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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: 231] [Impact Index Per Article: 25.7] [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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Rodríguez-Ramírez S, González de Cosío T, Mendez MA, Tucker KL, Méndez-Ramírez I, Hernández-Cordero S, Popkin BM. A Water and Education Provision Intervention Modifies the Diet in Overweight Mexican Women in a Randomized Controlled Trial. J Nutr 2015; 145:1892-9. [PMID: 26136584 PMCID: PMC6681834 DOI: 10.3945/jn.115.212852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is minimal information on the impact of replacing sugar-sweetened beverage (SSB) consumption with water on diet quality from randomized controlled trials. OBJECTIVE We evaluated the effect of a water intake intervention on diet quality in overweight Mexican women. METHODS Women with a body mass index ≥25 and <39, 18-45 y old, and a self-reported high intake of SSBs (≥250 kcal/d) were randomly allocated to either the water and education provision (WEP) group (n = 120) or the education provision (EP) only group (n = 120). Each group received monthly nutrition counseling, and the WEP group received biweekly water deliveries for 9 mo. Three 24-h recalls, anthropometry, and demographic information were collected at baseline, and 3, 6, and 9 mo. Energy, macronutrient, sugar, SSB, fruit and vegetable, salty snack, cake and cookie, and fast food intakes were assessed in study completers (n = 189) classified by intervention assignment and by actual water intake at every time point (low <1200 vs. high ≥1200 mL/d). RESULTS The WEP group reported greater decreases in SSB intake than the EP group (from 20.9% to 10.3% of energy/d vs. from 20.1% to 17.8%). Thirty-eight percent of the EP group and 84.3% of the WEP group reported attaining a water intake ≥1200 mL/d. Reductions in energy intake and food groups were similar across intervention groups. However, the high actual water intake group reported greater increases vs. the lower intake group in intake of fruits and vegetables (117 vs. 47 g/d), as well as larger reductions in salty snacks (4.6 vs. 0.7 g/d) and cakes and cookies (31.7 vs. 14.7 g/d). CONCLUSIONS Other than SSBs, improvements in food group intake did not differ by intervention group in overweight Mexican women. However, post hoc analyses suggested that achieving a high actual water intake was associated with additional beneficial changes in food group intake. This trial was registered at clinicaltrials.gov as NCT01245010.
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Affiliation(s)
- Sonia Rodríguez-Ramírez
- Center of Research in Nutrition and Health, National Institute of Public
Health, Cuernavaca, Morelos, Mexico
| | - Teresa González de Cosío
- Center of Research in Nutrition and Health, National Institute of Public
Health, Cuernavaca, Morelos, Mexico
| | - Michelle A Mendez
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel
Hill, NC
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, College of
Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Ignacio Méndez-Ramírez
- Department of Probability and Statistics, Institute of Research in Applied
Mathematics and Systems, National University of Mexico, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Center of Research in Nutrition and Health, National Institute of Public
Health, Cuernavaca, Morelos, Mexico
| | - Barry M Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC;
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Imamura F, O'Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, Forouhi NG. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ 2015; 351:h3576. [PMID: 26199070 PMCID: PMC4510779 DOI: 10.1136/bmj.h3576] [Citation(s) in RCA: 603] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom. DESIGN Systematic review and meta-analysis. DATA SOURCES AND ELIGIBILITY PubMed, Embase, Ovid, and Web of Knowledge for prospective studies of adults without diabetes, published until February 2014. The population attributable fraction was estimated in national surveys in the USA, 2009-10 (n = 4729 representing 189.1 million adults without diabetes) and the UK, 2008-12 (n = 1932 representing 44.7 million). SYNTHESIS METHODS Random effects meta-analysis and survey analysis for population attributable fraction associated with consumption of sugar sweetened beverages. RESULTS Prespecified information was extracted from 17 cohorts (38,253 cases/10,126,754 person years). Higher consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, by 18% per one serving/day (95% confidence interval 9% to 28%, I(2) for heterogeneity = 89%) and 13% (6% to 21%, I(2) = 79%) before and after adjustment for adiposity; for artificially sweetened beverages, 25% (18% to 33%, I(2) = 70%) and 8% (2% to 15%, I(2) = 64%); and for fruit juice, 5% (-1% to 11%, I(2) = 58%) and 7% (1% to 14%, I(2) = 51%). Potential sources of heterogeneity or bias were not evident for sugar sweetened beverages. For artificially sweetened beverages, publication bias and residual confounding were indicated. For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity = 0.008). Under specified assumptions for population attributable fraction, of 20.9 million events of type 2 diabetes predicted to occur over 10 years in the USA (absolute event rate 11.0%), 1.8 million would be attributable to consumption of sugar sweetened beverages (population attributable fraction 8.7%, 95% confidence interval 3.9% to 12.9%); and of 2.6 million events in the UK (absolute event rate 5.8%), 79,000 would be attributable to consumption of sugar sweetened beverages (population attributable fraction 3.6%, 1.7% to 5.6%). CONCLUSIONS Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showed positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes. Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes.
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Affiliation(s)
- Fumiaki Imamura
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
| | - Laura O'Connor
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
| | - Zheng Ye
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
| | - Jaakko Mursu
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Yasuaki Hayashino
- Department of Endocrinology, Tenri Hospital, Tenri City, Nara, Japan Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Sakyo-ku, Kyoto, Japan Department of Endocrinology, Tenri Hospital, Tenri City, Nara, Japan Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Sakyo-ku, Kyoto, Japan
| | | | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
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Swithers SE. Not so Sweet Revenge: Unanticipated Consequences of High-Intensity Sweeteners. THE BEHAVIOR ANALYST 2015; 38:1-17. [PMID: 27606166 PMCID: PMC4883499 DOI: 10.1007/s40614-015-0028-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
While no single factor accounts for the significant increases in overweight and obesity that have emerged during the past several decades, evidence now suggests that sugars, in general, and sugar-sweetened beverages, in particular, may be especially problematic. One response to this concern has been an explosion in the availability and use of noncaloric sweeteners as replacements for sugar. While consumers have been led to believe that such substitutes are healthy, long-term epidemiological data in a number of cohorts have documented increased risk for negative outcomes like type 2 diabetes, heart disease, and stroke among users of artificial sweeteners. Experimental data from animals has provided several plausible mechanisms that could explain this counterintuitive relationship. In particular, my research has demonstrated that artificial sweeteners appear to interfere with basic learned, predictive relations between sweet tastes and post-ingestive consequences such as the delivery of energy. By interfering with these relations, artificial sweeteners inhibit anticipatory responses that normally serve to maintain physiological homeostasis, and over the long term, this interference could result in negative health effects like those seen in the human cohort studies. These data suggest that reducing the consumption of all sweeteners is advisable to promote better health.
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Affiliation(s)
- Susan E. Swithers
- Department of Psychological Sciences, Purdue University, 703 Third Street, West Lafayette, IN 47907 USA
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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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Catenacci VA, Pan Z, Thomas JG, Ogden LG, Roberts SA, Wyatt HR, Wing RR, Hill JO. Low/no calorie sweetened beverage consumption in the National Weight Control Registry. Obesity (Silver Spring) 2014; 22:2244-51. [PMID: 25044563 PMCID: PMC4565596 DOI: 10.1002/oby.20834] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 06/20/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this cross-sectional study was to evaluate prevalence of and strategies behind low/no calorie sweetened beverage (LNCSB) consumption in successful weight loss maintainers. METHODS An online survey was administered to 434 members of the National Weight Control Registry (NWCR, individuals who have lost ≥13.6 kg and maintained weight loss for > 1 year). RESULTS While few participants (10%) consume sugar-sweetened beverages on a regular basis, 53% regularly consume LNCSB. The top five reasons for choosing LNCSB were for taste (54%), to satisfy thirst (40%), part of routine (27%), to reduce calories (22%) and to go with meals (21%). The majority who consume LNCSB (78%) felt they helped control total calorie intake. Many participants considered changing patterns of beverage consumption to be very important in weight loss (42%) and maintenance (40%). Increasing water was by far the most common strategy, followed by reducing regular calorie beverages. CONCLUSIONS Regular consumption of LNCSB is common in successful weight loss maintainers for various reasons including helping individuals to limit total energy intake. Changing beverage consumption patterns was felt to be very important for weight loss and maintenance by a substantial percentage of successful weight loss maintainers in the NWCR.
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Affiliation(s)
- Victoria A. Catenacci
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Zhaoxing Pan
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - J. Graham Thomas
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown, University, Brown University, Providence, Rhode Island, USA
| | - Lorraine G. Ogden
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan A. Roberts
- Global Scientific and Regulatory Affairs, The Coca-Cola Company, Atlanta, Georgia, USA
| | - Holly R. Wyatt
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rena R. Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown, University, Brown University, Providence, Rhode Island, USA
| | - James O. Hill
- Department of Medicine and Pediatrics, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Miller PE, Perez V. Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. Am J Clin Nutr 2014; 100:765-77. [PMID: 24944060 PMCID: PMC4135487 DOI: 10.3945/ajcn.113.082826] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Replacement of caloric sweeteners with lower- or no-calorie alternatives may facilitate weight loss or weight maintenance by helping to reduce energy intake; however, past research examining low-calorie sweeteners (LCSs) and body weight has produced mixed results. OBJECTIVE The objective was to systematically review and quantitatively evaluate randomized controlled trials (RCTs) and prospective cohort studies, separately, that examined the relation between LCSs and body weight and composition. DESIGN A systematic literature search identified 15 RCTs and 9 prospective cohort studies that examined LCSs from foods or beverages or LCSs consumed as tabletop sweeteners. Meta-analyses generated weighted mean differences in body weight and composition values between the LCS and control groups among RCTs and weighted mean correlations for LCS intake and these parameters among prospective cohort studies. RESULTS In RCTs, LCSs modestly but significantly reduced all outcomes examined, including body weight (-0.80 kg; 95% CI: -1.17, -0.43), body mass index [BMI (in kg/m²): -0.24; 95% CI: -0.41, -0.07], fat mass (-1.10 kg; 95% CI: -1.77, -0.44), and waist circumference (-0.83 cm; 95% CI: -1.29, -0.37). Among prospective cohort studies, LCS intake was not associated with body weight or fat mass, but was significantly associated with slightly higher BMI (0.03; 95% CI: 0.01, 0.06). CONCLUSIONS The current meta-analysis provides a rigorous evaluation of the scientific evidence on LCSs and body weight and composition. Findings from observational studies showed no association between LCS intake and body weight or fat mass and a small positive association with BMI; however, data from RCTs, which provide the highest quality of evidence for examining the potentially causal effects of LCS intake, indicate that substituting LCS options for their regular-calorie versions results in a modest weight loss and may be a useful dietary tool to improve compliance with weight loss or weight maintenance plans.
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Affiliation(s)
- Paige E Miller
- From the Center for Epidemiology, Biostatistics, and Computational Biology, Exponent Inc, Chicago, IL
| | - Vanessa Perez
- From the Center for Epidemiology, Biostatistics, and Computational Biology, Exponent Inc, Chicago, IL
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Abstract
PURPOSE OF REVIEW The consumption of low-calorie beverages has increased worldwide, mainly because of their combination of sweet taste without adding significant calories to the diet. However, some epidemiological studies have linked the higher consumption of low-calorie beverages with increased body weight gain. RECENT FINDINGS Although a matter of debate, this paradoxical association between low-calorie beverages and weight gain has been attributed to their effect on the enteral-brain axis. More specifically, artificial sweeteners present in low-calorie beverages could induce appetite increase, probably due to an ambiguous psychobiological signal (uncoupling sweet taste from calorie intake) that confounds the appetite's regulatory mechanisms, promoting overeating and, ultimately, leading to weight gain. However, many studies do not support this assumption, and the mechanisms underlying the interaction between low-calorie beverages and the enteral-brain axis remain to be defined. SUMMARY The understanding of the effects of low-calorie drinks on the enteral-brain axis still remains in its infancy and needs to be unveiled. The consumption of low-calorie beverages reduces the calories from that drink, but compensatory phenomena may increase energy intake, and if so must be recognized and avoided.
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Affiliation(s)
- Adaliene V M Ferreira
- aNutrition Department, Universidade Federal de Minas Gerais bInterdisciplinary Laboratory of Medical Investigation, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Peters JC, 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 during a 12-week weight loss treatment program. Obesity (Silver Spring) 2014; 22:1415-21. [PMID: 24862170 DOI: 10.1002/oby.20737] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/07/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the efficacy of non-nutritive sweetened beverages (NNS) or water for weight loss during a 12-week behavioral weight loss treatment program. METHODS An equivalence trial design with water or NNS beverages as the main factor in a prospective randomized trial among 303 men and women was employed. All participants participated in a behavioral weight loss treatment program. The results of the weight loss phase (12 weeks) of an ongoing trial (1 year) that is also evaluating the effects of these two treatments on weight loss maintenance were reported. RESULTS The two treatments were not equivalent with the NNS beverage treatment group losing significantly more weight compared to the water group (5.95 kg versus 4.09 kg; P < 0.0001) after 12 weeks. Participants in the NNS beverage group reported significantly greater reductions in subjective feelings of hunger than those in the water group during 12 weeks. CONCLUSION These results show that water is not superior to NNS beverages for weight loss during a comprehensive behavioral weight loss program.
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Affiliation(s)
- John C Peters
- Anschutz Health and Wellness Center, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Bray GA, Popkin BM. Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: health be damned! Pour on the sugar. Diabetes Care 2014; 37:950-6. [PMID: 24652725 PMCID: PMC9514031 DOI: 10.2337/dc13-2085] [Citation(s) in RCA: 259] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sugar-sweetened drinks have been associated with several health problems. In the point narrative as presented below, we provide our opinion and review of the data to date that we need to reconsider consumption of dietary sugar based on the growing concern of obesity and type 2 diabetes. In the counterpoint narrative following our contribution, Drs. Kahn and Sievenpiper provide a defense and suggest that dietary sugar is not the culprit. Data from the National Health and Nutrition Examination Survey and U.S. Department of Agriculture dietary surveys along with commercial Homescan data on household purchases were used to understand changes in sugar and fructose consumption. Meta-analyses and randomized clinical trials were used to evaluate outcomes of beverage and fructose intake. About 75% of all foods and beverages contain added sugar in a large array of forms. Consumption of soft drinks has increased fivefold since 1950. Meta-analyses suggest that consumption of sugar-sweetened beverages (SSBs) is related to the risk of diabetes, the metabolic syndrome, and cardiovascular disease. Drinking two 16-ounce SSBs per day for 6 months induced features of the metabolic syndrome and fatty liver. Randomized controlled trials in children and adults lasting 6 months to 2 years have shown that lowering the intake of soft drinks reduced weight gain. Recent studies suggest a gene-SSB potential relationship. Consumption of calorie-sweetened beverages has continued to increase and plays a role in the epidemic of obesity, the metabolic syndrome, and fatty liver disease. Reducing intake of soft drinks is associated with less weight gain.
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Piernas C, Ng SW, Popkin B. Trends in purchases and intake of foods and beverages containing caloric and low-calorie sweeteners over the last decade in the United States. Pediatr Obes 2013; 8:294-306. [PMID: 23529974 PMCID: PMC3711951 DOI: 10.1111/j.2047-6310.2013.00153.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 01/30/2013] [Accepted: 02/15/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current food databases might not capture rapidly occurring changes in the food supply, such as the increased use of caloric (CS) and low-calorie sweeteners (LCS) in products. OBJECTIVE We explored trends in purchases and intake of foods and beverages containing LCS, CS or both sweeteners over the last decade in the United States, as well as household and socioeconomic status (SES) predictors of these trends. METHODS We analyzed household purchases from Homescan 2000-2010 (n = 140 352 households; 408 458 individuals) and dietary intake from National Health And Nutrition Examination Survey (NHANES) 2003-2010 (n = 34 391 individuals). We estimated per capita purchases and intake (g or mL d(-1)) and percent of consumers of foods and beverages containing LCS, CS or both LCS + CS. We estimated change in purchases associated with SES and household composition using random-effects longitudinal models. RESULTS From 2000 to 2010, percent of households purchasing CS products decreased, whereas that for LCS and LCS + CS products increased among all types of households and particularly among those with children. African-American, Hispanic and households with children had a higher % CS beverage purchases (+9, +4 and +3%, respectively, P < 0.001) and lower % LCS beverage purchases (-12, -5 and -2%, respectively, P < 0.001). CONCLUSIONS During a period of declining purchases and consumption of CS products, we have documented an increasing trend in products that contain LCS and a previously unexplored trend in products with both LCS and CS, especially important among households with children.
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Affiliation(s)
- C. Piernas
- Department of Nutrition; Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill; NC; USA
| | - S. W. Ng
- Department of Nutrition; Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill; NC; USA
| | - B. Popkin
- Department of Nutrition; Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill; NC; USA
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