Review of Recommendations for the Use of Caloric Sweeteners by Adults and Children

Sweeteners are natural or artificial substances that give food or a product a sweet flavour, and are divide by their nutritional value to caloric and non-caloric. Although they have been reported as safe, this review analyses the findings of various studies to obtain recommendations for their use based on their effect on energy consumption, weight, glucose and blood lipids. In addition to the compensation in energy intake, effects on appetite, hydration, preference for sweet flavours and cardiovascular function were reviewed. We searched MEDLINE, EMBASE, LILACS, and WHO ICTRP Search Portal without language restrictions. We included systematic reviews, controlled trials and observational studies comparing the administration of caloric and non-caloric sweeteners in adults and children. Two authors used AMSTAR tool, Risk of bias tool of the Cochrane Collaboration or ROBINS-I instrument for screening the studies according to their methodological quality and were included those have a low risk of bias. A reduction in blood glucose was more effective when sweetening foods with fructose compared with the use of sucrose in non-diabetic patients (–4.81 mmol/L; 95% CI –6.34 to –3.29, p<0.05). The reduction in body mass index was greater with the use of non-caloric sweeteners compared with sucrose in patients regardless of their weight (–0.3 to –0.9 kg/m2, 95% CI –1.5 to 5). Although there is interest in identifying the efficacy of non-caloric sweeteners in preventing obesity and its complications, there is not sufficient evidence because of significant heterogeneity between the different studies and the lack of evidence in children. Thus, designing studies that will provide more evidence in this regard is necessary.