On May 15, 2023, the World Health Organization (WHO) issued a new guideline on non-sugar sweeteners (NSS), suggesting that the use of non-sugar sweeteners should not be used to control weight or reduce chronic diabetes. Means of infectious disease risk (conditional advice).

According to relevant WHO data, high intake of free sugars is associated with overweight and obesity, and is associated with diet-related chronic non-communicable diseases. In 2015, the World Health Organization issued recommendations to reduce the intake of free sugars, as part of efforts to address the epidemic of obesity and related diseases, and various measures are currently being taken globally to reduce the consumption of free sugars. The purpose of this WHO guideline is to provide guidance on the use of NSS to promote healthy diets, prevent unhealthy weight gain, and diet-related chronic non-communicable diseases in the context of reducing free sugar intake.

Free sugars refer to monosaccharides (fructose, glucose, etc.) and disaccharides (maltose, sucrose, etc.) added to food and beverages, as well as sugars naturally present in honey, syrupy fruit juice, and concentrated fruit juice. NSS is a free sugar substitute that is often advertised as an aid in weight loss or maintenance of a healthy weight due to its low- or no-calorie profile, and is often recommended as a means of controlling blood sugar for diabetics. Each NSS is subjected to toxicological evaluation to determine safe intake levels. This guidance applies to nonnutritive sweeteners, including all synthetic, naturally occurring or modified nonnutritive sweeteners. Common NSS include acesulfame potassium, aspartame, advantame, neotame, saccharin, sucralose, stevia and stevia derivatives, etc. Low-calorie sugars and sugar alcohols are caloric sugars and sugar derivatives that are not covered by the NSS and do not apply to this guidance.

The Joint Expert Committee on Food Additives (JECFA) has set acceptable daily intakes (ADIs) for most commercially used NSS. Intakes in all WHO studies for NSS were carried out within the ADI range set by JECFA. There is no clear consensus on whether NSS is effective for weight control in the long-term, or whether it is associated with other health effects within recommended daily intakes. There is evidence (the original description is low-certainty evidence "The recommendation is based on evidence of low certainty overall") that the use of NSS has no long-term benefit in reducing body fat in adults or children and that use of NSS during pregnancy may lead to an increased risk of preterm birth , the higher the intake of NSS during pregnancy, the higher the risk of preterm birth; the results of the study also show that long-term use of NSS may have potential adverse effects, such as type 2 diabetes, cardiovascular disease and increased mortality risk in adults.

WHO has published recommendations on reducing intake of free sugars and other guidelines to promote a healthy diet (including carbohydrates, total fat saturated and trans fatty acids, polyunsaturated fatty acids, sodium and potassium), in combination with Review of NSS usage guidelines. Ultimately, WHO issued a recommendation that NSS should not be used as a means to control weight or reduce the risk of chronic noncommunicable diseases. This advice applies to everyone except those with diabetes, including children, adults, and pregnant and breastfeeding women. Drugs, personal care and hygiene products are excluded from the scope of application.