• The World Health Organisation (WHO) has advised against the use of non-sugar sweeteners to control body weight or reduce the risk of non-communicable diseases.

• The recommendation is based on the findings of a review of the available evidence which suggests that use of non-sugar sweeteners (NSS) does not provide any long-term benefit in reducing body fat in adults or children.

• The findings also suggest that there may be potential undesirable impact from long-term use of NSS, such as an increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults.

• People need to consider other ways to reduce free sugars intake, such as consuming food with naturally occurring sugars, like fruit, or unsweetened food and beverages.

• NSS are not essential dietary factors and have no nutritional value. 

• The recommendation applies to all people except individuals with pre-existing diabetes and includes all synthetic and naturally occurring or modified non-nutritive sweeteners that are not classified as sugars.

• These sweeteners are found in manufactured foods and beverages, or sold on their own to be added to foods and beverages by consumers. 

The need to reduce intake of free sugars

• Escalating rates of overweight and obesity are a threat to the health of billions of people across the globe.

• In 2016, more than 1.9 billion adults aged 18 years and older were overweight. Of these, more than 600 million were obese. In 2020, more than 38 million children under 5 years of age were overweight – an increase of nearly 6 million during the past 20 years. 

• High body mass index (BMI) was responsible for an estimated 4 million deaths in 2017, with greater increases in BMI in the overweight and obesity range leading to a greater risk of mortality. 

• Obesity is also a risk factor for many noncommunicable diseases (NCDs), including cardiovascular diseases (CVDs), type 2 diabetes and certain types of cancer. NCDs are the leading causes of death globally and were responsible for an estimated 41 million (71 per cent) of the 55 million deaths in 2019. 

• A high level of free sugars intake is associated with poor dietary quality, obesity and risk of NCDs.

Non-sugar sweeteners

• Sweeteners are sugar substitutes that mimic the sweet taste of sugar but have a negligible impact on energy intake.

• Referred to by a variety of names, including high-intensity sweeteners, low or no-calorie sweeteners, non-nutritive sweeteners, non-caloric sweeteners and sugar-substitutes, non-sugar sweeteners (NSS) have been developed as an alternative to free sugars. 

• They are widely used as an additive in pre-packaged foods, beverages and personal care products (e.g. toothpaste, mouthwash), as well as added to foods and beverages directly by the consumer. Because of their ability to impart sweet taste without calories, NSS are generally marketed as aiding weight loss or maintenance of healthy weight.

• NSS include a wide variety of synthetically derived chemicals and natural extracts that may or may not be chemically modified, and are generally many times sweeter than sugars, which allows them to be added to foods and beverages in very small quantities. 

• Common NSS include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives.

• Certain D-amino acids, and several plant proteins and other extracts also impart a sweet taste.

• NSS elicit sweet taste through binding and activation of sweet-taste receptors located in the oral cavity, with subsequent signalling to the brain.

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