Low/no calorie sweetened beverages during pregnancy do not adversely affect gut microbiome in infants

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ISA statement in response to the study by Laforest-Lapointe et al.

Brussels, 4th January 2021: Contrary to the claims made in a new study by Laforest-Lapointe et al.1, the International Sweeteners Association (ISA) points to the safety assessments by regulatory authorities around the world which have repeatedly and consistently confirmed the safety of all approved low/no calorie sweeteners, including in pregnancy.2,3,4

Such regulatory authorities include the Joint Food and Agriculture Organization (FAO)/ World Health Organization (WHO) Expert Committee on Food Additives (JECFA), the US Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA). It goes without saying that in order to be approved for use, these authorities thoroughly assess all kinds of studies examining potential side effects, including any effect on the gut function.

Also, it is important to highlight the fact that being a case-control study, which is a type of observational study, the Laforest-Lapointe et al. study has a number of limitations. In fact, this study design cannot determine a cause-effect relationship due to potentially unmeasured and residual confounding factors. Furthermore, the results of this study are based only on a small subset (n=100) of a bigger cohort.

As also acknowledged by the authors and confirmed by the study results, several factors other than the consumption of low/no calorie sweetened beverages are the major drivers of infant gut microbiome composition. For example, breastfeeding, birth mode, ethnicity, infant age, and intrapartum antibiotics have been found to have a major effect on the microbiome diversity, while the observed effect of the consumption of low/no calorie sweetened beverages was minimal. Further methodological limitations of this study may have affected the above observation, such as potential measurement error in self-reported intakes of beverages.

Similarly, the factors affecting infant weight gain and body mass index (BMI) at one-year old are numerous, with no evidence supporting any causal, direct link between the consumption of diet beverages during pregnancy and infant weight status. Any observed associations in observational studies are very likely to be due to reverse causality, such as pregnant women at risk of gaining weight turning to low/no calorie sweeteners in order to reduce their sugar and calorie intakes.

At a time when obesity and non-communicable diseases including diabetes and dental diseases remain major global health challenges, and in light of current public health recommendations to reduce overall sugar intake, low/no calorie sweeteners can be helpful in creating healthier food environments. They provide a wide choice of sweet-tasting options with low or no calories, and thus can be a useful tool, when used in place of sugar and as part of a balanced diet, in helping reduce overall sugar and calorie intake, as well as in managing blood glucose levels, including for pregnant women who may be at risk of gestational diabetes.5 Low/no calorie sweeteners are also not fermentable by oral bacteria, which means that they do not contribute to tooth demineralisation, which is one of the reasons for tooth decay.5 They can therefore contribute to good dental health, when used in place of sugar6 and as part of a tooth-friendly diet.

  1. Laforest-Lapointe I, Becker AB, Mandhane PJ, Turvey SE, Moraes TJ, Sears MR, Subbarao P, Sycuro LK, Azad MB, Arrieta MC. Maternal consumption of artificially sweetened beverages during pregnancy is associated with infant gut microbiota and metabolic modifications and increased infant body mass index. Gut Microbes 2021;13(1):1-15. doi: 10.1080/19490976.2020.1857513. (open access)
  2. http://www.fao.org/food/food-safety-quality/scientific-advice/jecfa/en/
  3. https://www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners
  4. http://www.efsa.europa.eu/en/topics/topic/sweeteners
  5. EFSA Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA 2011 Journal 9(6): 2229, and 9(4): 2076 and Commission Regulation 432/2012/EU (OJ L 136 25.5.2012, p. 1): http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:136:0001:0040:en:PDF
  6. Sugar substitutes and their role in caries prevention, FDI World Dental Federation, September 2008