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Use of non-sugar sweeteners: WHO guideline. Geneva: World Health Organization; 2023.

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Use of non-sugar sweeteners: WHO guideline.

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Annex 5Key questions in PICO format (population, intervention, control and outcomes)

PICO questions

What is the effect on prioritized health outcomes in adults, children and pregnant women of higher intake of NSS compared with lower intake?

What is the effect on prioritized health outcomes in adults, children and pregnant women of replacing free sugars with NSS?

Population

Apparently healthy adults and children in low-, middle- and high-income countries, including those with elevated BMI.

In each, consider population characteristics, such as age, gender, ethnicity, country/region (urban/rural), socioeconomic status, demographic factors, sanitation, health background and health status, including baseline risk of CVDs

Intervention/exposure

The interventions of interest include intake of any type of NSS, either alone or in combination with one or more additional NSS. NSS may include aspartame, acesulfame K, saccharin, sucralose, advantame, neotame, cyclamate, stevia, thaumatin, brazzein and others.

NSS versus sugar (quantity/frequency)

High versus low intake of NSS (quantity/frequency)

NSS-sweetened beverages versus water

Possible subgroup analyses include:

discretionary use (i.e. consumer added versus pre-packaged foods)

solids and liquids

type of NSS

level of sweetness

“artificial” and “natural” NSS

ComparatorSugars, no intervention, “placebo”, water (in the case of NSS-sweetened beverages), other type of NSS (when sugars or nothing/placebo/water also included)
Outcome

Adults and children

Overweight/obesity

Dental caries

Prediabetes/type 2 diabetesa

Eating behaviour (appetite, satiety)

Sweet preference

Cancer

CVDsa

Mood

Behaviour (hyperactivity and aggression)

Neurocognition

Chronic kidney disease

Asthma (children only)

Allergies (children only)

a

Includes intermediate/surrogate markers of disease (i.e. markers of glycaemic control for diabetes, blood lipids for CVDs)

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Bookshelf ID: NBK592254

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