Americans are consuming less sugar and more nonnutritive sweeteners, but does it make a difference?
People in the US are buying fewer foods and beverages that contain caloric sweeteners or sugar while the purchase of products containing both nonnutritive sweeteners (sugar substitutes) and caloric sugars have increased. Non-nutritive sweeteners, such as aspartame, saccharin, rebaudioside A (Reb-A), and sucralose, provide sweetness to products with much fewer or no calories or other nutrients.
The proportion of US households purchasing products containing both caloric sugar and nonnutritive sweeteners together has gone up by more than 30% between 2002 and 2018, reveals a new study. The increase has been driven mainly by beverages, which showed an increase from 15.9% in 2002 to 49.4% in 2018. Compared to households without children, households with children are buying more packaged beverages and food products that contain caloric sweeteners. While this aligns with public health objectives, it also raised other concerns about exposure to nonnutritive sweeteners, says the research team.
According to Dr Shu Wen Ng, co-investigator and associate professor at the Gillings School of Global Public Health, a growing variety of non-nutritive sweeteners have been gradually introduced into the food supply of Americans over time, but the long-term and higher exposure to the growing variety of these sweeteners on health are still unknown.
"We found that the prevalence of various types of nonnutritive sweeteners (NNS) in the food purchased in the US has risen over time. These may be to fully or partially replace caloric sweeteners like high fructose corn syrup or cane sugar. Beverages were predominantly responsible for larger volume per capita purchases of products containing any non-nutritive sweeteners, but there are also increases in some categories of foods. Additionally, households with children are getting increasingly exposed to NNS in packaged beverages and foods,” Dr Ng tells MEA WorldWide (MEAWW).
The authors suggest that there is a need to be able to track exposure to specific types of sweeteners to properly understand their health implications. "There needs to be investments to monitor what companies are putting in their foods and data source that can account for such rapid changes to the food supply to better study the long-term and dose-response health implications of exposure to the growing variety of nonnutritive sweeteners present in our food supply," says Dr Ng.
While the intake of added sugars, and sugar-sweetened beverages, in particular, is commonly associated with poor health outcomes, the association between nonnutritive sweetener consumption and adverse health outcomes has remained relatively controversial in the academic literature. According to researchers, previous observational studies have linked nonnutritive sweeteners' consumption to increased body weight, type 2 diabetes and other adverse cardiometabolic outcomes, while others have found the opposite effect.
Results from randomized controlled trials and meta-analyses have not demonstrated any relationship between nonnutritive sweeteners and increased consumption of sweet foods. "It is unclear whether the inconsistency of the findings is due to studies typically categorizing all nonnutritive sweeteners together, rather than examining differences in the effect of specific types of nonnutritive sweeteners on outcomes," write authors in the analysis published in the Journal of the Academy of Nutrition and Dietetics.
The current study looked at how the prevalence and volume of foods that contain commonly consumed nonnutritive sweetener types in the US packaged food supply had changed between 2002 and 2018. The researchers found a decline in the prevalence of products containing aspartame and saccharin, but an increase in those with sucralose (up from 38.7% to 71%) and reb-A (up from 0.1% to 25.9%). Beverages accounted for most of the products purchased containing nonnutritive sweeteners only or combined with caloric sweeteners.
"With excessive sugar consumption linked to chronic cardiometabolic diseases, sugar reduction has become an important public health strategy. This has resulted in greater innovation by the food industry and increased use of NNS in our food supply," says lead investigator Dr Barry Popkin, distinguished professor, Department of Nutrition, Gillings Global School of Public Health, and Carolina Population Center, The University of North Carolina at Chapel Hill, US.
The study also showed that non-Hispanic Whites purchased almost double the volume of products containing NNS compared to Hispanics and non-Hispanic Blacks throughout the study period. However, non-Hispanic Black households showed a 42% increase in the proportion of households purchasing beverage products containing both caloric sweetener and nonnutritive sweetener between 2002 and 2018, indicating that purchasing behavior may be changing for this race-ethnic group.
The analysis used a nationally representative dataset on household purchases at the barcode level (Nielsen Homescan) in 2002 and 2018 linked with Nutrition Facts Panel (NFP) data and ingredient information using commercial nutrition databases that are updated regularly to capture reformulations. Keyword searches were performed on ingredient lists to classify products containing various types of NNS. The investigators then derived each household's total volume purchased per capita per day in 2002 and 2018 that contained NNS and/or caloric sugars and the percent of households purchasing foods and beverages by sweetener type.
The team explains that new NNS types enter the market regularly, and it is important to monitor changes not only in the amount of products containing NNS that US consumers purchase, but also the types of NNS that are present in food and beverage products. "A critical gap as NNS prevalence grows will be to add a legal requirement for amounts of NNS by type be added to nutrition facts panel as is done in Chile. Without such information, it would be very challenging to track the intake of these mixes of NNS that are becoming more prevalent in our food supply to begin understanding if and what types of effects they may have on population health and in addressing disparities. Efforts to encourage or require food manufacturers to disclose the amounts of the various types of NNS in their products should be undertaken," the team recommends.
According to Dr Ng, considering further improvements to the Nutrition Facts label to include the amounts of NNS when present in products can allow monitoring of people’s exposure to these additives so that researchers can better assess their potential harms or benefits on health. "Health and nutrition groups should advocate for investments to monitor our rapidly changing food supply. Consumers can pay more attention to what and when possible the amount of sweeteners (caloric or nonnutritive sweeteners) are in their foods and beverages to manage their exposure and try to gradually lower overall sweetness exposure (whether from caloric or non-nutritive sweeteners). Food policies should increase the transparency of what is in food products to empower consumers to learn about and manage their choices," adds Dr Ng.