Trends and amounts of consumption of low-calorie sweeteners: A cross-sectional study

Abstract

Background and aims: White sugar has been blamed to cause health consequences including diabetes and obesity. With the increased need to decrease sugar intake, attention was shifted towards sugar alternatives also known as low-calorie sweeteners. Low-calorie sweeteners are ubiquitous within food products, but their consumption among Lebanese adults isn't well elucidated. Our study aims to investigate the trends and amounts of low-calorie sweeteners' consumption in addition to their main sources among a sample of Lebanese adults.

Methods: A cross-sectional study was conducted over 384 adult Lebanese individuals from both genders residing in Beirut and Mount-Lebanon from February to August 2020. After excluding eight individuals, 376 completed the survey. To assess the trends, frequency and quantity of low-calorie sweeteners' consumption, a questionnaire was filled by trained and licensed dietitians in addition to a previously validated food frequency questionnaire adapted to the most widely known products in the Lebanese market. Food products were divided into categories, amount of sweeteners in each item was obtained from the label, and analysis was performed according to the type of sweetener they are made of. Frequencies were converted into numbers of servings per day and multiplied by the standard portion size. Daily individual consumption of each sweetener apart was obtained by multiplying the amount of sweetener in each item consumed by total daily consumption. The amount in mg/kg was obtained by dividing total consumption of each sweetener apart by the mean weight of our population. The Statistical Package for Social Sciences (SPSS) was used for data entry and analysis.

Results: Results showed that 94.4% were consuming an artificially-sweetened item at least once in the last six months. While weight loss and healthy lifestyle constituted the main reasons for past and current consumption respectively, safety and unpleasant taste affected consumption trends. Pills and powders' consumption was significantly associated with gender (p = 0.032) and dieting (p = 0.000) but not with age (p = 0.831), educational level (p = 0.294), living district (p = 0.421) or income (p = 0.828) where women and dieters used significantly more pills and powders than their counterparts. "Food and beverages" consumption was independent of all factors except age (p = 0.001); it peaked at 26-40 and declined thereafter. Consumption of low-calorie sweeteners came mainly from beverages and was as follows while remaining within the acceptable daily intake limits: aspartame: 98.9 mg/d (1.38 mg/kg/d); sucralose: 22.19 mg/d (0.31 mg/kg/d); acesulfame-K: 39.12 mg/d (0.55 mg/kg/d); stevia 3.28 mg/d (0.05 mg/kg/d). Food and beverages were consumed more than pills and powders due to unintentional consumption.

Conclusion: Despite that safety and unpleasant taste affected consumption of low-calorie sweetened products, intake of such products was found to be highly prevalent in the studied population. While remaining within the acceptable daily intake limits, consumption of food and beverages exceeded that of pills and powders due to unintentional consumption making awareness a necessity to help consumers make an informed decision. Moreover, a nation-level study is needed to generalize the results.

Keywords: Consumption amount; Consumption trend; Lebanese adult; Low-calorie sweetener; Nutrition.