Non-nutritive or artificial sweeteners are a growing part of US diets, now consumed by at least one in four children. A new American Academy of Pediatrics (AAP) policy statement is calling for the amount of these no- or low-calorie sweeteners to be listed on product labels. In this way, families and researchers can better understand how much children are consuming and any possible health effects.
The AAP policy statement, The Use of Non-nutritive Sweeteners in Children, offers a summary of the existing data around non-nutritive sweeteners and recommends future research into how they affect children’s weight, taste preferences, the risk for diabetes, and long-term safety.
“Looking at the evidence, we found there’s still a lot to learn about the impact of non-nutritive sweeteners on children’s health,” says Dr. Carissa Baker-Smith, lead author of the AAP policy statement and an Associate Professor of Pediatrics at the University of Maryland School of Medicine. “We need more research into the use of non-nutritive sweeteners and the risk for obesity and Type 2 diabetes, especially in children. Considering how many children are regularly consuming these products – which have become ubiquitous – we should have a better understanding of how they impact children’s long-term health.”
Non-nutritive sweeteners were introduced into the food supply more than 60 years ago to mimic the taste of sucrose (table sugar) without adding calories. Eight non-nutritive sweeteners are approved by the US Food and Drug Administration (FDA).
Saccharin, aspartame, acesulfame-potassium, sucralose, neotame and advantame were approved as food additives, while stevia and luo han guo (monk fruit) are approved under the generally recognized as safe (GRAS) designation. These products are 180 to 20,000 times sweeter than sugar.
Yet, when non-nutritive sweeteners were first introduced, health concerns focused on a potential risk of cancer, which was not borne out in subsequent research.
Now, health concerns around these products has shifted. As the obesity epidemic has driven increased use of these products, attention is directed at conflicting evidence over whether non-nutritive sweeteners actually help control weight.
However, in response to the newly published review, the International Sweeteners Association (ISA) sought to reassure the industry and public of the safety of sweeteners for children, and stated: “Food safety agencies monitor intake of approved low/no calorie sweeteners, and research at a global level confirms that low/no calorie sweeteners’ intake remains well below the individual sweetener ADI among the general population, in both children and adults.”
Labeling is key
The AAP now recommends that food and beverage manufacturers report non-nutritive sweetener content on food and beverage labels, rather than just listing them among ingredients, since they are now so widely available and consumed.
The National Health and Nutrition Examination Survey 2009-2012 showed that more than one-quarter of US children reported consumption of non-nutritive sweeteners, with 80 percent of these children reporting daily use.
“It is currently hard to know how much non-nutritive sweetener is in a product since manufacturers aren’t required to specify,” Dr. Baker-Smith says. “Listing the amount of non-nutritive sweetener a product contains would help families and researchers understand how much is actually being consumed by individuals and populations and further evaluate potentially related health effects.”
This is particularly important as research referenced by AAP suggests that many parents aren’t aware that their child is consuming these products. One study found that only 23 percent of parents can correctly identify food products that contain non-nutritive sweeteners. In addition, 53 percent of parents said they seek items labeled “reduced sugar,” but most did not recognize that the sweet taste was instead being provided by a non-nutritive sweetener.
Indeed, a recent report found that fruit drinks and flavored waters that contain added sugars and/or low-calorie sweeteners dominated sales of drinks intended for children in 2018. The report highlighted the confusing nature of the market for parents seeking to make healthful choices for their children. For example, popular juice and water blends do not contain added sweeteners, but equally popular flavored waters do.
Knowing the amounts of non-nutritive sweeteners in products would also help ensure children’s consumption remains below acceptable daily intake levels, Dr. Baker-Smith says.
In response, ISA stated: “Consumers worldwide, including in the US, are informed about the presence of low/no calorie sweeteners in a particular product through the list of ingredients, where sweeteners are indicated by their name, as any other food ingredient.”
