Nonnutritive sweeteners (NNSs)—also known as non-caloric artificial sweeteners or high-intensity sweeteners—are common in food, beverages, condiments, and even gum. NNSs have been proposed for use among those aiming to lose weight and have been largely deemed as safe for use by the Food and Drug Administration (FDA). Given the ubiquity of these agents, the American Academy of Pediatrics published the policy statement “The Use of Nonnutritive Sweeteners in Children” to provide pediatricians and others who care for children with information regarding the steps taken to obtain approval for the use of NNSs in the general population, summarize existing data regarding the safety of NNS use, review what is known regarding the potential benefits and/or adverse effects of NNS use in youth, identify knowledge gaps (Table I), and propose talking points that can be used by pediatricians when discussing NNS use with families (Table II).
It should be noted that NNSs are 180 to 20,000 times sweeter than sugar and that most are approved for use as food additives within an accepted daily intake level that is difficult to quantify, given that manufacturers are not required to report the amount of NNS contained in products on food labels. Furthermore, while many assume that NNS use is associated with weight loss, studies suggest that NNS use alone (in the absence of other lifestyle adjustments) is unlikely to lead to substantial weight loss. In rare cases (eg, phenylketonuria), there are absolute contraindications to NNS use.
Pediatricians can make families aware of the limitations of what we know regarding the safety of NNSs, particularly in young children, and consider advocating for limiting the intake of both sugar-sweetened and NNS-containing beverages and foods. Ultimately, however, family members should be informed of the available evidence so that they can make the best decisions for themselves and for their family members.
Future studies with high-quality evidence that takes into consideration actual intake amounts of NNS are needed in order to truly understand the benefits and limitations of NNS agent use.
The Use of Nonnutritive Sweeteners in Children