High intake of free sugars has been linked to overweight and obesity, which affects nearly 40% of the global adult population and millions of children, and, in turn, diet-related noncommunicable diseases (NCDs), which are the leading causes of death worldwide. In response, the World Health Organization (WHO) has issued recommendations to reduce the intake of free sugars. Various measures are being taken to reduce consumption of free sugars as part of global efforts to address the epidemic of obesity and associated diseases. Non-sugar sweeteners (NSS) are low- or no-calorie alternatives to free sugars that are generally marketed as aiding weight loss or maintenance of healthy weight, and are frequently recommended as a means of controlling blood glucose in individuals with diabetes. Individual sweeteners undergo toxicological assessment to establish safe levels of intake (i.e. acceptable daily intake, or ADI). However, there is no clear consensus on whether NSS are effective for long-term weight control or if they are linked to other long-term health effects at habitual intakes within the ADI. Since the release of updated WHO guidance on free sugars intake in 2015, interest in the potential utility of NSS in reducing sugars intake has increased. Therefore, it was considered necessary to review the evidence in a systematic manner, and issue WHO guidance on NSS use through the WHO guideline development process.
The objective of this guideline is to provide guidance on the use of NSS to be used by policy-makers, programme managers, health professionals and other stakeholders in efforts to reduce free sugars intake, promote healthy diets, and prevent unhealthy weight gain and diet-related NCDs. Because the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Diet and Health focuses on providing guidance on the prevention of unhealthy weight gain and diet-related NCDs, providing guidance on the management of diabetes in individuals with pre-existing diabetes is beyond the scope of this guideline. Therefore, the guidance in the guideline may not be relevant for individuals with existing diabetes. The guidance is based on evidence of health effects of NSS use at levels already considered safe (i.e. within the ADI), and is not intended to provide updated or alternative guidance on safe or maximal levels of intake.
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