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Sylvetsky AC. Metabolic Effects of Low-Calorie Sweeteners: A Brief Review. Obesity (Silver Spring) 2018; 26 Suppl 3:S25-S31. [PMID: 30070039 DOI: 10.1002/oby.22252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/07/2016] [Indexed: 12/12/2022]
Abstract
Low-calorie sweeteners (LCS) are found in a variety of foods and beverages, yet their role in diet, weight, and obesity-related chronic disease is controversial. This article summarizes proceedings from one of four presentations during a preconference session entitled "Low-Calorie Sweeteners and Weight Management," which took place at the 2017 Obesity Society Annual Meeting in Washington, District of Columbia. The objective of this brief review is to summarize findings of observational and interventional studies of LCS effects on weight and metabolic health and to provide potential explanations for their discrepant results. Key research priorities for advancing the understanding of the role of LCS in weight and chronic disease are also discussed. The existing literature suggests that LCS consumption is consistently associated with obesity, diabetes, and related cardiometabolic conditions in observational studies. Although several plausible mechanisms have been proposed to explain these associations and have received considerable support in cellular and rodent models, the relevance of these mechanisms to humans has yet to be confirmed. Meanwhile, randomized controlled trials demonstrate that NNS may benefit weight loss and weight maintenance. This is the case particularly when LCS are administered in the context of behavioral weight loss support and are consumed knowingly by habitual LCS consumers. Although these findings suggest that LCS may be useful for weight control among those cognitively engaged in weight loss and who are aware of their LCS consumption, LCS administration in these studies does not reflect typical consumption. Furthermore, few interventional studies have assessed the role of LCS on metabolic outcomes other than body weight. Additional factors must be considered before recommending LCS for weight management and chronic disease prevention and further study of LCS effects on a variety of cardiometabolic outcomes, including visceral adiposity and glucose homeostasis is warranted.
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Affiliation(s)
- Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, District of Columbia, Washington, USA
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, District of Columbia, Washington, USA
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Abstract
AbstractObjectiveExperts recommend that products containing artificial sweeteners are not marketed to children or sold at schools. The present study aimed to provide a baseline assessment of the extent to which state laws and local school district wellness policies (LWP) address restrictions on the use of artificial sweeteners in competitive foods and beverages (CF&B) sold at schools.DesignA descriptive, cross-sectional study of policies in place for the 2014–15 school year.SettingData were collected on laws in all fifty states and Washington, DC. LWP were compiled for 496/518 school food authorities (SFA) for which data were collected as part of the US Department of Agriculture’s School Nutrition and Meal Cost Study.SubjectsState laws and LWP respectively were coded on a 0–3 ordinal scale for the strength of their restrictions on artificial sweeteners in CF&B sold in each of five CF&B venues, separately by grade level. Prevalence of state laws and LWP for SFA nationwide was computed.ResultsThirteen states addressed the use of artificial sweeteners. Six states addressed the use of artificial sweeteners in both CF&B. District-level artificial sweetener policies were most frequently addressed for beverages in elementary schools’ vending machines. District policies also were more likely to address artificial sweeteners in states with laws addressing artificial sweeteners.ConclusionsMost state laws and LWP do not address artificial sweeteners in CF&B. This is not surprising given the Food and Drug Administration has approved eight artificial sweeteners for consumption and the Smart Snacks regulation does not limit artificial sweeteners for CF&B.
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Malek AM, Hunt KJ, DellaValle DM, Greenberg D, St. Peter JV, Marriott BP. Reported Consumption of Low-Calorie Sweetener in Foods, Beverages, and Food and Beverage Additions by US Adults: NHANES 2007-2012. Curr Dev Nutr 2018; 2:nzy054. [PMID: 30283913 PMCID: PMC6163106 DOI: 10.1093/cdn/nzy054] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Low-calorie sweeteners (LCSs), artificial sweeteners, or high-intensity sweeteners are incorporated into foods, beverages, and food and beverage additions (FBAs). Many prior studies have focused on LCS beverage consumption, but not included LCS consumption from foods or FBAs. OBJECTIVES We aimed to describe the prevalence of LCS consumption by US adults, and to examine the relation between intake of products containing LCSs and macronutrients. METHODS Two nonconsecutive 24-h dietary recalls from NHANES 2007-2012 and the National Cancer Institute usual intake method were used to estimate prevalence of LCS intake from foods, beverages, and FBAs, and macronutrients among US adults aged ≥19 y (n = 14,098, weighted n = 218,391,752) in a cross-sectional study. The prevalence of LCS consumption from reported foods, beverages, and FBAs among US adults was examined by sociodemographic characteristics and body mass index (BMI). Logistic regression estimated ORs and 95% CIs for associations between sociodemographic characteristics and LCS use (overall and in foods, beverages, and FBAs). RESULTS Among adults, 47.8% reported intake of ≥1 food, beverage, or FBA containing LCSs over 2 d. Intake was higher among: women non-Hispanic whites, college graduates or higher, and those with higher income and obese BMIs (P < 0.001). Intake of beverages containing LCSs was higher for ages 51-70 y than 19-30 y and those with overweight and obese BMIs (P < 0.001) than for normal-weight individuals. Calories, carbohydrate, and sugar intake were lower and fiber was higher in LCS-consumers than in nonconsumers. Specifically, calories from beverages were lower in those who reported LCS intake. CONCLUSIONS Individuals reporting LCS consumption demonstrated lower total energy intake than did individuals without LCS intake. Although the main source of LCSs in the US adult diet was beverages (31.9%), we found that FBAs also present a significant contribution (25.2%), surpassing food (9.3%). This enables targeted understanding of national consumption of these products as well as dietary education and intervention opportunities.
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Affiliation(s)
- Angela M Malek
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Kelly J Hunt
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Diane M DellaValle
- Departments of Medicine, Medical University of South Carolina, Charleston, SC
| | | | | | - Bernadette P Marriott
- Departments of Medicine, Medical University of South Carolina, Charleston, SC
- Departments of Psychiatry, Medical University of South Carolina, Charleston, SC
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Guercio BJ, Zhang S, Niedzwiecki D, Li Y, Babic A, Morales-Oyarvide V, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Ogino S, Zoltick ES, Stampfer M, Ng K, Wu K, Willett WC, Giovannucci EL, Meyerhardt JA, Fuchs CS. Associations of artificially sweetened beverage intake with disease recurrence and mortality in stage III colon cancer: Results from CALGB 89803 (Alliance). PLoS One 2018; 13:e0199244. [PMID: 30024889 PMCID: PMC6053135 DOI: 10.1371/journal.pone.0199244] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/01/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose Observational studies have demonstrated increased colon cancer recurrence and mortality in states of excess energy balance, as denoted by factors including sedentary lifestyle, diabetes, increased dietary glycemic load, and increased intake of sugar-sweetened beverages. Nonetheless, the relation between artificially sweetened beverages, a popular alternative for sugar-sweetened beverages, and colon cancer recurrence and survival is unknown. Methods We analyzed data from 1,018 patients with stage III colon cancer who prospectively reported dietary intake during and after chemotherapy while enrolled in a National Cancer Institute-sponsored trial of adjuvant chemotherapy. Using Cox proportional hazards regressions, we assessed associations of artificially sweetened beverage intake with cancer recurrence and mortality. Results Patients consuming one or more 12-ounce servings of artificially sweetened beverages per day experienced an adjusted hazard ratio for cancer recurrence or mortality of 0.54 (95% confidence interval, 0.36 to 0.80) when compared to those who largely abstained (Ptrend = .004). Similarly, increasing artificially sweetened beverage intake was also associated with a significant improvement in both recurrence-free survival (Ptrend = .005) and overall survival (Ptrend = .02). Substitution models demonstrated that replacing a 12-ounce serving of a sugar-sweetened beverage with an isovolumetric serving of an artificially sweetened beverage per day was associated with a 23% lower risk of cancer recurrence and mortality (relative risk, 0.77; 95% confidence interval, 0.63 to 0.95; P = .02). Conclusion Higher artificially sweetened beverage consumption may be associated with significantly reduced cancer recurrence and death in patients with stage III colon cancer. This association may be mediated by substitution for sugar-sweetened alternatives. Further studies are needed to confirm these findings.
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Affiliation(s)
- Brendan J. Guercio
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Sui Zhang
- Dana-Farber/Partners CancerCare, Boston, Massachusetts, United States of America
| | - Donna Niedzwiecki
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina, United States of America
| | - Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ana Babic
- Dana-Farber/Partners CancerCare, Boston, Massachusetts, United States of America
| | | | - Leonard B. Saltz
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Robert J. Mayer
- Dana-Farber/Partners CancerCare, Boston, Massachusetts, United States of America
| | - Rex B. Mowat
- Toledo Community Hospital Oncology Program, Toledo, Ohio, United States of America
| | | | - Alexander Hantel
- Edward-Elmhurst Healthcare, Naperville, Illinois, United States of America
| | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
| | - Daniel Atienza
- Virginia Oncology Associates, Norfolk, Virginia, United States of America
| | - Michael Messino
- Southeast Clinical Oncology Research (SCOR) Consortium, Mission Hospitals, Incorporated, Asheville, North Carolina, United States of America
| | - Hedy Kindler
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, California, United States of America
| | - Shuji Ogino
- Dana-Farber/Partners CancerCare, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Division of Molecular Pathological Epidemiology (MPE), Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Emilie S. Zoltick
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Meir Stampfer
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kimmie Ng
- Dana-Farber/Partners CancerCare, Boston, Massachusetts, United States of America
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Walter C. Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Edward L. Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Charles S. Fuchs
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
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Fantino M, Fantino A, Matray M, Mistretta F. Beverages containing low energy sweeteners do not differ from water in their effects on appetite, energy intake and food choices in healthy, non-obese French adults. Appetite 2018. [DOI: 10.1016/j.appet.2018.03.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sylvetsky AC, Rother KI. Nonnutritive Sweeteners in Weight Management and Chronic Disease: A Review. Obesity (Silver Spring) 2018; 26:635-640. [PMID: 29570245 PMCID: PMC5868411 DOI: 10.1002/oby.22139] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of this review was to critically review findings from recent studies evaluating the effects of nonnutritive sweeteners (NNSs) on metabolism, weight, and obesity-related chronic diseases. Biologic mechanisms that may explain NNS effects will also be addressed. METHODS A comprehensive review of the relevant scientific literature was conducted. RESULTS Most cross-sectional and prospective cohort studies report positive associations between NNS consumption, body weight, and health conditions, including type 2 diabetes, cardiovascular disease, and nonalcoholic fatty liver disease. Although findings in cellular and rodent models suggest that NNSs have harmful effects on metabolic health, most randomized controlled trials in humans demonstrate marginal benefits of NNS use on body weight, with little data available on other metabolic outcomes. CONCLUSIONS NNS consumption is associated with higher body weight and metabolic disease in observational studies. In contrast, randomized controlled trials demonstrate that NNSs may support weight loss, particularly when used alongside behavioral weight loss support. Additional long-term, well-controlled intervention studies in humans are needed to determine the effects of NNSs on weight, adiposity, and chronic disease under free-living conditions.
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Affiliation(s)
- Allison C. Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC 20052
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC 20052
- Section on Pediatric Diabetes and Metabolism, NIDDK, NIH, 9000 Rockville Pike, Building 10, Room 8C432A, Bethesda, MD 20892
| | - Kristina I. Rother
- Section on Pediatric Diabetes and Metabolism, NIDDK, NIH, 9000 Rockville Pike, Building 10, Room 8C432A, Bethesda, MD 20892
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Seferidi P, Millett C, Laverty AA. Sweetened beverage intake in association to energy and sugar consumption and cardiometabolic markers in children. Pediatr Obes 2018; 13:195-203. [PMID: 28112866 DOI: 10.1111/ijpo.12194] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/07/2016] [Accepted: 09/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Artificially sweetened beverages (ASBs) are promoted as healthy alternatives to sugar-sweetened beverages (SSBs) in order to reduce sugar intake, but their effects on weight control and glycaemia have been debated. This study examines associations of SSBs and ASBs with energy and sugar intake and cardiometabolic measures. METHODS One thousand six hundred eighty-seven children aged 4-18 participated in the National Diet and Nutrition Survey Rolling Programme (2008/9-2011/12) in the UK. Linear regression was used to examine associations between SSBs and ASBs and energy and sugar, overall and from solid foods and beverages, and body mass index, waist-to-hip ratio and blood analytes. Fixed effects linear regression examined within-person associations with energy and sugar. RESULTS Compared with non-consumption, SSB consumption was associated with higher sugar intake overall (6.1%; 4.2, 8.1) and ASB consumption with higher sugar intake from solid foods (1.7%; 0.5, 2.9) but not overall, mainly among boys. On SSB consumption days, energy and sugar intakes were higher (216 kcal; 163, 269 and 7.0%; 6.2, 7.8), and on ASB consumption days, sugar intake was lower (-1.0%; -1.8, -0.1) compared with those on non-consumption days. SSB and ASB intakes were associated with higher levels of blood glucose (SSB: 0.30 mmol L-1 ; 0.11, 0.49 and ASB: 0.24 mmol L-1 ; 0.06, 0.43) and SSB intake with higher triglycerides (0.29 mmol L-1 ; 0.13, 0.46). No associations were found with other outcomes. CONCLUSION Sugar-sweetened beverage intake was associated with higher sugar intake and both SSBs and ASBs with a less healthy cardiometabolic profile. These findings add to evidence that health policy should discourage all sweetened beverage consumption.
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Affiliation(s)
- P Seferidi
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - C Millett
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - A A Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Myers EA, Passaro EM, Hedrick VE. The Comparative Reproducibility and Validity of a Non-Nutritive Sweetener Food Frequency Questionnaire. Nutrients 2018. [PMID: 29534454 PMCID: PMC5872752 DOI: 10.3390/nu10030334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In order to better assess non-nutritive sweetener (NNS) consumption, measurement tools with greater utility are needed. The objective of this investigation is to determine the reproducibility and validity of a newly developed NNS food frequency questionnaire (NNS-FFQ) that measures five types of NNS (saccharin, aspartame, acesulfame potassium, sucralose and erythritol). Adult participants (n = 123, 56% female, 75% Caucasian, mean age = 36.8 ± 16.6) completed the NNS-FFQ twice and had 24-h dietary recalls three times over a two-week study period. Reproducibility between two administrations of the NNS-FFQ was assessed via Bland–Altman plots, Spearman’s correlations (rs) and paired samples t-tests. Bland–Altman plots, Cohen’s κ, Spearman’s correlations (rs), and paired samples t-tests compared NNS intake between the two methods for validity. For reproducibility analyses, Bland–Altman analyses revealed agreement levels above the 95% acceptance level for total NNS (99.2%), erythritol (99.2%), and aspartame (96.7%). Agreement levels for acesulfame potassium (94.3%), saccharin (94.3%), and sucralose (94.3%) were slightly below the acceptable level. For validity analyses, Bland–Altman analyses revealed agreement levels above the 95% acceptance level for total NNS (95.1%), sucralose (95.9%), saccharin (95.9%), and erythritol (95.1%). Agreement levels for aspartame (94.3%) and acesulfame potassium (92.7%) were slightly below the acceptable level. Although less than desirable agreement was found between the methods for aspartame and acesulfame potassium, some variance was expected due to the habitual nature of the NNS-FFQ as compared to the recent intake reported by recalls. Within the context of this constraint, the NNS-FFQ demonstrates acceptable reproducibility and validity. The NNS-FFQ is a brief questionnaire that could be administered among diverse participants at the individual and population levels to measure habitual NNS intake.
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Affiliation(s)
- Emily A Myers
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, 295 West Campus Drive, Blacksburg, VA 24061, USA.
| | - Erin M Passaro
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, 295 West Campus Drive, Blacksburg, VA 24061, USA.
| | - Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, 295 West Campus Drive, Blacksburg, VA 24061, USA.
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Nonnutritive Sweeteners and Their Role in the Gastrointestinal Tract. REFERENCE SERIES IN PHYTOCHEMISTRY 2018. [DOI: 10.1007/978-3-319-27027-2_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Winther R, Aasbrenn M, Farup PG. Intake of non-nutritive sweeteners is associated with an unhealthy lifestyle: a cross-sectional study in subjects with morbid obesity. BMC OBESITY 2017; 4:41. [PMID: 29299330 PMCID: PMC5745623 DOI: 10.1186/s40608-017-0177-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/11/2017] [Indexed: 12/31/2022]
Abstract
Background Subjects with morbid obesity commonly use Non-Nutritive Sweeteners (NNS), but the health-related effects of NNS have been questioned. The objectives of this study were to explore the associations between theuse of NNS and the health and lifestyle in subjects with morbid obesity. Methods This cross-sectional study included subjects with morbid obesity (BMI ≥ 40 kg/m2 or ≥35 kg/m2 with obesity-related comorbidity). Information about demographics, physical and mental health, and dietary habits was collected, and a blood screen was taken. One unit of NNS was defined as 100 ml beverages with NNS or 2 tablets/units of NNS for coffee or tea. The associations between the intake of NNS and the health-related variables were analyzed with ordinal regression analyses adjusted for age, gender and BMI. Results One hundred subjects (women/men 83/17; mean age 44.3 years (SD 8.5)) were included. Median intake of NNS was 3.3 units (range 0 - 43). Intake of NNS was not associated with BMI (p = 0.64). The intake of NNS was associated with reduced heavy physical activity (p = 0.011), fatigue (p < 0.001), diarrhea (p = 0.009) and reduced well-being (p = 0.046); with increased intake of total energy (p = 0.003), fat (p = 0.013), carbohydrates (p = 0.002), sugar (p = 0.003) and salt (p = 0.001); and with reduced intake of the vitamins A (p = 0.001), C (p = 0.002) and D (p = 0.016). Conclusions The use of NNS-containing beverages was associated with an unhealthy lifestyle, reduced physical and mental health and unfavourable dietary habits with increased energy intake including sugar, and reduced intake of some vitamins.
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Affiliation(s)
- Robert Winther
- Department of Research, Innlandet Hospital Trust, PB 104, N-2381 Brumunddal, Norway.,Faculty of Medicine, University of Aalborg, DK-9100 Aalborg, Denmark
| | - Martin Aasbrenn
- Department of Surgery, Innlandet Hospital Trust, N-2819 Gjøvik, Norway.,Unit for Applied Clinical Research, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
| | - Per G Farup
- Department of Research, Innlandet Hospital Trust, PB 104, N-2381 Brumunddal, Norway.,Unit for Applied Clinical Research, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
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Effects of replacing diet beverages with water on weight loss and weight maintenance: 18-month follow-up, randomized clinical trial. Int J Obes (Lond) 2017; 42:835-840. [PMID: 29633983 DOI: 10.1038/ijo.2017.306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Beneficial effects of replacing diet beverages (DBs) with water on weight loss, during a 24-week hypoenergetic diet were previously observed. However, it is not known whether this difference is sustained during a subsequent 12-month weight maintenance period. OBJECTIVE To evaluate effects of replacing DBs with water on body weight maintenance over a 12-month period in participants who undertook a 6-month weight loss plan. DESIGN Seventy-one obese and overweight adult women (body mass index (BMI): 27-40 kg m-2; age: 18-50 years) who usually consumed DBs in their diet were randomly assigned to either substitute water for DBs (water group: 35) or continue drinking DBs five times per week (DBs group: 36) after their lunch for the 6-month weight loss intervention and subsequent 12-month weight maintenance program. RESULTS A total of 71 participants who were randomly assigned were included in the study by using an intention-to-treat analysis. Greater additional weight loss (mean±s.d.) in the water group was observed compared with the DBs group after the 12-month follow-up period (-1.7±2.8 vs -0.1±2.7 kg, P=0.001). BMI decreased more in the water group than in the DBs group (-0.7±1 vs -0.05±1.1 kg m-2, P=0.003). There was also a greater reduction in fasting insulin levels (-0.5±1.4 vs -0.02±1.5 mmol l-1, P=0.023), better improvement in homeostasis model assessment of insulin resistance (-0.2±0.4 vs -0.1±0.3, P=0.013) and a greater decrease in 2-h postprandial plasma glucose (-0.2±0.3 vs -0.1±0.3 mmol l-1, P<0.001) in the water group compared with the DBs over the 12-month weight maintenance period. CONCLUSIONS Replacement of DBs with water after the main meal in women who were regular users of DBs may cause further weight reduction during a 12-month weight maintenance program. It may also offer benefits in carbohydrate metabolism including improvement of insulin resistance over the long-term weight maintenance period.
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Sylvetsky AC, Jin Y, Mathieu K, DiPietro L, Rother KI, Talegawkar SA. Low-Calorie Sweeteners: Disturbing the Energy Balance Equation in Adolescents? Obesity (Silver Spring) 2017; 25:2049-2054. [PMID: 29086493 PMCID: PMC5724388 DOI: 10.1002/oby.22005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between low-calorie sweeteners (LCSs), energy intake, and weight in US youth. METHODS Data were collected from individuals aged 2 to 19 years who participated in the National Health and Nutrition Examination Survey (NHANES) 2009-2010 (n = 3,296), 2011-2012 (n = 3,139), and 2013-2014 (n = 3,034). Logistic regression, unadjusted and adjusted for age, sex, race/ethnicity, income, energy intake, and physical activity, was used to estimate the odds of obesity in LCS consumers versus nonconsumers, both overall and across product categories (foods vs. beverages) and sociodemographic subgroups. RESULTS Among adolescents, the odds of obesity were 55% and 70% higher in LCS beverage consumers than in nonconsumers in unadjusted and adjusted models, respectively. Energy intakes did not differ based on LCS consumption. In contrast, associations between LCS consumption and obesity risk were not statistically significant among children (2-11 y old), except in boys and those who self-identified as Hispanic. CONCLUSIONS LCS consumption is associated with increased odds of obesity among adolescents. This relationship is strikingly independent of total energy intake. Although findings should be interpreted cautiously because of the limitations of self-reported dietary intake and the cross-sectional nature of this analysis, the observational analysis in this study supports the need to investigate the mechanisms by which LCS may influence body weight, independently of changes in energy intake.
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Affiliation(s)
- Allison C. Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 2 floor, Washington DC 20052
| | - Yichen Jin
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 2 floor, Washington DC 20052
| | - Kevin Mathieu
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 2 floor, Washington DC 20052
| | - Loretta DiPietro
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 2 floor, Washington DC 20052
| | - Kristina I. Rother
- Section on Pediatric Diabetes and Metabolism, NIDDK, NIH, 9000 Rockville Pike, Building 10, Room 8C432A, Bethesda, MD 20892
| | - Sameera A. Talegawkar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, 2 floor, Washington DC 20052
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The role of low-calorie sweeteners in the prevention and management of overweight and obesity: evidence v. conjecture. Proc Nutr Soc 2017; 77:230-238. [PMID: 29166970 DOI: 10.1017/s0029665117004049] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
By virtue of reducing dietary energy density, low-calorie sweeteners (LCS) can be expected to decrease overall energy intake and thereby decrease body weight. Such effects will be limited by the amount of sugar replaced by LCS, and the dynamics of appetite and weight control (e.g., acute compensatory eating, and an increase in appetite and decrease in energy expenditure accompanying weight loss). Consistent with these predictions, short-term intervention studies show incomplete compensation for the consumption of LCS v. sugar, and longer-term intervention studies (from 4 weeks to 40 months duration) show small decreases in energy intake and body weight with LCS v. sugar. Despite this evidence, there are claims that LCS undermine weight management. Three claims are that: (1) LCS disrupt the learned control of energy intake (sweet taste confusion hypothesis); (2) exposure to sweetness increases desire for sweetness (sweet tooth hypothesis); (3) consumers might consciously overcompensate for 'calories saved' when they know they are consuming LCS (conscious overcompensation hypothesis). None of these claims stands up to close examination. In any case, the results of the intervention studies comparing LCS v. sugar indicate that the effect of energy dilution outweighs any tendency LCS might conceivably have to increase energy intake.
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Lohner S, Toews I, Meerpohl JJ. Health outcomes of non-nutritive sweeteners: analysis of the research landscape. Nutr J 2017; 16:55. [PMID: 28886707 PMCID: PMC5591507 DOI: 10.1186/s12937-017-0278-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 09/04/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Food products containing non-nutritive sweeteners (NNSs) instead of sugar have become increasingly popular in the last decades. Their appeal is obviously related to their calorie-free sweet taste. However, with the dramatic increase in their consumption, it is reasonable and timely to evaluate their potential health benefits and, more importantly, potential adverse effects. The main aim of this scoping review was to map the evidence about health outcomes possibly associated with regular NNS consumption by examining the extent, range, and nature of research activity in this area. METHODS We systematically searched Ovid MEDLINE, EMBASE and the Cochrane CENTRAL databases for studies on NNSs (artificial sweeteners or natural, non-caloric sweeteners, either used individually or in combination) using text terms with appropriate truncation and relevant indexing terms. All human studies investigating any health outcomes of a NNS intervention or exposure were eligible for inclusion. No studies were excluded based on language, study design or methodological quality. Data for each health outcome were summarized in tabular form and were discussed narratively. RESULTS Finally, we included 372 studies in our scoping review, comprising 15 systematic reviews, 155 randomized controlled trials (RCTs), 23 non-randomized controlled trials, 57 cohort studies, 52 case-control studies, 28 cross sectional studies and 42 case series/case reports. In healthy subjects, appetite and short term food intake, risk of cancer, risk of diabetes, risk of dental caries, weight gain and risk of obesity are the most investigated health outcomes. Overall there is no conclusive evidence for beneficial and harmful effects on those outcomes. Numerous health outcomes including headaches, depression, behavioral and cognitive effects, neurological effects, risk of preterm delivery, cardiovascular effects or risk of chronic kidney disease were investigated in fewer studies and further research is needed. In subjects with diabetes and hypertension, the evidence regarding health outcomes of NNS use is also inconsistent. CONCLUSIONS This scoping review identifies the needs for future research to address the numerous evidence gaps related to health effects of NNSs use.It also specifies the research questions and areas where a systematic review with meta-analyses is required for the proper evaluation of health outcomes associated to regular NNSs consumption.
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Affiliation(s)
| | - Ingrid Toews
- Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 153, Freiburg, 79110 Germany
| | - Joerg J. Meerpohl
- Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 153, Freiburg, 79110 Germany
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité – U1153, Inserm / Université Paris Descartes, Cochrane France, Hôpital Hôtel-Dieu, 1 place du Parvis Notre Dame, 75181 Paris, Cedex 04 France
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Leahy M, Ratliff JC, Riedt CS, Fulgoni VL. Consumption of Low-Calorie Sweetened Beverages Compared to Water Is Associated with Reduced Intake of Carbohydrates and Sugar, with No Adverse Relationships to Glycemic Responses: Results from the 2001-2012 National Health and Nutrition Examination Surveys. Nutrients 2017; 9:E928. [PMID: 28837084 PMCID: PMC5622688 DOI: 10.3390/nu9090928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/08/2017] [Accepted: 08/22/2017] [Indexed: 12/15/2022] Open
Abstract
Although the 2015 Dietary Guidelines Advisory Committee concluded that there was moderate evidence that substituting sugar-containing sweeteners with low-calorie sweeteners (LCS) reduces calorie intake and weight, dietary recommendations encourage substituting only water for sugar-sweetened beverages during weight management. This cross-sectional study evaluated the relation of water and no- and low-calorie sweetened beverage (LCSB) intake with nutrient intakes and prediabetes criteria using data from the National Health and Nutrition Examination Survey (NHANES) 2001-2012 in 25,817 adults that were free of diabetes. Although linear trends were observed with both beverages, higher LCSB intake was associated with significantly lower consumption of carbohydrates (-9.1 g/day vs. -1.4 g/day), total sugars (-10.9 g/day vs. -2.2 g/day), and added sugars (-2.0 tsp eq vs. -0.8 tsp eq) than those associated with higher water intake. Higher intake of both beverages was significantly associated with lower insulin levels (p < 0.01); however, higher intake of LCSB was also associated with lower hemoglobin A1c (HbA1c) and lower homeostatic model assessment of insulin resistance (HOMA-IR) (p < 0.01). We observed lower odds ratios for elevated HbA1c (adjusted odds ratio [OR] 0.79, 95% CI 0.64-0.98), HOMA-IR (0.68, 0.53-0.87), and insulin levels (0.63, 0.49-0.80) in LCSB among the higher (2+ servings) intake group compared to the lowest (<1 serving) intake group. Contrary to conventional wisdom, LCSB consumption was associated with equal, if not better, dietary intake and glycemic response than water consumption. Although observational in nature, these results contribute to the growing body of evidence from human studies suggesting that in addition to water, LCSBs can also be sensible choices for reducing sugars and carbohydrate intake, with no adverse associations to measures of glycemic response.
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Affiliation(s)
- Marge Leahy
- Food, Nutrition and Policy Consultant, Fort Myers Beach, FL 33931, USA.
| | - Joseph C Ratliff
- Dr. Pepper Snapple Group, 5301 Legacy Drive, Plano, TX 75024, USA.
| | - Claudia S Riedt
- Dr. Pepper Snapple Group, 5301 Legacy Drive, Plano, TX 75024, USA.
| | - Victor L Fulgoni
- Nutrition Impact, LLC, 9725 D Drive North, Battle Creek, MI 49014, USA.
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Chan CB, Hashemi Z, Subhan FB. The impact of low and no-caloric sweeteners on glucose absorption, incretin secretion, and glucose tolerance. Appl Physiol Nutr Metab 2017; 42:793-801. [DOI: 10.1139/apnm-2016-0705] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The consumption of non-nutritive, low, or no-calorie sweeteners (LCS) is increasing globally. Previously thought to be physiologically inert, there is a growing body of evidence that LCS not only provide a sweet taste but may also elicit metabolic effects in the gastrointestinal tract. This review provides a brief overview of the chemical and receptor-binding properties and effects on chemosensation of different LCS but focuses on the extent to which LCS stimulates glucose transport, incretin and insulin secretion, and effects on glucose tolerance. Aspartame and sucralose both bind to a similar region of the sweet receptor. For sucralose, the data are contradictory regarding effects on glucose tolerance in humans and may depend on the food or beverage matrix and the duration of administration, as suggested by longer term rodent studies. For aspartame, there are fewer data. On the other hand, acesulfame-potassium (Ace-K) and saccharin have similar binding characteristics to each other but, while Ace-K may increase incretin secretion and glucose responses in humans, there are no data on saccharin except in rats, which show impaired glucose tolerance after chronic administration. Additional research, particularly of the effects of chronic consumption, is needed to provide concrete evidence for beneficial or detrimental effects of LCS on blood glucose regulation in humans.
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Affiliation(s)
- Catherine B. Chan
- Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB T6G 2P5, Canada
- Department of Physiology, University of Alberta, Edmonton, AB T6G 2H7, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, AB T2W 1S7, Canada
| | - Zohre Hashemi
- Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Fatheema B. Subhan
- Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB T6G 2P5, Canada
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Madjd A, Taylor MA, Delavari A, Malekzadeh R, Macdonald IA, Farshchi HR. Beneficial effects of replacing diet beverages with water on type 2 diabetic obese women following a hypo-energetic diet: A randomized, 24-week clinical trial. Diabetes Obes Metab 2017; 19:125-132. [PMID: 27748014 DOI: 10.1111/dom.12793] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/07/2016] [Accepted: 09/16/2016] [Indexed: 01/08/2023]
Abstract
AIMS To compare the effect of replacing diet beverages (DBs) with water or continuing to drink DBs in patients with type 2 diabetes during a 24-week weight loss program. The primary endpoint was the effect of intervention on weight over a 24-week period. The main secondary endpoints included anthropometric measurement and glucose and fat metabolism during the 24-week period. METHODS A total of 81 overweight and obese women with type 2 diabetes, who usually consumed DBs in their diet, were asked to either substitute water for DBs or continue drinking DBs five times per week after lunch for 24 weeks (DBs group) during a weight loss program. RESULTS Compared with the DBs group, the water group had a greater decrease in weight (water, -6.40 ± 2.42 kg; DBs, -5.25 ± 1.60 kg; P = .006), in BMI (water, -2.49 ± 0.92 kg/m2 ; DBs, -2.06 ± 0.62 kg/m2 ; P = .006), in FPG (water, -1.63 ± 0.54 mmol/L; DBs, -1.29 ± 0.48 mmol/L, P = .005), in fasting insulin (water, -5.71 ± 2.30 m lU/mL; DBs, -4.16 ± 1.74 m lU/mL, P = .011), in HOMA IR (water, -3.20 ± 1.17; DBs, -2.48 ± 0.99, P = 003) and in 2 hour postprandial glucose (water, -1.67 ± 0.62 mmol/L; DBs, -1.35 ± 0.39 mmol/L; P = 0.027) over the 24-week period. However, there was no significant time × group interaction for waist circumference, lipid profiles and HbA1c within both groups over the 24-week period. CONCLUSION Replacement of DBs with water after the main meal in obese adult women with type 2 diabetes may lead to more weight reduction during a weight loss program.
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Affiliation(s)
- Ameneh Madjd
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
- NovinDiet Clinic, Tehran, Iran
| | - Moira A Taylor
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Alireza Delavari
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ian A Macdonald
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Hamid R Farshchi
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
- NovinDiet Clinic, Tehran, Iran
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Borges MC, Louzada ML, de Sá TH, Laverty AA, Parra DC, Garzillo JMF, Monteiro CA, Millett C. Artificially Sweetened Beverages and the Response to the Global Obesity Crisis. PLoS Med 2017; 14:e1002195. [PMID: 28045913 PMCID: PMC5207632 DOI: 10.1371/journal.pmed.1002195] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Christopher Millett and colleagues argue that artificially sweetened beverages should not be promoted as part of a healthy diet.
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Affiliation(s)
- Maria Carolina Borges
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Maria Laura Louzada
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Thiago Hérick de Sá
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Diana C. Parra
- Washington University in St. Louis School of Medicine, Program in Physical Therapy, St. Louis, Missouri, United States of America
| | - Josefa Maria Fellegger Garzillo
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
- PhD Program on Global Health and Sustainability, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Carlos Augusto Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Christopher Millett
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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Masic U, Harrold JA, Christiansen P, Cuthbertson DJ, Hardman CA, Robinson E, Halford JCG. EffectS of non-nutritive sWeetened beverages on appetITe during aCtive weigHt loss (SWITCH): Protocol for a randomized, controlled trial assessing the effects of non-nutritive sweetened beverages compared to water during a 12-week weight loss period and a follow up weight maintenance period. Contemp Clin Trials 2016; 53:80-88. [PMID: 27979755 DOI: 10.1016/j.cct.2016.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute and medium-term intervention studies suggest that non-nutritive sweeteners (NNS) are beneficial for weight loss, however there is limited human data on the long-term effects of consuming NNS on weight loss, maintenance, and appetite. Further research is therefore required to elucidate the prolonged impact of NNS consumption on these outcome measures. METHODS/DESIGN A randomized parallel groups design will be used to assess whether regular NNS beverage intake is equivalent to a water control in promoting weight loss over 12-weeks (weekly weight loss sessions; Phase I), then supporting weight maintenance over 40-weeks (monthly sessions; Phase II) and subsequently independent weight maintenance over 52-weeks (Phase III) in 432 participants. A subset of these participants (n=116) will complete laboratory-based appetite probe days (15 sessions; 3 sessions each at baseline, at the start of phase I and the end of each phase). A separate subset (n=50) will complete body composition scans (DXA) at baseline and at the end of each phase. All participants will regularly be weighed and will complete questionnaires and cognitive tasks to assess changes in body weight and appetitive behaviours. Measures of physical activity and biochemical markers will also be taken. DISCUSSION The trial will assess the efficacy of NNS beverages compared to water during a behavioural weight loss and maintenance programme. We aim to understand whether the impact of NNS on weight, dietary adherence and well-being are beneficial or transient and effects on prolonged successful weight loss and weight maintenance through sustained changes in appetite and eating behaviour. TRIAL REGISTRATION Clinical Trials: NCT02591134; registered: 23.10.2015.
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70
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Chia CW, Shardell M, Tanaka T, Liu DD, Gravenstein KS, Simonsick EM, Egan JM, Ferrucci L. Chronic Low-Calorie Sweetener Use and Risk of Abdominal Obesity among Older Adults: A Cohort Study. PLoS One 2016; 11:e0167241. [PMID: 27880832 PMCID: PMC5120853 DOI: 10.1371/journal.pone.0167241] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/10/2016] [Indexed: 01/09/2023] Open
Abstract
Introduction Low-calorie sweetener use for weight control has come under increasing scrutiny as obesity, especially abdominal obesity, remain entrenched despite substantial low-calorie sweetener use. We evaluated whether chronic low-calorie sweetener use is a risk factor for abdominal obesity. Participants and Methods We used 8268 anthropometric measurements and 3096 food diary records with detailed information on low-calorie sweetener consumption in all food products, from 1454 participants (741 men, 713 women) in the Baltimore Longitudinal Study of Aging collected from 1984 to 2012 with median follow-up of 10 years (range: 0–28 years). At baseline, 785 were low-calorie sweetener non-users (51.7% men) and 669 participants were low-calorie sweetener users (50.1% men). Time-varying low-calorie sweetener use was operationalized as the proportion of visits since baseline at which low-calorie sweetener use was reported. We used marginal structural models to determine the association between baseline and time-varying low-calorie sweetener use with longitudinal outcomes—body mass index, waist circumference, obesity and abdominal obesity—with outcome status assessed at the visit following low-calorie sweetener ascertainment to minimize the potential for reverse causality. All models were adjusted for year of visit, age, sex, age by sex interaction, race, current smoking status, dietary intake (caffeine, fructose, protein, carbohydrate, and fat), physical activity, diabetes status, and Dietary Approaches to Stop Hypertension score as confounders. Results With median follow-up of 10 years, low-calorie sweetener users had 0.80 kg/m2 higher body mass index (95% confidence interval [CI], 0.17–1.44), 2.6 cm larger waist circumference (95% CI, 0.71–4.39), 36.7% higher prevalence (prevalence ratio = 1.37; 95% CI, 1.10–1.69) and 53% higher incidence (hazard ratio = 1.53; 95% CI 1.10–2.12) of abdominal obesity than low-calorie sweetener non-users. Conclusions Low-calorie sweetener use is independently associated with heavier relative weight, a larger waist, and a higher prevalence and incidence of abdominal obesity suggesting that low-calorie sweetener use may not be an effective means of weight control.
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Affiliation(s)
- Chee W. Chia
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Michelle Shardell
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Toshiko Tanaka
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - David D. Liu
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Kristofer S. Gravenstein
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Eleanor M. Simonsick
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Josephine M. Egan
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
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Substitution Models of Water for Other Beverages, and the Incidence of Obesity and Weight Gain in the SUN Cohort. Nutrients 2016; 8:nu8110688. [PMID: 27809239 PMCID: PMC5133076 DOI: 10.3390/nu8110688] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 12/23/2022] Open
Abstract
Obesity is a major epidemic for developed countries in the 21st century. The main cause of obesity is energy imbalance, of which contributing factors include a sedentary lifestyle, epigenetic factors and excessive caloric intake through food and beverages. A high consumption of caloric beverages, such as alcoholic or sweetened drinks, may particularly contribute to weight gain, and lower satiety has been associated with the intake of liquid instead of solid calories. Our objective was to evaluate the association between the substitution of a serving per day of water for another beverage (or group of them) and the incidence of obesity and weight change in a Mediterranean cohort, using mathematical models. We followed 15,765 adults without obesity at baseline. The intake of 17 beverage items was assessed at baseline through a validated food-frequency questionnaire. The outcomes were average change in body weight in a four-year period and new-onset obesity and their association with the substitution of one serving per day of water for one of the other beverages. During the follow-up, 873 incident cases of obesity were identified. In substitution models, the consumption of water instead of beer or sugar-sweetened soda beverages was associated with a lower obesity incidence (the Odds Ratio (OR) 0.80 (95% confidence interval (CI) 0.68 to 0.94) and OR 0.85 (95% CI 0.75 to 0.97); respectively) and, in the case of beer, it was also associated with a higher average weight loss (weight change difference = −328 g; (95% CI −566 to −89)). Thus, this study found that replacing one sugar-sweetened soda beverage or beer with one serving of water per day at baseline was related to a lower incidence of obesity and to a higher weight loss over a four-year period time in the case of beer, based on mathematical models.
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Szabo de Edelenyi F, Druesne-Pecollo N, Arnault N, González R, Buscail C, Galan P. Characteristics of Beverage Consumption Habits among a Large Sample of French Adults: Associations with Total Water and Energy Intakes. Nutrients 2016; 8:nu8100627. [PMID: 27727164 PMCID: PMC5084015 DOI: 10.3390/nu8100627] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/05/2016] [Accepted: 09/27/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Adequate hydration is a key factor for correct functioning of both cognitive and physical processes. In France, public health recommendations about adequate total water intake (TWI) only state that fluid intake should be sufficient, with particular attention paid to hydration for seniors, especially during heatwave periods. The objective of this study was to calculate the total amount of water coming from food and beverages and to analyse characteristics of consumption in participants from a large French national cohort. METHODS TWI, as well as contribution of food and beverages to TWI was assessed among 94,939 adult participants in the Nutrinet-Santé cohort (78% women, mean age 42.9 (SE 0.04)) using three 24-h dietary records at baseline. Statistical differences in water intakes across age groups, seasons and day of the week were assessed. RESULTS The mean TWI was 2.3 L (Standard Error SE 4.7) for men and 2.1 L (SE 2.4) for women. A majority of the sample did comply with the European Food Safety Authority (EFSA) adequate intake recommendation, especially women. Mean total energy intake (EI) was 1884 kcal/day (SE 1.5) (2250 kcal/day (SE 3.6) for men and 1783 kcal/day (SE 1.5) for women). The contribution to the total EI from beverages was 8.3%. Water was the most consumed beverage, followed by hot beverages. The variety score, defined as the number of different categories of beverages consumed during the three 24-h records out of a maximum of 8, was positively correlated with TWI (r = 0.4); and with EI (r = 0.2), suggesting that beverage variety is an indicator of higher consumption of food and drinks. We found differences in beverage consumptions and water intakes according to age and seasonality. CONCLUSIONS The present study gives an overview of the water intake characteristics in a large population of French adults. TWI was found to be globally in line with public health recommendations.
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Affiliation(s)
- Fabien Szabo de Edelenyi
- Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny F93017, France.
| | - Nathalie Druesne-Pecollo
- Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny F93017, France.
| | - Nathalie Arnault
- Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny F93017, France.
| | - Rebeca González
- Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny F93017, France.
| | - Camille Buscail
- Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny F93017, France.
- Public Health Department, Avicenne Hospital, Bobigny F93017, France.
| | - Pilar Galan
- Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny F93017, France.
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Appetite and energy balancing. Physiol Behav 2016; 164:465-471. [DOI: 10.1016/j.physbeh.2016.03.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/23/2016] [Accepted: 03/26/2016] [Indexed: 12/31/2022]
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Sylvetsky AC, Blau JE, Rother KI. Understanding the metabolic and health effects of low-calorie sweeteners: methodological considerations and implications for future research. Rev Endocr Metab Disord 2016; 17:187-94. [PMID: 26936185 PMCID: PMC5010791 DOI: 10.1007/s11154-016-9344-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Consumption of foods, beverages, and packets containing low-calorie sweeteners (LCS) has increased markedly across gender, age, race/ethnicity, weight status, and socio-economic subgroups. However, well-controlled intervention studies rigorously evaluating the health effects of LCS in humans are limited. One of the key questions is whether LCS are indeed a beneficial strategy for weight management and prevention of obesity. The current review discusses several methodological considerations in the design and interpretation of these studies. Specifically, we focus on the selection of study participants, inclusion of an appropriate control, importance of considering habitual LCS exposure, selection of specific LCS, dose and route of LCS administration, choice of study outcomes, and the context and generalizability of the study findings. These critical considerations will guide the design of future studies and thus assist in understanding the health effects of LCS.
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Affiliation(s)
- Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA
- Section on Pediatric Diabetes and Metabolism, NIDDK, NIH, 9000 Rockville Pike, Building 10, Room 8C432A, Bethesda, MD, 20892, USA
| | - Jenny E Blau
- Section on Pediatric Diabetes and Metabolism, NIDDK, NIH, 9000 Rockville Pike, Building 10, Room 8C432A, Bethesda, MD, 20892, USA
| | - Kristina I Rother
- Section on Pediatric Diabetes and Metabolism, NIDDK, NIH, 9000 Rockville Pike, Building 10, Room 8C432A, Bethesda, MD, 20892, USA.
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75
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Abstract
Replacing sugar-sweetened beverages with diet soft drinks containing sugar substitutes that provide few or no calories has been suggested as one strategy for promoting improved public health outcomes. However, current scientific evidence indicates that routine consumption of beverages with non-nutritive sweeteners not only fails to prevent disease, but is associated with increases in risks for the same health outcomes associated with sugar-sweetened beverages, including type 2 diabetes, cardiovascular disease, hypertension and stroke. Results from pre-clinical studies have provided plausible biological mechanisms that could promote these counterintuitive negative health effects of artificial sweeteners. Taken together, scientific studies currently indicate that public health will be improved by reducing intake of all sweeteners, both caloric and non-caloric.
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Affiliation(s)
- Susan E Swithers
- Department of Psychological Sciences Purdue University 703 Third Street West Lafayette, IN 47907
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76
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Lent MR, Vander Veur SS, Peters JC, Herring SJ, Wyatt HR, Tewksbury C, Wojtanowski AC, Hill JO, Foster GD. Initial weight loss goals: have they changed and do they matter? Obes Sci Pract 2016; 2:154-161. [PMID: 27840688 PMCID: PMC5089615 DOI: 10.1002/osp4.45] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/11/2016] [Accepted: 04/19/2016] [Indexed: 01/03/2023] Open
Abstract
Objective Nearly 20 years ago, participants in behavioural weight loss programmes reported goals that greatly exceeded the amount of weight typically produced by these programmes. Whether having unrealistic weight loss goals impacts weight loss or attrition is unclear. The intent of the current study was to revisit current weight loss goals and examine whether goals impact outcomes. Methods Adults (N = 308, BMI = 33.7 ± 4.2 kg/m2) participated in a 12‐month behavioural weight management programme and completed questionnaires about their goals. Results Participants' weight loss goal was 19.8 ± 7.9% of their body weight, and 90.4% selected a goal ≥10%. Weight goals were not associated with weight loss at 3 (p = 0.75) or 12 months (p = 0.47), or from 3 to 12 months (p = 0.55). Weight loss goals were not related to attrition at 3 (p = 0.91) or 12 months (p = 0.86). Participants believed that weight reduction would positively impact their health and psychosocial functioning. Conclusion Weight loss goals have decreased, but still greatly exceed what can be expected by most. Unrealistic goals, however, had no impact on weight loss or attrition. These results question the utility of counseling people with obesity to set more realistic weight loss goals, which is typically practiced in behavioural weight management.
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Affiliation(s)
- M R Lent
- Geisinger Obesity Institute Geisinger Health System Danville PA USA
| | | | - J C Peters
- Anschutz Health and Wellness Center University of Colorado Aurora CO USA
| | - S J Herring
- Center for Obesity Research and Education Temple University Philadelphia PA USA
| | - H R Wyatt
- Anschutz Health and Wellness Center University of Colorado Aurora CO USA
| | - C Tewksbury
- University of Pennsylvania Health System Philadelphia PA USA
| | | | - J O Hill
- Anschutz Health and Wellness Center University of Colorado Aurora CO USA
| | - G D Foster
- Weight Watchers International New York NY USA
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77
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Fowler SPG. Low-calorie sweetener use and energy balance: Results from experimental studies in animals, and large-scale prospective studies in humans. Physiol Behav 2016; 164:517-523. [PMID: 27129676 DOI: 10.1016/j.physbeh.2016.04.047] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 12/21/2022]
Abstract
For more than a decade, pioneering animal studies conducted by investigators at Purdue University have provided evidence to support a central thesis: that the uncoupling of sweet taste and caloric intake by low-calorie sweeteners (LCS) can disrupt an animal's ability to predict the metabolic consequences of sweet taste, and thereby impair the animal's ability to respond appropriately to sweet-tasting foods. These investigators' work has been replicated and extended internationally. There now exists a body of evidence, from a number of investigators, that animals chronically exposed to any of a range of LCSs - including saccharin, sucralose, acesulfame potassium, aspartame, or the combination of erythritol+aspartame - have exhibited one or more of the following conditions: increased food consumption, lower post-prandial thermogenesis, increased weight gain, greater percent body fat, decreased GLP-1 release during glucose tolerance testing, and significantly greater fasting glucose, glucose area under the curve during glucose tolerance testing, and hyperinsulinemia, compared with animals exposed to plain water or - in many cases - even to calorically-sweetened foods or liquids. Adverse impacts of LCS have appeared diminished in animals on dietary restriction, but were pronounced among males, animals genetically predisposed to obesity, and animals with diet-induced obesity. Impacts have been especially striking in animals on high-energy diets: diets high in fats and sugars, and diets which resemble a highly-processed 'Western' diet, including trans-fatty acids and monosodium glutamate. These studies have offered both support for, and biologically plausible mechanisms to explain, the results from a series of large-scale, long-term prospective observational studies conducted in humans, in which longitudinal increases in weight, abdominal adiposity, and incidence of overweight and obesity have been observed among study participants who reported using diet sodas and other LCS-sweetened beverages daily or more often at baseline. Furthermore, frequent use of diet beverages has been associated prospectively with increased long-term risk and/or hazard of a number of cardiometabolic conditions usually considered to be among the sequelae of obesity: hypertension, metabolic syndrome, diabetes, depression, kidney dysfunction, heart attack, stroke, and even cardiovascular and total mortality. Reverse causality does not appear to explain fully the increased risk observed across all of these studies, the majority of which have included key potential confounders as covariates. These have included body mass index or waist circumference at baseline; total caloric intake and specific macronutrient intake; physical activity; smoking; demographic and other relevant risk factors; and/or family history of disease. Whether non-LCS ingredients in diet beverages might have independently increased the weight gain and/or cardiometabolic risk observed among frequent consumers of LCS-sweetened beverages deserves further exploration. In the meantime, however, there is a striking congruence between results from animal research and a number of large-scale, long-term observational studies in humans, in finding significantly increased weight gain, adiposity, incidence of obesity, cardiometabolic risk, and even total mortality among individuals with chronic, daily exposure to low-calorie sweeteners - and these results are troubling.
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Affiliation(s)
- Sharon P G Fowler
- Department of Medicine, The University of Texas Health Science Center at San Antonio, Texas, United States.
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78
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Peters JC, Beck J. Low Calorie Sweetener (LCS) use and energy balance. Physiol Behav 2016; 164:524-528. [PMID: 27061939 DOI: 10.1016/j.physbeh.2016.03.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 03/19/2016] [Accepted: 03/21/2016] [Indexed: 12/30/2022]
Abstract
For thirty years there has been a debate about whether low calorie sweeteners (LCS) provide a benefit for body weight management. Early studies showed that when consumed alone in a beverage appetite and food intake were increased. Some, observational longitudinal cohort studies reported an association between LCS usage and increasing BMI, suggesting that LCS may actually promote weight gain. In the ensuing decades numerous additional observational and experimental trials have been conducted with the experimental trials nearly uniformly showing a benefit for LCS, either in weight loss or weight gain prevention. The observational trials have been more inconsistent with two recent meta-analyses indicating either a small positive association between LCS usage and BMI (weighted group mean correlation, p=0.03) or an inverse association with body weight change (-1.35 kg, p=.004). Numerous potential mechanisms have been explored, mostly in animal models, in an attempt to explain this association but none have yet been proven in humans. It is also possible that the association between LCS and BMI increase in the observational studies may be due to reverse causality or residual confounding. Randomized controlled trials are consistent in showing a benefit of LCS which suggests that simple behavioral engagement by individuals attempting to control their weight is a sufficiently strong signal to overcome any potential mechanism that might act to promote energy intake and weight gain. Based on existing evidence, LCS can be a useful tool for people actively engaged in managing their body weight for weight loss and maintenance.
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Affiliation(s)
- John C Peters
- University of Colorado, Denver, Anschutz Health and Wellness Center, USA.
| | - Jimikaye Beck
- University of Colorado, Denver, Anschutz Health and Wellness Center, USA
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79
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The use of low-calorie sweeteners is associated with self-reported prior intent to lose weight in a representative sample of US adults. Nutr Diabetes 2016; 6:e202. [PMID: 26950483 PMCID: PMC4817079 DOI: 10.1038/nutd.2016.9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/09/2016] [Accepted: 01/15/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Low-calorie sweeteners (LCSs) are said to be a risk factor for obesity and diabetes. Reverse causality may be an alternative explanation. METHODS Data on LCS use, from a single 24-h dietary recall, for a representative sample of 22 231 adults were obtained from 5 cycles of the National Health and Nutrition Examination Survey (1999-2008 NHANES). Retrospective data on intent to lose or maintain weight during the prior 12-months and 10-year weight history were obtained from the weight history questionnaire. Objectively measured heights and weights were obtained from the examination. Primary analyses evaluated the association between intent to lose/maintain weight and use of LCSs and specific LCS product types using survey-weighted generalized linear models. We further evaluated whether body mass index (BMI) may mediate the association between weight loss intent and use of LCSs. The association between 10-year weight history and current LCS use was evaluated using restricted cubic splines. RESULTS In cross-sectional analyses, LCS use was associated with a higher prevalence of obesity and diabetes. Adults who tried to lose weight during the previous 12 months were more likely to consume LCS beverages (prevalence ratio=1.64, 95% confidence interval (CI) 1.54-1.75), tabletop LCS (prevalence ratio=1.68, 95% CI 1.47-1.91) and LCS foods (prevalence ratio=1.93, 95% CI 1.60-2.33) as compared with those who did not. In mediation analyses, BMI only partially mediated the association between weight control history and the use of LCS beverages, tabletop LCS, but not LCS foods. Current LCS use was further associated with a history of prior weight change (for example, weight loss and gain). CONCLUSIONS LCS use was associated with self-reported intent to lose weight during the previous 12 months. This association was only partially mediated by differences in BMI. Any inference of causality between attempts at weight control and LCS use is tempered by the cross-sectional nature of these data and retrospective self-reports of prior weight loss/maintenance intent.
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80
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An R, McCaffrey J. Plain water consumption in relation to energy intake and diet quality among US adults, 2005-2012. J Hum Nutr Diet 2016; 29:624-32. [PMID: 26899737 DOI: 10.1111/jhn.12368] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The present study examined plain water consumption in relation to energy intake and diet quality among US adults. METHODS A nationally representative sample of 18 311 adults aged ≥18 years, from the National Health and Nutrition Examination Survey 2005-2012, was analysed. The first-difference estimator approach addressed confounding bias from time-invariant unobservables (e.g. eating habits, taste preferences) by using within-individual variations in diet and plain water consumption between two nonconsecutive 24-h dietary recalls. RESULTS One percentage point increase in the proportion of daily plain water in total dietary water consumption was associated with a reduction in mean (95% confidence interval) daily total energy intake of 8.58 (7.87-9.29) kcal, energy intake from sugar-sweetened beverages of 1.43 (1.27-1.59) kcal, energy intake from discretionary foods of 0.88 (0.44-1.32) kcal, total fat intake of 0.21 (0.17-0.25) g, saturated fat intake of 0.07 (0.06-0.09) g, sugar intake of 0.74 (0.67-0.82) g, sodium intake of 9.80 (8.20-11.39) mg and cholesterol intake of 0.88 (0.64-1.13) g. The effects of plain water intake on diet were similar across race/ethnicity, education attainment, income level and body weight status, whereas they were larger among males and young/middle-aged adults than among females and older adults, respectively. Daily overall diet quality measured by the Healthy Eating Index-2010 was not found to be associated with the proportion of daily plain water in total dietary water consumption. CONCLUSIONS Promoting plain water intake could be a useful public health strategy for reducing energy and targeted nutrient consumption in US adults, which warrants confirmation in future controlled interventions.
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Affiliation(s)
- R An
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - J McCaffrey
- Office of Extension and Outreach, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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81
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Peters JC, Beck J, Cardel M, Wyatt HR, Foster GD, Pan Z, Wojtanowski AC, Vander Veur SS, Herring SJ, Brill C, Hill JO. The effects of water and non-nutritive sweetened beverages on weight loss and weight maintenance: A randomized clinical trial. Obesity (Silver Spring) 2016; 24:297-304. [PMID: 26708700 PMCID: PMC4744961 DOI: 10.1002/oby.21327] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the effects of water versus beverages sweetened with non-nutritive sweeteners (NNS) on body weight in subjects enrolled in a year-long behavioral weight loss treatment program. METHODS The study used a randomized equivalence design with NNS or water beverages as the main factor in a trial among 303 weight-stable people with overweight and obesity. All participants participated in a weight loss program plus assignment to consume 24 ounces (710 ml) of water or NNS beverages daily for 1 year. RESULTS NNS and water treatments were non-equivalent, with NNS treatment showing greater weight loss at the end of 1 year. At 1 year subjects receiving water had maintained a 2.45 ± 5.59 kg weight loss while those receiving NNS beverages maintained a loss of 6.21 ± 7.65 kg (P < 0.001 for difference). CONCLUSIONS Water and NNS beverages were not equivalent for weight loss and maintenance during a 1-year behavioral treatment program. NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program. These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program.
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Affiliation(s)
- John C. Peters
- University of Colorado, Anschutz Medical Campus, Anschutz Health and Wellness CenterAuroraColoradoUSA
| | - Jimikaye Beck
- University of Colorado, Anschutz Medical Campus, Anschutz Health and Wellness CenterAuroraColoradoUSA
| | - Michelle Cardel
- University of FloridaDepartment of Health Outcomes and PolicyGainesvilleFloridaUSA
| | - Holly R. Wyatt
- University of Colorado, Anschutz Medical Campus, Anschutz Health and Wellness CenterAuroraColoradoUSA
| | | | - Zhaoxing Pan
- University of Colorado, Anschutz Medical Campus, Anschutz Health and Wellness CenterAuroraColoradoUSA
| | - Alexis C. Wojtanowski
- Department of MedicineTemple University, Center for Obesity Research and EducationPhiladelphiaPennsylvaniaUSA
| | | | - Sharon J. Herring
- Department of MedicineTemple University, Center for Obesity Research and EducationPhiladelphiaPennsylvaniaUSA
| | - Carrie Brill
- University of Colorado, Anschutz Medical Campus, Anschutz Health and Wellness CenterAuroraColoradoUSA
| | - James O. Hill
- University of Colorado, Anschutz Medical Campus, Anschutz Health and Wellness CenterAuroraColoradoUSA
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82
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Low Calorie Beverage Consumption Is Associated with Energy and Nutrient Intakes and Diet Quality in British Adults. Nutrients 2016; 8:nu8010009. [PMID: 26729159 PMCID: PMC4728623 DOI: 10.3390/nu8010009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 12/03/2022] Open
Abstract
It is unclear whether consumption of low-calorie beverages (LCB) leads to compensatory consumption of sweet foods, thus reducing benefits for weight control or diet quality. This analysis investigated associations between beverage consumption and energy intake and diet quality of adults in the UK National Diet and Nutrition Survey (NDNS) (2008–2011; n = 1590), classified into: (a) non-consumers of soft drinks (NC); (b) LCB consumers; (c) sugar-sweetened beverage (SSB) consumers; or (d) consumers of both beverages (BB), based on 4-day dietary records. Within-person data on beverage consumption on different days assessed the impact on energy intake. LCB consumers and NC consumed less energy and non-milk extrinsic sugars than other groups. Micronutrient intakes and food choices suggested higher dietary quality in NC/LCB consumers compared with SSB/BB consumers. Within individuals on different days, consumption of SSB, milk, juice, and alcohol were all associated with increased energy intake, while LCB and tea, coffee or water were associated with no change; or reduced energy intake when substituted for caloric beverages. Results indicate that NC and LCB consumers tend to have higher quality diets compared with SSB or BB consumers and do not compensate for sugar or energy deficits by consuming more sugary foods.
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83
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Stookey JJD. Negative, Null and Beneficial Effects of Drinking Water on Energy Intake, Energy Expenditure, Fat Oxidation and Weight Change in Randomized Trials: A Qualitative Review. Nutrients 2016; 8:nu8010019. [PMID: 26729162 PMCID: PMC4728633 DOI: 10.3390/nu8010019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/07/2015] [Accepted: 12/10/2015] [Indexed: 01/08/2023] Open
Abstract
Drinking water has heterogeneous effects on energy intake (EI), energy expenditure (EE), fat oxidation (FO) and weight change in randomized controlled trials (RCTs) involving adults and/or children. The aim of this qualitative review of RCTs was to identify conditions associated with negative, null and beneficial effects of drinking water on EI, EE, FO and weight, to generate hypotheses about ways to optimize drinking water interventions for weight management. RCT conditions that are associated with negative or null effects of drinking water on EI, EE and/or FO in the short term are associated with negative or null effects on weight over the longer term. RCT conditions that are associated with lower EI, increased EE and/or increased FO in the short term are associated with less weight gain or greater weight loss over time. Drinking water instead of caloric beverages decreases EI when food intake is ad libitum. Drinking water increases EE in metabolically-inflexible, obese individuals. Drinking water increases FO when blood carbohydrate and/or insulin concentrations are not elevated and when it is consumed instead of caloric beverages or in volumes that alter hydration status. Further research is needed to confirm the observed associations and to determine if/what specific conditions optimize drinking water interventions for weight management.
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Affiliation(s)
- Jodi J D Stookey
- Children's Hospital Oakland Research Institute, 5700 Martin Luther King Jr. Way, Oakland, CA 94609, USA.
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84
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Raynor HA, Champagne CM. Position of the Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults. J Acad Nutr Diet 2016; 116:129-147. [DOI: 10.1016/j.jand.2015.10.031] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Indexed: 02/06/2023]
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85
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Madjd A, Taylor MA, Delavari A, Malekzadeh R, Macdonald IA, Farshchi HR. Effects on weight loss in adults of replacing diet beverages with water during a hypoenergetic diet: a randomized, 24-wk clinical trial. Am J Clin Nutr 2015; 102:1305-12. [PMID: 26537940 DOI: 10.3945/ajcn.115.109397] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 09/15/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Obese people believe that drinking diet beverages (DBs) may be a simple strategy to achieve weight loss. However, nutritionists advise drinking water when attempting to lose weight. It is unclear how important drinking water instead of DBs is during a weight-loss program. OBJECTIVE In this study, we compared the effect on weight loss of either replacing DBs with water or continuing to consume DBs in adults during a 24-wk weight-loss program. DESIGN Overweight and obese women [n = 89; body mass index (BMI; in kg/m(2)): 27-40; age: 18-50 y] who usually consumed DBs in their diet were asked to either substitute water for DBs (water group) or continue drinking DBs 5 times/wk after their lunch for 24 wk (DB group) while on a weight-loss program. RESULTS Sixty-two participants (71%) completed the trial (32 in the DB group, 30 in the water group). Baseline variables were not statistically significantly different between groups. A statistically significant reduction in anthropometric measurements and statistically significant improvements in cardiometabolic risk characteristics were observed over 24 wk in both groups. Compared with the DB group, the water group had a greater decrease in weight (mean ± SD: water: -8.8 ± 1.9 kg; DBs: -7.6 ± 2.1 kg; P = 0.015, time × group), fasting insulin (mean ± SD: water: -2.84 ± 0.77 mU/L; DBs: -1.78 ± 1.25 mU/L, P < 0.001), homeostasis model assessment of insulin resistance (mean ± SD: water: -0.097 ± 0.049; DBs: -0.057 ± 0.042, P < 0.001), and 2-h postprandial glucose (mean ± SD: water: -1.02 ± 0.25 mmol/L; DBs: -0.72 ± 0.27 mmol/L; P < 0.001) over the 24 wk. However, there was no significant time × group interaction for waist circumference, fasting plasma glucose, and lipid profiles within both groups over 24 wk. CONCLUSIONS Replacement of DBs with water after the main meal may lead to greater weight reduction during a weight-loss program. It may also offer clinical benefits to improve insulin resistance. This trial was registered at www.irct.ir/ as IRCT201402177754N5.
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Affiliation(s)
- Ameneh Madjd
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom; NovinDiet Clinic, Tehran, Iran; and
| | - Moira A Taylor
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Alireza Delavari
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ian A Macdonald
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Hamid R Farshchi
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom; NovinDiet Clinic, Tehran, Iran; and
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86
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Baranowski T, Lytle L. Should the IDEFICS outcomes have been expected? Obes Rev 2015; 16 Suppl 2:162-72. [PMID: 26707025 DOI: 10.1111/obr.12359] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/27/2015] [Indexed: 01/16/2023]
Abstract
The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study evaluated with a large sample a comprehensive carefully planned obesity prevention intervention targeting multiple levels of influence that were culturally adapted to the situations in eight European countries. Despite the great effort and attention to detail, the IDEFICS study did not achieve its targeted adiposity or behaviour change objectives. Should we be surprised that the IDEFICS trial did not have its intended effects? We think not, and would have been surprised if it did. Recent research has revealed the lack of consistent meaningful relationships between several apparently obesogenic behaviours and adiposity, weak or no relationships among behavioural change procedures, mediating variables and targeted behaviours and inadequate attention to moderating effects. Future obesity prevention interventions would benefit from a more thorough understanding of the complex relationships that have been hypothesized and the interrelationships with biological factors. While systems modelling has been proposed as providing the solution, important less complex identification of new constructs, new relationships and community interventions are still needed, both to find innovative solutions and to provide input into the systems models. We should question results from cross-sectional studies and be satisfied only with longitudinal or experimental tests of relationships.
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Affiliation(s)
- T Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - L Lytle
- Department of Health Behavior, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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87
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Shrapnel W. Trends in Sugar-Sweetened Beverages: Are Public Health and the Market Aligned or in Conflict? Nutrients 2015; 7:8189-98. [PMID: 26404369 PMCID: PMC4586584 DOI: 10.3390/nu7095390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/18/2015] [Indexed: 01/04/2023] Open
Abstract
Adverse health consequences of consuming sugar-sweetened beverages are frequently cited as an example of market failure, justifying government intervention in the marketplace, usually in the form of taxation. However, declining sales of sugar-sweetened beverages in Australia and a corresponding increase in sales of drinks containing non-nutritive sweeteners, in the absence of significant government regulation, appear to reflect market forces at work. If so, the public health challenge in relation to sugar-sweetened beverages may have less to do with regulating the market and more to do with harnessing it. Contrary to assertions that consumers fail to appreciate the links between their choice of beverage and its health consequences, the health conscious consumer appears to be driving the changes taking place in the beverage market. With the capacity to meet consumer expectations for convenience and indulgence without unwanted kilojoules, drinks containing non-nutritive sweeteners enable the "small change" in health behaviour that individuals are willing to consider. Despite the low barriers involved in perpetuating the current trend of replacing sugar-sweetened beverages with drinks containing non-nutritive sweeteners, some public health advocates remain cautious about advocating this dietary change. In contrast, the barriers to taxation of sugar-sweetened beverages appear high.
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Affiliation(s)
- William Shrapnel
- Shrapnel Nutrition Consulting Pty Ltd., 790 Pinnacle Road, Orange, New South Wales 2800, Australia.
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88
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Rogers PJ, Hogenkamp PS, de Graaf C, Higgs S, Lluch A, Ness AR, Penfold C, Perry R, Putz P, Yeomans MR, Mela DJ. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Int J Obes (Lond) 2015; 40:381-94. [PMID: 26365102 PMCID: PMC4786736 DOI: 10.1038/ijo.2015.177] [Citation(s) in RCA: 234] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 08/28/2015] [Accepted: 08/28/2015] [Indexed: 02/07/2023]
Abstract
By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that LES exposure (versus sugars or unsweetened alternatives) has no effect on EI or BW, we conducted a systematic review of relevant studies in animals and humans consuming LES with ad libitum access to food energy. In 62 of 90 animal studies exposure to LES did not affect or decreased BW. Of 28 reporting increased BW, 19 compared LES with glucose exposure using a specific ‘learning' paradigm. Twelve prospective cohort studies in humans reported inconsistent associations between LES use and body mass index (−0.002 kg m−2 per year, 95% confidence interval (CI) −0.009 to 0.005). Meta-analysis of short-term randomized controlled trials (129 comparisons) showed reduced total EI for LES versus sugar-sweetened food or beverage consumption before an ad libitum meal (−94 kcal, 95% CI −122 to −66), with no difference versus water (−2 kcal, 95% CI −30 to 26). This was consistent with EI results from sustained intervention randomized controlled trials (10 comparisons). Meta-analysis of sustained intervention randomized controlled trials (4 weeks to 40 months) showed that consumption of LES versus sugar led to relatively reduced BW (nine comparisons; −1.35 kg, 95% CI –2.28 to −0.42), and a similar relative reduction in BW versus water (three comparisons; −1.24 kg, 95% CI –2.22 to −0.26). Most animal studies did not mimic LES consumption by humans, and reverse causation may influence the results of prospective cohort studies. The preponderance of evidence from all human randomized controlled trials indicates that LES do not increase EI or BW, whether compared with caloric or non-caloric (for example, water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water.
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Affiliation(s)
- P J Rogers
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - P S Hogenkamp
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - C de Graaf
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - S Higgs
- The School of Psychology, University of Birmingham, Birmingham, UK
| | - A Lluch
- Danone Research, Centre Daniel Carasso, RD, Palaiseau Cedex, France
| | - A R Ness
- National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Level 3, University Hospitals Bristol Education Centre, Bristol, UK
| | - C Penfold
- National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Level 3, University Hospitals Bristol Education Centre, Bristol, UK
| | - R Perry
- National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Level 3, University Hospitals Bristol Education Centre, Bristol, UK
| | - P Putz
- European Branch, ILSI Europe a.i.s.b.l., Brussels, Belgium
| | - M R Yeomans
- School of Psychology, University of Sussex, Brighton, UK
| | - D J Mela
- Unilever R&D Vlaardingen, Vlaardingen, the Netherlands
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89
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Parretti HM, Aveyard P, Blannin A, Clifford SJ, Coleman SJ, Roalfe A, Daley AJ. Efficacy of water preloading before main meals as a strategy for weight loss in primary care patients with obesity: RCT. Obesity (Silver Spring) 2015; 23:1785-91. [PMID: 26237305 DOI: 10.1002/oby.21167] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/29/2015] [Accepted: 05/01/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the efficacy of water preloading before meals as a weight loss strategy for adults with obesity. METHODS A two-group randomized controlled trial was conducted in Birmingham, England. Eighty-four adults with obesity were recruited from general practices. All participants were given a face-to-face weight management consultation at baseline (30 min) and a follow-up telephone consultation at 2 weeks (10 min). At baseline, participants were randomized to either drinking 500 ml of water 30 min before their main meals or an attention control group where participants were asked to imagine their stomach was full before meals. The primary outcome was weight change at 12-week follow-up. Several measures of adherence were also used, including 24 h total urine collections. RESULTS 41 participants were randomized to the intervention group and 43 to the comparator group. The water preloading group lost -1.3 kg (95% CI -2.4 to -0.1, P = 0.028) more than comparators at follow up. Adjusting for ethnicity, deprivation, age, and gender resulted in the intervention group losing -1.2 kg (95% CI -2.4 to 0.07, P = 0.063) more than the comparator. CONCLUSIONS There is preliminary evidence that water preloading before main meals leads to a moderate weight loss at follow up. ISRCTN33238158.
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Affiliation(s)
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, UK
| | - Andrew Blannin
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | - Sarah J Coleman
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Andrea Roalfe
- Primary Care Clinical Sciences, University of Birmingham, UK
| | - Amanda J Daley
- Primary Care Clinical Sciences, University of Birmingham, UK
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90
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Guelinckx I, Ferreira-Pêgo C, Moreno LA, Kavouras SA, Gandy J, Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, Ma G, Carmuega E, Babio N, Salas-Salvadó J. Intake of water and different beverages in adults across 13 countries. Eur J Nutr 2015; 54 Suppl 2:45-55. [PMID: 26072214 PMCID: PMC4473281 DOI: 10.1007/s00394-015-0952-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/03/2015] [Indexed: 02/08/2023]
Abstract
Purpose To describe the intake of water and all other fluids and to evaluate the proportion of adults exceeding the World Health Organisation (WHO) recommendations on energy intake from free sugar, solely from fluids. Methods A total of 16,276 adults (46 % men, mean age 39.8 years) were recruited in 13 countries from 3 continents. A 24-h fluid-specific record over 7 days was used for fluid assessment. Results In Spain, France, Turkey, Iran, Indonesia and China, fluid intake was characterised by a high contribution of water (47–78 %) to total fluid intake (TFI), with a mean water intake between 0.76 and 1.78 L/day, and a mean energy intake from fluids from 182 to 428 kcal/day. Between 11 and 49 % of adults exceeded the free sugar WHO recommendations, considering solely fluids. In Germany, UK, Poland and Japan, the largest contributors to TFI were hot beverages (28–50 %) and water (18–32 %). Mean energy intake from fluids ranged from 415 to 817 kcal/day, and 48–62 % of adults exceeded free sugar WHO recommendations. In Mexico, Brazil and Argentina, the contribution of juices and regular sugar beverages (28–41 %) was as important as the water contribution to TFI (17–39 %). Mean energy intake from fluids ranged 565–694 kcal/day, and 60–66 % of the adults exceeded the free sugar WHO recommendation. Conclusions The highest volumes recorded in most of the countries were for water, mean energy intake from fluids was up to 694 kcal/day, and 66 % of adults exceeded the free sugar WHO recommendation solely by fluids. Actions to create an environment in favour of water consumption and reduce sugar intake from fluids therefore are warranted. Electronic supplementary material The online version of this article (doi:10.1007/s00394-015-0952-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I Guelinckx
- Hydration and Health Department, Danone Research, Palaiseau, France
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91
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Novotny JA, Baer DJ, Khoo C, Gebauer SK, Charron CS. Cranberry juice consumption lowers markers of cardiometabolic risk, including blood pressure and circulating C-reactive protein, triglyceride, and glucose concentrations in adults. J Nutr 2015; 145:1185-93. [PMID: 25904733 DOI: 10.3945/jn.114.203190] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 03/17/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cardiometabolic risk is the risk of cardiovascular disease (CVD), diabetes, or stroke, which are leading causes of mortality and morbidity worldwide. OBJECTIVE The objective of this study was to determine the potential of low-calorie cranberry juice (LCCJ) to lower cardiometabolic risk. METHODS A double-blind, placebo-controlled, parallel-arm study was conducted with controlled diets. Thirty women and 26 men (mean baseline characteristics: 50 y; weight, 79 kg; body mass index, 28 kg/m(2)) completed an 8-wk intervention with LCCJ or a flavor/color/energy-matched placebo beverage. Twice daily volunteers consumed 240 mL of LCCJ or the placebo beverage, containing 173 or 62 mg of phenolic compounds and 6.5 or 7.5 g of total sugar per 240-mL serving, respectively. RESULTS Fasting serum triglycerides (TGs) were lower after consuming LCCJ and demonstrated a treatment × baseline interaction such that the participants with higher baseline TG concentrations were more likely to experience a larger treatment effect (1.15 ± 0.04 mmol/L vs. 1.25 ± 0.04 mmol/L, respectively; P = 0.027). Serum C-reactive protein (CRP) was lower for individuals consuming LCCJ than for individuals consuming the placebo beverage [ln transformed values of 0.522 ± 0.115 ln(mg/L) vs. 0.997 ± 0.120 ln(mg/L), P = 0.0054, respectively, and equivalent to 1.69 mg/L vs. 2.71 mg/L back-transformed]. LCCJ lowered diastolic blood pressure (BP) compared with the placebo beverage (69.2 ± 0.8 mm Hg for LCCJ vs. 71.6 ± 0.8 mm Hg for placebo; P = 0.048). Fasting plasma glucose was lower (P = 0.03) in the LCCJ group (5.32 ± 0.03 mmol/L) than in the placebo group (5.42 ± 0.03 mmol/L), and LCCJ had a beneficial effect on homeostasis model assessment of insulin resistance for participants with high baseline values (P = 0.035). CONCLUSION LCCJ can improve several risk factors of CVD in adults, including circulating TGs, CRP, and glucose, insulin resistance, and diastolic BP. This trial was registered at clinicaltrials.gov as NCT01295684.
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Affiliation(s)
- Janet A Novotny
- Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA, Beltsville, MD; and
| | - David J Baer
- Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA, Beltsville, MD; and
| | - Christina Khoo
- Ocean Spray Cranberries, Inc., Lakeville-Middleborough, MA
| | - Sarah K Gebauer
- Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA, Beltsville, MD; and
| | - Craig S Charron
- Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA, Beltsville, MD; and
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92
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Affiliation(s)
- John D. Fernstrom
- Department of Psychiatry and Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261;
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93
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Abstract
High intensity, low-energy sweeteners (LES) are used by many consumers in order to limit energy intake and possibly facilitate body weight control. These beneficial effects are often questioned in the scientific and lay media. LES are frequently accused of stimulating and/or maintaining a liking for sweetness which in turn would be deleterious for adequate body weight control. Evidence for the specific effects of LES use on appetite for sweet products will be extracted from observational studies, experimental laboratory studies, randomized controlled trials, and finally brain imaging studies. While many of the existing studies cannot identify any causal links between use of LES and appetite for sweetness, randomized trials in children and adults suggest that use of LES tends to reduce rather than increase the intake of sugar-containing foods and to facilitate, rather than impair, weight loss.
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Affiliation(s)
- France Bellisle
- Université Paris 13, Epidémiologie Nutritionnelle, Centre de Recherche en Nutrition Humaine d’Ile-de-France, U1153 INSERM, U1125 INRA, CNAM, 74 rue Marcel Cachin, 93017 Bobigny cedex, France
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94
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Antenucci RG, Hayes JE. Nonnutritive sweeteners are not supernormal stimuli. Int J Obes (Lond) 2015; 39:254-9. [PMID: 24942868 PMCID: PMC4262733 DOI: 10.1038/ijo.2014.109] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 06/04/2014] [Accepted: 06/10/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is often claimed that nonnutritive sweeteners (NNS) are 'sweeter than sugar', with the implicit implication that high-potency sweeteners are supernormal stimuli that encourage exaggerated responses. This study aimed to investigate the perceived sweetness intensity of a variety of nutritive sweeteners (sucrose, maple syrup and agave nectar) and NNS (acesulfame-K (AceK), rebaudioside A (RebA), aspartame and sucralose) in a large cohort of untrained participants using contemporary psychophysical methods. METHODS Participants (n=401 total) rated the intensity of sweet, bitter and metallic sensations for nutritive sweeteners and NNS in water using the general labeled magnitude scale. RESULTS Sigmoidal dose-response functions were observed for all stimuli except AceK. That is, sucrose follows a sigmoidal function if the data are not artifactually linearized via prior training. More critically, there is no evidence that NNS have a maximal sweetness (intensity) greater than sucrose; indeed, the maximal sweetness for AceK, RebA and sucralose were significantly lower than that for concentrated sucrose. For these sweeteners, mixture suppression due to endogenous dose-dependent bitter or metallic sensations appears to limit maximal perceived sweetness. CONCLUSIONS In terms of perceived sweetness, NNS cannot be considered supernormal stimuli. These data do not support the view that NNS hijack or overstimulate sweet receptors to produce elevated sweet sensations.
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Affiliation(s)
- Rachel G. Antenucci
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - John E. Hayes
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
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95
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Gibson S, Drewnowski A, Hill J, Raben AB, Tuorila H, Widström E. Consensus statement on benefits of low‐calorie sweeteners. NUTR BULL 2014. [DOI: 10.1111/nbu.12116] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Gibson
- Sig‐Nurture, Ltd. Guildford Surrey UK
| | - A. Drewnowski
- University of Washington Center for Obesity Research Washington, DC USA
| | - J. Hill
- Anschutz Health and Wellness Center University of Colorado Boulder CO USA
| | - A. B. Raben
- Department of Human Nutrition University of Copenhagen Denmark
| | - H. Tuorila
- Department of Food and Environmental Sciences University of Helsinki Finland
| | - E. Widström
- National Institute for Health and Welfare Helsinki Finland
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96
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Hernández-Cordero S, Barquera S, Rodríguez-Ramírez S, Villanueva-Borbolla MA, González de Cossio T, Dommarco JR, Popkin B. Substituting water for sugar-sweetened beverages reduces circulating triglycerides and the prevalence of metabolic syndrome in obese but not in overweight Mexican women in a randomized controlled trial. J Nutr 2014; 144:1742-52. [PMID: 25332472 PMCID: PMC6457091 DOI: 10.3945/jn.114.193490] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/03/2014] [Accepted: 08/08/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mexico's sugar-sweetened beverage (SSB) intake is among the highest globally. Although evidence shows that increases in SSB intake are linked with increased energy intake, weight gain, and cardiometabolic risks, few randomized clinical trials have been conducted in adults. OBJECTIVE The aim of this study was to determine if replacing SSBs with water affects plasma triglycerides (TGs) (primary outcome), weight, and other cardiometabolic factors. METHODS We selected overweight/obese (BMI ≥ 25 and <39 kg/m(2)) women (18-45 y old) reporting an SSB intake of at least 250 kcal/d living in Cuernavaca, Mexico. Women were randomly allocated to the water and education provision (WEP) group (n = 120) or the education provision (EP)-only group (n = 120). The WEP group received biweekly water deliveries, and both groups received equal monthly nutrition counseling. During nutrition counseling, the WEP group sessions included activities to encourage increased water intake, reduced SSB intake, and substitution of water for SSBs. Repeated 24-h dietary recalls, anthropometric measurements, and fasting blood samples were collected at baseline and at 3, 6, and 9 mo. The Markov-Monte Carlo method was used for multiple imputation; separate mixed-effects models tested each outcome. RESULTS An intent-to-treat (ITT) analysis indicated that the WEP group increased water intake and decreased SSB intake significantly over time, but there were no differences in plasma TG concentrations between groups at the end of the intervention (WEP at baseline: 155 ± 2.10 mg/dL; WEP at 9 mo: 149 ± 2.80 mg/dL; EP at baseline: 150 ± 1.90 mg/dL; EP at 9 mo: 161 ± 2.70 mg/dL; P for mean comparisons at 9 mo = 0.10). Secondary analyses showed significant effects on plasma TGs (change from baseline to 9 mo: WEP, -28.9 ± 7.7 mg/dL; EP, 8.5 ± 10.9 mg/dL; P = 0.03) and metabolic syndrome (MetS) prevalence at 9 mo (WEP: 18.1%; EP: 37.7%; P = 0.02) among obese participants. CONCLUSIONS Providing water and nutritional counseling was effective in increasing water intake and in partially decreasing SSB intake. We found no effect on plasma TGs, weight, and other cardiometabolic risks in the ITT analysis, although the intervention lowered plasma TGs and MetS prevalence among obese participants. Further studies are warranted. This trial was registered at http://www.clinicaltrials.gov as NCT01245010.
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Affiliation(s)
- Sonia Hernández-Cordero
- Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Simón Barquera
- Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; and
| | - Sonia Rodríguez-Ramírez
- Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; and
| | | | - Teresa González de Cossio
- Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; and
| | - Juan Rivera Dommarco
- Center of Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; and
| | - Barry Popkin
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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97
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Hill JO. What do you say when your patients ask whether low-calorie sweeteners help with weight management? Am J Clin Nutr 2014; 100:739-40. [PMID: 25080461 PMCID: PMC4135483 DOI: 10.3945/ajcn.114.094466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- James O Hill
- From the Anschutz Health and Wellness Center, University of Colorado, Aurora, CO.
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98
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Anton SD. Can non-nutritive sweeteners enhance outcomes of weight loss interventions? Obesity (Silver Spring) 2014; 22:1413-4. [PMID: 24862169 PMCID: PMC4147372 DOI: 10.1002/oby.20779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 04/13/2014] [Accepted: 04/14/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Stephen D. Anton
- Department of Aging and Geriatric Research, College of
Medicine, University of Florida, Gainesville, FL, USA
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL
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