The drivers, trends and dietary impacts of non-nutritive sweeteners in the food supply: a narrative review

Abstract

Poor diets, including excess added sugar consumption, contribute to the global burden of disease. Subsequently, many nutrition policies have been implemented to reduce added sugar intake and improve population health, including taxes, education, labelling and environmental interventions. A potential consequence of these policy actions is the substitution of added sugars with non-nutritive sweeteners (NNS) in a variety of foods and beverages. NNS are used to reduce the energy and sugar content of foods and beverages while maintaining their palatability. Evidence of the toxicological risks of NNS is inconsistent, though concerns have been raised over the potential substitution effects of ultra-processed foods containing NNS for whole foods. This review aimed to provide an overview of current NNS food supply and consumption patterns, assess added sugar reduction policies and their impact on NNS, and determine the impact of NNS on food choice, energy intake and diet quality. NNS are widely available in a variety of products, though most commonly in carbonated beverages, dairy products, confectionary, table-top sweeteners, and fruit drinks. However, the longitudinal trends of different product categories, and differences between geographies and economy-income levels, require further study. Few studies have examined NNS consumption trends globally, though and increase in NNS consumption in the has been observed. Research examining how the increased availability of low-sugar, NNS containing products affects global dietary patterns is limited, particularly in terms of their potential substitution effects.

Does the Australian Health Star Rating System Encourage Added Sugar Reformulation? Trends in Sweetener Use in Australia

“…Comprising stakeholders from industry, government, and public health, the Partnership aims to encourage healthy eating and incentivize food manufacturers to make ‘positive changes’ [ 8 ]. Despite a broad suite of potential policy actions available to reduce added sugar consumption and improve diet quality, including taxation of SSB, education and food environment interventions [ 9 ], the Partnership has focused predominantly on policies that promote nutrient reformulation, including voluntary targets for packaged, processed foods the Health Star Rating (HSR) labelling system and controlling the portion size of certain products [ 10 ]. Reformulation can be either overt, in which nutrient-profile changes are advertised to the consumer, or covert, in which compositional changes are not promoted [ 11 ].…”

“…However, observational studies have reported associations between NNS consumption and weight gain [ 28 , 29 , 30 , 31 ], changes to the gut microbiome [ 32 ] and type-two diabetes [ 33 , 34 ]. Relationships from observational studies are correlational and may be biased, as participants with existing morbidities may be more likely to consume NNS than those without [ 9 ]. Concerns have also been raised regarding the potential substitution effects of UPF containing NNS for nutritious whole foods, and the long-term impact this may have on dietary balance and population health [ 35 ].…”

Prevalence and Types of Non-Nutritive Sweeteners in the New Zealand Food Supply, 2013 and 2019

“…Public health strategies to reduce sugar overconsumption include addressing factors that influence the purchasing of high sugar foods (restriction of marketing and price promotions); tax on high-sugar beverages; reformulation of the food supply (setting sugar benchmarks and monitoring sugar content and portion size reduction); consumer education campaigns to increase awareness and providing practical steps to reduce sugar intake [ 13 ]; and food labelling of added sugar content [ 14 , 15 ]. The food industry’s response to global sugar reduction recommendations has included a reduction in added sugar and the replacement of sugars with non-nutritive and low-calorie sweeteners.…”

“…Functionally, NNS add sweetness to foods with little or no energy, thereby reducing the sugar and energy content of products. Such foods may or may not be labelled as ‘diet’, ‘sugar-free’ or ‘low-joule/calorie’ and commonly contain one or more NNS in full or partial replacement of sugar [ 15 ]. A recent study of packaged food in Hong Kong noted that many foods containing NNS were not labelled ‘diet’ and therefore NNS may be consumed in larger amounts than previously thought [ 18 ].…”

“…Globally, NNS are found in a wide range of products including beverages, dairy products, confectionery, condiments, processed fruit and vegetable products and snack foods [ 15 ]. Most of the data on consumption of NNS is from the USA and overall shows an increase in the consumption of NNS over time, with beverages being the predominant source [ 15 ]. Beverages, specifically carbonated soft drinks, were the main source of NNS in diets of adults and children in Australia [ 23 ].…”