Abstract
A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy substitution). The available evidence suggests no grounds for concerns about adverse effects of LCS on sweet preference, appetite or glucose control; indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality and developing effective communication strategies to foster informed choice. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation.
Highlights
Introduction and aim of the ConsensusReportA number of reviews, some narrative and some systematic, have discussed the evidence for the safety of low-calorie sweeteners (LCS) and their effects on appetite, food intake, body weight, glucose control and other health outcomes[1,2,3,4,5,6,7,8]
(3) The collective evidence supports the conclusion that LCS have no adverse effect on blood glucose and insulin regulation (HbA1c, fasting and postprandial glucose and insulin levels) in individuals with, and without, diabetes[2,33,34]
(5) Confounding by adiposity, and reverse causality can explain the positive association between LCS and type 2 diabetes and other cardiometabolic diseases, reported in some observational studies[35,36,37]
Summary
Introduction and aim of the ConsensusReportA number of reviews, some narrative and some systematic, have discussed the evidence for the safety of low-calorie sweeteners (LCS) and their effects on appetite, food intake, body weight, glucose control and other health outcomes[1,2,3,4,5,6,7,8]. Other groups of scientific experts have generated consensus statements, position papers, or other statements on LCS. These include the British Dietetic Association, Diabetes UK, the American Heart Association and American Diabetes Association (AHA/ADA)(14–20). This paper describes the results of a workshop in which seventeen experts convened to discuss and debate the science and policy relating to the use of LCS. The aims were to establish, via consensus-forming techniques, clear and simple statements on LCS that all the panel agreed (facts), to highlight the areas where more research is required (gaps) and to propose how progress might be achieved (actions). It is hoped that the provision of these statements on safety and potential benefits of LCS will assist health practitioners and policy makers to promote consistent messages and develop strategies based on sound science. Identification of the gaps and actions will help promote better study designs, suggest priorities for research funding and thereby encourage more coherent public health policy
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