The use of nonnutritive sweeteners in children

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Author(s): Carissa M. Baker-Smith, Sarah D. de Ferranti, William J. Cochran and COMMITTEE ON NUTRITION, SECTION ON GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION
Publication name: Pediatrics. 2019;144(5):e20192765
Publication year: 2019


The prevalence of nonnutritive sweeteners (NNSs) in the food supply has increased over time. Not only are more children and adolescents consuming NNSs, but they are also consuming a larger quantity of NNSs in the absence of strong scientific evidence to refute or support the safety of these agents. This policy statement from the American Academy of Pediatrics is intended to provide the pediatric provider with a review of (1) previous steps taken for approved use of NNSs, (2) existing data regarding the safety of NNS use in the general pediatric population, (3) what is known regarding the potential benefits and/or adverse effects of NNS use in children and adolescents, (4) identified gaps in existing knowledge and potential areas of future research, and (5) suggested talking points that pediatricians may use when discussing NNS use with families.


The current policy statement by the American Academy of Pediatrics concludes to a set of key findings and recommendations in relation to low/no calorie sweeteners [also called non-nutritive sweeteners (NNS)].

In relation to findings and recommendations about the role of low/no calorie sweeteners, the paper states that: “When substituted for caloric-sweetened foods or beverages, NNSs can reduce weight gain or promote small amounts of weight loss (+-1 kg) in children (and adults); however, data are limited, and use of NNSs in isolation is unlikely to lead to substantial weight loss.” It also concludes that, individuals affected by certain conditions (eg, obesity and type 1 or 2 diabetes mellitus) may benefit from the use of low/no calorie sweeteners if substituted for caloric sweeteners. Furthermore, the report concludes that with the exception of aspartame and neotame in children with phenylketonuria, there are no absolute contraindications to the use of low/no calorie sweeteners by children. Finally, it concludes that the use of low/no calorie sweeteners has been associated with a reduced presence of dental caries.

In relation to future research needs, the report calls for further high-quality research on the use of sweeteners in childhood, focusing on age of exposure and taste preferences, neurodevelopment, and effect on the microbiome and its relevance to obesity, metabolic syndrome, and diabetes.

The paper also provides the following guidance for paediatricians:

    • NNSs are FDA approved for use in humans or are GRAS and, thereby, approved for use under the GRAS designation.
    • The GRAS designation is based on consumption of NNSs within an ADI level; it is not possible to measure an individual’s daily intake of NNSs at this time.
    • Higher-quality data suggest that NNS use is associated with weight stabilization and/or weight loss in the short-term. Currently, there is a paucity of long-term data.
    • High-quality evidence, including meta-analysis and data from RCTs, suggests that there is no association between hyperactivity and NNS use in children.
  • There are limited data regarding the effect of NNS use on appetite change and taste preference.”

An article discussing this policy statement by the American Academy of Pediatrics in more detail has been published on the ISA website here.

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