Biomarker approaches to assessing intakes and health impacts of sweeteners: challenges and opportunities

The term ‘sweeteners’ encompasses both nutritive and non-nutritive sweeteners, which when added to food/beverages, can enhance the flavour and other functional properties of food/beverage products. This review considers how dietary biomarker approaches may enhance current understanding of nutritive sweeteners (namely free sugars) and non-nutritive or low-calorie sweeteners (LCS) intakes and how these may impact health. Recent public health strategies to reduce free sugar consumption will help contribute to challenging sugar intake targets. Robust evaluation is needed to determine the effectiveness of these approaches to reducing free sugars consumption. LCS provide a sweet taste without the addition of appreciable energy and can help maintain the palatability of reformulated products. All LCS undergo rigorous safety evaluations prior to approval for use. Whilst intervention data suggest LCS can be beneficial for health (relating to weight status and glycaemic control), debate persists on their use and findings from population-based research are mixed, in part because potential contributing factors such as reverse causality. Additionally, assessments often consider only certain sources of LCS (e.g. LCS-beverages) and/or LCS as a homogenous group despite differing biological fates, thus not adequately capture intakes of individual LCS or allow reliable estimation of overall intakes. Urinary biomarker approaches developed/investigated for sweetener consumption have the potential to overcome existing limitations of dietary data by providing more objective intake data, thereby enhancing population-based research. In conclusion, such biomarker approaches to the concomitant study of free sugars and LCS intakes are timely and represent interesting developments in an area of significant public health interest.