Low‐calorie sweetener use, weight, and metabolic health among children: A mini‐review

Abstract

Summary A reduction in the consumption of added sugars and sugar‐sweetened beverages (SSBs) is a key focus of public health recommendations for a healthy diet among children. One approach to lower added sugar intake is to instead use low‐calorie sweeteners (LCSs), which contain no or few calories. Consumption of LCSs is increasing worldwide, with the most marked rise observed among children and adolescents. However, the extent to which LCS consumption is helpful or harmful for weight management is controversial, particularly when LCS consumption begins in childhood. Herein, we summarize the limited existing literature examining effects of paediatric LCS consumption on appetite, energy intake, and body weight. While positive associations between LCS consumption and weight gain are reported in observational analyses, the majority of intervention studies, some of which blinded children to the contents of the drinks, report benefits of LCSs for reducing excessive child weight gain. Several potential mechanisms have been proposed to explain LCS effects on body weight, including LCS‐induced promotion of appetite and energy intake. Yet studies assessing effects of beverages with LCSs (LCSBs) compared with SSBs on child appetite report mixed findings. Some demonstrate that children completely compensate for the diluted energy content of LCSBs by eating more solid food calories at subsequent meals compared with children administered SSBs, while others report a reduction in total energy intake with LCSB ingestion. Given the limited studies and resulting uncertainty as to whether LCSs benefit or worsen weight and metabolic health in children is integral that effects of LCS use during childhood continue to be investigated in future prospective studies.

Biological Responses to the Consumption of Non-Nutritional Sweeteners

“…A pattern has emerged in which observational studies make NNS's appear harmful causing increased weight, while intervention studies find NNS's reduce weight. A natural hypothesis was that in the observational studies the people consuming NNS's must have compensated by eating more solid food calories at subsequent meals, which indeed was found in some studies, but others reported a reduction in total energy expenditure after NNS consumption [81]. When sweet receptors in the oral cavity are activated not only does the brain perceive sweetness but the body prepares to digest calories through the cephalic phase responses, most notably the cephalic phase insulin response (CPIR) which is a neurally-mediated release of insulin prior to nutrient absorption [82].…”

Changes in nonnutritive sweetener intake in a cohort of preschoolers after the implementation of Chile's Law of Food Labelling and Advertising

“…Exposing children to sugars or NNS might reinforce sweet preferences that could persist for their lifetime 15 and lead to overconsumption of sugar‐sweetened foods and beverages 16 . Furthermore, the consumption of some NNS has been associated with gut microbiota alterations, metabolic syndrome and higher body mass index, but results are inconclusive in paediatric population 14,16–18 . In addition, children are at risk of surpassing the limits for safe NNS intake because the acceptable daily intake (ADI) is calculated based on body weight, and children have lower body weight than adults 9…”

“…16 Furthermore, the consumption of some NNS has been associated with gut microbiota alterations, metabolic syndrome and higher body mass index, but results are inconclusive in paediatric population. 14,[16][17][18] In addition, children are at risk of surpassing the limits for safe NNS intake because the acceptable daily intake (ADI) is calculated based on body weight, and children have lower body weight than adults. 9 Chile is one of the few countries where eight different NNSs must be quantified on the nutrition facts panel (NFP).…”

Pediatric obesity: prevention is better than care

“…Sugary drinks taxation appears as one of the most promising prevention programs according to modeling studies and it can be of more impact if associated with other interventions enabling access to healthy foods [ 85 , 86 ]. Another approach is the use of low-calorie sweeteners that contain no or few added sugars that have been associated with contrasting results [ 87 ].…”