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Review
. 2023 Nov;77(11):1009-1013.
doi: 10.1038/s41430-023-01314-7. Epub 2023 Sep 18.

WHO guideline on the use of non-sugar sweeteners: a need for reconsideration

Affiliations
Review

WHO guideline on the use of non-sugar sweeteners: a need for reconsideration

Tauseef A Khan et al. Eur J Clin Nutr. 2023 Nov.
No abstract available

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Conflict of interest statement

TAK reports receiving grants from Institute for the Advancement of Food and Nutrition Sciences (IAFNS, formerly ILSI North America), and National Honey Board. He gave a presentation on the WHO draft guideline to members of Institute for the Advancement of Food and Nutrition Sciences (IAFNS), the International Food Information Council (IFIC), and the Calorie Control Council (CCC) for which he received an honorarium. He has also received an honorarium from the AmCham Dubai. He has received funding from the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. SA-C avoids consuming non-sugar sweeteners and sugar-sweetened beverages and has received an honorarium from the international food information council (IFIC) for a talk on artificial sweeteners, the gut microbiome, and the risk for diabetes. LC was a Mitacs-Elevate postdoctoral fellow jointly funded by the Government of Canada and the Canadian Sugar Institute (September 2019–August 2021). NM was a former employee of Loblaw Companies Limited and current employee of Enhanced Medical Nutrition. She has completed consulting work for contract research organizations, restaurants, start-ups, the International Food Information Council, and the American Beverage Association, all of which occurred outside of the submitted work. JLS has received research support from the Canadian Foundation for Innovation, Ontario Research Fund, Province of Ontario Ministry of Research and Innovation and Science, Canadian Institutes of Health Research (CIHR), Diabetes Canada, American Society for Nutrition (ASN), International Nut and Dried Fruit Council (INC) Foundation, National Honey Board (U.S. Department of Agriculture [USDA] honey “Checkoff” program), Institute for the Advancement of Food and Nutrition Sciences (IAFNS; formerly ILSI North America), Pulse Canada, Quaker Oats Center of Excellence, The United Soybean Board (USDA soy “Checkoff” program), The Tate and Lyle Nutritional Research Fund at the University of Toronto, The Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund established by the Alberta Pulse Growers), The Plant Protein Fund at the University of Toronto (a fund which has received contributions from IFF), and The Nutrition Trialists Network Research Fund at the University of Toronto (a fund established by an inaugural donation from the Calorie Control Council). He has received food donations to support randomized controlled trials from the Almond Board of California, California Walnut Commission, Peanut Institute, Barilla, Unilever/Upfield, Unico/Primo, Loblaw Companies, Quaker, Kellogg Canada, Danone, Nutrartis, Soylent, and Dairy Farmers of Canada. He has received travel support, speaker fees and/or honoraria from ASN, Danone, Dairy Farmers of Canada, FoodMinds LLC, Nestlé, Abbott, General Mills, Nutrition Communications, International Food Information Council (IFIC), Calorie Control Council, International Sweeteners Association, International Glutamate Technical Committee, Phynova, and Brightseed. He has or has had ad hoc consulting arrangements with Perkins Coie LLP, Tate & Lyle, and Inquis Clinical Research. He is a former member of the European Fruit Juice Association Scientific Expert Panel and former member of the Soy Nutrition Institute (SNI) Scientific Advisory Committee. He is on the Clinical Practice Guidelines Expert Committees of Diabetes Canada, European Association for the study of Diabetes (EASD), Canadian Cardiovascular Society (CCS), and Obesity Canada/Canadian Association of Bariatric Physicians and Surgeons. He serves as an unpaid member of the Board of Trustees and formerly served as an unpaid scientific advisor for the Carbohydrates Committee of IAFNS. He is a Director at Large of the Canadian Nutrition Society (CNS), founding member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the EASD, and Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His spouse is an employee of AB InBev. JJL and JCN do not report any competing interests.

Figures

Fig. 1
Fig. 1. Summary plot of the association between non-nutritive sweeteners (NSS) and cardiometabolic outcomes using prevalent, change, and substitution analysis in cohort studies.
Pooled estimates of mean differences (MD) and risk ratios (RR) were converted into standardized mean differences (SMD) to show the estimates among different outcomes on the same scale. Prevalent analyses show the association of NSS and cardiometabolic outcomes and is derived from the WHO SRMA on non-sugar sweeteners [2]. Change analyses show the association between increasing intake of low- and no-calorie sweetened beverages by one serving (330 mL) per day and cardiometabolic outcomes. Substitution analyses show the association between substituting low- and no-calorie sweetened beverages for sugar-sweetened beverages (matched by volume) and cardiometabolic outcomes. Both change and substitution analysis are derived from paper by Lee et al. [16] *Body weight was measured as the mean difference (kg) between high vs. low intake groups for prevalent analysis and as the difference (kg) per year for change and substitution analysis. †Waist circumference was measured as the mean difference (cm) between high vs. low intake groups for prevalent analysis, and as the difference (cm) per year for change and substitution analysis. Abbreviations: CHD coronary heart disease, CVD cardiovascular disease, T2D type 2 diabetes.

References

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