Role of Non-nutritive sweeteners in oral health/caries prevention-An Educational symposium for Dental Professionals

Preventing dental caries is an essential skill for all dental professionals yet information from expert interviews conducted by IAFNS and a review of the literature suggest a gap in knowledge around the safety and benefits of LNCS to oral health. These professionals are often called upon to provide advice regarding the importance of diet in caries prevention and can benefit from education on the role of sugars and nonnutritive sweeteners in caries formation and health. As such, they must be familiar with alternatives to sugar and the types of food products that are available with non-cariogenic sweetening agents. The American Dental Association (ADA) policies on diet and nutrition encourages members to obtain continuing education to learn more about the relationship between diet, nutrition, and oral health and encourage collaborations with stakeholders to understand the latest science-based nutrition recommendations and raise interprofessional awareness.

Phase I: IAFNS staff will work with oral health experts and members of the American Dental Association to develop an educational symposium for dental health professionals to educate then in the following areas:

  • Safety & efficacy of LNCS and LNCS as a substitute for sugar and effects on sugar consumption and body weight
  • The anti and non-cariogenic properties of NNS- what is known and where more research is needed
  • Dietary patterns associated with dental caries, prevention, and recommendations

Phase II: The Symposium will be submitted to the Greater NY Dental Meeting and or another scientific conference for dental health professionals for 2025. The results of the symposium will be drafted into a review paper for submission for publication in the Journal of the American Dental Association.

Project Lead: Trish Zecca

Start Date: May 2024

This work is supported by the IAFNS Low- and No-Calorie Sweeteners Committee

Reconciliation of Differences between Observational Studies and Randomized Controlled Trials: A Case Study on Low Calorie Sweeteners

Scientific evidence is commonly categorized into levels based on quality of evidence, commonly referred to as the hierarchy of evidence. The complexity of evaluating study quality based on study design becomes problematic for dietary exposures and health outcomes with conflicting evidence observed in observational studies and RCTs. Such conflicting evidence is well documented for low calorie sweeteners (LCS), in which observational trials tend to identify adverse associations between LCS use and adiposity, type 2 diabetes (T2D), mortality, cardiovascular disease (CVD), and cancer while RCTs highlight benefits or no effect of LCS on body weight, energy intake, markers of T2D, and markers of CVD (6). One possible explanation for this is that observational trials and RCT are simply addressing different research questions, evaluating different exposures, comparators, and outcomes.

The objective of the proposed project is to educate stakeholders on how to interpret contrasting evidence from observational studies and RCTs based on methodological differences between study designs, using LCS as a case-study. A rapid review of systematic reviews and metaanalyses on LCS and various health outcomes will be conducted to highlight how different intervention/exposures, comparators, outcomes, and study designs produce varying conclusions regarding the efficacy and safety of LCS. The deliverables of this project will be a peer-reviewed publication and presentation of findings at a conference for nutrition and dietetics practitioners

Institution: USDA Agricultural Research Service

Principal Investigator: Kelly Higgins, MPH PhD; David Baer, PhD

Year: 2022

Read More: An Overview of Reviews on the Association of Low Calorie Sweetener Consumption With Body Weight and Adiposity

Webinar: Low & No Calorie Sweeteners: What Does the Science Really Say, Speaker Kelly Higgins

This work was supported by the IAFNS Low- and No-Calorie Sweeteners Committee.

Low- and No-Calorie Sweeteners: How much is too much?

Recorded June 16, 2021

Continuing Education Hours: IAFNS is a Continuing Professional Education (CPE) provider with the Commission on Dietetic Registration (CDR). CDR Credentialed Practitioners will receive 1.5 Continuing Professional Education Unit (CPEU) for completion of this recorded webinar until June 16, 2024.

Description: The 2020 Dietary Guidelines Advisory Committee recommended reducing added sugars intake to less than 6% of calories. Although low- and no-calorie sweeteners (LNCSs) are approved as safe by US, and other global regulators, RDN and consumer confidence in LNCSs as a safe sugars replacement is enhanced by understanding how their safety and efficacy are determined. In this session, the US FDA safety review process, focusing on newer sweeteners (stevia and monkfruit) will be reviewed. Speakers will address the perspective that sweeteners are ubiquitous in the food supply and concerns about intake levels by providing evidence-based information and comparing levels of consumption with acceptable daily intakes (ADIs) as set by the FDA. Finally, the healthcare practitioner perspective on LNCSs use, particularly in children, will be presented. The audience will have the opportunity for a dialogue across these themes of safety, appearance in the food supply, and practical and safe use in the diet as a tool for added sugars intake reduction.

 Introduction and Background 

Moderator: Hope Warshaw, MMSc, RD, CDCES, BC-ADM

Hope Warshaw Associates, LLC

Safety Evaluation Process with a Focus on Novel Sweeteners 

Njwen Anyangwe, PhD

Regulatory Toxicologist

US Food and Drug Administration, Center for Food Safety and Applied Nutrition, Office of Food Additive Safety

Low- and No-Calorie Sweetener Occurrence in the Food Supply 

Danika Martyn, PhD

Director of Regulatory Affairs (Europe) & Dietary Intakes - Food & Nutrition

Intertek

Pediatrician Perspective 

Robert Murray, MD

Professor of Human Nutrition
Ohio State University

Q&A/discussion 

Performance Indicators

  • 6.2.5 Applies research/evidence-based findings to improve practice, service delivery, and health and nutrition of customers.
  • 8.1.2 Applies knowledge of food and nutrition as well as the biological, physical and social sciences in practice.
  • 4.1.2 Interprets and integrates evidence-based research and literature in decision making.

Addressing Perceptions of Low- and No-Calorie Sweeteners in the Healthcare Practitioner Community

Misperceptions are not new about low-and no-calorie sweeteners (LNCSs) within the healthcare practitioner (HCP) community and among consumers. Some confusion can be attributed to the mixed literature on LNCSs that results from variation in study hypotheses, design, interpretation and communication. Understanding HCP perspectives on LNCSs supports science-based information delivery to patients and clients. The first step in understanding these perspectives is to conduct a review of publicly available information, including published literature, surveys, market research and HCP professional organization policy statements, among other materials. This will inform the design of a more robust HCP survey to fill in gaps, and ultimately the content and delivery of science-based information appropriate to each topic. The objectives of Phase II of this project are to directly engage with HCPs, to: 1) assess HCPs' perspectives on the use of LNCSs for achieving various dietary goals, and 2) evaluate the effectiveness of science-based information on the safety evaluation process of LNCSs for addressing HCPs misperceptions of LNCSs.

Institution: University of Massachusetts Amherst

Principal Investigator: Dr. Alissa Nolden

Start Date: September 15, 2021

Learn More: FDA Regulatory Review Process For Food Additives-Including Low And No Calorie Sweeteners

This work is supported by the IAFNS Low- and No-Calorie Sweeteners Committee