Used by the indigenous peoples of South America for centuries, the plant Stevia
has recently hit the headlines. Stevia contains natural sweeteners, called steviol
glycosides, which taste up to 300 times sweeter than sugar without providing
calories. A new addition to the sweetness portfolio that could help with weight
management? European consumers will need to wait.
Sweet taste
Every newborn baby likes sweet taste, regardless of its mother’s diet during pregnancy.
Food preferences for sweeteners are shaped by children and adults from their own food
experiences, and therefore vary considerably from one person to another.
1
Nowadays, a large range of sweeteners available on the market can provide the sweet
taste without the energy associated with sugar.
2
Among this large group of compounds are
intense sweeteners such as aspartame, acesulfameK, saccharin, sucralose, and steviol
glycosides that taste several hundred times sweeter than sugar. As only very small
amounts are required to induce the sweet taste, their energy contribution is often negligible
compared with sugar. Unlike the other intense sweeteners, steviol glycosides offer the
additional appeal that they are entirely of plant origin, just like sugar.
The origin of Stevia
Stevia rebaudiana Bertoni, more commonly referred to as Stevia, was given its name by the Swiss botanist Moisés Santiago
Bertoni who first described the plant. It is a herb native to Central and South America and belongs to the same family of plants
as the sunflower and chicory. Widely cultivated for its sweet leaves, Stevia has been used for centuries by the South American
natives as a traditional sweetener, added to herbal teas and other beverages. There are two main sweet tasting glycoside
compounds present in its leaves: stevioside and rebaudioside A. These compounds taste 200300 times sweeter than sugar, so
that a very small amount is sufficient to achieve the desired sweetness. It is these glycosides that have been the subject of
recent safety studies and approvals.
Potential health benefits
Just like other intense sweeteners, steviol glycosides allow consumers to enjoy sweet taste without adding to the daily energy
intake as they do not contain significant calories. High intensity sweeteners may be an effective aid in weight management
when used in the diet as a substitute for added sugars.
3
People with a rare genetic disease known as phenylketonuria (PKU)
must control their phenylalanine intake from all sources, including aspartame: for them, steviol glycosides would be a
phenylalaninefree sweetening option.
Stevia around the world
Stevia is still cultivated today in Latin America, but the production market is now led by Asian countries. China is the largest
Stevia grower in the world, while Japan and Korea are currently the largest markets for Stevia extracts. Recently, the USA,
Australia and New Zealand authorised certain Stevia preparations as a food and beverage ingredient on their markets.
What about Europe?
In 1999, the European Commission refused authorisation of Stevia plants or dried leaves as a food or food ingredient because
of insufficient evidence to demonstrate safety. Therefore, foods and beverages containing the Stevia plant or extracts of the
plant as ingredients are not authorised for the European Union (EU) market. Since then, many safety studies have been
performed. In 2008, several key expert opinions supporting the safety of purified steviol glycosides became available. The
Joint FAO/WHO Expert Committee on Food Additives (JECFA) established a permanent ADI for pure (≥95%) steviol glycosides
validating safety for use as a food sweetener.
4
The US Food and Drug Administration (FDA), has also responded favourably to
the safety dossiers submitted in support of high purity steviol glycoside sweeteners.
5
JECFA has established an acceptable daily
intake of 04 mg/kg body weight expressed as steviol; which is equivalent to 12 mg/kg body weight as rebaudioside A or 720
mg for a 60 kg woman or 840 mg for a 70 kg man.
4
By March 2010, the European Food Safety Authority (EFSA) will perform a combined assessment of the safety of steviol
glycosides. Subject to a favourable EFSA opinion, the EU directive on sweeteners is likely to be updated to include steviol
glycosides. France recently authorised the use of rebaudioside A at 97% purity in foods and beverages for up to 2 years.
6
With
this in mind, some products sweetened with steviol glycosides may appear in certain European markets in the near future.
References
1. EUFIC podcast “Managing sweetness”.
Presentation of France Bellisle.
2.
EUFIC Food Today n° 49 (2005) Lowcalorie sweeteners, more than just a sweet taste
3. Phelan S, Lang W, Jordan D and Wing RR (2009) Use of artificial sweeteners and fatmodified foods in weight loss
maintainers and alwaysnormal weight individuals. International Journal of Obesity advance online publication 28 July
Stevia: a natural sweetener with potential
2009; doi: 10.1038/ijo.2009.147
4. Joint FAO/WHO Expert Committee on Food Additives (JECFA).
Evaluation of certain food additives. WHO
Technical Report Series 952, 2009.
5.
FDA response letter GRAS Notice No. GRN 000253, 17 December 2008.
6. French Ministry of Economy, Finance, and Employment.
Arrêté du 26 août 2009 relatif à l’emploi du
rébaudioside A (extrait de Stevia rebaudiana) comme additif alimentaire
. Le Journal officiel de la République
française, Edition n° 0206, 6 September 2009.
UPDATED 14 November 2011
On 11 November 2011, the European Commission granted final regulatory approval for the use of stevia
extracts in food and beverages
Having considered the assessments done by EFSA in April 2010 and January 2011, and acknowledging the need for new
products which are energyreduced to be placed on the market, the European Commission has granted final regulatory
approval for the use of steviol glycosides as sweetener at appropriate maximum use levels.
Parliament and of the Council with regard to steviol glycosides).
European Food Safety Authority (EFSA) established an Acceptable Daily Intake for the safe use of steviol
glycosides
The European Food Safety Authority’s scientific Panel on additives, the ANS Panel, assessed the safety of steviol glycosides,
sweeteners extracted from plant leaves, and established an Acceptable Daily Intake for their safe use, in April 2010. The
assessment was sent to the European Commission for it to consider whether or not to authorise the substances in the
European Union for their proposed use in particular in sugar free or reduced energy foods such as certain flavoured drinks,
confectionery with no added sugar or energy reduced soups.
Toxicological testing showed that the substances are not genotoxic, nor carcinogenic, or linked to any adverse effects on the
reproductive human system or for the developing child. The Panel set an Acceptable Daily Intake (ADI) of 4 mg per kg body
weight per day for steviol glycosides, a level consistent with the already established by the Joint FAO/WHO Expert Committee
on Food Additives (JECFA).
The Panel pointed out, however, that this ADI could be exceeded by both adults and children if these sweeteners are used at
the maximum levels proposed by the applicants. In January 2011, EFSA reviewed its previous assessment concluding that
although the revised exposure estimates are slightly lower than those of the April 2010 opinion, adults and children who are
high consumers of foods containing these sweeteners could still exceed the ADI established by the Panel if the sweeteners are
used at maximum levels.
Steviol glycosides are intense sweeteners extracted from the leaves of the stevia plant (Stevia rebaudiana Bertoni). These
substances, such as stevioside and rebaudioside, range in sweetness from 40 to 300 times sweeter than sucrose.
EFSA reviewed the safety of three dossiers supporting requests for authorisation. Food additives such as sweeteners must be
explicitly authorised at European level before they can be used in foods.
2
Within Europe and across the globe, several official organisations have a remit
which includes food safety and nutrition. These organisations publish policy
documents, develop strategies, monitor food intake or health, and in some cases
implement regulations. By their actions, they have the potential to influence the
foods that consumers get access to or choose to eat.
World Health Organization (WHO)
This global organisation with its headquarters in Geneva is responsible for coordinating
health within the United Nations (UN) system. It has a wide remit covering chronic and
infectious diseases, mental health, nutrition, food safety, accidents, biohazards, health
economics and preventative health. WHO’s widereaching role includes providing
leadership on global issues (the H1N1 flu virus is an example of this), funding research,
setting standards, creating evidencebased policy, monitoring health trends, and providing
technical support to individual nations. The WHO headquarters office in Geneva also coordinates six satellite offices covering
the major regions of the globe. The WHO European office is based in Copenhagen, Denmark where it oversees the public
health needs of more than 50 different countries.
As a global organisation, WHO’s policies take into account the needs of poor or emerging nations as well as those of affluent
Western nations. WHO’s activities in the area of food safety, diet and nutrition come under two departments: 1) Nutrition &
Health, and 2) Food Safety & Zoonoses.
The Nutrition & Health department has four work streams:
1. Growth assessment and surveillance: WHO produces standard growth charts for infants and children up to 19 years, which
are used widely by health professionals;
2. Countryfocused nutrition policies and programmes: WHO provides strategy and guidance to help individual countries
develop effective food and nutrition policies. Topics include infant and maternal nutrition, obesity, older people, dietary
recommendations, food security and HIV/AIDS. A key report is the Global Strategy on Diet, Physical Activity and Health;
3. Reduction of micronutrient malnutrition: WHO surveys vitamin and mineral intakes in various populations and publishes
recommendations to safeguard intakes, such as vitamin A, iodine and iron;
4. Nutrition in development and crisis: WHO provides technical support and surveillance during emergencies (e.g. war, famine,
flood) in order to prevent malnutrition and increase food security.
WHO also works closely with the UN Standing Committee on Nutrition, which is mandated to raise awareness about
malnutrition, mobilise commitment to solve problems at global, regional and national levels, and promote international policies
to improve food security.
The Department of Food Safety & Zoonoses has responsibility for food safety across the entire food chain. Its aim is to create
policies and implement actions that safeguard health, with a special focus on the reduction of foodborne diseases worldwide.
Issues have included acrylamide in cooked foods, polychlorinated biphenyls (PCB) and dioxins in salmon, and biomonitoring of
persistent organic pollutants. A major transnational initiative has been the ‘5 Keys to Safer Food’, which provides training and
resources that can be adapted locally to promote good food hygiene. Food safety is also covered by the International Food
Safety Authorities Network (INFOSAN) which is a global network of 177 national food safety authorities.
Food and Agriculture Organization (FAO)
With its headquarters based in Rome, the FAO is another important UN organisation. The mandate of FAO is to raise levels of
nutrition, improve agricultural productivity, better the lives of rural populations and contribute to the growth of the world
economy. It also acts as a neutral forum where different countries can meet to debate international policy and negotiate
agreements.
There are eight departments in FAO. Food safety and nutrition pertains to the Department of Agriculture and Consumer
Protection. Although FAO covers a broad range of foodrelated topics, e.g. food composition, additives, nutrition education, risk
assessment and quality assurance, the emphasis is on assisting countries where food insecurity is rife. Thus, the work of FAO
overlaps with that of WHO in identifying those at risk of malnutrition and putting in place local policies to improve food security.
However, FAO has special expertise in food production, animal and plant disease control, and trade.
The FAO facilitates a number of webbased portals where people can access foodrelated information from different countries.
The FAOLEX database brings together national laws and regulations on food, agriculture and renewable natural resources. The
Global Forum on Food Security & Nutrition facilitates knowledge transfer between 300 food and nutrition practitioners from five
continents. The international portal on Food Safety, Animal & Plant Health facilitates trade and food safety by providing a single
access point to official international and national standards and legislation. The FAO statistical databases are a valuable and
much used source of information when trends in food consumption are compared timewise and between different countries.
Other activities of FAO include the publication of food composition tables (e.g. for Asian and African foods) and working with
WHO to publish scientific advice on food and nutrition (e.g.; requirements for energy and micronutrients). Finally, FAO is the
home of the Codex Alimentarius Commission.
1
The Joint FAO/WHO Expert Committee on Food Additives (JECFA) is an international scientific expert committee that is
administered jointly by the two UN organisations. This committee has been meeting twice a year since 1956, initially to
evaluate the safety of food additives. Today, it is also tasked with the evaluation of contaminants, naturally occurring toxicants
and residues of veterinary drugs in food.
European organisations
As in a number of Member States, risk assessment and risk management with respect to the food supply is tasked to different
organisations. The European Food Safety Authority (EFSA) is responsible for risk assessment while the European Commission
Who’s who in international and European food safety and nutrition?
3
(EC) is responsible for implementing actions arising from scientific advice, i.e. policy, research and regulation in collaboration
with the European Parliament and Member States. Both organisations are described in more detail below.
European Commission (EC)
Within the EC, food safety and nutrition is shared between three policy directorates; Agriculture & Rural Development, Health &
Consumers, and Environment, with overlap between remits. Underpinning this work is a substantial research programme co
ordinated under various frameworks by the Directorate General (DG) Research.
Within DG Agriculture & Rural Development, topics include food quality, food supply and plant/animal health. Work undertaken
includes initiatives to supply dairy products and fruit/vegetables to targeted schools, educational and awarenessraising
schemes, and programmes to distribute food to disadvantaged communities within the European Union (EU).
The EC is the primary source of food regulations across the EU, with Member States taking the role of enforcers rather than
law makers. Topics include provenance, authenticity, addition of nutrients, nutrition claims, health claims, additives and
permitted ingredients. The lead directorate in this area is DG Health & Consumers whose activities include labelling, regulation,
public health and food chain safety (including animal health and feed as well as food safety).
The DG Health & Consumers also promotes policies to help Member States address lifestylerelated conditions such as obesity,
cardiovascular disease and cancer. A key example of work is the Platform for Action on Diet, Physical Activity and Health which
coordinates transnational action to reformulate food products, limit marketing of less healthy foods, improve labelling,
promote physical activity and educate atrisk populations. Members include a wide variety of European stakeholders ranging
from food companies to consumer organisations.
A major partner of this Platform is the High Level Group on Nutrition and Physical Activity, which comprises representatives
from all 27 Member States plus the four countries of the European Free Trade Association (EFTA). Since 2007, the group has
facilitated an exchange of policy ideas and practices around nutrition, food product reformulation and promotion of an active
lifestyle through the built environment. A recent outcome has been the creation of a Europewide campaign to reduce salt
intakes which is set for review in 2010.
European Food Safety Authority (EFSA)
EFSA was set up in 2002 by the EC as an independent authority, in response to a series of food scares, to ensure a high level
of consumer protection and help to strengthen confidence in the EU food supply. The remit of the organisation covers the
safety of human food and animal feed, nutrition, animal health and welfare, plant protection and plant health.
EFSA complements the regulatory role of the EC, and the policing role of Member States, by providing independent risk
assessment and communication on food safety and nutrition matters. This work can be in response to a request from the EC,
the European Parliament or a Member State, or can be initiated by EFSA itself. All advice is publicly available.
EFSA has 10 Scientific Panels and an overarching Scientific Committee, comprising independent experts mainly from across
the EU. The Panels cover topics such as animal health, food additives, toxicology, geneticallymodified organisms, plant health,
nutrition and allergies. Panel members are supported by EFSA staff who are responsible for providing data on intakes, methods
and exposure in order to inform deliberations. Examples of Panel opinions include the welfare of farmed fish, safety
assessment of wild and farmed fish, safety aspects of adding lycopene, taurine and aspartame to foods, setting of nutrient
profiles for foods bearing nutrition and health claims, reviews of tolerable intake levels, and advice on citrus pests.
A key development in nutrition is the regulation on Nutrition & Health Claims which involves the EFSA Panel on Dietetic
Products, Nutrition and Allergies. This Panel has been tasked with working through more than 4000 submitted health claims and
delivering opinions on whether or not these are justified by the science. Once this work is complete, the EC will draw up a list
of permitted EUwide health claims which can be used by the food industry to communicate benefits to consumers.
On the topic of safety, a key development is reassessment of the regime to prevent BSE in cattle, which has implications for
the meat industry. The Biological Hazards Panel has been involved in assessing the potential risk to human health as a result of
these changes in practice.
Further information
World Health Organization
Joint FAO/WHO Expert Committee on Food Additives (JECFA)
http://www.who.int/ipcs/food/jecfa/en/
Global
Strategy
on
Diet,
Physical
Activity
and
Health
report
www.who.int/dietphysicalactivity/strategy/eb11344/en/index.html
WHO Briefing note on ‘5 Keys to Safer Food’
www.who.int/foodsafety/consumer/Briefing_keys.pdf
Food and Agriculture Organization of the United Nations
European Commission
http://ec.europa.eu/policies/index_en.htm
European Food Safety Authority
References
1. EUFIC Food Today n° 44 (2004). What is Codex Alimentarius? Available at:
www.eufic.org/article/en/page/FTARCHIVE/artid/codexalimentarius
4
Poor diets are a major concern and one of the greatest public health challenges of
the 21st century. Many campaigns promoting healthy eating and physical activity
have been launched in an attempt to reverse this trend, but have they been
shown to be effective? If not, how can that be improved? The European Union
funded project EATWELL is tasked with finding these answers.
Unhealthy eating in Europe
Overweight and obesity are the most visible manifestation of poor diets, but diet quality
matters too western societies consume too little fruit and vegetables and omega3 fatty
acids, too much saturated fatty acids, trans fats, salt and sugar.
Overweight (Body Mass Index (BMI) 2529.9) affects 30–80% of adults in Europe and the proportion of people suffering from
obesity (BMI ≥ 30) is dramatically increasing, over one in four adults in some countries (e.g., Italy, Spain).
1
The trend in
obesity is especially alarming in young people, as about 20% of children and adolescents are overweight, and a third of these
are obese.
2
Obesity is recognised as having a negative impact on quality of life, increasing susceptibility to other chronic diseases (e.g.,
heart disease and type2 diabetes) and potentially leading to premature death. According to the World Health Organization
(WHO), obesity is already responsible for 1013% of deaths in different parts of Europe and 28% of health costs.
3
Additionally,
overconsumption of salt, sugar and saturated fats and underconsumption of fruit and vegetables cause almost 70,000
premature deaths annually in the UK alone.
4
Indeed, poor diets do not only impact on European citizens’ health, but also
increase the economic burden through absenteeism, higher insurance costs and a greater dependency on health services. In
response, European Union (EU) Member States have initiated a variety of national policy interventions to encourage physical
activity and healthy eating, such as promotion of fruit and vegetable consumption, nutrition labelling, regulation of school
meals and public sector canteens to ensure healthy food offerings. However, such interventions have rarely been evaluated in
a systematic way.
EATWELL project
The EATWELL project, full name “Interventions to Promote Healthy Eating Habits: Evaluation and Recommendations”, is a 3.5
year multicentre project funded by the European Commission (running from April 2009 to October 2012). It aims to provide
EU Member States with best practice guidelines to develop appropriate policy interventions that will encourage healthy eating.
The project brings together nine consortium partners, including leading European universities, institutes, notforprofit
organisations as well as representatives of the food industry and communication agencies. They will work together and share
their complementary expertise in consumer behaviour, nutrition, economics, communication and health policy.
Lessons learned from the past
EATWELL will identify policy interventions focusing on nutrition and healthy eating habits, as well as the relevant campaign
evaluations. There is also an abundance of secondary data available across the EU and beyond containing rich information on
aspects relating to healthiness of diets, which have been insufficiently exploited in nutrition policy evaluation and will be
included in this study. This will provide the EATWELL team with an overview of the actions undertaken and assist with
identifying gaps, as well as success and failure factors for the campaigns.
Some interventions may be better received than others and different population groups may have different attitudes towards
healthy eating and the role of policy in intervening to influence food choices. In a second phase, EATWELL will compare public
acceptance for alternative interventions, across countries and individuals, focusing on different subgroups of the population
(e.g., parents vs. nonparents, education level, etc.). EATWELL will also assess policy acceptance by other stakeholders
including manufacturers, retailers and nongovernmental associations.
The private sector has considerable experience with tools aimed at influencing consumer food choice. Particular attention will
therefore be paid to lessons that can be learned from the private sector that are applicable to public efforts to promote
healthier eating.
Impact of interventions
Once campaigns have been identified and the methodology of evaluation determined, the impact on consumers’ health and
quality of life, as well as the costs and savings for the society will be assessed to highlight the return on investment of such
campaigns. The evaluation will also include results on acceptance by the general public.
Improving the future of healthy eating policies
Based on this analysis, consortium partners will develop a range of consumer behaviour models, harmonised methods for
intervention evaluation and make recommendations for use in the evaluation of future policy interventions. A bestpractice
guide will indicate actions appropriate and acceptable at European and Member State levels and their transferability across
cultures.
References
1. Berghöfer A et al. (2008). Obesity prevalence from a European perspective: a systematic review. BMC Public Health
8:200.
Improving policy interventions to promote healthy eating in Europe
5
2. WHO Europe (2007).
The challenge of obesity in the WHO European Region and the strategies for response.
3. WHO Europe website.
4. UK Cabinet Office Strategy Unit (2008).
Food Matters: Towards a strategy for the 21st Century.
6
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