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Non-sugar sweeteners and health

BMJ 2019; 364 doi: (Published 03 January 2019) Cite this as: BMJ 2019;364:k5005

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Association between intake of non-sugar sweeteners and health outcomes

  1. Vasanti S Malik, research scientist1
  1. 1Department of Nutrition, Harvard T H Chan School of Public Health, 665 Huntington Ave, Building 2, Boston, MA 02115, USA
  1. Correspondence to: V S Malik vmalik{at}

The weight of evidence hints at benefits, but the full picture has yet to emerge

There is much public and scientific interest in whether foods and beverages containing non-sugar sweeteners (NSS)—which contain few or no calories—should be recommended as a strategy to reduce consumption of free sugars, particularly sugar sweetened beverages. However, inconsistent research findings and potential safety concerns have hampered official guidance.1

To clarify the benefits and harms of NSS consumption and to inform WHO guidance, Toews and colleagues conducted a systematic review and meta-analysis evaluating the effect of NSS intake on a broad range of health outcomes in adults and children (doi:10.1136/bmj.k4718).2 They included 56 interventional and observational studies, making this review the most comprehensive on this topic so far.

Among adults, findings from the few trials comparing NSS intake with sugar intake suggested small improvements in body mass index and fasting concentrations of blood glucose favouring NSS. Among children, NSS intake led to a smaller increase in body mass index z score than sugar intake, but NSS made no difference to body weight. For most other outcomes, no statistically …

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