Sweeteners: Children and Pregnant Women

by ADA

Recommendations for nonnutritive sweetener use during childhood and pregnancy must be based on well-designed and approved clinical investigations to ensure a healthy pregnancy and healthy babies

SWEETENER USE IN SEGMENTS OF THE POPULATION

Children Because of their size and relatively high food and fluid intakes compared with adults, children will have the highest intake of nutritive and nonnutritive sweeteners as calculated by milligram intake per kilogram body weight. Children can safely consume nutritive sweeteners within a diet consistent with the Dietary Guidelines. Children have shown a substantial increase in intake of fructose, presumably through intake of sweetened drinks and fruit drinks (5). Healthy young children (aged 6 to 18 months) can exhibit carbohydrate malabsorption (eg, fructose and sorbitol) with ingestion of common fruit juices (eg, apple juice) (48). (One cup apple juice can contain 14 g fructose and 2.5 g sorbitol.) Children who exhibit nonspecific diarrhea may benefit from a reduction in fructose and products containing polyols.

It has been suggested that caregivers may want to limit intake of saccharin by young children because of the limited amount of data available for its use in children (49). The estimated daily intake of aspartame in children ranges from 8 to 17 mg/kg body weight in children aged 2 to 5 years, which is below the acceptable daily intake of 50 mg/kg body weight. Intakes of acesulfame-K in children are also below ADI (ranges from 3 to 9 mg/kg body weight).

Pregnant Women Use of nutritive sweeteners that have GRAS status is acceptable during pregnancy. Recommendations for nonnutritive sweetener use during pregnancy must be based on well-designed and approved clinical investigations to ensure a healthy pregnancy and healthy babies. Saccharin can cross the placenta and may remain in fetal tissues because of slow fetal clearance (50). It has been suggested that women consider careful use of saccharin during pregnancy (49).

The issue with aspartame in pregnancy relates to fetal exposure to aspartic acid, phenylalanine, or methanol. In animals, an aspartame load does not change fetal exposure to aspartic acid (51). Fetal circulation levels of phenylalanine exceed maternal levels because of concentration across the placental barrier (52). A bolus of aspartame (34 mg/kg or the 99th percentile of estimated daily intake) results in a peak plasma level of phenylalanine in normal subjects (112 micromol/L)1 and phenylketonuric heterozygotes (162 micromol/L) below the level that would cause neurological problems in the fetus (1,090 micromol/L) (53). Plasma response of methanol and formate were not significant after an aspartame load. Thus, if placental transport of these compounds occurs, the amount is not clinically harmful (54). Use of aspartame within FDA guidelines appears safe for pregnant women.

Safety of acesulfame-K use during pregnancy has been determined with rat studies. (JECFA has determined that rats are an appropriate model for human beings.) At high levels (3% of the diet), there was no change observed in fertility, size of litter, body weight, growth, or mortality (55). Thus, use of acesulfame-K within FDA guidelines appears safe for pregnant women.

1To convert micromol/L phenylalanine to mg/dL, multiply micromol/L by 0.01652.
To convert mg/dL phenylalanine to micromol/L, multiply mg/dL by 60.54.
Phenylalanine of 300 micromol/L=4.96 mg/dL.

References

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