Low- and no-calorie sweetener intakes from beverages - an up-to-date assessment in four regions: Brazil, Canada, Mexico and the United States.

The current assessment estimated exposure to four low- and no-calorie sweeteners (LNCS) (aspartame, acesulfame potassium (AceK), steviol glycosides and sucralose) from beverages in Brazil, Canada, Mexico and the United States, using up-to-date nationally representative consumption data and industry reported-use level information. Two modelling scenarios were applied - the probabilistic model was guided by reported use level data, with estimated intake for an individual leveraging market-weighted average use level of a particular LNCS in any given LNCS-sweetened beverage type, while the distributional (brand-loyal) model assumed consumer behaviour-led patterns, namely that an individual will be brand loyal to a pre-determined beverage type. Consumer-only and general population intake estimates were derived for the overall population and individual age categories, and compared to the respective acceptable daily intake (ADI) as established by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) for each LNCS. The mean, 90th percentile and 95th percentile intake estimates were substantially lower than the ADI in both modelling scenarios, regardless of the population group or market. In the probabilistic model, the highest consumer-only intake was observed for AceK in Brazilian adolescents (95th percentile, 12.4% of the ADI), while the highest 95th percentile intakes in the distributional model were observed for sucralose in Canadian adults at 20.9% of the ADI. This study provides the latest insights into current intakes of LNCS from water-based non-alcoholic LNCS-sweetened beverages in these regions, aligning well with those published elsewhere.

Low- and no-calorie sweetener intakes in the Brazilian population estimated using added sugar substitution modelling.

This research examined the intakes of six low- and no-calorie sweeteners (LNCS) (acesulfame-K, aspartame, cyclamate, saccharin, steviol glycosides, and sucralose) by the Brazilian population using an added sugar substitution approach. Detailed exposure modelling requires the use of proprietary concentration data, which can be difficult to obtain. Two exposure models were conducted using nationally representative food consumption data. The first model ('per person') estimated added sugar intakes on an individual person basis, replacing 50% of added sugar intakes >10% total energy with each LNCS considering sucrose sweetness equivalence. The second model ('per food') replaced 50% of the added sugar content in foods and beverages with each LNCS, incorporating sucrose sweetness equivalence and Brazilian tonnage data. Both models predicted that intakes would be below the JECFA ADI for five of the six LNCS in all population groups examined (≥10 years) for average and heavy consumers. For cyclamate, exceedance of the ADI was determined for all age groups amongst heavy consumers in the 'per person' model, while estimated intakes in the 'per food' model were below or reached the ADI for the cohort. Additional research is needed for younger age groups to confirm whether these findings are applicable to the entire Brazilian population.

An updated estimate of benzoate intakes from non-alcoholic beverages in Canada and the United States.

In 2017, the results of a comprehensive assessment of intake for benzoic acid and its salts from non-alcoholic beverages were published for four regions (Brazil, Canada, Mexico, and the United States [U.S.]). These regions were among those identified as having the most prevalent use of benzoates in beverages globally. The results of the 2017 study did not indicate a safety concern relative to the acceptable daily intake (ADI) established for benzoates (5 mg kg body weight-1 day-1, as benzoic acid), and supported maintaining the Codex maximum benzoate level in water-based beverages (250 mg kg-1). Since this time, population-specific food consumption data have been released for public use for Canada, and updated beverage consumption data have become available for the U.S. To ensure estimated intakes remain relevant, these consumption data were incorporated with previously collected brand-specific benzoate use level and market volume data for beverages. Dietary exposure to benzoates from non-alcoholic beverages was assessed using statistical modelling, either probabilistic (non-brand loyal; considering the full distribution of use levels) or deterministic (brand loyal; assuming all regular carbonated soft drinks, the brand loyal beverage type, contain benzoates at the maximum use level, and all other beverage types in which benzoates are used contain benzoates at the market-weighted average use level). In both models, estimated daily intakes at the mean and 95th percentile were below the ADI (≤76% of the ADI) in all Canadian and U.S. population groups with a statistically reliable population size. The findings from updated Canadian and U.S. consumption data continue to support the Codex maximum benzoate level in water-based flavoured drinks at 250 mg kg-1.

Chewing gum consumption in the United States among children, adolescents and adults.

Data regarding chewing gum consumption habits and attitudes were collected for 963 children and adolescents (aged 6-14) and 3150 adolescents and adults (aged 13 years+) in the United States (U.S.) using a dedicated online food frequency questionnaire. A total of 79.6% of children/adolescents reported using chewing gum in the last 3 months, whereas 61.8% of adolescents/adults chewed gum in the previous 6 months. The mean and 90th percentile of consumption among children/adolescents aged 6-14 were 1.95 and 4.71 g day-1, equivalent to 0.75 and 1.78 pieces per day, respectively. Stratification by gender and age brackets revealed that the consumption of chewing gum was more heavily reported in boys compared to girls. Among adolescents/adults aged 13 years and older, the mean and 90th percentile of consumption of chewing gum was estimated to be 2.98 and 7.67 g day-1, or 1.05 and 3.00 pieces per day, respectively. Stratification by gender and by age brackets in this cohort did not reveal any marked patterns although it was noted that there was a decrease in the percent consuming with age (from 87.0 to 34.5%). The most commonly reported chew frequency among all ages was 'two or three times a week' (23.7 to 26.8%). The average and high-level estimates reported herein provide up-to-date estimates of chewing gum consumption in the U.S. Comparisons of the calculated intake values with those reported from the National Health and Nutrition Examination Survey dataset suggests that national nutrition surveys may result in an under-reporting of the percent consumers, but similar estimates for the daily intakes in g day-1.

Ibero⁻American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages.

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2⁻4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.

Low-/No-Calorie Sweeteners: A Review of Global Intakes.

The current review examined published data on the intake of all major low-/no-calorie sweeteners-aspartame, acesulfame-K, saccharin, sucralose, cyclamate, thaumatin and steviol glycosides-globally over the last decade. The most detailed and complex exposure assessments were conducted in Europe, following a standardized approach. Japan and Korea similarly had up-to-date and regular intake data available. The data for other Asian countries, Latin America, Australia/New Zealand and global estimates, evaluated by the Joint FAO/WHO Expert Committee on Food Additives (JECFA), while available, were shown to be more limited in terms of design. Overall, the studies conducted since 2008 raised no concerns with respect to exceedance of individual sweetener acceptable daily intake (ADIs) among the general population globally. The data identified do not suggest a shift in exposure over time, with several studies indicating a reduction in intake. However, some data suggest there may have been an increase in the numbers of consumers of low-/no-calorie-sweetened products. Future research should consider a more standardized approach to allow the monitoring of potential changes in exposure based upon events such as sugar reduction recommendations, to ensure there is no shift in intake, particularly for high-risk individuals, including diabetics and children with specific dietary requirements, and to ensure risk management decisions are based on quality intake analyses.

Temporal patterns of caffeine intake in the United States.

To investigate whether caffeine intake among adolescents and adults in the U.S. varies across the week or throughout the day, data from a 7-day online beverage consumption survey (2010-2011) were analyzed. Mean (206.8-213.0 mg/day) and 90th percentile (437.4-452.6 mg/day) daily caffeine intakes among consumers 13 years and older were relatively constant across the week with no marked difference among weekdays versus weekend days. Percent consumers of caffeinated beverages likewise remained stable across the week. Mean daily caffeine intake for coffee and energy drink consumers 13 years and older was higher than contributions for tea and carbonated soft drink consumers. Caffeinated beverage consumers (13 + yrs) consumed most of their caffeine in the morning (61% versus 21% and 18% in the afternoon and evening) which was driven by coffee. Caffeinated beverage consumption patterns among adolescents (13-17 yrs) - who typically consume less daily caffeine - were more evenly distributed throughout the day. These findings provide insight into U.S. temporal caffeine consumption patterns among specific caffeinated beverage consumers and different age brackets. These data suggest that while caffeine intakes do not vary from day-to-day, mornings generally drive the daily caffeine intake of adults and is predominantly attributed to coffee.

Benzoates intakes from non-alcoholic beverages in Brazil, Canada, Mexico and the United States.

Food consumption data from national dietary surveys were combined with brand-specific-use levels reported by beverage manufacturers to calculate the exposure to benzoic acid and its salts (INS Nos 210-213) from non-alcoholic beverages in Brazil, Canada, Mexico and the United States. These four jurisdictions were identified as having some of the most prevalent use of benzoates in beverages globally. Use levels were weighted according to the brand's market volume share in the respective countries. Benzoates were reported to be used primarily in 'water-based flavoured drinks' (Codex General Standard for Food Additives (GSFA) category 14.1.4). As such, the assessments focused only on intakes from these beverage types. Two different models were established to determine exposure: probabilistic (representing non-brand loyal consumers) and distributional (representing brand-loyal consumers). All reported-use levels were incorporated into both models, including those above the Codex interim maximum benzoate use level (250 mg kg-1). The exception to this was in the brand-loyal models for consumers of regular carbonated soft drinks (brand loyal category) which used (1) the interim maximum use level for beverages with a pH ≤ 3.5 and (2) all reported use levels for beverages pH > 3.5 (up to 438 mg kg-1). The estimated exposure levels using both models were significantly lower than the ADI established for benzoates at the mean level of intake (4-40% ADI) and lower than - or at the ADI only for toddlers/children - at the 95th percentile (23-110% ADI). The results rendered in the models do not indicate a safety concern in these jurisdictions, and as such provide support for maintaining the current Codex interim maximum benzoate level of 250 mg kg-1 in water-based beverages.

Dietary intake of four artificial sweeteners by Irish pre-school children.

In spite of rigorous pre- and post-market reviews of safety, there remains a high level of debate regarding the use of artificial sweeteners in foods. Young children are of particular interest when assessing food chemical exposure as a result of their unique food consumption patterns and comparatively higher exposure to food chemicals on a body weight basis when compared with the general population. The present study examined the intakes of four intense sweeteners (acesulfame K, aspartame, saccharin, sucralose) in the diets of children aged 1-4 years using food consumption and sweetener presence data from the Irish National Pre-school Nutrition Survey (2010-11) and analytical data for sweetener concentration in foods obtained from a national testing programme. Four exposure assessment scenarios were conducted using the available data on sweetener occurrence and concentration. The results demonstrated that the mean daily intakes for all four sweeteners were below the acceptable daily intake (ADI) (17-31%), even considering the most conservative assumptions regarding sweetener presence and concentration. High consumer intakes (P95) were also below the ADI for the four sweeteners when more realistic estimates of exposure were considered. Both sweetener occurrence and concentration data had a considerable effect on reducing the estimated intake values, with a combined reduction in intakes of 95% when expressed as a proportion of the ADI. Flavoured drinks were deemed to be a key contributor to artificial sweetener intakes in this population cohort. It was concluded that there is no health risk to Irish pre-school children at current dietary intake levels of the sweeteners studied.

Food additives and preschool children.

Food additives have been used throughout history to perform specific functions in foods. A comprehensive framework of legislation is in place within Europe to control the use of additives in the food supply and ensure they pose no risk to human health. Further to this, exposure assessments are regularly carried out to monitor population intakes and verify that intakes are not above acceptable levels (acceptable daily intakes). Young children may have a higher dietary exposure to chemicals than adults due to a combination of rapid growth rates and distinct food intake patterns. For this reason, exposure assessments are particularly important in this age group. The paper will review the use of additives and exposure assessment methods and examine factors that affect dietary exposure by young children. One of the most widely investigated unfavourable health effects associated with food additive intake in preschool-aged children are suggested adverse behavioural effects. Research that has examined this relationship has reported a variety of responses, with many noting an increase in hyperactivity as reported by parents but not when assessed using objective examiners. This review has examined the experimental approaches used in such studies and suggests that efforts are needed to standardise objective methods of measuring behaviour in preschool children. Further to this, a more holistic approach to examining food additive intakes by preschool children is advisable, where overall exposure is considered rather than focusing solely on behavioural effects and possibly examining intakes of food additives other than food colours.

Inhibition of proinflammatory biomarkers in THP1 macrophages by polyphenols derived from chamomile, meadowsweet and willow bark.

Antiinflammatory compounds in the diet can alleviate excessive inflammation, a factor in the pathogenesis of common diseases such as rheumatoid arthritis, atherosclerosis and diabetes. This study examined three European herbs, chamomile (Matricaria chamomilla), meadowsweet (Filipendula ulmaria L.) and willow bark (Salix alba L.), which have been traditionally used to treat inflammation and their potential for use as antiinflammatory agents. Aqueous herbal extracts and isolated polyphenolic compounds (apigenin, quercetin and salicylic acid, 0-100 µM) were incubated with THP1 macrophages, and interleukin (IL)-1ß, IL-6 and tumour necrosis factor-alpha (TNF-α) were measured. At concentrations of 10 µM, both apigenin and quercetin reduced IL-6 significantly ( p < 0.05). Apigenin at 10 µM and quercetin at 25 µM reduced TNF-α significantly ( p < 0.05). Amongst the herbal extracts, willow bark had the greatest antiinflammatory activity at reducing IL-6 and TNF-α production. This was followed by meadowsweet and then chamomile. The lowest effective antiinflammatory concentrations were noncytotoxic (MTT mitochondrial activity assay). The Comet assay, which was used to study the protective effect of the isolated phenols against oxidative damage, showed positive results for all three polyphenols. These are the first findings that demonstrate the antiinflammatory capacity of these herbal extracts.