title: Impact of substituting added sugar in carbonated soft drinks by intense sweeteners in young adults in the Netherlands: example of a benefit-risk approach.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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/m(2) in men and 1.3 kg/m(2) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Institute for Public Health and Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands. marieke.hendriksen@rivm.nl
authors.forename: Marieke A
authors.initials: MA
authors.lastname: Hendriksen
authors.forename: Mariken J
authors.initials: MJ
authors.lastname: Tijhuis
authors.forename: Heidi P
authors.initials: HP
authors.lastname: Fransen
authors.forename: Hans
authors.initials: H
authors.lastname: Verhagen
authors.forename: Jeljer
authors.initials: J
authors.lastname: Hoekstra
mesh_terms: D000328:Adult; D000818:Animals; D015992:Body Mass Index; D002253:Carbonated Beverages / Q000032:analysis*; D003663:Decision Trees; D003731:Dental Caries / Q000453:epidemiology / Q000517:prevention & control; D004032:Diet / Q000706:statistics & numerical data; D050528:Diet, Carbohydrate-Restricted; D019422:Dietary Sucrose / Q000008:administration & dosage / Q000009:adverse effects*; D002149:Energy Intake; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D050177:Overweight / Q000178:diet therapy / Q000517:prevention & control*; D018570:Risk Assessment / Q000379:methods; D012727:Sex Characteristics; D013549:Sweetening Agents / Q000008:administration & dosage / Q000009:adverse effects*; D013662:Tea; D055815:Young Adult
chemical_list: D019422:Dietary Sucrose; D013549:Sweetening Agents; D013662:Tea