Nutritive and Non-Nutritive Sweeteners

NNNS: Estimated and Acceptable Intake (2011)

Citation:

Renwick AG. The intake of intense sweeteners-an update review. Food Additives and Contaminants, 2006 April; 23 (4): 327-338.

 
Study Design:
Narrative Review
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:
The intake of intense sweeteners are reviewed since the last review (Renwick, 1999) in chronological order of publication, with descriptions of the findings and strengths and weaknesses of the study design.
Inclusion Criteria:
Published articles since last review of Renwick (1999).
Exclusion Criteria:
Description of Study Protocol:
Data Collection Summary:
Description of Actual Data Sample:
Summary of Results:

Summary of Recent Studies On the Intake of Sweeteners

Reference Date of Study Subjects Studies Design Average Intake by Consumers (Percentage ADI) Intake by High Consumers1 (Percentage ADI) Conclusions
Leclercq et al, 1999 1996 212 teenagers (aged 13 to 19 years) in Italy Prospective 14-day food diary with brand information 0.1% (Ace), 0.1% (Asp), 2.2% (Cyc) and 4.2 % (Sac) 1.5% (Ace), 1.0% (Asp), 5.6%(Cyc) and 10.6% (Sac)2 The pattens of sweetener intake were similar to previous publications and the intakes were well below the ADI
Wilson et al, 1999 Not stated 188 subjects (aged three to 74 years) in UK Designed to validate the use of urinary excretion of acesulfame-K and of saccharin as biomarkers of intake 9% (Ace) and 14% (Sac) Not reported The mean intakes of acesulfame-K and saccharin were reported to be below their ADI values
Garnier-Sagne et al, 2001 1997 227 insulin-dependent diabetics (aged two to 20 years) in France A five-day prospective food diary with the assumption that all sugar-free products contained the same sweetener 7% (Ace), 6% (Asp), 8% (Sac) 27%(Ace), 20%(Asp), 26% (Sac) The study supports other studies in that intakes of acesulfame-K, aspartame and saccharin would not exceed their ADI values, even in the highest consumers
Food Standards Agency UK, 2003 2001 1,110 children (aged 1.5 to 4.5 years) in UK A seven-day diary of beverage consumption, but brand information was not obtained 6% (Ace), 8% (Asp), 41% (Cyc) and 23% (Sac) 25%(Ace), 30%(Asp), 128% (Cyc) and 77% (Sac) The results support other findings that it is only cyclamate where the ADI might be exceeded by the highest intakes in young children
Ilback et al, 2003 1999 243 diabetic children aged (zero to 15 years) and 547 adult diabetics (aged 16 to 90 years) in Sweden A retrospetive food frequency questionnaire, maximum permitted concentration for each product category and assumed Intakes were below ADI values for Ace, Asp, cyc and Sac, but the published data are difficult to interpret 45% (Asp), 114% (Cyc) and 46% (Sac) in adults and 115% (Asp), 317% (Cyc) and 126% (Sac) in children3 The data show that only cyclamate could have an intake above it's ADI
Serra-Majem et al, 2003 1994 to 1996 784 men (aged 30 to 50 years) in Spain A retrospective food-frequency questionnaire designed to focus on cyclamate intake in relation to its metabolism 6% (Cyc)4 Not reported The population probably has higher than average cyclamate use
Arcella et al, 2004 2000 to 2001 362 teenagers (aged 14 to 17 years), including 139 female high consumers of sugar-free soft drinks, in Italy Three prospective four-day food diaries with brand information 0.3% (Ace), 0.2% (Asp), 4.5% (Cyc), 0.7% (Sac) in the female high consumers 0.7% (Ace), 0.4%(Asp), 4.5 (Cyc), 0.7% (Sac) in the female high consumers The intakes are well below the ADI values
Devitt et al, 2004 Not stated 56 diabetic children (aged two to six years) in Canada An interactive 24-hour dietary recall by the parents with food items identified from product labels 4%(Ace), 10% (Asp), 0% (Cyc), 9% (Sac) and 1% (Suc) 13%(Ace), 20% (Asp), 0%(Cyc) and 6% (Suc) The intakes for all sweetners were well below their ADI values
Food Standards Australia New Zealand, 2004 2002 to 2003 298 diabetics and 299 non-diabetic subjects with high intakes of sugar-free products (aged 12 to over 60 years) in Australia and New Zealand A prospective seven-day food diary that included brand information 3% (Ace), 6% (Asp), 27% (Cyc), 9% (Sac) and 3%(Suc) 9%(Ace), 19% (Asp), 85% (Cyc), 47% (Sac) and 15% (Suc) The means and 95th percentile intakes were below the ADI values of the different sweeteners in the selected high consumers and diabetics, with the exception of cyclamate in diabetics, where the 95th percentile slightly exceeded the JECFA ADI value
van Rooij-van den Bos et al, 2004 1997 to 1998 National Food Survey on 6,250 subjects (aged one to 97 years) in the Netherlands A prospective two-day food diary <0.5% (Ace), <0.3% (Asp), 0.9% (Cyc) and 0.4% (Sac) 0.7% (Ace), 1.3% (Asp), 3.6% (Cyc) and 0.4% (Sac) The mean and 95th percentile intakes were below the ADI values

  1. 95th percentile intakes used for the consumer data except for Garnier-Sagne et al, 2001, (97.5th percentile of the theoretical maximum daily intake), FSA, 2003, (97.5th percentile) and Devitt et al, 2004, (ninth percentile)
  2. Maximum reported intake
  3. Intakes by the 10 children and 10 adults with the highest intakes (values read from published histograms)
  4. The arithmetric mean of the median intakes reported for cases and controls, which include consumers. The maximum intake was reported to be less than the ADI; Ace-acesulfame, Ali-alitame, Asp-aspartame, cyc-cylcamate, Sac-saccharin, Suc-sucralose. The percentage ADI values are calculated using the ADIs established by the WHO/FAO Joint Expert Committee on Food Additives of 0-15 (Ace), 0-1 (Ali), 0-40 (Asp), 0-11 (Cyc), 0-5 (Sac) and 0-15 (Suc)mg per kg body weight per day.
Author Conclusion:
  • Studies on the intakes of intense sweeteners in different countries, published since the previous review in 1999, indicate that the average and 95th percentile intakes of acesulfame-K, aspartame, cyclamate and saccharin by adults are below the relevent acceptable daily intake (ADI) values
  • Overal, there has not been a significant change in the intakes of sweeteners in recent years
  • Fewer data are available for the newer sweeteners, sucralose and alitame
  • The only data indicating that the intake of an intense sweetener could exceed its ADI value were the 95th percentile intakes of cyclamate in children, particularly with diabetes.
Funding Source:
University/Hospital: University of Southhampton
Reviewer Comments:
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes