European Journal of Nutrition

, Volume 50, Issue 1, pp 41–51 | Cite as

Impact of substituting added sugar in carbonated soft drinks by intense sweeteners in young adults in the Netherlands: example of a benefit–risk approach

  • Marieke A. HendriksenEmail author
  • Mariken J. Tijhuis
  • Heidi P. Fransen
  • Hans Verhagen
  • Jeljer Hoekstra
Original Contribution



Substituting added sugar in carbonated soft drinks with intense sweeteners may have potential beneficial, but also adverse health effects. This study assessed the benefits and risks associated with substituting added sugar in carbonated soft drinks with intense sweeteners in young adults in the Netherlands.


A tiered approach was used analogous to the risk assessment paradigm, consisting of benefit and hazard identification, exposure assessment and finally benefit and risk characterization and comparison. Two extreme scenarios were compared in which all carbonated soft drinks were sweetened with either intense sweeteners or added sugar. National food consumption survey data were used, and intake of added sugar and intense sweeteners was calculated using the food composition table or analytical data for sweetener content.


Reduction in dental caries and body weight were identified as benefits of substituting sugar. The mean difference in total energy intake between the scenarios was 542 kJ per day in men and 357 kJ per day in women, under the assumption that no compensation takes place. In the 100% sweetener scenario, the average BMI decreased 1.7 kg/m2 in men and 1.3 kg/m2 in women when compared to the 100% sugar scenario. Risks are negligible, as the intake of intense sweeteners remains below the ADI in the substitution scenario.


Substitution of added sugar by intense sweeteners in carbonated soft drinks has beneficial effects on BMI and the reduction in dental caries, and does not seem to have adverse health effects in young adults, given the available knowledge and assumptions made.


Benefit–risk assessment Intense sweeteners Added sugar Carbonated soft drinks 



We would like to thank the Netherlands Food and Consumer Product Safety Authority (VWA) who financially supported this research.

Conflict of interest

The Authors declare that they have no conflicts of interest.


  1. 1.
    Anonymous (2006) Guidelines for a healthy diet 2006. Health Council of the Netherlands, The HagueGoogle Scholar
  2. 2.
    Arcella D, Le Donne C, Piccinelli R, Leclercq C (2004) Dietary estimated intake of intense sweeteners by Italian teenagers. Present levels and projections derived from the INRAN-RM-2001 food survey. Food Chem Toxicol 42:677–685CrossRefGoogle Scholar
  3. 3.
    Bao Y, Stolzenberg-Solomon R, Jiao L, Silverman DT, Subar AF, Park Y, Leitzmann MF, Hollenbeck A, Schatzkin A, Michaud DS (2008) Added sugar and sugar-sweetened foods and beverages and the risk of pancreatic cancer in the national institutes of health-AARP diet and health study. Am J Clin Nutr 88:431–440Google Scholar
  4. 4.
    Benton D (2008) Sucrose and behavioral problems. Crit Rev Food Sci Nutr 48:385–401CrossRefGoogle Scholar
  5. 5.
    Bes-Rastrollo M, Sanchez-Villegas A, Gomez-Gracia E, Martinez JA, Pajares RM, Martinez-Gonzalez MA (2006) Predictors of weight gain in a Mediterranean cohort: the Seguimiento Universidad de Navarra study 1. Am J Clin Nutr 83:362–370 quiz 394–365Google Scholar
  6. 6.
    European Commission. Food safety. Accessed 7 Dec 2009
  7. 7.
    Creasy DM, Ford GR, Gray TJ (1990) The morphogenesis of cyclohexylamine-induced testicular atrophy in the rat: in vivo and in vitro studies. Exp Mol Pathol 52:155–169CrossRefGoogle Scholar
  8. 8.
    de la Hunty A, Gibson S, Ashwell M (2006) A review of the effectiveness of aspartame in helping with weight control. Nutr Bull 31:115–128CrossRefGoogle Scholar
  9. 9.
    DiMeglio DP, Mattes RD (2000) Liquid versus solid carbohydrate: effects on food intake and body weight. Int J Obes Relat Metab Disord 24:794–800CrossRefGoogle Scholar
  10. 10.
    Drewnowski A, Bellisle F (2007) Liquid calories, sugar, and body weight. Am J Clin Nutr 85:651–661Google Scholar
  11. 11.
    Duffey KJ, Popkin BM (2006) Adults with healthier dietary patterns have healthier beverage patterns. J Nutr 136:2901–2907Google Scholar
  12. 12.
    Ebbeling CB, Feldman HA, Osganian SK, Chomitz VR, Ellenbogen SJ, Ludwig DS (2006) Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: a randomized, controlled pilot study. Pediatrics 117:673–680CrossRefGoogle Scholar
  13. 13.
    EFSA (2007) EFSA Scientific colloquium 6 summary report: Risk-benefit analysis of foods—methods and approaches. In: Risk-benefit analysis of foods—methods and approaches. European Food Safety Authority, ParmaGoogle Scholar
  14. 14.
    EFSA European Food safety authority. . Accessed 7 Dec 2009
  15. 15.
    EFSA (2006) Opinion of the scientific panel on food additives, flavourings, processing aids and materials in contact with Food on a request from the commission related to a new long-term carcinogenicity study on aspartame. European Food Safety Authority, Parma, pp 1–44Google Scholar
  16. 16.
    EFSA (2008) The setting of nutrient profiles for foods bearing nutrition and health claims pursuant to article 4 of the regulation (EC) º No 1924/2006. European Food Safety Authority, Parma, pp 1–44Google Scholar
  17. 17.
    EFSA (2009) Updated opinion on a request from the European Commission related to the 2nd ERF carcinogenicity study on aspartame, taking into consideration study data submitted by the Ramazzini Foundation in February 2009. European Food Safety Authority, Parma, pp 1–18Google Scholar
  18. 18.
    Elcock M, Morgan RW (1993) Update on artificial sweeteners and bladder cancer. Regul Toxicol Pharmacol 17:35–43CrossRefGoogle Scholar
  19. 19.
    Forshee RA, Anderson PA, Storey ML (2008) Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis. Am J Clin Nutr 87:1662–1671Google Scholar
  20. 20.
    Fransen H, de Jong N, Hendriksen M, Mengelers M, Castenmiller J, Hoekstra J, van Leeuwen R, Verhagen HA (2010) Tiered approach for risk-benefit assessment of foods. Risk Anal [Epub ahead of print]Google Scholar
  21. 21.
    Gallus S, Scotti L, Negri E, Talamini R, Franceschi S, Montella M, Giacosa A, Dal Maso L, La Vecchia C (2007) Artificial sweeteners and cancer risk in a network of case-control studies. Ann Oncol 18:40–44CrossRefGoogle Scholar
  22. 22.
    Gurney JG, Pogoda JM, Holly EA, Hecht SS, Preston-Martin S (1997) Aspartame consumption in relation to childhood brain tumor risk: results from a case-control study. J Natl Cancer Inst 89:1072–1074CrossRefGoogle Scholar
  23. 23.
    Harrington S (2008) The role of sugar-sweetened beverage consumption in adolescent obesity: a review of the literature. J Sch Nurs 24:3–12CrossRefGoogle Scholar
  24. 24.
    Hulshof KFAM, Balder HF, ter Doest D (2006) Suikers in de Nederlandse Voeding. TNO Kwaliteit van Leven, ZeistGoogle Scholar
  25. 25.
    Hulshof KFAM, Ocké MC, van Rossum CTM, Buurma-Rethans EJM, Brants HAM, Drijvers JJMM, ter Doest D (2003) Resultaten van de Voedselconsumptiepeiling 2003. Rijksinstituut voor Volksgezondheid en Milieu, BilthovenGoogle Scholar
  26. 26.
    Husoy T, Mangschou B, Fotland TO, Kolset SO, Notvik Jakobsen H, Tommerberg I, Bergsten C, Alexander J, Frost Andersen L (2008) Reducing added sugar intake in Norway by replacing sugar sweetened beverages with beverages containing intense sweeteners—A risk benefit assessment. Food Chem Toxicol 46:3099–3105CrossRefGoogle Scholar
  27. 27.
    Ilback NG, Alzin M, Jahrl S, Enghardt-Barbieri H, Busk L (2003) Estimated intake of the artificial sweeteners acesulfame-K, aspartame, cyclamate and saccharin in a group of Swedish diabetics. Food Addit Contam 20:99–114CrossRefGoogle Scholar
  28. 28.
    Key TJ, Spencer EA (2007) Carbohydrates and cancer: an overview of the epidemiological evidence. Eur J Clin Nutr 61(Suppl 1):S112–S121CrossRefGoogle Scholar
  29. 29.
    Kroger M, Meister K, Kava R (2006) Low-calorie sweeteners and other sugar substitutes: a review of the safety issues. Compr Rev Food Sci Food Saf 5:35–47CrossRefGoogle Scholar
  30. 30.
    Kvaavik E, Andersen LF, Klepp KI (2005) The stability of soft drinks intake from adolescence to adult age and the association between long-term consumption of soft drinks and lifestyle factors and body weight. Public Health Nutr 8:149–157CrossRefGoogle Scholar
  31. 31.
    Larsson SC, Bergkvist L, Wolk A (2006) Consumption of sugar and sugar-sweetened foods and the risk of pancreatic cancer in a prospective study. Am J Clin Nutr 84:1171–1176Google Scholar
  32. 32.
    Leclercq C, Berardi D, Sorbillo MR, Lambe J (1999) Intake of saccharin, aspartame, acesulfame K and cyclamate in Italian teenagers: present levels and projections. Food Addit Contam 16:99–109CrossRefGoogle Scholar
  33. 33.
    Libuda L, Alexy U, Remer T, Stehle P, Schoenau E, Kersting M (2008) Association between long-term consumption of soft drinks and variables of bone modeling and remodeling in a sample of healthy German children and adolescents. Am J Clin Nutr 88:1670–1677CrossRefGoogle Scholar
  34. 34.
    Libuda L, Alexy U, Sichert-Hellert W, Stehle P, Karaolis-Danckert N, Buyken AE, Kersting M (2008) Pattern of beverage consumption and long-term association with body-weight status in German adolescents–results from the DONALD study. Br J Nutr 99:1370–1379CrossRefGoogle Scholar
  35. 35.
    Lien L, Lien N, Heyerdahl S, Thoresen M, Bjertness E (2006) Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among adolescents in Oslo, Norway. Am J Public Health 96:1815–1820CrossRefGoogle Scholar
  36. 36.
    Lim U, Subar AF, Mouw T, Hartge P, Morton LM, Stolzenberg-Solomon R, Campbell D, Hollenbeck AR, Schatzkin A (2006) Consumption of aspartame-containing beverages and incidence of hematopoietic and brain malignancies. Cancer Epidemiol Biomarkers Prev 15:1654–1659CrossRefGoogle Scholar
  37. 37.
    Magnuson BA, Burdock GA, Doull J, Kroes RM, Marsh GM, Pariza MW, Spencer PS, Waddell WJ, Walker R, Williams GM (2007) Aspartame: a safety evaluation based on current use levels, regulations, and toxicological and epidemiological studies. Crit Rev Toxicol 37:629–727CrossRefGoogle Scholar
  38. 38.
    Malik VS, Schulze MB, Hu FB (2006) Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 84:274–288Google Scholar
  39. 39.
    Mann J (2007) Dietary carbohydrate: relationship to cardiovascular disease and disorders of carbohydrate metabolism. Eur J Clin Nutr 61(Suppl 1):S100–S111CrossRefGoogle Scholar
  40. 40.
    McNeill G (2000) Energy intake and expenditure. In: Garrow J, James W, Ralph A (eds) Human nutrition and dietetics. Churchill Livingstone, London, p 900Google Scholar
  41. 41.
    Morgan RW, Wong O (1985) A review of epidemiological studies on artificial sweeteners and bladder cancer. Food Chem Toxicol 23:529–533CrossRefGoogle Scholar
  42. 42.
    Porikos KP, Hesser MF, van Itallie TB (1982) Caloric regulation in normal-weight men maintained on a palatable diet of conventional foods. Physiol Behav 29:293–300CrossRefGoogle Scholar
  43. 43.
    Raben A, Vasilaras TH, Moller AC, Astrup A (2002) Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. Am J Clin Nutr 76:721–729Google Scholar
  44. 44.
    Rennie KL, Livingstone MB (2007) Associations between dietary added sugar intake and micronutrient intake: a systematic review. Br J Nutr 97:832–841CrossRefGoogle Scholar
  45. 45.
    Renwick AG, Nordmann H (2007) First European conference on aspartame: putting safety and benefits into perspective. Synopsis of presentations and conclusions. Food Chem Toxicol 45:1308–1313CrossRefGoogle Scholar
  46. 46.
    Renwick AG, Thompson JP, O’Shaughnessy M, Walter EJ (2004) The metabolism of cyclamate to cyclohexylamine in humans during long-term administration. Toxicol Appl Pharmacol 196:367–380CrossRefGoogle Scholar
  47. 47.
    Ruxton CH (2003) Dietary guidelines for sugar: the need for evidence. Br J Nutr 90:245–247CrossRefGoogle Scholar
  48. 48.
    SCF (2000) Opinion: re-evaluation of acesulfame-K with reference to the previous SCF opinion of 1991. Scientific Committee on Food. European Commission, BrusselsGoogle Scholar
  49. 49.
    SCF (2000) Revised opinion on cyclamic acid and its sodium and calcium salts. Scientific committee on food. European Commission, BrusselsGoogle Scholar
  50. 50.
    Schernhammer ES, Hu FB, Giovannucci E, Michaud DS, Colditz GA, Stampfer MJ, Fuchs CS (2005) Sugar-sweetened soft drink consumption and risk of pancreatic cancer in two prospective cohorts. Cancer Epidemiol Biomarkers Prev 14:2098–2105CrossRefGoogle Scholar
  51. 51.
    Schofield WN (1985) Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 39(Suppl 1):5–41Google Scholar
  52. 52.
    Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, Hu FB (2004) Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Jama 292:927–934CrossRefGoogle Scholar
  53. 53.
    Serra-Majem L, Bassas L, Garcia-Glosas R, Ribas L, Ingles C, Casals I, Saavedra P, Renwick AG (2003) Cyclamate intake and cyclohexylamine excretion are not related to male fertility in humans. Food Addit Contam 20:1097–1104CrossRefGoogle Scholar
  54. 54.
    Sichieri R, Paula Trotte A, de Souza RA, Veiga GV (2009) School randomised trial on prevention of excessive weight gain by discouraging students from drinking sodas. Public Health Nutr 12:197–202CrossRefGoogle Scholar
  55. 55.
    Sigman-Grant M, Morita J (2003) Defining and interpreting intakes of sugars. Am J Clin Nutr 78:815S–826SGoogle Scholar
  56. 56.
    Tordoff MG, Alleva AM (1990) Effect of drinking soda sweetened with aspartame or high-fructose corn syrup on food intake and body weight. Am J Clin Nutr 51:963–969Google Scholar
  57. 57.
    Tucker KL, Morita K, Qiao N, Hannan MT, Cupples LA, Kiel DP (2006) Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: the Framingham osteoporosis study. Am J Clin Nutr 84:936–942Google Scholar
  58. 58.
    van Dam RM, Seidell JC (2007) Carbohydrate intake and obesity. Eur J Clin Nutr 61(Suppl 1):S75–S99Google Scholar
  59. 59.
    Vartanian LR, Schwartz MB, Brownell KD (2007) Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health 97:667–675CrossRefGoogle Scholar
  60. 60.
    Vermunt SH, Pasman WJ, Schaafsma G, Kardinaal AF (2003) Effects of sugar intake on body weight: a review. Obes Rev 4:91–99CrossRefGoogle Scholar
  61. 61.
    Whiting SJ, Vatanparast H, Baxter-Jones A, Faulkner RA, Mirwald R, Bailey DA (2004) Factors that affect bone mineral accrual in the adolescent growth spurt. J Nutr 134:696S–700SGoogle Scholar
  62. 62.
    WHO (2003) Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation. World Health Organization, GenevaGoogle Scholar
  63. 63.
    WHO Joint FAO/WHO Expert Committee on Food Additives (JECFA). . Accessed 7 Dec 2009
  64. 64.
    WHO (1993) Saccharin and its salts. WHO food additives series 32. World Health Organization, GenevaGoogle Scholar
  65. 65.
    Wolraich ML, Wilson DB, White JW (1995) The effect of sugar on behavior or cognition in children. A meta-analysis. Jama 274:1617–1621CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Marieke A. Hendriksen
    • 1
    Email author
  • Mariken J. Tijhuis
    • 1
  • Heidi P. Fransen
    • 1
  • Hans Verhagen
    • 1
  • Jeljer Hoekstra
    • 1
  1. 1.National Institute for Public Health and the Environment (RIVM)Bilthoventhe Netherlands

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