Sales for products with both sugar, nonnutritive sweeteners up in recent years

Fewer people in the United States are buying products with containing only caloric sweeteners like sugar, but more are buying products with both caloric and nonnutritive sweeteners, according to a study published in the Journal of the Academy of Nutrition and Dietetics.

Using data from a nationally representative sample of U.S. households — the Nielsen Homescale Consumer Panel — researchers compared food purchase data from 2002 through 2018.

The data included information on household purchases of packaged food and beverages, which participants provided using handheld scanners to record yearly purchases of these items. Once items were scanned, they were linked with databases on nutritional facts and ingredients. Researchers used this information to classify products as containing caloric sweeteners (CS), nonnutritive sweeteners (NNS), both or neither.

Researchers determined that the volume of products purchased that contained a CS decreased from 2002 (436.6 g per capita per day) to 2018 (362.4 g per capita per day). Purchases of products containing only NNS also experienced a small decrease from 2002 (102.2 g per capita per day) to 2018 (100 g per capita per day).

However, the volume of products purchased that contained both CS and NNS increased from 2002 (10.8 g per capita per day) to 2018 (36.2 g per capita per day).

In terms of the specific type of NNS consumed, researchers determined that there were changes in the prevalence of households that purchased products that contained saccharin (1.3%-1.1%), aspartame (60%-49.9%), rebaudioside A (0.1%-25.9%) and sucralose (38.7%-71%) during the study period.

They found that white participants purchased twice the volume of products with NNS compared with Hispanic and Black participants in both 2002 and 2018.

According to researchers, beverages were responsible for most of the increase per person of products that contained nonnutritive sweetener and those that contained both CS and NNS.

Healio Primary Care spoke with study author Barry M. Popkin, PhD, W.R. Kenan Jr. Distinguished Professor in the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, to learn more about findings and NNS consumption.

Q: What health effects are associated with nonnutritive sweetener consumption?

A: This is the great unknown.[For] risk of non-communicable disease (NCD), there are RCT’s that suggest minimal or no negative impact and, in a few cases, a positive impact. Then there is a large cluster of cohort studies that find significant impacts on the risk of many biomarkers of NCDs. But another smaller cluster [of studies] control for diet very carefully as an effect modifier. Then they find either no effect or, for healthy eaters, a positive impact on all the key biomarkers of reduced risk for many NCD’s. [For] impact on children, this is all in the area of speculation. We cannot do an RCT on this topic in children. But the biggest fear is an increase in sweetness preference, and this drives many recommendations and regulations affecting preschoolers and school-age children. Mouse studies are really problematic. Mice have 100 times our sweetness preference per g of sugar or NNS/body weight. Taste researchers think these studies are just inappropriate and quite wrong.

Q: Would it be better for patients to consume regular sugar instead of nonnutritive sweeteners?

A: Never. The risks of sugar always outweigh those of NNS in all cases. There is a strong consensus on the impact of sugar in any form as a major negative force in our health.

Q: What should physicians tell patients about nonnutritive sweeteners?

A: Try to drink unsweetened coffee, tea and waters, if possible. But nonnutritive sweetened beverages are better than sugary beverages — be they coffee, tea or any fruit drink, carbonated beverage or flavored water. The U.S. beverage guidelines we published years ago still hold.

Q: What should dietary guidelines recommend on nonnutritive sweetener consumption?

A: Unsweetened is best, but nonnutritive sweeteners are best consumed over any added sugar beverage or even 100% juice, which functions like a sugar-sweetened beverage on risks of NCD, especially risk of diabetes.