New Non-Sugar Sweetener Guideline from the World Health Organization
The World Health Organization recently released the Use of Non-Sugar Sweeteners: WHO Guideline (1). The guideline is based on a 2022 systemic review (2) that used GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) to summarize the evidence and make a practice recommendation.
A total of 283 studies conducted in adults, children, pregnant women or mixed populations were included in the systematic review (50 RCTs, 144 prospective cohort studies/case-control studies and 89 other studies/trials (2). The non-sugar sweeteners (NSS) that were reviewed included acesulfame K, advantame, aspartame, cyclamate, neotame, saccharin, sucralose and steviol glycosides (2). The review looked at key outcomes in adults (including individuals who are pregnant) such as measures of adiposity, prediabetes and type 2 diabetes, cardiovascular diseases, cancer, dental caries and chronic kidney disease (2).
A concluding conditional recommendation in the guideline suggests against the use of NSS to control body weight or reduce the risk of non-communicable diseases (NCDs) (1). This recommendation was based on undesirable effects from long-term use of NSS, such as an increased risk of type 2 diabetes, cardiovascular diseases and mortality in adults (2).
The PEN Team will conduct a rapid review of the content within the following three practice questions against the new guideline and related systemic review:
- Are there any specific considerations with regard to the use of sweeteners (e.g. nonnutritive, artificial, sugar substitutes, intense, low calorie) in pregnancy/lactation?
- What effect do sweeteners (e.g. nonnutritive, artificial, intense, low calorie, sugar substitutes) have on cardiometabolic health?
- What effect do sweeteners (e.g. nonnutritive, artificial, intense, low calorie and sugar substitutes) have on weight management?
Watch for updates to these practice questions in the next couple of months. Practitioners can help consumers reduce NSS and free sugar intake by providing guidance on how to eat a variety of foods with naturally-occurring sugars, like fruit, or unsweetened food and beverages instead (1).
- WHO. Use of non-sugar sweeteners: WHO guideline. 2023 May. Available from: https://www.who.int/publications/i/item/9789240073616
- WHO. Health effects of the use of non-sugar sweeteners: a systematic review and meta-analysis. 2022 Apr. Available from: https://www.who.int/publications/i/item/9789240046429