The World Health Organization (WHO) has published new guidance on non-sugar sweeteners (NSS), which recommends against using NSS to control body weight or reduce the risk of non-communicable diseases (NCDs).
The recommendation is based on the findings of a systematic review of the available evidence that suggests that the use of non-sugar sweeteners (NSS) does not confer any long-term benefit in reducing body fat in adults or children. The results of the review also suggest that there may be possible unwanted effects from long-term use of non-sugar sweeteners (NSS), such as an increased risk of type 2 diabetes, cardiovascular disease and mortality in adults.
"Replacing free sugars with non-sugar sweeteners (NSS) does not help with long-term weight control. People should consider other ways to reduce their consumption of free sugars, such as eating foods with natural sugars, such as fruits or foods and drinks without sugar," says Francesco. Branca, Director of Nutrition and Food Safety at WHO: "NSS are not essential dietary factors and have no nutritional value. People should reduce dietary sweetness completely, starting early in life, to improve their health."
The recommendation applies to all people, except people with pre-existing diabetes, and includes all synthetic and natural or modified non-nutritive sweeteners that are not classified as sugars found in manufactured foods and beverages, or sold alone for Add them to foods and drinks. beverages by consumers. Common non-sugar sweeteners (NSS) include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia, and stevia derivatives.
The recommendation does not apply to personal care and hygiene products containing NSS, such as toothpaste, skin cream and medicines, nor to low-calorie sugars and sugar alcohols (polyols), which are sugars or sugar derivatives. sugar that contain calories and are therefore not considered NSS.
Because the link observed in the evidence between NSS and disease outcomes may be confounded by the baseline characteristics of the study participants and the complicated patterns of NSS use, the recommendation was evaluated as conditional , following WHO processes to develop guidelines. This indicates that policy decisions based on this recommendation may require substantive discussion in specific country contexts, linked, for example, to the degree of consumption in different age groups.
The WHO guideline on non-sugar sweeteners (NSS) is part of a set of existing and future guidelines on healthy diets that aim to establish healthy eating habits for life, improve diet quality and reduce the risk of disease not transmissible throughout the world.
Guide Overview
This guide is aimed at a broad audience involved in the development, design and implementation of policies and programs in nutrition and public health. This guideline includes a recommendation on the use of sugar-free sweeteners that can be used by policymakers and program administrators to address the use of sugar-free sweeteners in their populations through a variety of policy actions and public health interventions. The recommendation of this guideline should be considered in the context of other WHO guidelines on healthy diets. |
WHO recommendation
The WHO suggests that sugar-free sweeteners should not be used as a means to achieve weight control or reduce the risk of non-communicable diseases (conditional recommendation).
Justification
▶ The recommendation is based on overall low-certainty evidence from a systematic review that assessed the health effects of a higher intake compared to a lower intake of NSS.1 The systematic review found no evidence of long-term benefit on measures of body fat in adults or children, and the possible undesirable effects of long-term use in the form of increased risk of type 2 diabetes, cardiovascular disease and mortality in adults. Limited evidence suggests possible undesirable effects in the form of an increased risk of preterm birth with the use of NSS during pregnancy.
The evidence
Evidence from a recent systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective observational studies found that higher NSS consumption by adults led to lower body weight and body mass index (BMI), compared with consuming no non-sugar sweeteners (NSS) or consuming lower amounts of NSS, when evaluated in short- term RCTs , but was associated with higher BMI and risk of incident obesity in long-term prospective observational studies . The effects on body weight and BMI of RCTs are seen only when non-sugar sweetener (NSS) intake is compared to free sugar intake, and are likely mediated, at least in part, by a reduction in intake. of energy.
No other significant effects or associations were observed on body fat measures in either RCTs or prospective cohort studies. Long-term use of NSS was associated with an increased risk of type 2 diabetes, cardiovascular disease (CVD), and mortality in prospective cohort studies conducted in adults. However, no significant effects were observed on intermediate markers of the disease such as fasting glucose, fasting insulin or blood lipids when evaluated in short-term RCTs.
The evidence from studies conducted in children and pregnant women was more limited than that identified for adults. An RCT in children reported a reduction in several measures of body fat when sugary drinks were replaced with drinks containing NSS; however, no effect was observed when BMI z-score2 results were combined with those from a second trial. Results from prospective observational studies did not suggest any significant association between NSS use and body fat measures. Two RCTs conducted in children reported lower indicators of dental caries with the use of NSS stevia. All other identified studies reported no significant associations between NSS use and prioritized health outcomes in children.
Meta-analysis of three prospective observational studies found an increased risk of preterm birth with increased use of non-sugar sweeteners (NSS) during pregnancy, but observed associations between birth weight or offspring weight later in life and use of NSS during pregnancy were inconsistent. Single prospective observational studies have reported associations between NSS use during pregnancy and outcomes in offspring, including increased risk of asthma and allergies, and poorer cognitive function .
Comments
▶ With the exception of people with diabetes (as noted below), this recommendation is relevant to everyone: children and adults of any age, including pregnant and lactating women.
▶ The purpose of this guideline is to provide guidance on the use of non-sugar sweeteners (NSS) in efforts to prevent unhealthy weight gain and diet-related NCDs, in the context of reducing free sugar intake. . Assessing the effects of NSS on the health of people with preexisting diabetes with the goal of providing guidance on disease management was beyond the scope of the guideline. Consequently, in the evidence reviewed, studies conducted exclusively in people with pre-existing diabetes were excluded, and in studies with mixed populations, diabetes was often controlled for as a potential confounding characteristic. Therefore, although people with diabetes can also reduce their intake of free sugars without needing NSS, the recommendation does not apply to people with existing diabetes .
▶ The recommendation is relevant to all non-sugar sweeteners (NSS), which are defined in this guideline as all synthetic and natural or modified non-nutritive sweeteners that are not classified as sugars. Common NSSs include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia, and stevia derivatives. Because low-calorie sugars and sugar alcohols (polyols) are sugars or sugar derivatives that contain calories, they are not considered NSS and therefore the recommendation does not apply to these sweeteners.
▶ In this recommendation, “use” of non-sugar sweeteners (NSS) means consumption of foods or beverages containing NSS, or the addition of NSS to foods or beverages by the consumer.
▶ Many medications, hygiene and personal care products contain NSS in small amounts to make them more palatable. The recommendation in this guide does not apply to such products.
▶ “Weight control” in this recommendation refers to weight loss in cases of existing overweight or obesity, and preventing unhealthy weight gain by maintaining a healthy weight. ▶ The Joint FAO/WHO Expert Committee on Food Additives (JECFA) has established acceptable daily intakes (ADIs) for most NSS in commercial use. The evidence supporting this WHO recommendation comes from a systematic review of studies in which NSS were consumed in quantities within the ADI established by JECFA, either because this was explicitly stated in the study or because it was reasonably inferred that the ADI was not exceeded.2
▶ The recommendation in this guideline was made based on evidence suggesting that there may be health effects associated with the use of non-sugar sweeteners (NSS) regardless of which NSS is being used, i.e. non-sugar sweeteners (NSS). As a class of compounds , although individual NSS have different chemical structures, they can have an impact on health. It is recognized that NSS are not a homogeneous class of compounds: each has a unique chemical structure. As a result, individual NSSs have different intensities of sweetness and organoleptic properties, and are processed differently by the body. Although limited evidence suggests that individual non-sugar sweeteners (NSS) may also differ in some of their physiological effects in humans, the evidence is currently insufficient to make recommendations for individual NSS. Efforts to reduce intake of free sugars should be implemented in the context of achieving and maintaining a healthy diet. Because free sugars are often found in highly processed foods and beverages with undesirable nutritional profiles, simply replacing free sugars with non-sugar sweeteners (NSS) means that the overall quality of the diet is largely unaffected. Replacing free sugars in the diet with sources of natural sweetness , such as fruits, as well as minimally processed sugar-free foods and beverages, will help improve dietary quality and should be the preferred alternative to foods and beverages containing free sugars.
* Related document : Health effects of the use of non-sugar sweeteners: a systematic review and meta-analysis
