• 'The majority of observational studies showed no effects on lipid profile related to intense sweeteners. Two studies reported that replacing sugars with aspartame reduced plasma concentrations of triglycerides but the data are too limited to conclude that intense sweeteners have a beneficial effect on lipid profile'.

• 'Current data regarding the potential benefit of NNSs in modifying cardiovascular disease risk factors are limited but suggest an association between NNS consumption and metabolic syndrome, an association that may be limited by reverse causation. There are no conclusive data regarding the risk of cardiovascular disease events and NNS intake.’

• 'a cause and effect relationship has been established between the consumption of foods/drinks containing xylitol, sorbitol, mannitol, maltitol, lactitol, isomalt, erythritol, D-tagatose, isomaltulose, sucralose or polydextrose instead of sugar and reduction in post-prandial blood glucose responses (without disproportionally increasing post-prandial insulinaemic responses) as compared to sugar-containing foods/drinks /drinks'. This scientific substantiation also applies to intense sweeteners.
• 'A cause and effect relationship has not been established between the consumption of foods and beverages in which sugars have been replaced by intense sweeteners and maintenance of normal blood glucose concentrations'.

• For blood glucose regulation short- and medium-term intense sweetener consumption 'does not result in the post-prandial elevation of blood glucose or insulin levels in healthy or diabetic subjects'.
• In diabetics, regular consumption of intense sweeteners as sugar substitutes on blood glucose control has not demonstrated any benefits.
• 'The most robust epidemiological studies on type 2 diabetes do not show a higher or lower incidence of diabetes' in daily intense sweetener consumers.

• ‘[Nonnutritive sweeteners] do not appear to have a significant effect on glycemic management … and they can reduce overall calorie and carbohydrate intake … as long as individuals are not compensating with additional calories from other food sources.’

• 'Better understanding is needed concerning the effects of [nonnutritive sweeteners (NNSs)] on metabolism and risk of diabetes, including whether NNS intake is merely correlated with a higher risk of metabolic syndrome and diabetes or there is a causal and harmful relationship mediated through the gut microbiome or other as-yet-unidentified pathways.’

• 'a cause and effect relationship has not been established between the consumption of foods and beverages in which sugars have been replaced by intense sweeteners and contribution to the maintenance or achievement of a normal body weight'.

• Replacing free sugars with non-nutritive sweeteners may reduce short term energy intake in the short-term, but their effectiveness remains to be evaluated as a strategy for weight management in the long term. 

• 'Randomised controlled trials conducted in adults indicate that increasing or decreasing the percentage of total dietary energy as sugars when consuming an ad libitum diet, either through the substitution of other macronutrient components or by replacing sugars with non-caloric sweeteners, leads to corresponding relative increases or decreases in energy intake'.
• 'Evidence from trials conducted in children and adolescents indicates that consumption of sugars-sweetened beverages, as compared with non-calorically sweetened beverages, results in greater weight gain and increases in body mass index, however the evidence is limited to a small number of studies'.

• 'Robust evidence from RCTs suggests non-caloric sweeteners are useful in weight maintenance/loss as they enable the calorie content of foods and drinks to be reduced while maintaining the same sweet taste desired by consumers. How these study outcomes reflect behaviour in reali life is however unclear'.

• In most cases, the use of intense sweeteners as sugar substitutes 'results in a decrease in short-term energy intake due to their low calorie content and the lack of compensation. 

• ‘Limited evidence suggests no association between low- and no-calorie sweetened beverage consumption and adiposity in children.’
• ‘Limited evidence suggests that low- and no- calorie sweetened beverage consumption is associated with reduced adiposity in adults.’ 

• ‘The addition of [nonnutritive sweeteners] to eating plans poses no benefit for weight loss or reduced weight gain without energy restriction.’

• ‘non-sugar sweeteners [should] not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases (conditional recommendation)’ ^a
• ‘although individuals with diabetes can also reduce free sugars intake without the need for NSS, the recommendation does not apply to individuals with existing diabetes’

AAP 2019  

• ‘the preponderance of data suggests that the use of NNSs can lead to weight stabilization or a small degree of weight loss by helping lower total caloric intake, especially among children and adolescents with obesity'

• 'the consumption of foods/drinks containing xylitol, sorbitol, mannitol, maltitol, lactitol, isomalt, erythritol […] instead of sugar in sugar-containing foods/drinks, may maintain tooth mineralisation compared with sugar-containing foods, provided that such foods/drinks do not lead to dental erosion'.  This scientific substantiation also applies to intense sweeteners.

• moderate evidence of a beneficial effect of polyols on dental caries. Use of chewing gum containing polyols, compared to not using a chewing gum,  is beneficial to oral health (mixed and permanent dentition).

• occasional consumption of intense sweeteners before or during a meal 'has no effect on food intake or energy intake during the next meal'.
• Occasional intense sweetener consumption before a meal 'reduces the sensation of hunger and the desire to eat, just like caloric sweeteners, but this effect is temporary and disappears before the start of the meal'.
• for habituation to sweetness, intense sweetener consumption 'has not shown any effects in adults'. 

• Limited evidence that consumption of some polyols increases faecal weight, mass and affects faecal bacterial content (e.g. Bifidobacterium spp.). The health impact of an effect on faecal bacteria is currently uncertain, thus, whether this observation is beneficial or biologically relevant cannot be determined. No effects on faecal pH, faecal short chain fatty acids, based on limited evidence.

• ‘There is limited evidence that aspartame causes liver cancer (hepatocellular carcinoma) in humans.’

AAP 2019  

• ‘observational data in adult-human studies show no association between NNS use and cancer.’ 

• Artificial sweetened beverages and sugar sweetened beverages should not be consumed as substitutes for water.

• ‘With the exception of the use of aspartame and neotame in children with phenylketonuria, there are no absolute contraindications to NNS use in children.’ 

• For some diabetics, non-nutritive sweeteners (containing few or no calories) can be acceptable substitutes for nutritive sweeteners (containing calories) when consumed in moderation.