):e13020.
  6. Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA Journal 2011, 9(6), 2229. Available online: Available online:
  7. 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
  8. Greyling A, Appleton KM, Raben A, Mela DJ. Acute glycemic and insulinemic effects of low-energy sweeteners: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2020 Oct 1;112(4):1002-1014
  9. Lohner S, Kuellenberg de Gaudry D, Toews I, Ferenci T, Meerpohl JJ. Non-nutritive Sweeteners for Diabetes Mellitus. Cochrane Database of Systematic Reviews 2020 May 25;5:CD012885
  10. World Health Organization, Rios-Leyvraz Magali & Montez Jason‎. Health effects of the use of non-sugar sweeteners: a systematic review and meta-analysis. World Health Organization 2022. License: CC BY-NC-SA 3.0 IGO