Low-/No-Calorie Sweeteners: A Review of Global Intakes

Food Additives and Evolved Methods of Detection: A Review

Food additives are essential constituents of food products in the modern world. The necessity of food processing went up rapidly as to meet requirements including, imparting desirable properties like preservation, enhancement and regulation of color and taste. The methods of identification and analysis of such substances are crucial. With the advancement of technology, a variety of techniques are emerging for this purpose which have many advantages over the existing conventional ways. This review is on different kinds of additives used in the food industry and few prominent methods for their determination ranging from conventional chromatographic techniques to the recently evolved nano-sensor techniques.

Long-term metabolic effects of non-nutritive sweeteners

OBJECTIVE

Excessive consumption of added sugars has been linked to the rise in obesity and associated metabolic abnormalities. Non-nutritive sweeteners (NNSs) offer a potential solution to reduce sugar intake, yet their metabolic safety remains debated. This study aimed to systematically assess the long-term metabolic effects of commonly used NNSs under both normal and obesogenic conditions.

METHODS

To ensure consistent sweetness level and controlling for the acceptable daily intake (ADI), eight weeks old C57BL/6 male mice were administered with acesulfame K (ace K, 535.25 mg/L), aspartame (411.75 mg/L), sucralose (179.5 mg/L), saccharin (80 mg/L), or steviol glycoside (Reb M, 536.25 mg/L) in the drinking water, on the background of either regular or high-fat diets (in high fat diet 60% of calories from fat). Water or fructose-sweetened water (82.3.gr/L), were used as controls. Anthropometric and metabolic parameters, as well as microbiome composition, were analyzed following 20-weeks of exposure.

RESULTS

Under a regular chow diet, chronic NNS consumption did not significantly affect body weight, fat mass, or glucose metabolism as compared to water consumption, with aspartame demonstrating decreased glucose tolerance. In diet-induced obesity, NNS exposure did not increase body weight or alter food intake. Exposure to sucralose and Reb M led to improved insulin sensitivity and decreased weight gain. Reb M specifically was associated with increased prevalence of colonic Lachnospiracea bacteria.

CONCLUSIONS

Long-term consumption of commonly used NNSs does not induce adverse metabolic effects, with Reb M demonstrating a mild improvement in metabolic abnormalities. These findings provide valuable insights into the metabolic impact of different NNSs, aiding in the development of strategies to combat obesity and related metabolic disorders.

Could Insulin Be a Better Regulator of Appetite/Satiety Balance and Body Weight Maintenance in Response to Glucose Exposure Compared to Sucrose Substitutes? Unraveling Current Knowledge and Searching for More Appropriate Choices

BACKGROUND

Insulin exerts a crucial impact on glucose control, cellular growing, function, and metabolism. It is partially modulated by nutrients, especially as a response to the intake of foods, including carbohydrates. Moreover, insulin can exert an anorexigenic effect when inserted into the hypothalamus of the brain, in which a complex network of an appetite/hunger control system occurs. The current literature review aims at thoroughly summarizing and scrutinizing whether insulin release in response to glucose exposure may be a better choice to control body weight gain and related diseases compared to the use of sucrose substitutes (SSs) in combination with a long-term, well-balanced diet.

METHODS

This is a comprehensive literature review, which was performed through searching in-depth for the most accurate scientific databases and applying effective and relevant keywords.

RESULTS

The insulin action can be inserted into the hypothalamic orexigenic/anorexigenic complex system, activating several anorexigenic peptides, increasing the hedonic aspect of food intake, and effectively controlling the human body weight. In contrast, SSs appear not to affect the orexigenic/anorexigenic complex system, resulting in more cases of uncontrolled body weight maintenance while also increasing the risk of developing related diseases.

CONCLUSIONS

Most evidence, mainly derived from in vitro and in vivo animal studies, has reinforced the insulin anorexigenic action in the hypothalamus of the brain. Simultaneously, most available clinical studies showed that SSs during a well-balanced diet either maintain or even increase body weight, which may indirectly be ascribed to the fact that they cannot cover the hedonic aspect of food intake. However, there is a strong demand for long-term longitudinal surveys to effectively specify the impact of SSs on human metabolic health.

Exploring the Impact of Saccharin on Neovascular Age-Related Macular Degeneration: A Comprehensive Study in Patients and Mice

Purpose

We aimed to determine the impact of artificial sweeteners (AS), especially saccharin, on the progression and treatment efficacy of patients with neovascular age-related macular degeneration (nAMD) under anti-vascular endothelial growth factor (anti-VEGF-A) treatment.

Methods

In a cross-sectional study involving 46 patients with nAMD undergoing intravitreal anti-VEGF therapy, 6 AS metabolites were detected in peripheral blood using liquid chromatography - tandem mass spectrometry (LC-MS/MS). Disease features were statistically tested against these metabolite levels. Additionally, a murine choroidal neovascularization (CNV) model, induced by laser, was used to evaluate the effects of orally administered saccharin, assessing both imaging outcomes and gene expression patterns. Polymerase chain reaction (PCR) methods were used to evaluate functional expression of sweet taste receptors in a retinal pigment epithelium (RPE) cell line.

Results

Saccharin levels in blood were significantly higher in patients with well-controlled CNV activity (P = 0.004) and those without subretinal hyper-reflective material (P = 0.015). In the murine model, saccharin-treated mice exhibited fewer leaking laser scars, lesser occurrence of bleeding, smaller fibrotic areas (P < 0.05), and a 40% decrease in mononuclear phagocyte accumulation (P = 0.06). Gene analysis indicated downregulation of inflammatory and VEGFR-1 response genes in the treated animals. Human RPE cells expressed taste receptor type 1 member 3 (TAS1R3) mRNA and reacted to saccharin stimulation with changes in mRNA expression.

Conclusions

Saccharin appears to play a protective role in patients with nAMD undergoing intravitreal anti-VEGF treatment, aiding in better pathological lesion control and scar reduction. The murine study supports this observation, proposing saccharin's potential in mitigating pathological VEGFR-1-induced immune responses potentially via the RPE sensing saccharin in the blood stream.

Substituting Low-Calorie Sweetened Beverages for Sugar-Sweetened Beverages to Prevent Obesity and Cardiometabolic Diseases: Still a Good Idea?

Low-calorie sweeteners (LCSs) and LCS-containing beverages have been proposed as appropriate substitutes for caloric sugars in recent years. In this Perspective, we highlight the recent findings from observational and interventional studies, focusing on obesity, gut microbiome, and cardiometabolic health. We provide public health actors and health care professionals with an insightful overview of recent evidence to bridge the gap between research and practice.

Relative validity of habitual sugar and low/no-calorie sweetener consumption assessed by food frequency questionnaire, multiple 24-h dietary recalls and urinary biomarkers: an observational study within the SWEET project

BACKGROUND

Studies investigating associations between sweeteners and health yield inconsistent results, possibly due to subjective self-report dietary assessment methods.

OBJECTIVES

We compared the performance of a food frequency questionnaire (FFQ), multiple 24-h dietary recalls (24hRs), and urinary biomarkers to estimate intake of sugars and low/no-calorie sweeteners (LNCSs).

METHODS

Participants (n = 848, age 54 ± 12 y) from a 2-y observational study completed 1 semiquantitative FFQ and ≥ 3 nonconsecutive 24hRs. Both methods assessed intake of sugars (mono- and disaccharides, sucrose, fructose, free and added sugars) and sweetened foods and beverages (sugary foods, fruit juice, and sugar or LNCS-containing beverages [sugar-sweetened beverages and low/no-calorie sweetened beverages (LNCSBs)]); 24hRs also included LNCS-containing foods and tabletop sweeteners (low/no-calorie sweetened foods [LNCSFs]). Urinary excretion of sugars (fructose+sucrose) and LNCSs (acesulfame K+sucralose+steviol glucuronide+cyclamate+saccharin) were simultaneously assessed using ultrapressure liquid chromatography coupled to tandem mass spectrometry in 288 participants with 3 annual 24-h urine samples. Methods were compared using, amongst others, validity coefficients (correlations corrected for measurement error).

RESULTS

Median (interquartile range) FFQ intakes ranged from 0 (0-7) g/d for LNCSBs to 94 (73-117) g/d for mono- and disaccharides. LNCSB use was reported by 32% of participants. Median LNCSB+LNCSF intake using 24hRs was 1 (0-50) g/d and reported by 58%. Total sugar excretions were detected in 100% of samples [56 (37-85) mg/d] and LNCSs in 99% of urine samples [3 (1-10) mg/d]. Comparing FFQ against 24hRs showed VCs ranging from 0.38 (fruit juice) to 0.74 (LNCSB). VCs for comparing FFQ with urinary excretions were 0.25 to 0.29 for sugars and 0.39 for LNCSBs; for 24hR they amounted to 0.31-0.38 for sugars, 0.37 for LNCSBs, and 0.45 for LNCSFs.

CONCLUSIONS

The validity of the FFQ against 24hRs for the assessment of sugars and LNCSBs ranged from moderate to good. Comparing self-reports and urine excretions showed moderate agreement but highlighted an important underestimation of LNCS exposure using self-reports.

Consumption of the nonnutritive sweetener acesulfame potassium increases central precocious puberty risk

The prevalence of precocious puberty and the consumption of nonnutritive sweeteners (NNS) is rapidly growing worldwide. However, the effects of NNSs on precocious puberty remain unclear. We examined the impact of acesulfame potassium (AceK), one of the most widely used NNS, on central precocious puberty (CPP) development using ex vivo and in vitro studies. 884 girls aged 6-12 were enrolled with complete AceK consumption data and CPP outcome assessment in the Taiwan Pubertal Longitudinal Study from 2018 to 2022. After adjustment for confounders, compared with no AceK consumption, AceK consumption at more than the median dose was associated with higher CPP risk in girls (odds ratio = 1.88, 95% confidence interval = 1.16-3.06; p for trend = 0.003). In rats, AceK consumption from in-utero to post-weaning stages accelerated puberty onset, accompanied by increased brain gonadotropin-releasing hormone (GnRH) expression. Intracerebroventricular AceK injection also induced early puberty onset in rats. In N44 hypothalamic neuron cells, AceK treatment increased reactive oxygen species production, which led to protein kinase A (PKA) activation and increased GnRH expression. These findings suggest that prepubertal girls should consume soft drinks or food products containing AceK more cautiously.

Simultaneous analysis of natural and artificial sweeteners in sugar-free drinks and urine samples by column-switching UHPLC-charged aerosol detection method

Sweeteners are considered an alternative to high-calorie foods or drinks and have been widely used globally. However, the simultaneous separation and detection of high-polarity natural and artificial sweeteners are challenging owing to their broad-spectrum physical and chemical properties. Herein, we developed a column-switching UHPLCCAD method and used it for detecting and quantitating 12 sweeteners, including natural sweeteners (erythritol, mannitol, xylitol, sorbitol and stevioside) and artificial sweeteners (acesulfame potassium, saccharin sodium salt, sodium cyclamate, sucralose, aspartame, alitame and neotame). The LOD and LOQ were 0.932-6.25 μg/mL and 3.10-20.83 μg/mL, respectively, and the method demonstrated excellent linearity (R² ≥ 0.9990), good precision (intraday and interday precision was 0.59-6.88 %), and high recovery (average recoveries were 85.16-108.64 %). This method was applied to determine the sweeteners in 15 sugar-free drinks purchased from the local Chinese supermarkets. What's more, natural sweetener erythritol and artificial sweetener acesulfame potassium were suspected over addition in sugar-free drinks. Meanwhile the method was applied to the sweeteners in various sugar-free drinks and the dynamic monitoring of transit and excretion in vivo after drinking. Those prove that the method can be used to the detection of sugar free drinks and quality control of the sweeteners. The study highlights the potential of UHPLC-charged aerosol detection technology in detection of multiple components in food industry.

Nutritive/non-nutritive sweeteners and high fat diet contribute to dysregulation of sweet taste receptors and metabolic derangements in oral, intestinal and central nervous tissues

OBJECTIVES

Overconsumption of non-nutritive sweeteners is associated with obesity, whereas the underlying mechanisms remain controversial. This study aimed to investigate the effects of long-term consumption of nutritive or non-nutritive sweeteners with or without high fat diet on sweet taste receptor expression in nutrient-sensing tissues and energy regulation dependent on sweet-sensing.

METHODS

50 Male Sprague-Dawley rats (140-160 g) were assigned to 10 groups (n = 5/group). All received fructose at 2.5% or 10%, sucralose at 0.01% or 0.015% or water with a normal chow diet or high fat diet for 12 weeks. Food and drink intake were monitored daily. Oral glucose tolerance test and intraperitoneal glucose tolerance test were performed at week 10 and 11 respectively. Serum was obtained for measurement of biochemical parameters. Tongue, duodenum, jejunum, ileum, colon and hypothalamus were rapidly removed to assess gene expression.

RESULTS

Long-term consumption of sweeteners impaired glucose tolerance, increased calorie intake and body weight. A significant upregulation of sweet taste receptor expression was observed in all the four intestinal segments in groups fed 0.01% sucralose or 0.015% sucralose, most strikingly in the ileum, accompanied by elevated serum glucagon-like peptide-1 levels and up-regulated expression of sodium-dependent glucose cotransporter 1 and glucose transporter 2. A significant down-regulation in the tongue and hypothalamus was observed in groups fed 10% fructose or 0.015% sucralose, with alterations in hypothalamic appetite signals. The presence of high fat diet differentially modulates sweet taste perception in nutrient-sensing tissues.

CONCLUSIONS

Long-term consumption of whether nutritive sweeteners or non-nutritive sweeteners combined with high fat diet contribute to dysregulation of sweet taste receptor expression in oral, intestinal and central nervous tissues.

[Low and non-calorie sweeteners as a tool for reducing the energy density at foodstuffs. An alternative for helping to control and reduce overweight and obesity]

Introduction

Introduction: there is more and more scientific data on sweeteners but at the same time there is more dissemination of information and it is sometimes contradictory Methods: observational field study with analysis of data referring to current legislation, approvals by European Union authorities and systematic reviews. Results: the European Union has one of the best systems in the world for the evaluation, approval and authorization of sweeteners and those approved have been immersed since 2010 in a revaluation process, such as that of the other additives. Conclusions: sweeteners are a tool for the reduction and elimination of sugar at foodstuffs. The total diet is the one that must have as a whole a reduction in calories to be effective in the control and reduction of overweight and obesity.

Artificial Sweeteners and Risk of Type 2 Diabetes in the Prospective NutriNet-Santé Cohort

OBJECTIVE

To study the relationships between artificial sweeteners, accounting for all dietary sources (total and by type of artificial sweetener) and risk of type 2 diabetes (T2D), in a large-scale prospective cohort.

RESEARCH DESIGN AND METHODS

The analyses included 105,588 participants from the web-based NutriNet-Santé study (France, 2009-2022; mean age 42.5 ± 14.6 years, 79.2% women). Repeated 24-h dietary records, including brands and commercial names of industrial products, merged with qualitative and quantitative food additive composition data, enabled artificial sweetener intakes to be accurately assessed from all dietary sources. Associations between artificial sweeteners (total, aspartame, acesulfame potassium [K], and sucralose) and T2D were investigated using Cox proportional hazard models adjusted for potential confounders, including weight variation during follow-up.

RESULTS

During a median follow-up of 9.1 years (946,650 person-years, 972 incident T2D), compared with nonconsumers, higher consumers of artificial sweeteners (i.e., above the sex-specific medians of 16.4 mg/day in men and 18.5 mg/day in women) had higher risks of developing T2D (hazard ratio [HR] 1.69; 95% CI 1.45-1.97; P-trend <0.001). Positive associations were also observed for individual artificial sweeteners: aspartame (HR 1.63 [95% CI 1.38-1.93], P-trend <0.001), acesulfame-K (HR 1.70 [1.42-2.04], P-trend <0.001), and sucralose (HR 1.34 [1.07-1.69], P-trend = 0.013).

CONCLUSIONS

Potential for reverse causality cannot be eliminated; however, many sensitivity analyses were computed to limit this and other potential biases. These findings of positive associations between artificial sweetener intakes and increased T2D risk strengthen the evidence that these additives may not be safe sugar alternatives. This study provides important insights in the context of on-going reevaluation of artificial sweeteners by health authorities worldwide.

The Effect of Nonnutritive Sweeteners on the Antimicrobial Activity of Eucalyptus Extracts against Salivary Mutans Streptococci (in-vitro Study)

The eucalyptus tree is an excellent source of antimicrobial agents; it is used in many oral cure products. The bitter taste of these agents could compromise their usage. Therefore, fortifying the extracts with non-nutritive sweeteners could be a promising procedure for masking their unpleasant taste. This study was an in vitro evaluation of the antimicrobial activity of eucalyptus (alcoholic and aqueous) extracts against salivary Streptococci mutans. It aimed to investigate the effect of non-nutritive sweeteners on the antimicrobial activity of these extracts against salivary S. mutans. The test microbes were sensitive to different concentrations of eucalyptus alcoholic and aqueous extract, and the inhibition zone increased as the concentration of the extracts increased. All the Mutans isolates were killed at a concentration of 75 mg/ml for the alcoholic extract and 175 mg/ml for the aqueous extracts. In this experiment, the concentration of up to 15% stevia and up to 5% sucralose did not affect the antimicrobial activity of eucalyptus alcoholic extract. While the concentration of up to 1% of stevia and sucralose did not interfere with the antimicrobial activity of aqueous eucalyptus extract against salivary S. mutans. An increase in the concentration of non-nutritive sweeteners in this experiment appeared to interfere with the antimicrobial activity of eucalyptus extract against salivary S. mutans.

Sweeteners in food samples: An update on pretreatment and analysis techniques since 2015

Sweeteners play an irreplaceable role in daily life and have been found in multitudinous food products. However, excessive or unreasonable intake of sweeteners as food additives brings about untoward problems due to the accumulation in the human body. Therefore, a comprehensive review of different sweeteners' pretreatment and determination methods is urgently needed. In this review, we comprehensively reviewed the progress of different pretreatment and detection methods for sweeteners in various food, focusing on the latest development since 2015. Current state-of-the-art technologies, such as headspace single-drop microextraction, ultrasound-assisted emulsification microextraction, solid-phase microextraction, two-dimensional liquid chromatography, and high-resolution mass spectrometry, are thoroughly discussed. The advantages, disadvantages, critical comments, and future perspectives are also proposed. This review is expected to provide rewarding insights into the future development and broad application of pretreatment and detection methods for sweeteners in different food samples.

Sweetener System Intervention Shifted Neutrophils from Homeostasis to Priming

BACKGROUND

Non-nutritive sweeteners (NNS) are part of personalized nutrition strategies supporting healthy glycemic control. In contrast, the consumption of non-nutritive sweeteners has been related to person-specific and microbiome-dependent glycemic impairments. Reports on the effects of NNS on our highly individual cellular immune system are sparse. The recent identification of taste receptor expression in a variety of immune cells, however, suggested their immune-modulatory relevance.

METHODS

We studied the influence of a beverage-typical NNS system on the transcriptional profiling of sweetener-cognate taste receptors, selected cytokines and their receptors, and on Ca²⁺ signaling in isolated blood neutrophils. We determined plasma concentrations of saccharin, acesulfame-K, and cyclamate by HPLC-MS/MS, upon ingestion of a soft drink-typical sweetener surrogate. In an open-labeled, randomized intervention study, we determined pre- versus post-intervention transcript levels by RT-qPCR of sweetener-cognate taste receptors and immune factors.

RESULTS

Here we show that the consumption of a food-typical sweetener system modulated the gene expression of cognate taste receptors and induced the transcriptional regulation signatures of early homeostasis- and late receptor/signaling- and inflammation-related genes in blood neutrophils, shifting their transcriptional profile from homeostasis to priming. Notably, sweeteners at postprandial plasma concentrations facilitated fMLF (N-formyl-Met-Leu-Phe)-induced Ca²⁺ signaling.

CONCLUSIONS

Our results support the notion of sweeteners priming neutrophils to higher alertness towards their adequate stimuli.

Low- and no-calorie sweetener intakes from beverages - an up-to-date assessment in four regions: Brazil, Canada, Mexico and the United States

The current assessment estimated exposure to four low- and no-calorie sweeteners (LNCS) (aspartame, acesulfame potassium (AceK), steviol glycosides and sucralose) from beverages in Brazil, Canada, Mexico and the United States, using up-to-date nationally representative consumption data and industry reported-use level information. Two modelling scenarios were applied - the probabilistic model was guided by reported use level data, with estimated intake for an individual leveraging market-weighted average use level of a particular LNCS in any given LNCS-sweetened beverage type, while the distributional (brand-loyal) model assumed consumer behaviour-led patterns, namely that an individual will be brand loyal to a pre-determined beverage type. Consumer-only and general population intake estimates were derived for the overall population and individual age categories, and compared to the respective acceptable daily intake (ADI) as established by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) for each LNCS. The mean, 90th percentile and 95th percentile intake estimates were substantially lower than the ADI in both modelling scenarios, regardless of the population group or market. In the probabilistic model, the highest consumer-only intake was observed for AceK in Brazilian adolescents (95th percentile, 12.4% of the ADI), while the highest 95th percentile intakes in the distributional model were observed for sucralose in Canadian adults at 20.9% of the ADI. This study provides the latest insights into current intakes of LNCS from water-based non-alcoholic LNCS-sweetened beverages in these regions, aligning well with those published elsewhere.

Tiered dietary exposure assessment of steviol glycosides in the Belgian population

The objective of the present study was to assess the dietary intake of steviol glycosides in the Belgian population and to conduct a risk assessment by comparing the estimated intakes to the acceptable daily intake (ADI). A tiered approach was adopted in this study. First, a Tier 2 assessment was performed using maximum permitted levels. Next, the calculations were refined because market share data were used (refined Tier 2). Finally, the actual concentration data of 198 samples purchased from the Belgian market were used for Tier 3 exposure assessment. Based on a Tier 2 assessment, the ADI was exceeded for the high-consumer children population. However, the results of a more refined exposure assessment (Tier 3) of high consumers (P95) within the child, adolescent and adult populations were 13·75, 10 and 6·25 % of the ADI, respectively, using mean analytical results. Even with more conservative refined approaches, the estimated daily intake remained below 20 % of ADI. Flavoured drinks, flavoured fermented milk products and jams, jellies, and marmalades were the top three contributing food groups to steviol intake at 26–49 %, 12–27 % and 5–13 %, respectively. Despite the high concentrations (up to 94 000 mg/kg) of steviol glycosides in tabletop sweeteners, their contribution to the total intake remains low. The impact of the use of food supplements on the total intake was also considered to be limited. It was concluded that there was no risk for the Belgian population related to dietary exposure to steviol glycoside.

Aspartame Consumption, Mitochondrial Disorder-Induced Impaired Ovarian Function, and Infertility Risk

Frequent consumption of diet drinks was associated with oocyte dysmorphism, decreased embryo quality, and an adverse effect on pregnancy rate. We investigated the harmful effects of aspartame and potential mechanisms through which it increases infertility risk through clinical observations and in vivo and in vitro studies. Methods: We established a cohort of 840 pregnant women and retrospectively determined their time to conceive. We assessed the estrus cycle, the anti-Mullerian hormone level, ovarian oxidative stress, and ovarian mitochondrial function in an animal study. We also evaluated mitochondria function, mitochondrial biogenesis, and progesterone release with in vitro studies. Aspartame consumption was associated with increased infertility risk in the younger women (Odds ratio: 1.79, 95% confidence interval: 1.00, 3.22). The results of the in vivo study revealed that aspartame disrupted the estrus cycle and reduced the anti-Mullerian hormone level. Aspartame treatment also suppressed antioxidative activities and resulted in higher oxidative stress in the ovaries and granulosa cells. This phenomenon is caused by an aspartame-induced decline in mitochondrial function (maximal respiration, spare respiratory capacity, and ATP production capacity) and triggered mitochondrial biogenesis (assessed by examining the energy depletion signaling-related factors sirtuin-1, phosphorylated adenosine monophosphate-activated protein kinase, peroxisome proliferator-activated receptor-gamma coactivator-1α, and nuclear respiratory factor 1 expression levels). Aspartame may alter fertility by reserving fewer follicles in the ovary and disrupting steroidogenesis in granulosa cells. Hence, women preparing for pregnancy are suggested to reduce aspartame consumption and avoid oxidative stressors of the ovaries.

Dietary exposure to low-calorie sweeteners in a sample of Brazilian pregnant women

The dietary exposure to low-calorie sweeteners (LCS) was estimated in a sample of pregnant Brazilian women. Consumption data were obtained with a 24-h Dietary Recall interview. Because of the uncertainty in assessing foods with LCS, they were classified into three scenarios to ensure inclusion of the 15 LCS allowed for use in Brazil: ranging from a less to a more conservative scenario. The concentration of LCS was estimated using the amount declared on the label or the maximum permitted levels and analytical determination data for table-top sweeteners. The frequency of consumption was higher for acesulfame-K, aspartame, and cyclamate. The food groups contributing the most to the consumption of LCS were non-alcoholic beverages, table-top sweeteners, confectionary and desserts. The level of dietary exposure to LCS was within the safety limit. However, continued efforts to monitor their dietary exposure are necessary given the limitations highlighted in this study.

The Impact of Non-caloric Sweeteners on Male Fertility: A Systematic Review and Narrative Synthesis in Rodent Models

Understanding the factors which influence fertility is essential for developing appropriate nutritional recommendations for couples trying to conceive. Non-caloric sweeteners (NCS) are increasing in the food chain and despite being no/low calorie, several adverse metabolic consequences have been attributed to their consumption. Their effects on reproduction have been relatively under-researched, particularly in males. This review aims to systematically review the literature for evidence of the effect of NCS on male fertility in rodents, with sperm parameters (sperm quantity and quality) assessed as primary outcomes. Given the lack of information available in humans this review has been carried out using evidence from rodent models. Risk of bias assessment was carried out using the Syrcle risk of bias tool. Nine studies met the inclusion criteria. Forty-four percent showed a negative effect of NCS on male reproductive parameters compared with controls. The effects of NCS on fertility have been conflicting and selected studies have been heterogeneous in relation to study design. It is unclear if NCS has an impact on male reproductive function. There is a need for randomized controlled trials using a standardized protocol for analysis, to formulate a clear message in terms of male fertility.

Dose-Response and Substitution Analyzes of Sweet Beverage Consumption and Body Weight in Dutch Adults: The Lifelines Cohort Study

Background/Methods

Prospective studies investigating sweet beverages and body weight associations show inconsistent results. Within the SWEET project, we examined prospective dose-response associations of sugar-sweetened beverages (SSB), low/no-calorie beverages (LNCB), and fruit juice with body weight-related outcomes among 78,286 Dutch adults followed for ~4 years. Baseline intakes were assessed using a validated food-frequency questionnaire (FFQ) with 150 ml representing a standard serving. Outcome variables were body weight change, waist circumference change, overweight/obesity, and abdominal obesity. Associations were investigated by using linear and non-linear dose-response analysis, as well as substitution models while adjusting for multiple socio-demographic, lifestyle, health, and dietary variables.

Results

Participants were 46 ± 13 (mean ± SD) years old and 60% were women. Adjusted dose-response analyzes indicated an association between SSB and LNCB, and both body weight (+0.02 kg/year; SE 0.01 and +0.06 kg/year; SE 0.01) and waist circumference changes (+0.04 cm/year; SE: 0.01 and +0.11 cm/year; SE: 0.01). Associations for overweight/obesity and abdominal obesity incidence were +3% (95%CI: 1.00–1.06) and +2% (95%CI: 0.99–1.06) for SSB and +8% (95%CI: 1.06–1.11) and +5% (95%CI: 1.03–1.07) for LNCB, respectively. Substitution of SSB with LNCB was associated with higher weight change (+0.04 kg/year), waist circumference change (+0.09 cm/year), overweight/obesity incidence (+6%), but not abdominal obesity incidence. For fruit juice, we observed beneficial associations for intake levels below ~1 serving/day with weight, waist circumference change, and overweight/obesity incidence, and no association with abdominal obesity. Subsequent substitution analyzes indicated a small beneficial association for the replacement of SSB with fruit juice on weight (−0.04 kg/year) and waist circumference (−0.04 cm/year), but not with other outcomes.

Conclusions

Overall, our results suggest that habitual consumption of both SSB and LNCB may adversely affect weight-related outcomes. In contrast, fruit juice consumption <150 ml may be beneficial with respect to weight and waist circumference.

Development and Validation of the Chinese Version Non-Nutritive Sweetener Food Frequency Questionnaire with Urinary Biomarker in Children and Adolescents

OBJECTIVE

The purpose of this study was to develop a validated food frequency questionnaire (FFQ) to evaluate the intake of non-nutritive sweeteners (NNSs) in child and adolescent Asian populations.

DESIGN

Intensive and overall market research was performed to create the applicable NNS-FFQ with 13 food categories and 305 items. Six intense sweeteners, including acesulfame potassium, aspartame, sucralose, glycyrrhizin, steviol glycosides and sorbitol, were investigated. The validity and reproducibility of the NNS-FFQ were evaluated. The validity was further assessed by examining the consistency of reported NNS intake compared with urinary biomarkers using Cohen's κ analysis.

SETTINGS

This work was considered to be relevant in Asian societies.

PARTICIPANTS

One hundred and two children and adolescents recruited from several clinics were invited to participate in this study.

RESULTS

High content validity indices and high content validity ratio levels were revealed for each sweetener and food category. Reproducibility among subjects was satisfactory. Significant moderate correlations between estimated steviol glycoside/sucralose consumption and sensitive urinary biomarker levels were demonstrated (κ values were 0.59 and 0.45 for steviol glycosides and sucralose, respectively), indicating that the NNS-FFQ can be used to assess an individual's NNS intake. The dietary intense sweetener consumption pattern evaluated in this measurement was similar to those observed in other Asian countries but differed from those observed in Western populations with respect to types and amounts of NNSs.

CONCLUSIONS

This validated NNS-FFQ can be an applicable and useful tool to evaluate NNS intake in future epidemiological and clinical studies.

Trends and amounts of consumption of low-calorie sweeteners: A cross-sectional study

BACKGROUND AND AIMS

White sugar has been blamed to cause health consequences including diabetes and obesity. With the increased need to decrease sugar intake, attention was shifted towards sugar alternatives also known as low-calorie sweeteners. Low-calorie sweeteners are ubiquitous within food products, but their consumption among Lebanese adults isn't well elucidated. Our study aims to investigate the trends and amounts of low-calorie sweeteners' consumption in addition to their main sources among a sample of Lebanese adults.

METHODS

A cross-sectional study was conducted over 384 adult Lebanese individuals from both genders residing in Beirut and Mount-Lebanon from February to August 2020. After excluding eight individuals, 376 completed the survey. To assess the trends, frequency and quantity of low-calorie sweeteners' consumption, a questionnaire was filled by trained and licensed dietitians in addition to a previously validated food frequency questionnaire adapted to the most widely known products in the Lebanese market. Food products were divided into categories, amount of sweeteners in each item was obtained from the label, and analysis was performed according to the type of sweetener they are made of. Frequencies were converted into numbers of servings per day and multiplied by the standard portion size. Daily individual consumption of each sweetener apart was obtained by multiplying the amount of sweetener in each item consumed by total daily consumption. The amount in mg/kg was obtained by dividing total consumption of each sweetener apart by the mean weight of our population. The Statistical Package for Social Sciences (SPSS) was used for data entry and analysis.

RESULTS

Results showed that 94.4% were consuming an artificially-sweetened item at least once in the last six months. While weight loss and healthy lifestyle constituted the main reasons for past and current consumption respectively, safety and unpleasant taste affected consumption trends. Pills and powders' consumption was significantly associated with gender (p = 0.032) and dieting (p = 0.000) but not with age (p = 0.831), educational level (p = 0.294), living district (p = 0.421) or income (p = 0.828) where women and dieters used significantly more pills and powders than their counterparts. "Food and beverages" consumption was independent of all factors except age (p = 0.001); it peaked at 26-40 and declined thereafter. Consumption of low-calorie sweeteners came mainly from beverages and was as follows while remaining within the acceptable daily intake limits: aspartame: 98.9 mg/d (1.38 mg/kg/d); sucralose: 22.19 mg/d (0.31 mg/kg/d); acesulfame-K: 39.12 mg/d (0.55 mg/kg/d); stevia 3.28 mg/d (0.05 mg/kg/d). Food and beverages were consumed more than pills and powders due to unintentional consumption.

CONCLUSION

Despite that safety and unpleasant taste affected consumption of low-calorie sweetened products, intake of such products was found to be highly prevalent in the studied population. While remaining within the acceptable daily intake limits, consumption of food and beverages exceeded that of pills and powders due to unintentional consumption making awareness a necessity to help consumers make an informed decision. Moreover, a nation-level study is needed to generalize the results.

Is a Non-Caloric Sweetener-Free Diet Good to Treat Functional Gastrointestinal Disorder Symptoms? A Randomized Controlled Trial

Background: A diet containing non-caloric sweeteners (NCS) could reduce calorie intake; conversely, some animal studies suggest that NCS consumption may increase functional gastrointestinal disorder symptoms (FGDs). This study aimed to compare the effect of consuming a diet containing NCS (c-NCS) versus a non-caloric sweetener-free diet (NCS-f) on FGDs. Methods: We conducted a randomized, controlled, parallel-group study using two different diets for five weeks: the c-NCS diet contained 50−100 mg/day NCS, whereas the NCS-f diet had less than 10 mg/day NCS. At the beginning of the study (PreTx) and at the end (PostTx), we assessed FGDs, dietary intake, and NCS consumption. Results: The percentage of participants with diarrhea (PreTx = 19% vs. PstTx = 56%; p = 0.02), post-prandial discomfort (PreTx = 9% vs. PstTx = 39%; p = 0.02), constipation (PreTx = 30% vs. PostTx = 56%; p < 0.01), and burning (PreTx = 13% vs. PostTx = 33%; p < 0.01) increased in the c-NCS diet group. Conversely, abdominal pain (PreTx = 15% vs. PostTx = 3%; p = 0.04), post-prandial discomfort (PreTx = 26% vs. PostTx = 6%; p = 0.02), burning (PreTx = 15% vs. PostTx = 0%; p = 0.02), early satiety (PreTx = 18% vs. PostTx = 3%; p < 0.01), and epigastric pain (PreTx = 38% vs. PostTx = 3%; p < 0.01) decreased in the NCS-f diet group. Conclusion: A c-NCS diet is associated with increased FGDs, including diarrhea, post-prandial discomfort, constipation, and burning or retrosternal pain. The NCS-f diet also decreased FGDs, as well as abdominal pain, post-prandial discomfort, burning or retrosternal pain, early satiety, and epigastric pain.

Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study

BACKGROUND

The food industry uses artificial sweeteners in a wide range of foods and beverages as alternatives to added sugars, for which deleterious effects on several chronic diseases are now well established. The safety of these food additives is debated, with conflicting findings regarding their role in the aetiology of various diseases. In particular, their carcinogenicity has been suggested by several experimental studies, but robust epidemiological evidence is lacking. Thus, our objective was to investigate the associations between artificial sweetener intakes (total from all dietary sources, and most frequently consumed ones: aspartame [E951], acesulfame-K [E950], and sucralose [E955]) and cancer risk (overall and by site).

METHODS AND FINDINGS

Overall, 102,865 adults from the French population-based cohort NutriNet-Santé (2009-2021) were included (median follow-up time = 7.8 years). Dietary intakes and consumption of sweeteners were obtained by repeated 24-hour dietary records including brand names of industrial products. Associations between sweeteners and cancer incidence were assessed by Cox proportional hazards models, adjusted for age, sex, education, physical activity, smoking, body mass index, height, weight gain during follow-up, diabetes, family history of cancer, number of 24-hour dietary records, and baseline intakes of energy, alcohol, sodium, saturated fatty acids, fibre, sugar, fruit and vegetables, whole-grain foods, and dairy products. Compared to non-consumers, higher consumers of total artificial sweeteners (i.e., above the median exposure in consumers) had higher risk of overall cancer (n = 3,358 cases, hazard ratio [HR] = 1.13 [95% CI 1.03 to 1.25], P-trend = 0.002). In particular, aspartame (HR = 1.15 [95% CI 1.03 to 1.28], P = 0.002) and acesulfame-K (HR = 1.13 [95% CI 1.01 to 1.26], P = 0.007) were associated with increased cancer risk. Higher risks were also observed for breast cancer (n = 979 cases, HR = 1.22 [95% CI 1.01 to 1.48], P = 0.036, for aspartame) and obesity-related cancers (n = 2,023 cases, HR = 1.13 [95% CI 1.00 to 1.28], P = 0.036, for total artificial sweeteners, and HR = 1.15 [95% CI 1.01 to 1.32], P = 0.026, for aspartame). Limitations of this study include potential selection bias, residual confounding, and reverse causality, though sensitivity analyses were performed to address these concerns.

CONCLUSIONS

In this large cohort study, artificial sweeteners (especially aspartame and acesulfame-K), which are used in many food and beverage brands worldwide, were associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of food additive sweeteners by the European Food Safety Authority and other health agencies globally.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03335644.

Low Dose of Sucralose Alter Gut Microbiome in Mice

Sucralose is a non-nutritive artificial sweetener (NNS) used in foods or beverages to control blood glucose levels and body weight gain. The consumption of NNS has increased in recent years over the world, and many researches have indicated long-term sucralose administration altered the gut microbiome composition of mice. These studies all focus on the US Food and Drug Administration (FDA) defined acceptable daily intake (ADI), approximately 5 mg/kg BW/day for human. In our study, mice were given with T1-4 (0.0003, 0.003, 0.03, and 0.3 mg/mL) of sucralose, respectively, Control group mice were given normal water. In particular, 0.3 mg/mL of sucralose was equal to the ADI (5 mg/kg BW/day). After 16 weeks, all mice were weighted and sacrificed, the liver of each mouse was isolated and weighed, segments of jejunum, ileum and colon were collected for H&E-stained. The contents of jejunum, ileum, cecum and colon were collected for 16S rRNA gene sequencing. The results showed sucralose administration affects the intestinal barrier function evidenced by distinct lymphocyte aggregation in ileum and colon while not change the mice body weight. The 16S rRNA gene sequencing of the mice gut microbiome suggested sucralose administration significantly changed the composition of gut microbiota, especially in T1 and T4 group. For example, a reduction of probiotics abundance (Lachnoclostridium and Lachnospiraceae) was found in cecum of T4 group mice compared with Control group. On the other hand, Allobaculum, which was reported positively correlated with diabetes, was increased in the T1 and T4 group. In addition, the potential pathogens, including Tenacibaculum, Ruegeria, Staphylococcus were also increased in jejunum, ileum and colon by sucralose administration in T1 and T4 group. These new findings indicate that low dose of sucralose (T1) alter gut microbiome in mice, and these adverse health effects are equal to ADI level (T4). Overall, our study provides guidance and suggestions for the use of sucralose in foods and beverages.

Ten-Week Sucralose Consumption Induces Gut Dysbiosis and Altered Glucose and Insulin Levels in Healthy Young Adults

Sucralose consumption alters microbiome and carbohydrate metabolism in mouse models. However, there are no conclusive studies in humans. Our goals were to examine the effect of sucralose consumption on the intestinal abundance of bacterial species belonging to Actinobacteria, Bacteroidetes, and Firmicutes and explore potential associations between microbiome profiles and glucose and insulin blood levels in healthy young adults. In this open-label clinical trial, volunteers randomly drank water, as a control (n = 20), or 48 mg sucralose (n = 20), every day for ten weeks. At the beginning and the end of the study, participants were subjected to an oral glucose tolerance test (OGTT) to measure serum glucose and insulin every 15 min for 3 h and provided fecal samples to assess gut microbiota using a quantitative polymerase chain reaction. Sucralose intake altered the abundance of Firmicutes without affecting Actinobacteria or Bacteroidetes. Two-way ANOVA revealed that volunteers drinking sucralose for ten weeks showed a 3-fold increase in Blautia coccoides and a 0.66-fold decrease in Lactobacillus acidophilus compared to the controls. Sucralose consumption increased serum insulin and the area under the glucose curve compared to water. Long-term sucralose ingestion induces gut dysbiosis associated with altered insulin and glucose levels during an OGTT.

Low- and no-calorie sweetener intakes in the Brazilian population estimated using added sugar substitution modelling

This research examined the intakes of six low- and no-calorie sweeteners (LNCS) (acesulfame-K, aspartame, cyclamate, saccharin, steviol glycosides, and sucralose) by the Brazilian population using an added sugar substitution approach. Detailed exposure modelling requires the use of proprietary concentration data, which can be difficult to obtain. Two exposure models were conducted using nationally representative food consumption data. The first model ('per person') estimated added sugar intakes on an individual person basis, replacing 50% of added sugar intakes >10% total energy with each LNCS considering sucrose sweetness equivalence. The second model ('per food') replaced 50% of the added sugar content in foods and beverages with each LNCS, incorporating sucrose sweetness equivalence and Brazilian tonnage data. Both models predicted that intakes would be below the JECFA ADI for five of the six LNCS in all population groups examined (≥10 years) for average and heavy consumers. For cyclamate, exceedance of the ADI was determined for all age groups amongst heavy consumers in the 'per person' model, while estimated intakes in the 'per food' model were below or reached the ADI for the cohort. Additional research is needed for younger age groups to confirm whether these findings are applicable to the entire Brazilian population.

Prevalence and Types of Non-Nutritive Sweeteners in the New Zealand Food Supply, 2013 and 2019

The widely recognized association between high sugar intakes and adverse health outcomes has increased consumer demand for products lower in sugar. This may lead to increased use of other sweeteners by the food industry. The current study investigated the prevalence and types of non-nutritive sweeteners over time (2013-2019) in New Zealand's packaged food and beverages, overall and between categories. A New Zealand database of packaged foods and beverages was used to investigate the presence of Food Standards Australia New Zealand Code-approved non-nutritive sweeteners (n = 12). Products available in 2013 (n = 12,153) and 2019 (n = 14,645) were compared. Between 2013 and 2019, the prevalence of non-nutritive sweeteners in products increased from 3% to 5%. The most common non-nutritive sweeteners in both years were acesulphame-potassium, sucralose, aspartame, and stevia, which were predominantly found in special foods (breakfast beverages and nutritional supplements), non-alcoholic beverages, dairy products, and confectionery. The prevalence of non-nutritive sweeteners is increasing over time in New Zealand's packaged foods and beverages and is likely a consequence of consumer demand for lower-sugar products. Ongoing monitoring of the prevalence and type of NNS is important to detect further increases.

Copper(II) Prevents the Saccarine-Dialkylcyanamide Coupling by Forming Mononuclear (Saccharinate)(Dialkylcyanamide)copper(II) Complexes

The reaction in the system CuII/sacNa(H)/NCNR2 (sacNa(H) = sodium saccharinate (saccharin); R = Me, Et) results in the formation of the complexes [Cu(sac)2(NCNR2)(H2O)2] (R = Me 1, Et 2) instead of the expected products derived from the saccharin–cyanamide coupling. Complexes 1, 2, and hydrate 1·2H2O were characterized by IR, AAS (Cu%), TGA, and also by single-crystal X-ray diffraction for 1 and 1·2H2O. An integrated computational study of model structure 1 in the gas phase demonstrates that the Cu–Ncyanamide and Cu–Nsac coordination bonds exhibited a single bond character, polarized toward the N atom and almost purely electrostatic, with the calculated vertical total energies for the Cu–Ncyanamide and Cu–Nsac of 43.6 and 156.4 kcal/mol, respectively. These data confirmed that the copper(II) completely blocks the nucleophilic centers of ligands via coordination, thus preventing the saccharin–cyanamide coupling.

Screening level intake estimates of low and no-calorie sweeteners in Argentina, Chile, and Peru

As obesity rates increase, several countries in Latin America have implemented strategies to curb the consumption of sugars, resulting in reformulations of products with low and no-calorie sweeteners (LNCS). The increased availability of LNCS-containing products raises concerns about the potential risk of exceeding the Acceptable Daily Intake (ADI). Information on the intake of LNCS among Latin American countries are limited by the lack of publicly available national consumption data. Using the Budget Method, screening level intake estimates of six LNCS (acesulfame potassium, aspartame, cyclamate, saccharin, steviol glycosides, and sucralose) were derived for Argentina, Chile, and Peru based on national sales data and product labels. Four tiered assessments were conducted where assumption of LNCS use ranged from the most conservative Tier 1 to the more refined yet conservative LNCS use and concentrations in subsequent tiers. The estimated intakes, applicable to the total population as well as children, were below their ADIs for all tiers. For Tier 2 where average LNCS concentrations were assumed present in all LNCS-containing products, intakes were <60% of the ADI. Estimates for the more refined tiers were comparable to published estimates based on select subpopulations in these countries, validating the approach used in this study.

Saccharin and Sucralose Protect the Glomerular Microvasculature In Vitro against VEGF-Induced Permeability

Diabetic kidney disease (DKD) has become a global health concern, with about 40% of people living with type 1 and type 2 diabetes mellitus developing DKD. Upregulation of vascular endothelial growth factor (VEGF) in the kidney is a significant pathology of DKD associated with increased glomerular vascular permeability. To date, however, current anti-VEGF therapies have demonstrated limited success in treating DKD. Recent studies have shown that artificial sweeteners exhibit anti-VEGF potential. The aim of this study was therefore to assess the effects of aspartame, saccharin, and sucralose on VEGF-induced leak using an in vitro model of the glomerular endothelium. Saccharin and sucralose but not aspartame protected against VEGF-induced permeability. Whilst the sweeteners had no effect on traditional VEGF signalling, GC-MS analysis demonstrated that the sweetener sucralose was not able to enter the glomerular endothelial cell to exert the protective effect. Chemical and molecular inhibition studies demonstrated that sweetener-mediated protection of the glomerular endothelium against VEGF is dependent on the sweet taste receptor, T1R3. These studies demonstrate the potential for sweeteners to exert a protective effect against VEGF-induced increased permeability to maintain a healthy endothelium and protect against vascular leak in the glomerulus in settings of DKD.

Updated Database and Trends of Declared Low- and No-Calorie Sweeteners From Foods and Beverages Marketed in Spain

Background: The past few years have witnessed an increase in the availability of food products containing one or more low- and no-calorie sweeteners (LNCS) in the Spanish market, mostly due to the new massive reformulation plan. However, these are not included in food composition tables or databases, and, therefore, assessment of their intake among the population is complex. This study aims to update a database including commercialized foods and beverages.

Method: A systematic search of ingredients information from the different food and beverage categories was undertaken during 2019 by recording the availability and type of LNCS declared in the information of the product from labels and online shopping platforms of retailers from Spain to update a previous food composition database compiled in 2017.

Results: A total of 1,238 products were identified. The major groups were sugar and sweets (24%), non-alcoholic beverages (21%), cereals and grains (19%), and milk and dairy products (14%) accounting for >70% of total products. The mainly declared LNCS were sorbitol (19.5%), sucralose (19.5%), and acesulfame K (19.2%).

Conclusion: There is a wide variety of products that include LNCS as a main ingredient with higher availability than when compared with the results of database of 2017, consequently, it might be expected that LNCS are commonly consumed at present in the Spanish diet.

Metabolic engineering for the synthesis of steviol glycosides: current status and future prospects

With the pursuit of natural non-calorie sweeteners, steviol glycosides (SGs) have become one of the most popular natural sweeteners in the market. The SGs in Stevia are a mixture of SGs synthesized from steviol (a terpenoid). SGs are diterpenoids. Different SGs depend on the number and position of sugar groups on the core steviol backbone. This diversity comes from the processing of glycoside steviol by various glycosyltransferases. Due to the differences in glycosylation, each SG has unique sensory properties. At present, it is more complicated to extract high-quality SGs from plants, so the excavation of the metabolic pathways of engineered microorganisms to synthesize SGs has been extensively studied. Specifically, the expression of different glycosyltransferases in microbes is key to the synthesis of various SGs by engineered microorganisms. To trigger more researches on the functional characterization of the enzymes encoded by these genes, this review describes the latest research progresses of the related enzymes involved in SG biosynthesis and metabolic engineering.Key points• Outlines the research progress of key enzymes in the biosynthetic pathway of SGs• Factors affecting the catalytic capacity of stevia glucosyltransferase• Provide guidance for the efficient synthesis of SGs in microbial cell factories.

Food additives: From functions to analytical methods

Food additives refer to all kinds of trace substances used in food or food processing to preserve flavor or enhance food taste, appearance, or other qualities. At present, artificial synthetic food additives have gradually replaced the natural food additives and many problems related to food additives, involving the abuse of food additives, excessive additives or even toxic additives. Obviously, food additives can bring people great sensory enjoyment and commercial convenience, but they may also cause potential risks to human health. So, it is of high significance to conduct quantitative analysis on the content of food additives. According to their functions and the regulatory requirements of food additives, this review starts from the classification and structures of various food additives involving colorants, preservatives, antioxidants, sweeteners, emulsifiers, stabilizers, thickeners, gelling agents. It then summarizes and discusses analytical methods for quantification of food additives including modern immunoassays and other biotechnological methods. The proposed review aspires to fill in the knowledge gap of food additives between academia and industry by covering all kinds of analytical methods for quantifying food additives.

Low- and No-Calorie Sweetener (LNCS) Consumption Patterns Amongst the Spanish Adult Population

Low- and no-calorie sweeteners (LNCS) are a group of food additives characterized by their high sweetness intensity and virtually zero caloric content, attributes that make them potential substitutes for added sugars in processed foods and beverages. However, there is currently scarce information available about both the different LNCS used in food products available in Spain and their consumption patterns. Prompted by these reasons, the aim of this research work was to identify the presence and consumption of LNCS in food and beverages consumed by a representative sample of the Spanish adult population (n = 507). For this purpose, a Food Frequency Questionnaire was carried out. Overall, it was found that 4.5% of the foods and 22.3% of the beverages consumed by the surveyed population contained LNCS. The food groups that presented the highest percentage of daily servings containing LNCS were non-alcoholic beverages such as soft drinks and juices (36.1%); sugars and sweets such as chocolates, candies, or chewing gum (14.2%); milk and dairy products (7.0%); meat and derivative products (5.1%); cereals and derivatives (4.3%); appetizers (1.7%); and, finally, sauces and condiments such as ketchup or mustard (1.0%). The main LNCS consumed were acesulfame-K, sucralose, sorbitol, aspartame, and cyclamate, although their prevalence of use differs greatly among foods, beverages, or tabletop sweeteners. Our results show the great diversity of food groups that are currently including these compounds as ingredients. Consequently, there is a need for these food additives to be included in food composition databases, which should be regularly updated to include LNCS in order to facilitate their assessment and monitoring in dietary nutritional surveys.

Use of acceptable daily intake (ADI) as a health-based benchmark in nutrition research studies that consider the safety of low-calorie sweeteners (LCS): a systematic map

BACKGROUND

It is well-recognized that consumers face many challenges in understanding and applying nutritional guidance for low-calorie sweeteners (LCS). Thus, this research aims to (1) assess how benchmarks for safe levels of consumption of LCS are utilized by researchers, and (2) understand how varying use of such benchmarks may contribute to challenges in understanding and applying nutritional guidance for LCS consumption.

METHODS

A systematic mapping exercise was employed to characterize when and how acceptable daily intake (ADI) values are used as health-based benchmarks in nutrition research studies that consider the safety of LCS.

RESULTS

Based on results from charting 121 studies, our findings demonstrate that comparisons of LCS intake to an ADI derived by an authoritative body have been made in a diverse set of published literature, varying widely in their objectives, approaches, and populations of interest. The majority of studies compared the ADI to intake in a population under study; these represent the type of comparison that is most consistent with the intent of the ADI. Other applications of the ADI included use as a benchmark in experimental studies, risk-benefit analyses, and metabolism studies.

CONCLUSION

Although most instances of ADI use were reasonable within the context of the individual studies' objectives, the diversity in use by original-study authors amplifies the continued need for development of "best practices" regarding the use and interpretation of the ADIs in current research. Using comparisons to the ADI can be a helpful way to provide context to research findings. However, in doing so, it is important that researchers utilize the value in a manner specific with its intent, as the ADI is a metric that represents an estimate of the amount of a substance that can be consumed daily over a lifetime without presenting an appreciable risk to health.

An Overview of Current Knowledge of the Gut Microbiota and Low-Calorie Sweeteners

This review provides an overview of the interrelationships among the diet, gut microbiota and health status, and then focuses specifically on published research assessing the relationship of low/no-calorie sweeteners (LNCS) to selected aspects of the gut microbiota. Microbiome research is expanding as new data on its role in health and disease vulnerability emerge. The gut microbiome affects health, digestion, and susceptibility to disease. In the last 10 years, investigations of LNCS effects on the gut microbiota have proliferated, though results are conflicting and are often confounded by differences in study design such as study diet, the form of the test article, dosage, and study population. Staying current on microbiome research and the role of dietary inputs, like LNCS, will allow healthcare and nutrition practitioners to provide evidenced-based guidance to the individuals they serve.

Effects of Non-Nutritive Sweeteners on Energy Intake, Body Weight and Postprandial Glycemia in Healthy and with Altered Glycemic Response Rats

The aim of this study was to evaluate the effects of non-nutritive sweeteners (NNS) consumption on energy intake, body weight and postprandial glycemia in healthy and with altered glycemic response rats. Animals on normal diet (ND) or high-fat diet (HFD) were divided to receive NNS (sucralose, aspartame, stevia, rebaudioside A) or nutritive sweeteners (glucose, sucrose) for 8 weeks. The NNS were administered at doses equivalent to the human acceptable daily intake (ADI). A test using rapidly digestible starch was performed before and after treatments to estimate glycemic response. No effects of NNS consumption were observed on energy intake or body weight. Sucrose provoked an increased fluid consumption, however, energy intake, and weight gain were not altered. In ND, no effects of NNS on glycemic response were observed. In HFD, the glycemic response was increased after sucralose and stevia when only the final tolerance test was considered, however, after including the baseline test, these results were no longer significant compared to glucose. These findings provide further evidence suggesting that at the recommended doses, NNS do not alter feeding behavior, body weight or glycemic tolerance in healthy and with altered glycemic rats.

A Healthy Diet Rich in Calcium and Vitamin C Is Inversely Associated with Metabolic Syndrome Risk in Korean Adults from the KNHANES 2013-2017

The association between metabolic syndrome and eating patterns remains unclear. We hypothesized that Korean Healthy Eating Index (KHEI) scores were related to metabolic syndrome (MetS) risk in adults in a gender-dependent manner. We aimed to examine the hypothesis using the Korea National Health and Nutrition Examination Survey-VI (2013-2017) data with a complex sample survey design. Adjusted means and 95% confidence intervals of KHEI scores and nutrient intake estimated by the 24-h recall were calculated according to MetS status after adjusting for age, residence area, region, education, obesity, income, drinking status, smoking status, marriage, and exercise. Adjusted odds ratios for MetS were measured according to KHEI quartiles using logistic regression analysis while controlling for covariates. MetS incidence was significantly higher in females than in males. Those who were older, less educated, earning less income, more obese, living in rural areas, drinking severely, non-exercising, and married had higher MetS incidence than those with the opposite state. Total KHEI scores of all components KHEI scores were lower for those with MetS (MetS group) than those without MetS (Non-MetS group) in both genders. For KHEI components, having breakfast and milk and fat intake had lower scores for the MetS group than for the Non-MetS group in women, whereas fruits and milk and milk product intake had lower scores for the MetS group in men. Nutrient intake influenced the MetS risk in females more than in males. Fat, calcium, and vitamin C intakes from 24-h recall were lower in the MetS group than in the Non-MetS group in women. KHEI scores had an inverse association with MetS risk by 0.98-fold in both genders after adjusting for covariates. In conclusion, a healthy diet that includes adequate calcium and vitamin C is associated with a lower the risk of MetS in both men and women.

Factors associated with salt intake in the Brazilian adult population: National Health Survey

This paper aims to identify the factors associated with high salt intake in the Brazilian adult population. This is a cross-sectional study with 8,083 adults participating in the National Health Survey (PNS, 2014/15). Salt intake was based on the estimation of 24-hour urinary sodium calculated from the sodium/creatinine ratio in spot urine samples. The highest quartile of the distribution was considered high salt intake. The relationship between high salt consumption and sociodemographic factors, lifestyles, morbidity, and self-rated health status was analyzed by calculating the crude prevalence ratios and the prevalence ratios adjusted for age and gender. Approximately 28.1% had an estimated salt intake higher than 10.56 g/day. Overweight (Adjusted Prevalence Ratio; 95%CI - PRadj 1.23; 1.09-1.39), obesity (PRadj 1.61; 1.43-1.83), and diabetes (PRadj 1.36; 1.17-1.58) were positively associated with high salt intake. Female gender (PRadj 0.73; 0.66-0.80), high schooling level (PRadj 0.88; 0.79-0.99), living in the North and chronic kidney disease (PRadj 0.71; 0.56-0.90) were protective factors. Salt consumption is elevated nationwide and in all population subgroups, requiring coordinated actions.

Soft drinks and sweeteners intake: Possible contribution to the development of metabolic syndrome and cardiovascular diseases. Beneficial or detrimental action of alternative sweeteners?

The rapid increase in obesity, metabolic syndrome, and cardiovascular diseases (CVDs) has been related to the rise in sugar-added foods and sweetened beverages consumption. An interesting approach has been to replace sugar with alternative sweeteners (AS), due to their impact on public health. Preclinical and clinical studies, which analyze the safety of AS intake, are still limited. Major pathogenic mechanisms of these substances include ROS and AGEs formation. Indeed, endothelial dysfunction involving in the pathogenesis of micro- and macro-vascular diseases is mitochondrial dysfunction dependent. Hyperglycemia and endoplasmic reticulum stress together produce ROS, contributing to the development and progression of cardiovascular complications during type 2 diabetes (T2D), thus causing oxidative changes and direct damage of lipids, proteins, and DNA. Epidemiological studies in healthy subjects have suggested that the consumption of artificial AS can promote CV complications, such as glucose intolerance and predisposition to the onset of T2D, whereas natural AS could reduce hyperglycemia, improve lipid metabolism and have antioxidant effects. Long-term prospective clinical randomized studies are needed to evaluate precisely whether exposure to alternative sugars can have clinical implications on natural history and clinical outcomes, especially in children or during the gestational period through breast milk.

Tiered intake assessment for low- and no-calorie sweeteners in beverages

A tiered intake assessment approach is presented and applied to derive the maximum potential global low- and no-calorie sweeteners (LNCS) intake estimates. The US and Uk markets served as representative for the world and the EU region, respectively, to determine the maximum potential exposure for acesulfame potassium (AceK), aspartame, saccharin, steviol glycosides, and sucralose in various subpopulations, including brand-loyal consumers. Conservative intake estimates for LNCS used in non-alcoholic beverages were calculated for the general population 2 + y, toddlers (12-35 months (US) or 18-35 months (UK)), young children 3-9 y, adolescents 10-17 y, adults 18-64 y, elderly 65-74 y, and very elderly 75 + y based on assumed uses in high beverage consumption markets, leveraging either the 2-day food consumption data from the 2013-2016 US National Health and Nutrition Examination Survey or the 4-day food consumption data from the 2008-2017 UK National Diet and Nutrition Survey Rolling Programme. Strong concordance between the refined budget method and the brand-loyal deterministic approach was shown, the latter assumes the maximum industry-reported global LNCS use level is present in 100% of non-alcoholic beverages. This study shows that safety of LNCS in beverages at proposed use levels can be supported for any geography, with all intake estimates falling below the acceptable daily intake in refined assessments. Importantly, this study shows the refined budget method to be a valid first-tier screening assessment in prioritising those LNCS that may benefit from more refined intake assessments when warranted.

Intake of low and no-calorie sweeteners (LNCS) by the Brazilian population

Estimated intake of six low and no-calorie sweeteners (LNCS) (acesulfame potassium, aspartame, cyclamate, saccharin, steviol glycosides and sucralose) from processed foods and beverages, as well as from tabletop sweeteners uses, by the Brazilian population were derived and compared to the respective Acceptable Daily Intake (ADI). The estimates were based on dietary consumption data from a nationwide cross-sectional survey conducted by the Instituto Brasileiro de Geografia e Estatística (IBGE) in 2008-2009 and LNCS use rates and associated market share information based on data provided by Brazilian industry members. Two intake scenarios were considered: a conservative brand loyal consumer scenario that assumes all LNCS-containing foods and beverages and tabletop sweeteners contain the maximum reported LNCS concentrations (Scenario A) and a scenario representative of the general consumer population that uses a market share weighted average of the reported concentrations (Scenario B). Intake estimates were derived for the total Brazilian population (age 10 + y), and for the subpopulations of adolescents (10-18y), adults (19-59y), and older adults (60 + y). Intake of LNCS up to the 95^th percentile did not exceed their respective ADI for all subpopulations considered, in either the general consumer scenario or the brand loyal scenario. Among consumers age 10 + y, the 95^th percentile intakes of the various LNCS ranged from 6.8% to 54% of their respective ADI for the brand loyal scenario and from <1% to 6.0% of their respective ADIs for the general consumer scenario.

Acute glycemic and insulinemic effects of low-energy sweeteners: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

It has been suggested that low-energy sweeteners (LES) may be associated with an increased risk of metabolic diseases, possibly due to stimulation of glucose-responsive mechanisms.

OBJECTIVE

We conducted a systematic review and meta-analysis of human intervention studies examining the acute effect of LES intake on postprandial glucose (PPG) and postprandial insulin (PPI) responses, in order to comprehensively and objectively quantify these relations.

METHODS

We systematically searched the Medline, OVID FSTA, and SCOPUS databases until January 2020. Randomized controlled trials comparing acute postprandial effects on PPG and/or PPI after exposure to LES, either alone, with a meal, or with other nutrient-containing preloads to the same intervention without LES were eligible for inclusion. PPG and PPI responses were calculated as mean incremental area under the curve divided by time. Meta-analyses were performed using random effects models with inverse variance weighing.

RESULTS

Twenty-six papers (34 PPG trials and 29 PPI trials) were included. There were no reports of statistically significant differences in the effects of LES on PPG and PPI responses compared with control interventions. Pooled effects of LES intake on the mean change difference in PPG and PPI were -0.02 mmol/L (95% CI: -0.09, 0.05) and -2.39 pmol/L (95% CI: -11.83, 7.05), respectively. The results did not appreciably differ by the type or dose of LES consumed, cointervention type, or fasting glucose and insulin levels. Among patients with type 2 diabetes, the mean change difference indicated a smaller PPG response after exposure to LES compared with the control (-0.3 mmol/L; 95% CI: -0.53, -0.07).

CONCLUSIONS

Ingestion of LES, administered alone or in combination with a nutrient-containing preload, has no acute effects on the mean change in postprandial glycemic or insulinemic responses compared with a control intervention. Apart from a small beneficial effect on PPG (-0.3 mmol/L) in studies enrolling patients with type 2 diabetes, the effects did not differ by type or dose of LES, or fasting glucose or insulin levels. This review and meta-analysis was registered at PROSPERO as CRD42018099608.

Artificial sweeteners in non-alcoholic beverages: Occurrence and exposure estimation of the Portuguese population

Artificial sweeteners such as acesulfame-potassium (ACE-K). saccharin (SAC), and aspartame (ASP), play a vital role in the food industry. Despite apparent benefits, several studies report adverse reactions on consumers. EFSA is currently re-evaluating several individual sweeteners, including ASP, Ace-K and SAC that shall be completed by 31 December 2020. Our goal was to evaluate, by liquid chromatography with ultraviolet detection (LC-UV), their levels in non-alcoholic beverages from the Portuguese market (soft drinks, sport drinks, energy drinks, and nectars), and estimate the exposure of the Portuguese adolescent/adult population. ACE-K was found in 85.7% of the samples, in mean levels of 97.4 mg/L. ASP and SAC, detected in 37.5% and 33.9% of the samples, were found in averages of 161.5 and 55.0 mg/L, respectively. The maximum limits set for ASP were exceeded in one energy drink. SAC exceeded the maximum permitted level (MPL) level in 3 soft drinks based on tea extracts. In 4 samples SAC was found but not mentioned in the label, and in one of these samples exceeded the MPL. The estimated daily intake (EDI), calculated in mg per kilogram of body weight per day, of ACE-K, SAC and ASP was found to be below the acceptable daily intake (ADI), both for Portuguese adolescents and adult population. Traditional soft drinks accounted for the highest EDIs representing 1.8%, 2.3% and 0.6% for ACE-K, SAC and ASP, respectively, of the ADI. Considering the previous report in Portugal it is observed that the population is currently exposed to a greater amount of artificial sweeteners, which may indicate a trend for more artificial sweeteners' usage in order to reduce sugar intake.