Scientific evidence to inform guidelines: The role of sweeteners in diet and health

Key outcomes of the Scientific Report of the 2020 Dietary Guidelines Advisory Committee in the U.S.


  • The typical American diet results in overconsumption of fats, sodium and added sugars, while intakes of fruits, vegetables, and whole grains are lower than recommended.
  • Excess intake of added sugars should be reduced but focus should also be on the overall diet quality.
  • Available evidence suggests that low- or no-calorie sweetened beverage consumption is associated with reduced adiposity in adults while limited evidence indicates no association for children.

The scientific report prepared by the experts of the 2020 Dietary Guidelines Advisory Committee1 will inform the next edition of the Dietary Guidelines for Americans 2020-2025 aiming to help address the major public health challenges of overweight and obesity and related co-morbidities that are associated with poor diets. Tackling obesity is getting more urgent amidst the new coronavirus outbreak as these two major health challenges have been found to be inter-related. Seventy percent (70%) of Americans have overweight or obesity, and accumulating evidence shows that excess weight can increase risk of serious illness and death from COVID-19.2

Focus on dietary patterns: It’s the whole diet that matters the most

An important feature of the 2020 Committee’s report is the focus on dietary patterns. People do not eat nutrients in isolation but a combination of foods and drinks with various nutrients and ingredients, which, as a whole, is more likely to affect health or the risk of chronic disease than any single food or ingredient. The quantities, frequency and combination of what we eat and drink is what we call a dietary pattern.

Analysing data regarding the dietary patterns of Americans, the scientific report identified a consistent profile associated with health benefits, which is described by: higher intake of vegetables, fruits, legumes, whole grains, low- or non-fat dairy, lean meat and poultry, seafood, nuts and unsaturated vegetable oils, and low consumption of red and processed meats, sugar-sweetened foods and drinks, and refined grains. It is shown that a high-quality dietary pattern can help achieve nutrient adequacy and energy balance, promote health and reduce the risk of diet-related chronic conditions such as overweight and obesity, type 2 diabetes, cardiovascular diseases, bone diseases, cancer and neurocognitive disorders.

Intake of added sugars is higher than recommended

Patterns of food group intake have not changed over the last decade. Americans exceed the recommended amounts for fats and added sugars for all age groups, while intakes of fruit, vegetables, dairy, and whole grains are generally below recommended amounts. The 2020 Dietary Guidelines Advisory Committee re-examined data regarding added sugars consumption and suggested that reducing the amount of added sugars in the diet through changes in consumer behaviour and/ or food production could contribute to improved population health. The Committee concludes that less than 6% of total energy intake from added sugars (versus 10% recommended by the current guidelines) is more in line with a healthier dietary pattern.

The role of beverages in a healthy dietary pattern

Beverages have important roles in our diet, mainly helping us to meet our hydration needs. Even a mild dehydration may result in reduced cognitive and physical performance. At the same time, questions have arisen about whether some types, amounts, and frequency of beverage consumption may contribute to overweight and obesity or other health issues. Therefore, the Committee reviewed the available data on the relationships between beverage consumption and growth, size, body composition, and risk of overweight and obesity for children and adults. Among the beverages examined, only sugar-sweetened beverage intake was associated with adiposity.

Regarding low/no calorie sweetened beverages, upon a systematic review of the evidence examining their role on adiposity, the Committee concluded that: “Limited evidence suggests that LNCSB [low/no calorie sweetened beverage] consumption is associated with reduced adiposity in adults. The studies reviewed in adults and children did not provide evidence that LNCSB promote weight gain or adiposity.” The review included 17 prospective cohort studies for children and 20 studies (6 randomised controlled trials and 14 prospective cohort studies) for adults which met the pre-set criteria. Considering several factors, the Committee recommends low/no calorie sweeteners to be considered as an option for managing body weight.

Take home message

As the American diet continues to be far from a healthy dietary pattern, and overweight and obesity rates are still at concerning levels, there is a need for dietary tools that can help adults and children follow a higher quality diet. In light of this, low/no calorie sweeteners as approved food and drink ingredients with well-established safety may bring benefits to consumers by helping reduce excess sugar and calorie intake and, thus, have a useful role as part of an overall healthy diet.

  1. Dietary Guidelines Advisory Committee. 2020. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC.
  2. Public Health England (PHE). Excess weight and COVID-19: Insights from new evidence. Published July 2020. Available at: