Artificial sweeteners are food additives with the technological function of conferring a sweet taste on foods, but with a very low or zero nutritional energy value. There are doubts among consumers about the health risks that might be associated with the use of non-caloric sweeteners. In the pediatric community, there is interest in the body of research that evaluates safety and possible use of these additives in some pathological situations or in healthy children. This paper, a working group after an extensive review of the literature and grading of the available evidence, provide to health professionals and particularly pediatricians, conclusions based on the quality of scientific literature. Regarding non- caloric sweeteners in childhood, the topics of interest that are the subject of critical analysis of the working group are: toxicological safety, potential impact on obesity and energy balance, caloric compensation, diabetes, carcinogenicity, teratogenicity, allergies, neurological aspects, lactation, phenylketonuria, gastrointestinal effects, mineral metabolism and dental caries.
Low calorie sweeteners can be safely consumed within the Acceptable Daily Intake (ADI) levels during any stage of life including childhood. There is no evidence of any risks or adverse effects from their use in childhood, or at pregnancy and lactation, at current levels of consumption. This is a key conclusion of a group of experts in Mexico comprised of medical, nutrition and scientific experts including paediatricians, endocrinologists, nutritionists among other researchers, who reviewed the available data about the use of low calorie sweeteners in childhood and evaluated the evidence according to the GRADE system.
Other conclusions of this experts’ review document include:
- The use of low calorie sweeteners in place of sugar can help reduce energy and carbohydrate intake in children; evidence also does not support an adverse effect of low calorie sweeteners on increasing appetite. Limited evidence shows that low calorie sweeteners’ use in place of sugar can lead to reduction of weight gain in children; a few studies in adolescents have shown that replacing sugar with sweeteners can have modest beneficial effects in overweight and obese adolescents. However, overall, evidence in children is limited and more trials in children are essential.
- In children with obesity, metabolic syndrome or diabetes, low calorie sweeteners can be an additional tool to be included within a healthy lifestyle that combines a balanced diet and physical activity.
- In general, since growth and development are stages where caloric restriction should not be promoted for healthy children, it is not justifiable to generally promote the use of low calorie sweeteners at this age. However, in children who require caloric restriction or sugar reduction, such as overweight or obese children, low calorie sweeteners can be used safely.