- Click here for explanation of classification scheme.

The purpose is to convey the position of the ADA that consumers can safely enjoy a range of nutritive and nonnutritive sweeteners when consumed in moderation and within the context of a diet consistent with the Dietary Guidelines for Americans.

Article inclusion criteria not described.

Not described.

Recruitment:  Article selection methods not described.

Design Position Statement.

Blinding used (if applicable) Not applicable.

Intervention (if applicable) Not applicable.

Statistical Analysis Not performed.

Timing of Measurements Not applicable.

Dependent Variables Not applicable.

Independent Variables  Not applicable.

Control Variables Not applicable.

 

Initial N: 73 references

Attrition (final N):  73

Age: Varied

Ethnicity: Not reported.

Other relevant demographics: Not reported.

Anthropometrics Not applicable.

Location:  International references

 

Persons can include sugar in their diets and still consume a healthful diet.  The association between sugar intake and nutrient adequacy of the diet has a U shape suggesting that extreme intakes of sugar, too high or too low, are not optimal.

The safety and use of polyols has been extensively reviewed.  Because of the incomplete absorption, polyols produce a low glycemic response.  Sorbitol and mannitol have a GRAS status and both contain a warning: "excess consumption may have a laxative effect".  At the time of publication, a petition for GRAS status had been accepted for filing for isomalt, lactitol, maltitol, hydrogenated starch hydrolysates and erythritol.

The FDA has approved 4 nonnutritive sweeteners and regulates them as food additives:  saccharin (on an interim basis pending additional study), aspartame, acesulfame-K, and sucralose.  With the exception of saccharin, the other sweetners have received FDA approval.  Saccharin has been listed as an anticipated "carcinogen", although studies of high users do not support an association between saccharin and cancer.  Subgroups of person such as heavy smokers, may present increased risk. 

Alitame and cyclamate are two nonnutritive sweetners not approved at time of publication of report.

Children will have the highest intake of nutritive and nonnutritive sweetners as calculated by mg intake/kg body weight.  Children can safely consume nutritive sweeteners within a diet consistent with the Dietary Guidelines.  Children who exhibit nonspecific diarrhea may benefit from a reduction in fructose and products containing polyols.  It has been suggested that children limit their intake of saccharin because of the limited amount of data available for use in children.  Intakes of aspartame and acesulfame K are below the ADI.

Use of nutritive sweeteners that have GRAS status is acceptable during pregnancy.  It has been suggested that women consider careful use of saccharin during pregnancy.

Claims of sugar intake and hyperactivity have not been supported.  Claims re: aspartame and hyperactivity, aspartame and seizures and aspartame and brain tumors are not supported and the FDA continues to support the original approval of aspartame.

Risk of dental caries increases with intake of nutritive sugars, however, this risk does not work independently from factors such as oral hygiene and fluoridation.  Use of polyol gum, especially xylitol-based gums can reduce the risk of dental caries as compared to sucrose based gums.  Nonnutritive sweeteners do not promote tooth decay.

Nutritive sweeteners do not produce greater increases in blood glucose response as compared to complex starches.  The selection of healthful foods within the context of the Food Guide Pyramid and with attention to energy intake and blood glucose control is recommended for the management of diabetes.  Nonnutritive sweeteners are also appropriate in meal plans and may help with energy intake control.

Very high intakes of dietary fructose and sucrose can result in elevations of plasma triglycerides.

Obesity is a complex problem and its cause cannot be attributed to sugars alone.  The contribution of nonnutritive sweeteners to obesity is unclear.  Therefore, persons who wish to lose weight may choose to use nonnutritive sweeteners but should do so within the context of a sensible weight management program incuding a sensible diet and enjoyable exercise.

 

 

Consumers can incorporate nutritive sweeteners into a healthful eating plan and meet the Dietary Guidelines for Americans.  The food label also provides information to consumers on types and amounts of nutritive sweeteners in food and beverages.

Nonnutritive sweeteners are safe for use by most persons within the approved guidelines. 

As new nonnutritive sweeteners emerge, the safety of these substitues used alone or in combination with other nutritive and nonnutritive sweeteners and macronutrient substitutes will need to be examined.

Additionally, national surveillance of intake of both nutritive and nonnutritive sweeteners is important to detrmine if they help consumers meet the recommended dietary goals.

Thorough overview of the different types of nutritive and nonnutritive sweetners including regulatory status in addition to sweetner use in specific populations, ie children and pregnant mothers, as well as chronic conditions.

This paper is not a review and is likely the reason no information related to the choosing of references is included.