Abstract
International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2–4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.
Highlights
Justification and Need of the Ibero–American ConsensusLow- and no-calorie sweeteners (LNCS) are food additives that are added to a variety of foods and beverages in place of sugars either during the manufacturing process or as table-top sweeteners
International of of 32 of FDA: Food and Drug Administration; ADI: Acceptable Daily Intake; EFSA: European Food Safety Authority; 1 Sweetening power: modified from Carocho et al (2017) [29], Difference of sweetness among different molecules, calculated based on the assumption that Sucrose is equivalent to 1 unit of sweetness
In Canada in addition to the requirement to label on the front of a food or beverage package that it contains one or more non-nutritive sweeteners (e.g., “contains aspartame”), the amount of the sweetener or sweeteners expressed in milligrams per serving and a statement describing the sweetness per serving, expressed as the amount of sugar needed to produce an equivalent degree of sweetness, must be present on the package and grouped with the ingredient list [61]
Summary
Low- and no-calorie sweeteners (LNCS) are food additives that are added to a variety of foods and beverages in place of sugars either during the manufacturing process or as table-top sweeteners. The debate on labelling regulations on sugar and LNCS is increasing at different levels, and not always based on scientific evidence Based on this premise, and as a continuation of a previous multidisciplinary meeting of experts in LNCS [19], 66 international scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2–4 July 2017 to develop a consensus on the use of LNCS as substitutes for sugar and other caloric sweeteners. The experts of the Lisbon Consensus analysed and evaluated the role of LNCS in the diet, their safety and regulation, and the nutritional and dietary aspects of their use in foods and beverages The goal of this Consensus document was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations [20], in the context of the prevention and treatment of obesity and related diseases in Latin American countries. These results were discussed on the basis of its results, methodological quality and policy implications
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