As Americans consume less sugar, consumption of sugar substitutes is on the rise

Though American households are purchasing fewer food and beverage products that are sweetened with sugar, they’re purchasing more products that include non-nutritive sweeteners (NNS) like aspartame, saccharin, rebaudioside A (reb-A) and sucralose.

A new study from researchers at UNC-Chapel Hill published today (July 29, 2020) in the Journal of the Academy of Nutrition and Dietetics examined household purchases between 2002 and 2018 and found a decline in products that contained caloric sweeteners (CS) like sugar and high fructose corn syrup, as well as an increase of products that contained NNS, which adds sweetness to products without adding calories.

“With excessive sugar consumption linked to chronic cardiometabolic diseases, sugar reduction has become an important public health strategy. This has resulted in greater innovation by the food industry and increased use of NNS in our food supply,” says lead investigator Barry Popkin, PhD, W.R. Kenan Jr. Distinguished Professor in the Department of Nutrition at the UNC Gillings Global School of Public Health.

“Types and amounts of non-nutritive sweeteners purchased by US households: A comparison of 2002 and 2018 Nielsen Homescan purchases,” is co-authored by Gillings School and Carolina Population Center (CPC) faculty Shu Wen Ng, PhD, associate professor, and Elizabeth K. Dunford, PhD, assistant professor, as well as CPC Director of Research Programming Services Donna R. Miles, PhD.

The analysis used a nationally representative dataset on household purchases at the barcode level (Nielsen Homescan) in 2002 and 2018 linked with Nutrition Facts Panel (NFP) data and ingredient information using commercial nutrition databases that are updated regularly to capture reformulations. The study found a decline in prevalence of products containing aspartame and saccharin, but a steep increase in those with sucralose (from 38.7 percent to 71.0 percent) and reb-A (from 0.1 percent to 25.9 percent).

Beverages accounted for most of products purchased containing NNS only or combined with CS. Compared to households without children, households with children are buying more packaged beverages and foods products that contain NNS. While this aligns with the public health objectives, it also raised other concerns about exposure to NNS, as their long-term health effects are still unknown.

“Considering further improvements to the nutrition facts label to include the amounts of NNS when present in products can allow monitoring of our exposure to these additives so that we can better assess their potential harms or benefits on health” says Ng.

Some observational studies have linked NNS consumption to increased body weight, type 2 diabetes, and other adverse cardiometabolic outcomes, while others have found the opposite effect, particularly when controlled for diet to focus on the impact of NNS. Results from randomized controlled trials and meta-analyses have not demonstrated any relationship between NNS and increased consumption of sweet foods. It is unclear whether the inconsistency of the findings is due to studies typically categorizing all NNS together, rather than examining differences in the effect of specific types of NNS on outcomes.

The study also showed that non-Hispanic whites purchased almost double the volume of products containing NNS compared to Hispanics and non-Hispanic Blacks throughout the study period. However, non-Hispanic Black households showed a 42 percent increase in the proportion of households purchasing beverage products containing both CS and NNS between 2002 and 2018, indicating that purchasing behavior may be changing for this race-ethnic group.

“There is a need to be able to track our exposure to specific types of sweeteners in order to properly understand their health implications,” says Dunford. “The change to the food supply that our study documents reinforces the need to develop and maintain the data systems to monitor what companies are putting in their foods. This work can help complement new and emerging clinical evidence about the different cardiometabolic and health effects of each NNS type.”

The authors are all part of the Global Food Research Program at UNC, a team that collaborates with partners across the globe to carefully evaluate food and nutrition policies and help to develop in-depth, longitudinal research on large-scale obesity prevention efforts.