GLOBAL – The World Health Organization (WHO) has recommended that non-sugar sweeteners not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases as they do not confer any long-term benefits.

Free sugar consumption has been connected to obesity and being overweight, which afflict over 40% of adults worldwide and millions of children. Diet-related noncommunicable diseases (NCDs), which are the main causes of death globally, are then thought to be a direct result of this association.

The potential utility of non-sugar sweeteners (NSS) in decreasing sugar intake at the population level has attracted more attention since the WHO guideline on free sugars intake was published. In response, the WHO issued recommendations on the use of NSS in line with the current WHO guideline development process and has now published new guidance on NSS, advising against the use of NSS to regulate body weight or lower the risk of noncommunicable diseases (NCDs).

The WHO recommendation on NSS is one of several current and upcoming dietary recommendations that are intended to promote lifelong healthy eating patterns, enhance dietary quality, and lower the risk of NCDs globally.

Non-sugar sweeteners (NSS)1 are low- or no-calorie substitutes for free sugars that are typically marketed as helping people lose weight or maintain a healthy weight.

They are also widely suggested as a way to help people with diabetes control their blood sugar levels. To define safe intake levels (also known as acceptable daily intake, or ADI), each sweetener is subjected to a toxicological study.

However, it is unclear if NSS are beneficial for maintaining weight loss over the long run or if they are associated with other long-term health impacts at routine intakes within the ADI.

According to evidence from a recent systematic review and meta-analyses of randomized controlled trials (RCTs) and prospective observational studies, adults who consumed more NSS were associated with lower body weight and body mass index (BMI) when compared to those who consumed less or none at all in short-term RCTs, but with higher BMI and an increased risk of incident obesity when compared to those who consumed more NSS over a longer period of time.

The WHO recommendation on NSS is one of several current and upcoming dietary recommendations that are intended to promote lifelong healthy eating patterns, enhance dietary quality, and lower the risk of NCDs globally.


Only when intake of NSS is compared to intake of free sugars are effects on body weight and BMI from RCTs reported, and these effects are likely at least partially mediated by a decrease in caloric intake. Neither RCTs nor prospective cohort studies found any further notable connections or effects on body fatness measurements.

In prospective cohort studies done on adults, long-term NSS usage was linked to an elevated incidence of type 2 diabetes, cardiovascular diseases (CVDs), and mortality.

However, when measured in short-term RCTs, substantial improvements were not seen on intermediate indicators of disease such as fasting glucose, fasting insulin, or blood lipids.

There was less evidence from research on children and pregnant women than there was for adults.

When sugar-sweetened beverages were swapped out with those containing NSS, one RCT conducted in children revealed a decrease in various markers of body fatness. However, no effect was seen when BMI z-score2 data were merged with those from a second experiment.

Results from prospective observational studies failed to find any conclusive links between NSS use and body fat measurements.

With the use of the NSS stevia, two RCTs on young children found fewer indications of dental cavities.

None of the other studies that were found reported a connection between NSS use and children’s health outcomes that were given priority.

An increased risk of preterm delivery was linked to higher NSS usage during pregnancy, according to a meta-analysis of three prospective observational studies, while correlations between birth weight or child weight in later life and NSS use during pregnancy were erratic.

NSS usage during pregnancy has been linked to consequences in offspring, including a higher risk of asthma and allergies as well as lower cognitive function, according to a single prospective observational study.

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