The AAP policy statement "The Use of Nonnutritive Sweeteners in Children" recommends that the amount of the no- or low-calorie sweeteners be listed on product labels (rather than just listing them among ingredients) so families and researchers can better understand how much children are consuming and any possible health effects.
"It is currently hard to know how much non nutritive sweetener is in a product since manufacturers aren't required to specify," said Carissa Baker-Smith, MD, MPH, FAAP, lead author of the AAP policy statement and an associate professor of pediatrics at the University of Maryland School of Medicine.
"Listing the amount of nonnutritive sweetener a product contains would help families and researchers understand how much is actually being consumed by individuals and populations and further evaluate potentially related health effects."
One quarter of US children report consumption of sweeteners
Since non-nutritive sweeteners entered the commercial food supply more than 60 years ago, their use has extended across food categories. Eight are currently approved by the U.S. Food and Drug Administration (FDA). Saccharin, aspartame, acesulfame-potassium, sucralose, neotame and advantame were approved as food additives, while stevia and luo han guo (monk fruit) are approved under the generally recognized as safe (GRAS) designation.
The National Health and Nutrition Examination Survey 2009-2012 showed that more than one-quarter of US children reported consumption of non-nutritive sweeteners, with 80% of these children reporting daily use.
While these sweeteners were introduced as a means to help control weight and help Americans cut down on calories, the rise in childhood obesity has raised questions on whether they can actually help control weight.
The majority of short-term studies suggest that substituting a non nutritive sweetener for sugar may reduce weight gain and promote small amounts of weight loss in children, according to the AAP. However, data is limited. There is also research suggesting possible links between nonnutritive sweetener use and weight gain.
In addition, some studies suggest links between non nutritive sweetener use and changes in appetite and taste preferences, as well as in the gut microbiome, which may affect blood sugar levels and lead to metabolic syndrome, insulin resistance, diabetes and weight gain. But findings remain inconsistent.
"Looking at the evidence, we found there's still a lot to learn about the impact of non nutritive sweeteners on children's health," added Dr. Baker-Smith.
"We need more research into the use of non nutritive sweeteners and the risk for obesity and Type 2 diabetes, especially in children. Considering how many children are regularly consuming these products -- which have become ubiquitous -- we should have a better understanding of how they impact children's long-term health."
Calorie Control Council: APP statement 'unnecessarily raises concerns'
However, the Calorie Control Council said the sweeteners in question had been exhaustively studied.
"I'm troubled by the AAP statement calling for even more research on LNCS, which have already gone through years of rigorous testing and research and been established as safe by health authorities the world over," said Calorie Control Council's medical advisor Keith-Thomas Ayoob, EdD, RD, FAND, Associate Clinical Professor Emeritus, Department of Pediatrics, Albert Einstein College of Medicine.
"LNCS (low and no calorie sweeteners) are a tool for managing both calorie intake and helping to reduce sugar intake. They are not a cure for obesity, and were never intended to solve obesity, but can be used by anyone of any age to help manage dietary intakes of added sugar. Moreover, judicious use of LNCS can help people feel less deprived as they reduce added sugar and thus help them reach dietary goals and improve compliance with a more balanced diet."
“Low calorie sweeteners remain an important tool in reducing sugar consumption in children. While available data reinforces the safety of these products in children, future research should be embraced to further enhance our understanding. I am an advocate for product labeling of nonnutritive sweetener content, as transparency in what children are ingesting is important for parents. Current estimates show that intake is well below the ADI (average daily intake),” added Dr. Keri Peterson, Internal Medicine, medical advisor to the Calorie Control Council.
The Calorie Control Council reiterated that when consumed as part of a healthy and balanced diet, the consumption of LNCS may serve as a tool for managing overall caloric and sugar intake.