Ibero–American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages
by
Lluis Serra-Majem 1,2,3,4,*
, António Raposo 5, Javier Aranceta-Bartrina 2,4,6,7, Gregorio Varela-Moreiras 2,8,9, Caomhan Logue 10, Hugo Laviada 11, Susana Socolovsky 12, Carmen Pérez-Rodrigo 2,6,7, Jorge Antonio Aldrete-Velasco 13, Eduardo Meneses Sierra 13,14, Rebeca López-García 15, Adriana Ortiz-Andrellucchi 1,4, Carmen Gómez-Candela 16,17, Rodrigo Abreu 18, Erick Alexanderson 19,20,21, Rolando Joel Álvarez-Álvarez 21, Ana Luisa Álvarez Falcón 1,22, Arturo Anadón 23, France Bellisle 24, Ina Alejandra Beristain-Navarrete 25, Raquel Blasco Redondo 26, Tommaso Bochicchio 27,28, José Camolas 29, Fernando G. Cardini 30, Márcio Carocho 31, Maria Do Céu Costa 32, Adam Drewnowski 33, Samuel Durán 34, Víctor Faundes 35, Roxana Fernández-Condori 36, Pedro P. García-Luna 37, Juan Carlos Garnica 38, Marcela González-Gross 4,39, Carlo La Vecchia 40, Rosaura Leis 4,41,42, Ana María López-Sobaler 43, Miguel Agustín Madero 38, Ascensión Marcos 44,45, Luis Alfonso Mariscal Ramírez 46, Danika M. Martyn 47, Lorenza Mistura 48, Rafael Moreno Rojas 49, José Manuel Moreno Villares 50, José Antonio Niño-Cruz 46,51, María Beatriz P. P. Oliveira 52, Nieves Palacios Gil-Antuñano 53, Lucía Pérez-Castells 54, Lourdes Ribas-Barba 3,4, Rodolfo Rincón Pedrero 55, Pilar Riobó 56,57, Juan Rivera Medina 58,59, Catarina Tinoco de Faria 1, Roxana Valdés-Ramos 60, Elsa Vasco 61, Sandra N. Wac 62, Guillermo Wakida 63, Carmina Wanden-Berghe 64, Luis Xóchihua Díaz 65, Sergio Zúñiga-Guajardo 66, Vasiliki Pyrogianni 67 and Sérgio Cunha Velho de Sousa 68
Lluis Serra-Majem 1,2,3,4,*, António Raposo 5, Javier Aranceta-Bartrina 2,4,6,7, Gregorio Varela-Moreiras 2,8,9, Caomhan Logue 10, Hugo Laviada 11, Susana Socolovsky 12, Carmen Pérez-Rodrigo 2,6,7, Jorge Antonio Aldrete-Velasco 13, Eduardo Meneses Sierra 13,14, Rebeca López-García 15, Adriana Ortiz-Andrellucchi 1,4, Carmen Gómez-Candela 16,17, Rodrigo Abreu 18, Erick Alexanderson 19,20,21, Rolando Joel Álvarez-Álvarez 21, Ana Luisa Álvarez Falcón 1,22, Arturo Anadón 23, France Bellisle 24, Ina Alejandra Beristain-Navarrete 25, Raquel Blasco Redondo 26, Tommaso Bochicchio 27,28, José Camolas 29, Fernando G. Cardini 30, Márcio Carocho 31, Maria Do Céu Costa 32, Adam Drewnowski 33, Samuel Durán 34, Víctor Faundes 35, Roxana Fernández-Condori 36, Pedro P. García-Luna 37, Juan Carlos Garnica 38, Marcela González-Gross 4,39, Carlo La Vecchia 40, Rosaura Leis 4,41,42, Ana María López-Sobaler 43, Miguel Agustín Madero 38, Ascensión Marcos 44,45, Luis Alfonso Mariscal Ramírez 46, Danika M. Martyn 47, Lorenza Mistura 48, Rafael Moreno Rojas 49, José Manuel Moreno Villares 50, José Antonio Niño-Cruz 46,51, María Beatriz P. P. Oliveira 52, Nieves Palacios Gil-Antuñano 53, Lucía Pérez-Castells 54, Lourdes Ribas-Barba 3,4, Rodolfo Rincón Pedrero 55, Pilar Riobó 56,57, Juan Rivera Medina 58,59, Catarina Tinoco de Faria 1, Roxana Valdés-Ramos 60, Elsa Vasco 61, Sandra N. Wac 62, Guillermo Wakida 63, Carmina Wanden-Berghe 64, Luis Xóchihua Díaz 65, Sergio Zúñiga-Guajardo 66, Vasiliki Pyrogianni 67 and Sérgio Cunha Velho de Sousa 68
1
Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria 35016, Spain
2
Spanish Academy of Nutrition and Food Sciences (AEN), Barcelona 08029, Spain
3
Nutrition Research Foundation (FIN), University of Barcelona Science Park, Barcelona 08028, Spain
4
CIBER Fisiopatología de la Obesidad y Nutrición (CIBER OBN), Instituto de Salud Carlos III, Madrid 28029, Spain
5
Research Center for Biosciences and Health Technologies-CBIOS, Universidade Lusófona de Humanidades e Tecnologias, Lisboa 1749-024, Portugal
6
Spanish Society of Community Nutrition (SENC), Barcelona 08029, Spain
7
Department of Physiology, University of the Basque Country (UPV/EHU), Leioa (Bizkaia) 48940, Spain
8
Spanish Nutrition Foundation (FEN), Madrid 28010, Spain
9
Department of Pharmaceutical & Health Sciences, School of Pharmacy, CEU San Pablo University, Boadilla del Monte (Madrid) 28668, Spain
10
Nutritional Innovation Centre for Food & Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraines BT52 1SA, UK
11
Research Department of Metabolism and Nutrition, Medical School, Marist University of Merida, Mérida Yucatan 97300, Mexico
12
Argentine Association of Food Technologists, Buenos Aires 1088, Argentina
13
Mexican College of Internal Medicine, Mexico City 03910, Mexico
14
Hospital General de Especialidades del ISSSTE, Saltillo, Coahuila 25020, Mexico
15
Logre International Food Science Consulting, Mexico City 14650, Mexico
16
Clinical Nutrition Department, La Paz University Hospital, Madrid 28046, Spain
17
Hospital La Paz Health Research Institute - IdiPAZ, Autonomous University of Madrid, Madrid 28046, Spain
18
Atelier de Nutrição, Lisboa 1250, Portugal
19
Nuclear Cardiology Department, Instituto Nacional de Cardiología “Ignacio Chávez, Tlalpan, Ciudad de Mexico 14080, Mexico
20
Phisiology Department, National Autonomous University of Mexico, Coyoacán, Ciudad de México 04510, Mexico
21
Mexican Society of Cardiology, México City 14080, Mexico
22
Dr. Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria 35010, Spain
23
Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Complutense University of Madrid, Madrid 28040, Spain
24
Nutritional Epidemiology Unit, University of Paris 13, Bobigny 93017, France
25
Mexican College of Nutrition - Yucatan, Mérida 97133, Mexico
26
Regional Center for Sports Medicine of the Junta de Castilla y León, Valladolid 47011, Spain
27
Facultad Mexicana de Medicina, La Salle University, Mexico 14000, D. F., Mexico
28
Mexican Transplant Institute, Cuernavaca, Morelos 62448, Mexico
29
Serviço de Endocrinologia, Hospital de Santa Maria–CHLN, Lisboa 1649-035, Portugal
30
Argentine Quality Institute-Instituto Argentino para la Calidad (IAPC), Ciudad Autónoma de Buenos Aires 1406, Argentina
31
Mountain Research Centre (CIMO), Polytechnic Institute of Bragança, Campus de Santa Apolónia, Bragança 5300-253, Portugal
32
ASAE-Autoridade de Segurança Alimentar e Económica, CBIOS/ECTS-The Biosciences Research Center and NICiTeS/ERISA–Núcleo de Investigação em Ciências e Tecnologias da Saúde, Grupo Lusófona, Lisboa 1749-024, Portugal
33
Center for Public Health Nutrition, University of Washington-Center for Obesity Research, Seattle, WA 98195, USA
34
Chilean College of Nutritionists, Universidad San Sebastian, Santiago 7500000, Chile
35
Nutrition and Food Technology Institute, University of Chile, Santiago 7830490, Chile
36
Peruvian Nutrition Society-Sociedad Peruana de Nutrición (SOPENUT), Miraflores 15074, Peru
37
Andalusian Society of Endocrinology, Diabetes and Nutrition, Department of Endocrinology and Nutrition, Virgen del Rocio Hospital, Sevilla 41013, Spain
38
Mexican Nutrition and Endocrinology Society, Mexico City 04330, Mexico
39
ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, Madrid 28040, Spain
40
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano 20133, Italy
41
School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela 15782, Spain
42
Gastroenterology, Hepatology and Paediatric Nutrition Unit of the Santiago Clinical University Hospital, Santiago de Compostela 15706, Spain
43
Department of Nutrition and Food Science, School of Pharmacy, Complutense University of Madrid (UCM), Madrid 28040, Spain
44
Spanish Federation of Nutrition, Food and Dietetics Societies, Madrid 28918, Spain
45
Institute of Food Science, Technology and Nutrition (ICTAN); Spanish National Research Council (CSIC), Madrid 28040, Spain
46
Mexican Nephrological Research Institute, Mexico City 14080, Mexico
47
Intertek, HERS, Cody Technology Park, Farnborough GU14 0LX, UK
48
Council for Agricultural Research and Economics, Research Centre for Food and Nutrition, Rome 00178, Italy
49
Department of Food Science and Technology, University of Cordoba, Cordoba 14071, Spain
50
Pediatric Department, Cínica Universidad de Navarra, Madrid 28027, Spain
51
Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan-Ciudad de México 14080, Mexico
52
University of Porto, Faculty of Pharmacy, REQUIMTE/LAQV, Porto 4050-313, Portugal
53
Department of Medicine, Endocrinology and Nutrition, Sport Medicine Center, AEPSAD, High Sports Council, Madrid 28040, Spain
54
Nutriguía Uruguay, Montevideo 11000, Uruguay
55
Departamento de Educación Médica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan-Ciudad de México 14080, Mexico
56
Endocrinology and Nutrition Department, Fundación Jiménez Díaz Hospital, IDC Salud, Madrid 28040, Spain
57
Facultad de Medicina, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, Madrid 28049, Spain
58
Servicio de Gastroenterología, Hepatología y Nutrición del Instituto Nacional de Salud del Niño, Lima 15083, Peru
59
Departamento de Pediatría, Universidad Nacional Mayor de San Marcos, Lima 15083, Peru
60
Faculty of Medicine, Autonomous University of the State of Mexico, Toluca 50180, Mexico
61
Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa 1649-016, Portugal
62
Nutrition and Public Health Working Group, Argentine Nutrition Society, La Plata, Buenos Aires 1900, Argentina
63
Mexican Society of Paediatrics, Mexico City 06760, Mexico
64
Scientific and Educational Committee, Spanish Society of Parenteral and Enteral Nutrition (SENPE), Barcelona 08017, Spain
65
Instituto Nacional de Pediatria, Sociedad Mexicana de Pediatria, Insurgentes Cuicuilco, Ciudad de México 04530, Mexico
66
Mexican Diabetes Federation, Mexico. Facultad de Medicina y Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey 64630, Mexico
67
International Sweeteners Association-ISA, Brussels 1040, Belgium
68
Pediatric Hospital of Coimbra-Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
*
Author to whom correspondence should be addressed.
Nutrients 2018, 10(7), 818; https://doi.org/10.3390/nu10070818
Received: 3 May 2018 / Revised: 7 June 2018 / Accepted: 20 June 2018 / Published: 25 June 2018
(This article belongs to the Special Issue Fructose and Glucose for Human Health)
International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2–4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.
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Keywords:
non-nutritive sweeteners; low-calorie sweeteners; sweeteners; Ibero-American; safety; regulation; obesity; diabetes; cancer; added sugars
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
MDPI and ACS Style
Serra-Majem, L.; Raposo, A.; Aranceta-Bartrina, J.; Varela-Moreiras, G.; Logue, C.; Laviada, H.; Socolovsky, S.; Pérez-Rodrigo, C.; Aldrete-Velasco, J.A.; Meneses Sierra, E.; López-García, R.; Ortiz-Andrellucchi, A.; Gómez-Candela, C.; Abreu, R.; Alexanderson, E.; Álvarez-Álvarez, R.J.; Álvarez Falcón, A.L.; Anadón, A.; Bellisle, F.; Beristain-Navarrete, I.A.; Blasco Redondo, R.; Bochicchio, T.; Camolas, J.; Cardini, F.G.; Carocho, M.; Costa, M.D.C.; Drewnowski, A.; Durán, S.; Faundes, V.; Fernández-Condori, R.; García-Luna, P.P.; Garnica, J.C.; González-Gross, M.; La Vecchia, C.; Leis, R.; López-Sobaler, A.M.; Madero, M.A.; Marcos, A.; Mariscal Ramírez, L.A.; Martyn, D.M.; Mistura, L.; Moreno Rojas, R.; Moreno Villares, J.M.; Niño-Cruz, J.A.; Oliveira, M.B.P.P.; Palacios Gil-Antuñano, N.; Pérez-Castells, L.; Ribas-Barba, L.; Rincón Pedrero, R.; Riobó, P.; Rivera Medina, J.; Tinoco de Faria, C.; Valdés-Ramos, R.; Vasco, E.; Wac, S.N.; Wakida, G.; Wanden-Berghe, C.; Xóchihua Díaz, L.; Zúñiga-Guajardo, S.; Pyrogianni, V.; Cunha Velho de Sousa, S. Ibero–American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages. Nutrients 2018, 10, 818.
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