Low- and No- Calorie Sweeteners (LNCS): critical evaluation of their safety and health risks

Abstract The increase of the prevalence of type-2 diabetes as a consequence of overweight and obesity has stimulated public health authorities worldwide to develop strategies for its risk management and prevention. Among them, a reduction on the content of sugar in sugar-sweetened foods and beverages has been suggested, which led the food industry to replace partially sucrose with food additives, such as low- and no-calorie sweeteners (LNCS). As a consequence, there has been an increase of their consumption, which has made regulatory agencies to evaluate their exposure and possible consequences. At the same time, speculations about adverse effects, such as carcinogenicity, preterm delivery and metabolic changes involving appetite, weight increase and glucose intolerance, have been published. This scenario led ILSI Brasil to organize a meeting to update scientific knowledge on the safety of LNCS and to promote discussions among academia, regulatory bodies and food industries to clarify currently controversial information. The results of this initiative are presented in this review. It is suggested that LNCS, when used according to recommendations provided by scientific committees and regulatory authorities are considered safe. Further studies are required to evaluate the current level of exposure in general population and specific ones as children.摘要 由超重与肥胖引发的2型糖尿病（type-2 diabetes）患病率持续攀升，促使全球各国公共卫生主管部门制定相关策略，以开展该疾病的风险管理与预防工作。其中，降低含糖食品与饮料中的糖分含量这一方案被提出，进而推动食品工业使用低热量与无热量甜味剂（low- and no-calorie sweeteners, LNCS）等食品添加剂部分替代蔗糖。随之而来的是该类甜味剂的消费量增长，这使得监管机构开始评估人体的暴露水平及其潜在健康影响。与此同时，有关其不良反应的推测陆续被公开报道，涵盖致癌性、早产以及涉及食欲变化、体重增加和葡萄糖耐受不良的代谢异常。这一背景促使国际生命科学学会巴西分部（ILSI Brasil）组织专题会议，以更新关于低热量与无热量甜味剂安全性的科学认知，并推动学术界、监管机构与食品工业界展开研讨，厘清当前存在争议的相关信息。本综述即呈现该倡议的相关成果。研究表明，若严格遵循科学委员会与监管机构给出的推荐规范使用低热量与无热量甜味剂，则该类物质被认为是安全的。目前仍需开展进一步研究，评估普通人群以及儿童等特定群体当前的暴露水平。