Circulation. 2018 Aug 28;138(9):e126-e140. doi: 10.1161/CIR.0000000000000569.
In the United States, 32% of beverages consumed by adults and 19% of beverages consumed by children in 2007 to 2010 contained low-calorie sweeteners (LCSs). Among all foods and beverages containing LCSs, beverages represent the largest proportion of LCS consumption worldwide. The term LCS includes the 6 high-intensity sweeteners currently approved by the US Food and Drug Administration and 2 additional high-intensity sweeteners for which the US Food and Drug Administration has issued no objection letters. Because of a lack of data on specific LCSs, this advisory does not distinguish among these LCSs. Furthermore, the advisory does not address foods sweetened with LCSs. This advisory reviews evidence from observational studies and clinical trials assessing the cardiometabolic outcomes of LCS beverages. It summarizes the positions of government agencies and other health organizations on LCS beverages and identifies research needs on the effects of LCS beverages on energy balance and cardiometabolic health. The use of LCS beverages may be an effective strategy to help control energy intake and promote weight loss. Nonetheless, there is a dearth of evidence on the potential adverse effects of LCS beverages relative to potential benefits. On the basis of the available evidence, the writing group concluded that, at this time, it is prudent to advise against prolonged consumption of LCS beverages by children. (Although water is the optimal beverage choice, children with diabetes mellitus who consume a balanced diet and closely monitor their blood glucose may be able to prevent excessive glucose excursions by substituting LCS beverages for sugar-sweetened beverages [SSBs] when needed.) For adults who are habitually high consumers of SSBs, the writing group concluded that LCS beverages may be a useful replacement strategy to reduce intake of SSBs. This approach may be particularly helpful for persons who are habituated to a sweet-tasting beverage and for whom water, at least initially, is an undesirable option. Encouragingly, self-reported consumption of both SSBs and LCS beverages has been declining in the United States, suggesting that it is feasible to reduce SSB intake without necessarily substituting LCS beverages for SSBs. Thus, the use of other alternatives to SSBs, with a focus on water (plain, carbonated, and unsweetened flavored), should be encouraged.
在美国，2007 年至 2010 年间，成年人饮用的饮料中有 32%和儿童饮用的饮料中有 19%含有低热量甜味剂（LCS）。在所有含有 LCS 的食品和饮料中，饮料占全球 LCS 消费的最大比例。LCS 一词包括目前已获得美国食品和药物管理局批准的 6 种高强度甜味剂，以及美国食品和药物管理局尚未提出异议的另外 2 种高强度甜味剂。由于缺乏特定 LCS 的数据，本咨询报告未对这些 LCS 进行区分。此外，本咨询报告不涉及用 LCS 增甜的食品。本咨询报告审查了评估 LCS 饮料对心血管代谢结果的观察性研究和临床试验的证据。它总结了政府机构和其他卫生组织对 LCS 饮料的立场，并确定了有关 LCS 饮料对能量平衡和心血管代谢健康影响的研究需求。使用 LCS 饮料可能是帮助控制能量摄入和促进减肥的有效策略。尽管如此，与潜在益处相比，LCS 饮料潜在不良影响的证据仍然不足。根据现有证据，编写小组的结论是，目前建议儿童不要长时间饮用 LCS 饮料是谨慎的。（虽然水是最佳的饮料选择，但患有糖尿病且饮食均衡并密切监测血糖的儿童，通过在需要时用 LCS 饮料代替含糖饮料[SSB]，可能能够防止血糖过度波动。）对于习惯性大量饮用 SSB 的成年人，编写小组的结论是，LCS 饮料可能是减少 SSB 摄入量的有用替代策略。对于那些习惯饮用含糖饮料且至少最初不喜欢水的人来说，这种方法可能特别有帮助。令人鼓舞的是，美国 SSB 和 LCS 饮料的自我报告消费量均呈下降趋势，这表明在不必用 LCS 饮料替代 SSB 的情况下，减少 SSB 摄入量是可行的。因此，应鼓励使用 SSB 的其他替代品，重点是水（普通、碳酸和无糖调味）。
