[Evidence, controversies, and research priorities regarding Low- and No-Calorie Sweeteners (LNCS) in Latin America - Results of the First Latin American Scientific Forum on LNCS].

The First Latin American Scientific Forum on Low- and No-Calorie Sweeteners (LNCS) was held in Merida, México, in 2025 with several key objectives: to critically review evidence regarding their safety, health effects, and regulation; to analyze current recommendations and policies on sugars and LNCS in the region; and to establish an initial agenda for Latin American research and collaboration. Reviews indicated that risk assessment agencies across North America, Europe, and Latin America agree on the safety of approved LNCS when consumption remains within the Acceptable Daily Intake (ADI) levels. Data from Chile, México, and Brazil show that sugar intake systematically exceeds recommendations, while LNCS consumption is frequent but generally well below the recommended upper limits. Randomized controlled trials (RCTs) indicate that replacing sugar-sweetened beverages with LNCS-sweetened alternatives is associated with modest reductions in body weight and improvements in cardiometabolic health. In contrast, some observational studies suggest adverse associations, which are likely influenced by inherent methodological limitations such as residual confounding, reverse causality, and heterogeneity in comparators. These discrepancies are typically reduced or eliminated when applying appropriate substitution models and more comprehensive adjustments. Recent RCTs in adults with overweight or obesity identify neutral or modestly beneficial effects on appetite, weight, and blood glucose when LNCS replace sugar. These findings also highlight the need to explore the potential differential effects of individual LNCS and their impact on specific populations, including people with diabetes, to expand the evidence base and confirm results from existing RCTs. Experts concluded that sugar and LNCS policies in Latin America must balance the high disease burden related to excessive sugar consumption with the evidence for LNCS safety and the heterogeneous findings based on specific molecules, populations, and study designs. Proposals included strengthening consumption surveillance, promoting local cohorts and RCTs, investigating real-world exposure to LNCS, and developing multicentric networks and communication strategies to support sugar reduction through safe, low-calorie alternatives.