Food Additives & Contaminants: Part A

ISSN: 1944-0049 (Print) 1944-0057 (Online) Journal homepage: http://www.tandfonline.com/loi/tfac20

Dietary intake of non-nutritive sweeteners in Type 1 diabetes mellitus children Louise Dewinter, Kristina Casteels, Karen Corthouts, Kristel Van de Kerckhove, Katrien Van der Vaerent, Kelly Vanmeerbeeck & Christophe Matthys To cite this article: Louise Dewinter, Kristina Casteels, Karen Corthouts, Kristel Van de Kerckhove, Katrien Van der Vaerent, Kelly Vanmeerbeeck & Christophe Matthys (2015): Dietary intake of non-nutritive sweeteners in Type 1 diabetes mellitus children, Food Additives & Contaminants: Part A, DOI: 10.1080/19440049.2015.1112039 To link to this article: http://dx.doi.org/10.1080/19440049.2015.1112039

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Date: 09 November 2015, At: 05:14

Publisher: Taylor & Francis Journal: Food Additives & Contaminants: Part A DOI: 10.1080/19440049.2015.1112039

Dietary intake of non-nutritive sweeteners in Type 1 Diabetes Mellitus Children.

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Department of Health and Technology, University College Leuven, Leuven, Belgium;

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Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium; 3Department of

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Development and Regeneration, KU Leuven, Leuven, Belgium; 4Clinical Nutrition Unit, Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium; 5Department

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of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium Corresponding author email: [email protected]

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Running title: sweeteners intake in type 1 diabetes children

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Abstract

The aims of the current cross-sectional study were i) to assess the intake of aspartame, cyclamate,

acesulfame-k,

neohesperidine

dihydrochalcone,

sucralose,

saccharin,

steviolglycosides and neotame among children with Type 1 Diabetes mellitus (T1D); ii) to compare the obtained intakes with the respective Acceptable Daily Intake (ADI) values and iii) to conduct a scenario analysis to obtain practical guidelines for a safe consumption of non-

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Van der Vaerent4, Kelly Vanmeerbeeck1 and Christophe Matthys4,5*

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Louise Dewinter1, Kristina Casteels2, 3, Karen Corthouts4, Kristel Van de Kerckhove4, Katrien

nutritive sweeteners (NNS) among children with T1D.

Type 1 diabetic patients of the

Paediatrics Department of the University Hospitals Leuven were invited to complete a food frequency questionnaire, designed to assess NNS intake using a Tier 2 and Tier 3 exposure assessment approach. A scenario analysis was conducted by reducing the P95 consumption of the most contributing food categories in order to reach a total sweetener intake lower or equal to the ADI. Estimated total intakes higher than ADIs were only found for the P95 consumersonly of acesulfame-k, cyclamate and steviolglycosides (Tier 2 and Tier 3 approach). Scenario analysis created dietary guidelines for each age category for diet soda, bread spreads and

dairy drinks. There is little chance for T1D children to exceed the ADI of the different NNS, however diabetes educators and dieticians needs to pay attention regarding the use of NNS. Keywords: non-caloric sweeteners, guideline, dietary exposure, diabetes Introduction One of the key elements in the nutrition therapy for Type 1 (and type 2) Diabetes (T1D) is to

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adjust insulin doses to carbohydrate intake in order to constitute constant blood glucose

levels. Since non-nutritive sweeteners (NNS) provide an intense sweet taste without i) having

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an effect on glycemic responses and ii) without the associated high energy content of caloric

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their optimal blood glucose levels. Replacing some sugar containing food products (e.g. soft drinks), by the NNS variant (e.g. diet soda) can be seen as a possible method to attempt to optimize glycemic control. The use of NNS in the diet of T1D thus has some benefits. There

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is broad consensus in the medical and dietetic communities that the use of NNS is a possible element in the medical nutrition therapy for T1D (Fitch & Keim 2012; Franz et al. 2010;

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Shankar et al. 2013). Nevertheless, some studies associated the consumption of NNS with weight gain (Horwitz et al. 1988), increased type 2 diabetes risk (Nettleton et al. 2009),

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modification on how the body handles sugar (Pepino et al. 2013) and in a recent publication it was suggested that NNS can cause glucose intolerance through the gut microbiota (Suez et al. 2014). In Europe, non-nutritive sweeteners (NNS) are regulated as food additives and

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evaluated by the European Food Safety Authority (EFSA) to assess the safety before approval and during use in the EU. EFSA establishes Acceptable Daily Intakes (ADI) of NNS. The consumption of NNS below ADI values, expressed in mg per kg body weight per day, includes no chronic health risks for the consumer (Dusemund et al. 2012). As NNS have no effect on blood glucose levels, type 1 & 2 diabetes patients are considered to constitute a

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sugars, patients do not need to include their use in the total carbohydrate intake to regulate

group with high consumption of NNS. Especially children with T1D turn out to have the highest risk on exceeding ADIs. Yet very little research has been done on the intake of NNS among children with T1D (Franz et al. 2010; Huvaere et al. 2012; Shankar et al. 2013) . To avoid any exceeding of the ADI of the different NNS among children with T1D there is a need for specific guidelines in the clinical practice. The aims of the current cross-sectional study were i) to assess the intake of aspartame, cyclamate,

acesulfame-k,

neohesperidine

dihydrochalcone,

sucralose,

saccharin,

steviolglycosides and neotame among children with Type 1 Diabetes mellitus (T1D); ii) to

compare the obtained intakes with the respective ADI values and iii) to conduct a scenario analysis to obtain practical guidelines for a safe consumption of NNS among children with T1D. These practical guidelines can assist T1D children in their consumption of NNS.

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Material and methods For the current exposure assessment a new survey was conducted (from March 2014 to May

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2014) at the University Hospitals Leuven. Participants of the newly conducted survey were

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Leuven. The University Hospital Leuven is following 250 children who have been diagnosed with T1D. All patients from 1 to 18 years old that could be reached electronically (via e-mail) were contacted (n=242). An information letter was sent to all eligible participants. In this

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letter information about the study, the link to the questionnaire and the demand to participate in the study as well as the informed consent for this study was provided. This letter was sent

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by mail via the Secretariat of the Paediatrics Department in the University Hospitals of Leuven. A reminder was sent one week after the initial invitation. All participants were invited to participate in the survey and to complete a

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questionnaire. The questionnaire consisted of two parts. The first part of the questionnaire examined socio-demographic data, body weight and length of the participants. The second

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part was a newly developed online food frequency questionnaire (FFQ) to estimate the consumption of NNS. The FFQ questions both frequency of use and quantity of use of seven food categories (soft drinks; sweet bread spreads (e.g. jam or chocolate spread); dairy drinks; yoghurt and other dairy desserts; chocolate; sweets (e.g. candy and cake); tabletop sweeteners) containing sweeteners. These seven food categories were chosen, as they are the

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Type 1 diabetic (T1D) patients of the Paediatrics Department of the University Hospitals

most commonly used food categories in which the use of NNS is allowed according to European law (European Parliament and Council 2011) and according to the results of the Belgian food consumption survey of 2004 (De Vriese et al. 2005) . To avoid confusion among the participants an example of a food product was given for each category. For each food category, two questions were asked. First, participants were asked to indicate frequency of consumption: less than 1 day per month, 1 to 3 days per month, 1 day per week, 2 to 4 days per week, 5 to 6 days per week, every day. Second, they were asked about the portion size consumed. The four portion-size categories (n=4) were based on widely

used standard sizes (e.g. a teaspoon or a glass) and the portion-size question was accompanied by a small list of common standard measures as examples (e.g., one can of soft drink = 330 mL). The participants indicated the portion-size category that best fitted their daily portion and are based on the Belgian Food Consumption Survey 2004 (De Vriese et al. 2005). The first and last portion size categories started with ‘less than’ (e.g. Less than 100 ml) or ‘more than’ (e.g. more than 1000 ml). To calculate this portion size 20% was deducted respectively added to the respectively minimum or maximum portion size. Food intakes (g/day) of each

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food group were computed by multiplying frequency of consumption by specified portion. Extreme values were removed when they were considered as unreliable data.

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The exposure assessment is based on the principles of the phased tier approach (European

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Commission 2001). In order to calculate the intake of acesulfame-k, aspartame, cyclamate, neohesperidin DC, saccharin, steviol glycoside, sucralose and neotame among the

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participants, the principles of the Tier 2 (maximum concentration approach) and Tier 3 (maximum used concentrations approach) approaches were used.

In first instance a Tier 2 approach (=maximum concentration approach) was used,

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which combines the actual food consumption data and maximum permitted levels (MPLs) of use. The MPLs are those listed by the European Directive (1333/2008/EG) (European

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Parliament and Council 2011). The maximum permitted concentrations of table top sweeteners however are indicated as ‘quantum satis’ in this Regulation (European Parliament and Council 2011). Therefore the maximum concentrations found in table top sweeteners sold

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in Belgium, based on a study of Belgian Institute of Public Health, were used (Huvaere et al. 2012).

The second exposure assessment was based on the principles of the Tier 3 approach

(=maximum used concentration approach) (European Commission 2001). The consumption data were combined with the mean concentration of acesulfame-k, saccharin, cyclamate,

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Exposure assessment

sucralose and aspartame in each food category. The mean concentrations of the before mentioned sweeteners are the results of a recent Belgian study that determined the amount of acesulfame-k, saccharin, cyclamate, sucralose and aspartame in the different food categories (Huvaere et al. 2012). For stevia, neohesperidin DC and neotame no data were available. Therefore MPLs were used for these sweeteners. The total intake of each intense sweetener for each participant was then achieved by taking the sum of the estimated intake of each food category of the specific participant. In

order to set out the total intake of each sweetener against the ADI (mg/kg body weight), the total intake was divided by the self-reported body weight of the participant. A similar exposure assessment was conducted for consumers-only, in which the nonconsumers of each food category were removed from the calculations. The total intake of the 95th percentile of the consumers-only was then obtained by taking the sum of the 95th percentile intake of each food category. Scenario Analysis

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In the present study a scenario analysis was conducted to deduct the acceptable portion sizes without exceeding the acceptable daily intake of the specific sweeteners. The benefit of this

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related to a specific sweetener can be derived based on the principle of the development of

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food-based dietary guidelines. Therefore a stepwise approach was used. In the first series of steps, the relevant (modifying these categories will have an effect on the total intake) food

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categories were identified. At first the sweeteners exceeding the ADI were identified, therefore the highest consumption (P95) of the consumers-only distribution, using the Tier 2 approach, was used (= maximum intake). In a second step the relative contribution of each

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food category to the total intake of each sweetener was calculated by setting out the P95 intake (consumers-only) of each food category to the P95 total intake of that specific

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sweetener. In a third step the percentage of consumers of each food category was calculated. In a fourth step the food categories with the highest relative contribution and the highest number of consumers for a specific sweetener exceeding the ADI were identified. In the fifth

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step the total intake of the particular sweetener was calculated (the sum of this maximum intake per food category). The maximum intake of the particular sweetener was obtained for each food group, based on the consumption of the highest consumers (P95) of the food groups.

In the second series of steps the 95th percentile consumption of the greatest

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scenario-analysis is that guidelines for a safe consumption of the corresponding food category

contributing (based on relative contribution and number of consumers) food categories was then reduced with one or more portion size, until the total intake of the particular sweetener did not exceed the ADI anymore. The authors opted to work with portion sizes as this is relevant information for patients in the clinical context. Written informed consent was obtained from every participant and the study has been approved by the University Hospital Leuven Ethical Committee (Nr S56199). Results

No response was received from the age category 1 to 3 years old. The response in the three other age categories was respectively 64.3%, 42.7% and 40.9% (table 1). Table 1 shows the basic characteristics of these groups as well as the consumption data. One participant of the age category 4 to 6 years was excluded from the study due to the extreme value of her body weight, being 35 kg. The extreme value of the consumption of sweet bread spreads, being 144g a day (8 slices of bread or more) of a participant in the age category 4 to 6 years old has

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been excluded for further analysis.

Total average intakes and high consumers intakes of each sweetener, derived from the

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cyclamate, neohesperidine DC, saccharin, steviol glycoside, sucralose and neotame does not

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exceed the ADI in any age and gender category. Participants from 4 to 6 years old with a high intake (P95) tend to exceed the ADI for acesulfame-k and cyclamate (122% of ADI resp.

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120% of ADI). The intake of the consumers-only with a high intake (P95) exceeds the ADI for acesulfame-k (211% of ADI), cyclamate (214% of ADI), saccharin (100% of ADI) and steviol glycerides (119% of ADI) in the age category 4 to 6 years old. The two oldest age

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categories of the consumers-only show an exceeding of the ADI for acesulfame-k (124% resp. 111% of ADI) and cyclamate (125% resp. 122% of ADI) as well. (Table 2)

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The results of the exposure assessment Tier 3 (maximum used concentrations) are lower than the results of the Tier 2 approach. Neither the mean total intake of the eight sweeteners, nor the P95 intake exceeds the limit of the ADI. The high consumers (P95) of the

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consumers-only of the 4 to 6 years old have an intake that is higher than the ADI for acesulfame-k (116% of ADI), cyclamate (138% of ADI) and steviol glycerides (119% of ADI). (Table 3)

Scenario analysis

According to the proposed methodology, acesulfame-k, steviol glycosides and cyclamate

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Tier 2 assessments is shown in table 2. The average total intake of acesulfame-k, aspartame,

were identified as the sweeteners exceeding the ADI values among high consumers (P95) of the consumers-only (Table 2). Secondly, the relative contribution to the total intake of each sweetener was highest for dairy drinks, diet soda and bread spreads among 4 to 6 years old. Age category 7 to 12 had the highest relative contribution to the total intake of each sweetener for dairy drinks and diet soda and the oldest age category showed the highest mean relative consumption for diet soda (Supplemental data Table 1). The third step identified bread spreads, diet soda and dairy drinks as the food categories with the highest percentage

consumers (88.9% resp. 55.6% and 44.4%) in the age category 4 to 6. For the 7 to 12 years

old this is candy (91.4%) and diet soda (88.5%) and among the 13 to 18 years old this is diet soda (89.8%) (Table 1). Based on these results dairy drinks, bread spreads and diet soda are identified as the highest contributing food categories to the total sweetener intake as well as the food categories with a high consumers percentage and therefore the scenario-analyses used these food categories. Table 4 reflects the highest consumption (P95) among consumers-only of the different food categories before and after the scenario-analysis. Table 5 reflects the total intake of

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acesulfame-k, steviol glycosides and cyclamate, based on the sum of the maximum intake

(P95) per food category before and after the scenario-analysis. In the final step of the

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soda were both reduced to 150 ml (1 glass). The maximum consumption of bread spreads was

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reduced to 45g (+/- 3 slices of bread). The total intake of acesulfame-k, steviol glycosides and cyclamate was respectively 105%, 61% and 108% of the ADI. Based on the scenario-analyses

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a reduction to 2 glasses a day (300ml) of dairy drink and diet soda among 7 to 12 years old is enough to reach an intake of respectively 103%, 61% and 102% of the ADI for acesulfame-k, steviol glycosides and cyclamate. Among 13 to 18 years old a reduction to 3 glasses of diet

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soda (450ml) is sufficient to reach a total maximum intake equal to or less than the ADI, being 91%, 53% and 101% of the ADI for respectively acesulfame-k, steviol glycosides and

Discussion

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cyclamate.

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The present study, in T1D children, shows that the ADI is not exceeded by any of the sweeteners based on the mean intake using the maximum concentration approach and the used concentration approach. However, based on the maximum concentration approach exposure assessment, the intake of acesulfame-k and cyclamate exceed the ADI for the high consumers (P95) in the age category 4 to 6. For consumers-only analyses, it was found that

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scenario-analysis the maximum consumption in age category 4 to 6 of dairy drinks and diet

acesulfame-k, cyclamate, saccharin and steviol glycosides exceeded the respective ADI in the youngest age category. In the two oldest age categories the ADI was exceeded by acesulfame k and cyclamate. Based on the Tier 3 approach exposure assessment, the intake of cyclamate and steviol glycosides exceeded the ADI in the age category 4 to 6 among the high consumers (P95) of the consumers-only analysis. The conducted scenario analysis created following guidelines: maximum 1 glass (150 ml) of diet soda, 1 glass of dairy drinks and 3 slices of bread with bread spreads per day for children from 4 to 6 years old, 2 glasses (300ml) of diet soda and 2 glasses of dairy drinks a day for age category 7 to 12 and maximum 3 glasses (450

ml) of diet soda a day for children aged 13 to 18 years old. Due to the heterogeneity in bread spreads, all containing a variety of sweeteners, the guideline of three slices of bread per day for the age category of 4 to 6 years can be more flexible if different kind of bread spreads are introduced. An important strength of the study is the high response in the two oldest age categories (42.7% and 40.9%). The low number of participants (n=9) in the age category 4 to 6 however can be misleading, despite the high response rate (64.3%). Nevertheless, the prevalence of

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T1D in this age group is low. The current sample of T1D children is not representative for the whole Belgian population as only patients of one hospital were included, however the current

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of representativeness could be considered as a sampling and extrapolation uncertainty of the

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study (Scientific Committee EFSA 2006). Other sources of uncertainties include the use of MPLs for stevia, neohesperidin DC and neotame in the Tier 3 approach, because of a lack of

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data. A strength of the study is the use of newly obtained consumption data as the current EFSA Food Additives Intake Model is not equipped to assess the specific dietary pattern of T1D children (European Food Safety Authority 2014). The applied methodology of the

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scenario-analysis is based on the precautionary principle, but this is justifiable knowing that the used FFQ underestimates the real consumption of these specific food categories (Cade et

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al. 2002). In the present study the exposure assessment using maximum concentration approach should be considered as a worst-case scenario, especially when high consumers and

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consumers-only were used as it is assumed that all processed foods in which the food additive is authorised contain the food additive at the MPLs. The used concentration approach has lower total intakes compared to the maximum concentration approach, where exceeding of the ADI only occurs among high consumers (P95) for cyclamate. Cyclamate occurs to be an additive that is often associated in studies with a high intake (Garnier-Sagne et al. 2001;

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data could be considered as an indication for the use of sweeteners in T1D children. The lack

Huvaere et al. 2012; Ilback et al. 2003; Leth et al. 2008; Renwick 2006). A limited number of studies (Garnier-Sagne et al. 2001; Ilback et al. 2003; Renwick

2006) have investigated the intake of non-caloric sweeteners among children with T1D. In 2001, France conducted a study on the intake of acesulfame-k, aspartame and saccharin among children with diabetes between 2 and 20 years old (Garnier-Sagne et al. 2001). The study was based on a conservative scenario (MPLs for all sweeteners in the consumed foods). The conclusion was that there is no risk of exceeding the ADI for none of the three sweeteners. The estimated intakes of acesulfame-k, aspartame and saccharin in this study

were resp. 96%, 40% and 54% of the ADI. The largest contribution of these sweeteners came from non-alcoholic beverages, in similarity with the findings of this study. A Swedish study investigated the consumption of several intense sweeteners among Swedish adults (16-90 years) and children (0-15 years) with diabetes(Ilback et al. 2003). A FFQ was used to obtain the needed consumption data and MPLs were used to estimate the intake. No exceeding of the ADI was found, except for estimated intakes in young children for cyclamate (317% of ADI). In a Belgian study the intake of acesulfame-k, saccharin, cyclamate, sucralose and aspartame

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among the adult Belgian population was investigated. The national food consumption data were used and combined with maximum sweetener concentrations and used concentrations.

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using used concentrations (Tier 3) showed an exceeding of the ADI (Huvaere et al. 2012). A

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Danish study estimated the intake of acesulfame-k, cyclamate, aspartame and saccharin in non-alcoholic beverages in non-diabetic children (Leth et al. 2008). Consumption data of the

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Danish Dietary Survey were combined with used concentrations of sweeteners, derived from chemical analysis of non-alcoholic beverages sold in Denmark. The estimated intakes of acesulfame-k, aspartame and saccharin were well below ADI values. The 99th percentile

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intake of cyclamate for 1 to 3 years old slightly exceeded the ADI value (7.4 mg.kg-1.day-1). In a review on the intake of intense sweeteners, Renwick (2006) stated that the only data

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indicating that the intake of an intense sweetener could exceed its ADI values were the 95th percentile intakes of cyclamate in children, especially those with diabetes.(Renwick 2006). In a recent dietary modelling exercise based on the Irish National Preschool and Nutrition

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Survey the intake (P95) of sucralose and acesulfame K exceeded the ADI in children with Phenylketonuria and the intake (P95) of sucralose exceeded the ADI in children with cow’s milk protein allergy (O'Sullivan et al. 2014). The data of the used concentration approach indicated that the ADI was not exceeded for the different sweeteners in the different age & gender categories. In conclusion, there is little chance for T1D children to exceed acceptable

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Neither the estimated intakes of sweeteners using MPLs (Tier 2), nor the estimated intakes

daily

intakes

for

acesulfame-k,

aspartame, th

steviolglycosides and neotame. The 95

neohesperidin,

sucralose,

saccharin,

percentile intake of cyclamate using used

concentration approach among 4 to 6 years old consumers however still slightly exceeds its ADI. The scenario analysis created consumption guidelines for clinical practice and guarantees T1D children a safe consumption of sweeteners, especially for cyclamate. Conclusions

There is little chance for T1D children to exceed acceptable daily intakes for acesulfame-k, aspartame, neohesperidin, sucralose, saccharin, steviolglycosides and neotame. Based on our modelling exercise, the following dietary guidelines can be used in clinical practice for children with T1D to exclude any risk of exceeding ADI values of acesulfame-k, aspartame, cyclamate, neohesperidin, saccharin, steviolglycosides, sucralose and neotame: -

Maximum 1 glass of diet soda (150 ml), 1 glass of dairy drinks and 3 slices of bread with the same bread spread containing sweeteners a day for children

-

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with T1D from 4 to 6 years old.

Maximum 2 glasses of diet soda (300ml) and 2 glasses of dairy drinks

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-

A maximum of 3 glasses (450 ml) of diet soda a day for 13 to 18 years old.

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Finally a general well-known guideline, alternation between different products, especially for bread spreads, as this reduces the chance to exceed the ADI, is re-confirmed by this study.

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Acknowledgements

The authors acknowledge the willingness of the participants of the study. The authors

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appreciated the technical assistance of the secretariat of the Department of Pediatrics UZ

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Leuven.

Conflict of interest: the authors declare no conflict of interest.

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Author contributions

CM and KC designed the study, assisted in the overall analyses and writing of the final results and conclusions. LD conducted the study, analysed the data and drafted the paper. KVD, KVDV, KVM and KC assisted in the conduction of the study and in the interpretation/translation of the results into clinical practice.

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containing sweeteners (300ml) a day for 7 to 12 years old.

References

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Table 1: Participants’ characteristics and consumption data Characteristics

Age ≤ 3

4 to 6 (years)

7 to 12 (years)

13 to 18 (years)

0 2

9 5

45 37

76 68

0 0 0.0

9 0 64.3

21 14 42.7

34 25 40.9

20.4 (3.3)

34.5 (4.4) 33.8 (7.7)

1.12 (0.1)

1.42 (0.1) 1.43 (0.2)

ip t

an

Consumption data

ce pt

ed

M

Consumers (%) Diet soda 55.5 Bread spreads 88.9 Dairy drinks 44.4 Yoghurt etc. 77.7 Chocolate 55.5 Candy 55.5 Table top sweeteners 33.3 1 Daily consumption (g or ml) Diet soda 33.3 (73.7) Bread spreads 51.5 (51.9) Dairy drinks 78.5 (139.7) Yoghurt etc. 40.4 (43.7) Chocolate 2.2 (2.2) Candy 3.1 (3.0) Table top sweeteners 4.1*10-6 Daily consumption consumers-only (g or ml)1 Diet soda 60.0 (90.5) Bread spreads 58.0 (51.6) Dairy drinks 176.6 (163.2) Yoghurt etc. 52.1 (43.1) Chocolate 4.0 (1.4) Candy 6.4 (1.7) Table top sweeteners 0.2*10-4 1

Mean (Standard Deviation)

65.2 (18.5) 59.7 (10.2)

cr

us

Eligible (N) Boys Girls Response (N) Boys Girls Total response (%) Weight (kg)1 Boys Girls Length (m) 1 Boys Girls

Ac

Downloaded by [University of Ottawa] at 05:14 09 November 2015

(years)

1.74 (0.1) 1.66 (0.1)

88.6 77.1 65.7 80.0 65.7 91.4 65.7

89.8 76.3 55.9 76.3 52.5 59.3 74.6

150.9 (125.5) 15.1 (19.8) 86.5 (133.2) 45.5 (51.1) 6.7 (8.8) 5.8 (6.3) 1.4*10-2

273.3 (281.7) 24.3 (26.6) 66.3 (110.4) 52.9 (68.5) 7.0 (11.7) 2.6 (4.1) 4.6*10-2

170.4 (120.0) 19.6 (20.6) 131.6 (145.7) 56.9 (51.1) 10.2 (9.2) 6.4 (6.3) 0.2*10-1

304.3 (281.1) 31.9 (26.2) 118.5 (125.5) 69.4 (70.9) 13.3 (13.3) 4.4 (4.5) 0.6*10-1 (0.7.10-1)

Aspartame

Cyclamate

Neohesperidin

Saccharin

9

40

7

5

5

5.07 3.63 11.16 19.07

8.18 6.01 18.63 31.62

4.23 2.70 8.40 15.17

0.51 0.46 1.33 2.03

Sucralose

Neotame

15

2

1.34 0.93 2.89 5.03

1.32 0.85 2.67 4.75

3.74 3.10 9.27 14.87

0.27 0.20 0.62 1.03

M an us c

ADI (mg.kg-1.day-1) age (years) 4-6 Mean SD° P95 P95 (CO)*

Steviolglycosides 4

rip t

Acesulfame-k

Mean SD° P95 P95 (CO)*

3.50 2.32 6.99 11.13

6.53 4.23 13.51 21.06

2.04 1.75 5.41 8.74

0.38 0.27 0.81 1.28

1.17 0.72 2.26 3.93

0.90 0.55 1.78 2.88

3.07 2.04 6.28 9.82

0.21 0.14 0.43 0.70

13-18

Mean SD° P95 P95 (CO)*

2.68 1.78 5.22 10.01

4.69 3.62 9.17 19.17

2.05 1.72 4.34 8.56

0.24 0.19 0.53 1.03

0.91 0.81 2.10 4.02

0.63 0.48 1.21 2.54

2.13 1.62 4.25 8.49

0.15 0.11 0.29 0.59

te ep

°SD: standard deviation *CO: consumers-only

d

7-12

Ac c

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Table 2: Total intakes (mean, standard deviation, 95th percentile and 95th percentile consumers-only) of each sweetener derived from maximum concentration approach – Tier 2 approach (mg.kg-1.day-1)

Table 3: Total intakes (mean, standard deviation, 95th percentile and 95th percentile consumers-only) of each sweetener derived from maximum used concentration approach – Tier 3 approach (mg.kg-1.day-1) 40

7

5

2.30

0.91

2.51

0.51

SD°

3.28

1.09

2.01

0.46

P95

8.38

2.89

5.78

P95(CO)*

10.43

3.89

Mean

2.16

SD°

Saccharin 5

Steviolglycosides 4

Sucralose

Neotame

15

2

1.32

2.57

0.27

1.39

0.85

3.21

0.20

1.33

3.75

2.67

8.58

0.62

9.66

2.03

4.91

4.75

11.00

1.03

1.07

1.74

0.39

0.70

0.93

1.95

0.22

1.72

0.68

1.21

0.27

0.70

0.54

1.70

0.13

P95

5.05

2.07

3.51

0.81

2.03

1.78

5.09

0.43

P95(CO)*

7.57

3.46

1.28

2.64

2.89

7.34

0.67

Mean

1.26

0.68

1.44

0.26

0.45

0.67

1.05

0.15

SD°

0.93

0.47

1.02

0.17

0.36

0.43

0.85

0.10

P95

2.91

1.41

3.05

0.53

1.23

1.21

2.94

0.29

P95(CO)*

5.22

2.72

4.99

1.03

1.86

2.54

4.87

0.59

°SD: standard deviation *CO: consumers-only

d

M an us c

1.16

5.20

te

13-18

Neohesperidin

9

ep

7-12

Cyclamate

rip t

ADI (mg.kg-1.day-1) age (years) 4-6 Mean

Aspartame

Ac c

Downloaded by [University of Ottawa] at 05:14 09 November 2015

Acesulfame-k

Table 4: 95th percentile consumption of each food category among consumers-only and consumption after reduction of diet soda, bread spread and dairy drinks. Diet soda (ml)

Bread spreads (g)

Dairy drinks (ml)

Yoghurt etc.

Before reduction 198.8

94.5

388.7

7-12

415.0

42.1

415.0

13-18

750.0

75.0

415.0

4-6

150.0

45.0

150.0

7-12

300.0

42.1

300.0

13-18

450.0

75.0

415.0

ep

te

d

After reduction

100.0

5.7

M an us c

4-6

Ac c

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(ml)

Chocolate (g)

rip t

Age (year)

Candy (g)

Table top (g)

6.4

2.4*10-5

104.8

30.4

15.0

0.1

250.0

40.0

12.8

0.2

100.0

5.7

6.4

2.4*10-5

104.8

30.4

15.0

0.1

250.0

40.0

12.8

0.2

Table 5: Total intake of acesulfame-k, cyclamate and steviolglycosiden, based on the sum of the maximum intake per food category. (mg.kg.day-1) and after reduction of maximum intake of diet soda, bread spread and dairy drinks (mg.kg-1.day-1) Diet soda

Bread spreads

Dairy drink

Yoghurt etc.

Chocolate

(year)

(mg.kg-1.dag-1)

(mg.kg-1.dag-1)

(mg.kg-1.dag-1)

(mg.kg-1.dag-1)

(mg.kg-1.dag-1)

4-6

3.40

4.63

7-12

4.25

1.23

13-18

4.20

1.20

4-6

0.78

1.23

7-12

0.97

0.33

13-18

0.96

0.32

Before reduction:

4.63

7-12

3.04

1.23

13-18

3.00

1.20

4-6

2.57

After reduction:

Acesulfame-k

7-12 13-18

(mg.kg-1.dag-1)

(mg.kg-1.dag-1)

0.14

0.16

0.10

16.81

187

4.25

1.07

0.45

0.22

0.16

11.64

129

2.33

1.40

0.32

0.10

0.31

9.86

110

1.52

0.49

0.08

0.11

0.1.10-3

4.20

105

0.97

0.31

0.24

0.15

0.02

2.99

75

0.53

0.40

0.17

0.07

0.04

2.50

63

13.05

186

4.76

-2

1.23

0.00

0.00

0.5.10

3.04

0.77

0.00

0.00

0.73

8.80

126

1.66

1.00

0.00

0.00

1.43

8.29

118

2.57

1.72

0.14

0.16

0.10

9.46

105

9.28

103

8.18

91

2.44

61

2.21

3.07

1.23

3.07

1.07

0.45

0.22

0.16

2.52

1.20

2.33

1.40

0.32

0.10

0.31 -3

0.59

0.58

0.59

0.97

0.08

0.11

0.1.10

7-12

0.70

0.33

0.70

0.31

0.24

0.15

0.02

2.45

61

13-18

0.58

0.32

0.53

0.40

0.17

0.07

0.04

2.11

52

4-6 Steviolglycosiden

(mg.kg-1.dag-1)

% ADI

1.72

M an us c

2.43

Total

6.67

d

Cyclamate

4-6

Table top

te

Steviolglycosiden

ep

Acesulfame-k

Candy

rip t

Age

Ac c

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1

2.21

1.84

2.42

0.00

0.00

0.4.10-2

7.11

101

7-12

2.19

1.23

2.20

0.77

0.00

0.00

0.73

7.11

102

13-18

1.80

1.20

1.66

1.00

0.00

0.00

1.43

7.09

100

ep

te

d

M an us c

rip t

1.84

Ac c

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Cyclamate

4-6

Dietary intake of non-nutritive sweeteners in type 1 diabetes mellitus children.

The aims of the current cross-sectional study were (1) to assess the intake of aspartame, cyclamate, acesulfame-k, neohesperidine dihydrochalcone, suc...
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