Sweeteners
understanding of the role of LCS in the diet. Finally, in the context of sugar reduction and obesity, it would be helpful to review the regulatory and public health policy hurdles that prevent wider use of LCS in food products for those sweeteners where dietary intake is very low compared with the ADI.
Extending the consensus
Dietary intake must be monitored to ensure sufficient energy levels are met while using LCS replacements.
in calorie (energy) intake that ensues. Use of LCS alone cannot be expected to act as a ‘silver bullet’ for weight loss.
Nutrition policy
It was agreed that reducing the intake of ‘free sugars’ and ‘added sugars’ is being recommended around the world to lower the risk and prevalence of obesity, which is a major public health concern. LCS are one of the strategies to consider, meanwhile, it can also be useful in dietary approaches to both prevent and manage diabetes. Despite repeated and consistent reassurances from food safety authorities, there is still some distrust of LCS among health professionals and policy makers. Some policies acknowledge LCS consumption as a useful strategy to reduce sugar intakes, however, there are discrepancies with other national and international policies and regarding use in children. In relation to these findings, it is still unclear whether LCS can help individuals meet the population-level dietary recommendations for reduction of sugars intake and how this might be achieved. Moreover, how does a dietary approach that includes LCS-sweetened food and drinks affect dietary quality compared with low-sugar diets, and what are the best strategies to communicate LCS safety and efficacy to interested parties such as health professionals and the general public? To resolve these quandaries, the panel suggests that there is a need to model the potential for LCS to reduce sugar content and sugar intakes while ensuring that other dietary recommendations can also be met in the overall diet. Trends in dietary intake of LCS need to be monitored, linked with food and beverage reformulation and ultimately with health outcomes. Simultaneously, policies relating to LCS from different countries should be reviewed to compare their remit, priorities, evidence base and interpretation. To reconcile policy discrepancies, policy makers, scientists and regulatory affairs experts should agree on their
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Our consensus workshop was designed to stimulate forward thinking, as well as to restate principles. The consensus statements on actions put the focus firmly on what is required to deliver. For example, the panel made recommendations for further long-term randomised controlled trials of LCS with different comparators and multiple endpoints, for prospective studies that control for obesity and other confounders, and for better estimates of LCS exposure. Such recommendations may help research funding bodies select priorities. Clarity and consistency of policy would be improved by a comprehensive evaluation of all the evidence on effects of LCS.
Our expert panel argues that there is a continued need for ongoing exposure assessment to account for changing LCS use, and also consideration of any new evidence that might emerge. Novel recommendations made by the panel included better strategies and methods to improve communications about the safety and efficacy of LCS, modelling of the effect of LCS on sugar reduction and diet quality, relaxing regulation to increase the potential for reformulation using LCS, and review and reconciliation of policy differences on the use of LCS.
LCS in summary
The panel considered that the substantial body of evidence concerning LCS safety should be communicated in a consistent manner. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Research priorities should include the compilation of a dossier of the totality of evidence on LCS and body weight control; studies to monitor and model LCS intakes and their impact on sugar reduction and diet quality; effective communication strategies to inform consumers, non-governmental organisations (NGOs), health professionals, research funding bodies and the food and beverage industry.
Greater efforts should be made to understand and reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede product development and reformulation designed to reduce sugars and/or energy. ●
This article is an abridged version of the paper ‘Expert consensus on low-calorie sweeteners: facts, research gaps and suggested actions’ published by Cambridge University Press on 13 January 2020.
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