There is no evidence to indicate health benefits of sweeteners over sugar, and potential harms cannot be ruled out, according to a new review of studies published in The BMJ.
Although several non-sugar sweeteners are approved for use, less is known about their potential benefits and harms within acceptable daily intakes beacause the evidence is often limited and conflicting.
To better understand these potential benefits and harms, a team of European researchers analysed 56 studies comparing no intake or lower intake of sweeteners with higher intake in healthy adults and children.
Measures included weight, blood sugar (glycaemic) control, oral health, cancer, cardiovascular disease, kidney disease, mood and behaviour. Studies were assessed for bias and certainty of evidence.
Overall, the results show that, for most outcomes, there seemed to be no statistically or clinically relevant differences between those exposed to non-sugar sweeteners and those not exposed, or between different doses of non-sugar sweeteners.
For example, in adults, findings from a few small studies suggested small improvements in body mass index and fasting blood glucose levels with non-sugar sweeteners, but the certainty of this evidence was low.
In children, a smaller increase in body mass index score was seen with non-sugar sweeteners compared with sugar, but intake of non-sugar sweeteners made no differences to body weight.
And no good evidence of any effect of non-sugar sweeteners was found for overweight or obese adults or children actively trying to lose weight.
The researchers point out that this is the most comprehensive review on this topic to date, and will inform a World Health Organisation guideline for health experts and policy makers.