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Impact on Health When Sugar Is Replaced with Intense Sweeteners in Soft Drinks, ‘Saft’ and Nectar

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Impact on Health When Sugar Is Replaced with Intense Sweeteners in Soft Drinks, ‘Saft’ and Nectar Vitenskapskomiteen for mattrygghet Rapport nr 2007: 10 Norwegian Scientifi c Commitee for Food Safety Impact on health when sugar is replaced with intense sweeteners in soft drinks, ‘saft’ and nectar Impact on health when sugar is replaced with intense sweeteners in soft drinks, ‘saft’ and nectar Lene Frost Andersen Trine Husøy Svein Olav Kolset Henrik Nøtvik Jakobsen Preface In 2004, the Norwegian Food Safety Authority (Mattilsynet) asked the Norwegian Scientifi c Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) to carry out an assessment of the health impact if consumers substitute sugar sweetened soft drinks, ‘saft ’ and nectar with the intense sweetened alternatives. Ad hoc group Under the auspices of VKM, an ad hoc group comprised of VKM members and external experts has prepared this report. Th e members of the ad hoc group have been Professor Lene Frost Andersen, PhD (Chair), Senior scientist Trine Husøy, PhD, Henrik Nøtvik Jakobsen, Cand. odont and Professor Svein Olav Kolset, PhD. Jannicke Fredriksen (Master in Clinical Nutrition) and Tone Kristin Omsland (Master in Clinical Nutrition) both from the University of Oslo have contributed with literature and back- ground material regarding overweight and diabetes and consumption of sugar sweetened soft drinks in chapter 6. Christina Bergsten and Ingvild Kristine Tømmerberg from the Norwegian Food Safety Authority have contributed with intake estimates for the intense sweeteners and benzoic acid and added sugar, method description for these estimates and defi nition of soft drinks, ‘saft ’ and nectar in the legislation. Two of VKM’s scientifi c panels have reviewed the report during its preparation, and the members of the VKM Scientifi c Steering Committee have given their fi nal assessment and approval. Th e report has been submitted to and discussed in the National Council of Nutrition (Nasjonalt råd for ernæring). Panel on food additives, fl avourings, processing aids, materials in contact with food and cosmetics Jan Alexander (Chair), Mona-Lise Binderup, Knut Helkås Dahl, Trine Husøy, Kristine Naterstad, Jan Erik Paulsen, Tore Sanner, Inger-Lise Steff ensen. Panel on nutrition, dietetic products, novel food and allergy Margaretha Haugen (Chair), Lene Frost Andersen, Livar Frøyland, Ragnhild Halvorsen, Kåre Julshamn, Helle Margrete Meltzer, Judith Narvhus, Jan Erik Paulsen. Scientifi c Steering Committee Åshild Krogdahl (Chair), Bjørn Næss, Jan Alexander, Lene Frost Andersen, Erik Dybing, Wenche Farstad, Anne-Kathrine Lundebye Haldorsen, Margaretha Haugen, Georg Kapperud, Hilde Kruse, Øyvind Lie, Judith Narvhus, Ingolf Nes, Janneche Utne Skåre, Leif Sundheim. Th e report was approved by the members of the VKM Scientifi c Steering Committee of the Norwegian Scientifi c Committee for Food Safety (VKM) on 1 February 2007. Coordinators in the VKM Secretariat have been Bente Mangschou and Tor Øystein Fotland. Acknowledgement VKM wishes to thank Alix Young Vik (Associate Professor), Faculty of Odontology, University of Oslo for her contribution regarding dental health in this report, and Ragnhild Halvorsen (MD PhD) for her contribution to the section on benzoic acid and hypersensitivity. Norwegian Scientific Committee for Food Safety Vitenskapskomiteen for mattrygghet 3 Table of Contents Preface. 3 1 Summary . 8 1.1 Background. .8 1.2 Results and conclusions . .8 1.3 Recommendations . 10 Norsk sammendrag . 12 1.1 Bakgrunn . 12 1.2 Resultater og konklusjoner . 12 1.3 Anbefalinger. 14 2 Introduction . 15 3 Terms of reference . 16 4 Defi nitions and terms . 17 4.1 Sugars . 17 4.2 Intense sweeteners . 17 4.3 Preservatives . 18 4.4 Soft drinks . 18 4.5 ‘Saft ’ . 18 4.6 Nectar . 19 4.7 Body Mass Index (BMI) and BMI Z-score . 19 4.8 Overweight and obesity . 19 4.9 Insulin resistance . 20 4.10 Acceptable Daily Intake (ADI) . 20 th 4.11 95 percentile and median . 20 4.12 Percent of energy (E%) . 20 4.13 Weighted average content . 20 4.14 Spearman’s rank correlation coeffi cient . 20 5 Trends in the consumption of sugar, intense sweeteners, soft drinks and ‘saft’ . 21 5.1 Summary of trends in the consumption of sugar, intense sweeteners, soft drinks and ‘saft ’. 23 6 Health consequences (overweight, diabetes, dental health) associated with consumption of soft drinks . 24 6.1 Methodological considerations for evaluation of epidemiological studies . 24 6.2 Sugar/intense sweeteners from soft drinks/’saft ’ and weight regulation. 25 6.2.1 Prevalence of overweight and obesity. 25 6.2.2 Re-formation of fat fr om carbohydrates . 26 6.2.3 Sugared soft drinks/’saft ’ and overweight. 26 6.2.3.1 Prospective population studies . 26 6.2.3.2 Intervention studies . 28 6.2.3.3 Discussion of results in prospective population studies and intervention studies . 30 6.2.3.4 Does fl uid sugar satiate less than solid form sugar? . 31 6.2.3.5 Summary of sugared soft drinks/’saft ’ and overweight. 32 6.2.4 Soft drinks/’saft ’ with intense sweeteners and weight regulation . 32 6.2.4.1 Prospective studies . 32 6.2.4.2 Intervention studies . 32 6.2.4.3 Summary of soft drinks/’saft ’ with intense sweeteners and weight regulation . 33 6.3 Sugar/intense sweeteners from soft drinks/’saft ’ and diabetes . 33 6.3.1 Prevalence of diabetes . 33 6.3.2 Sugar and type 1 diabetes . 34 Impact on health when sugar is replaced with intense sweeteners 4 in soft drinks, ‘saft’ and nectar 6.3.3 Sugar/intense sweeteners and type 2 diabetes . ..
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