A new University of North Carolina study published in the Journal of the Academy of Nutrition and Dietetics found that, between 2002 and 2018, purchases, at the barcode level, by U.S. households of foods and beverages containing caloric sweetener (sugar) declined, while purchases of products containing both sugar and sugar substitutes increased. Beverages accounted for most of the products purchased containing sugar substitutes only, or a combination of sugar and substitutes.
 
“With excessive sugar consumption linked to chronic cardiometabolic diseases, sugar reduction has become an important public health strategy,” lead investigator Barry Popkin, PhD, said. This has resulted in greater innovation by the food industry and increased use of NNS [non-nutritive sweeteners] in our food supply.”
 
NNS includes products such as aspartame, saccharin, rebaudioside A, and sucralose, which sweeten the flavors of products without adding calories, as sugar or high-fructose corn syrup do.
 
The study looked at the prevalence and volume of foods that contain commonly-consumed NNS types in the U.S. food supply, and how they changed over 16 years. Co-investigator Shu Wen Ng, PhD, said the study found a decline in the prevalence of produccts containing aspartame and saccharin, but an increase in those with sucralose (from 38.7% to 71%), and reb-A (from 0.1% to 25.9%). Compared to households without children, households with children are buying more packaged foods and beverages that contain NNS. While this aligns with public health objectives, it also raises other concerns about exposure to NNS, the authors wrote.
 
Non-Hispanic White people purchased almost double the volume of products containing NNS compared to Hispanic people and non-Hispanic Black people. However, non-Hispanic Black households showed a 42% increase in the proportion of households purchasing beverage products containing both sugars and sugar substitutes between 2002 and 2018, indicating that purchasing behavior may be changing for this demographic group.
 
The barcode-level purchase data was linked with the Nutrition Facts Panel data and ingredient information using commercial nutrition databases that capture reformulations. The investigators derived each household’s total volume purchased per capita per day in 2002 and 2018 that contained sugar substitutes and/or caloric sugars and the percent of households purchasing foods and beverages by sweetener type.
 
The researchers involved in this study said that population-based evaluations of these data will be necessary to grasp any potential problems, or benefits, that arise as a result of long-term exposure to increasingly abundant non-nutritive sweeteners in lieu of sugars.
 
“There is a need to be able to track our exposure to specific types of sweeteners in order to properly understand their health implications,” Dr. Elizabeth Dunford, affiliated with UNC, said. “The change to the food supply 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.”
 
“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,” Ng said.
 
Their concerns center around conflicting evidence from previous observational studies, which have linked NNS consumption to increased body weight, type 2 diabetes, and other adverse cardiometabolic outcomes. Other studies, however, have observed the opposite effect. These inconsistencies may be attributable to some studies characterizing all NNS together, rather than examining the differences of specific types of sugar substitutes.