Low calorie sweeteners: a useful tool in helping reduce overall calorie intake in both adults and children

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ISA statement in response to new study by Sylvetsky et al.

The International Sweeteners Association (ISA) responds to a new study by Sylvetsky et al.1, pointing to the overwhelming body of scientific evidence that shows low calorie sweeteners can help adults and children reduce their calorie intake and be a useful tool to help manage their body weight, when used instead of sugar, and as part of a varied and balanced diet and a healthy lifestyle.2,3,4,5

By replacing sugars in common foods and beverages, low calorie sweeteners can help decrease the energy density of these foods, which, in turn, can mean significant calorie savings. In contrast to the outcomes of this publication by Sylvetsky et al., findings of robust studies conducted in other populations, in adults6,7 and in both children and adults8,9, have shown that the consumption of low calorie sweeteners is associated with an overall higher diet quality and lower sugar intake. In fact, another recent NHANES (National Health and Nutrition Examination Survey) data analysis from 2009-2016, found that across all life stages including in children and adolescents, consumers of low- and no-calorie sweetened beverages had actually lower intakes of total sugars, added sugars and carbohydrates compared to sugary beverage consumers.8

Looking at the study by Sylvetsky et al. in more detail, and to put its findings into context, it is crucial to first highlight the limitations associated with its design: being a cross-sectional observational study, its findings cannot establish causality. In addition, the authors themselves state that their analysis did not take into account the quality of the overall diet from participants, a potential confounding factor which may well have influenced the results of the study.

Another serious limitation of their analysis, which makes the study findings further questionable, is the reporting method used for the beverage intake assessment. Indeed, this assessment, and therefore the whole study outcomes, were based on the use of a single and self-reported 24-hour recall, by the children or their parents. This method may bring significant bias to the study, as the results were not based on an actual measurement of dietary intake, but on the self-reported consumption of beverages and over one single day only, which may well not reflect their usual diet. Furthermore, from a statistical perspective, the group categorisation used in this data analysis makes it difficult to disentangle low calorie sweetened beverage (LCSB) from sugary beverage consumption in each group. For example, participants were characterised as LCSB consumers if they reported consumption of greater than or equal to 4 oz of LCSB on a single day, and less than 4 oz of sugar beverages, which however is not a negligible amount and could well have affected results about energy and sugar intake. Finally, the number of participants in the LCSB group is small (n=345; approx. 6% of the sample).

Used in foods, beverages and tabletop sweeteners, low calorie sweeteners can provide people with a wide choice of sweet-tasting options with low or no calories, thus can be a useful tool, when used in place of sugar and as part of a varied and balanced diet and a healthy lifestyle, in helping reduce overall sugar and calorie intake, as well as manage blood glucose levels.10 Low calorie sweeteners are also non-cariogenic, which means that they do not contribute to tooth decay.10

  1. Sylvetsky AC, Figueroa J, ZimmermanT, Swithers SE, Welsh JA. Consumption of low?calorie sweetened beverages is associated with higher total energy and sugar intake among children, NHANES 2011–2016. Pediatric Obesity. 2019;1–5. https://doi.org/10.1111/ijpo.12535
  2. Extract from publication: “We found a considerable weight of evidence in favour of consumption of LES [low energy sweeteners] in place of sugar as helpful in reducing relative EI [energy intake] and BW [body weight], with no evidence from the many acute and sustained intervention studies in humans that LES increase EI”. Rogers PJ., Hogenkamp PS., de Graaf C., Higgs S., Lluch A., Ness AR., . . . Mela DJ. 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. Gibson S, Drewnowski J, Hill A, Raben B, Tuorila H and Windstrom E. Consensus statement on benefits of low calorie sweeteners. Nutrition Bulletin 2014; 39(4): 386-389
  4. Extract from publication: “replacement of a sugar-containing beverage with a sugar-free beverage significantly reduced weight gain and body fat gain in healthy children”. de Ruyter, JC., Olthof, MR., Seidell, JC., & Katan, MB.. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med 2012;367(15):1397–1406
  5. Extract from publication: “results provide support for the use of NNS [non?nutritive sweeteners] beverages as a tool to help with weight loss and maintenance”. Peters, J. C., Beck, J., Cardel, M., Wyatt, H. R., Foster, G. D., Pan, Z., . . . Hill, J. O. (2016). The effects of water and non-nutritive sweetened beverages on weight loss and weight maintenance: A randomized clinical trial. Obesity (Silver Spring), 24(2), 297-304
  6. Drewnowski A., Rehm C., Consumption of Low-Calorie Sweetners among U.S. Adults Is Associated with Higher Healthy Eating Index (HEI 2005) Scores and More Physical Activity Journal: Nutrients, 2014, 6, 4389-4403; doi: 10.3390/nu6104389
  7. Patel L, Alicandron G, La Vecchia C. Low-calorie beverage consumption, diet quality and cardiometabolic risk factor in British adults. Nutrients 2018; 10: 1261
  8. Barraj LM, Bi X, Murphy MM, Scrafford CG and Tran NL. Comparisons of Nutrient Intakes and Diet Quality among Water-Based Beverage Consumers. Nutrients 2019, 11, 314; doi:10.3390/nu11020314
  9. Silva Monteiro L, Kulik Hassan B, Melo Rodrigues PR, Massae Yokoo E, Sichieri R, Alves Pereira R. Use of table sugar and artificial sweeteners in Brazil: National Dietary Survey 2008-2009. Nutrients 2018 Mar 1;10(3). pii: E295. doi: 10.3390/nu10030295
  10. The European Food Safety Authority (EFSA) has concluded that: “Consumption of foods/drinks containing intense sweeteners instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods/drinks” and that: “Consumption of foods/drinks containing intense sweeteners instead of sugar contributes to the maintenance of tooth mineralisation”. EFSA Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA 2011 Journal 9(6): 2229, and 9(4): 2076