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Romo-Romo A, Aguilar-Salinas CA, López-Carrasco MG, Guillén-Pineda LE, Brito-Córdova GX, Gómez-Díaz RA, Gómez-Pérez FJ, Almeda-Valdes P. Sucralose Consumption over 2 Weeks in Healthy Subjects Does Not Modify Fasting Plasma Concentrations of Appetite-Regulating Hormones: A Randomized Clinical Trial. J Acad Nutr Diet 2020; 120:1295-1304. [PMID: 32711853 DOI: 10.1016/j.jand.2020.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The effect of nonnutritive sweeteners on appetite is controversial. Some studies have found changes in certain appetite control hormones with sucralose intake that may be through interaction with sweet taste receptors located in the intestine. OBJECTIVE The aim of this study was to evaluate whether sucralose consumption could produce changes in fasting plasma concentrations of appetite-regulating hormones, including glucagon-like peptide 1, ghrelin, peptide tyrosine tyrosine, and leptin, and secondarily in insulin resistance. DESIGN A 2-week parallel randomized clinical trial with an additional visit conducted 1 week after dosing termination. PARTICIPANTS/SETTING Sixty healthy, normal-weight individuals, without habitual consumption of nonnutritive sweeteners were recruited from July 2015 to March 2017 in Mexico City. INTERVENTION Daily sucralose consumption at 15% of the acceptable daily intake by using commercial sachets added to food. The control group followed the same protocol without an intervention. MAIN OUTCOMES MEASURED Fasting concentrations of appetite regulating hormones before and after the intervention. Fasting glucose and insulin concentrations were measured to assess insulin resistance as a secondary outcome. STATISTICAL ANALYSIS PERFORMED Basal and final concentrations were compared using Wilcoxon matched-pairs test and Mann-Whitney U test for analysis between groups. Repeated measures analysis of variance was used to evaluate changes in the homeostasis model assessment of insulin resistance. RESULTS Sucralose was not associated with changes in any of the hormones measured. One week postintervention, an incremental change (P=0.04) in the homeostasis model assessment of insulin resistance was found in the intervention group. CONCLUSIONS Sucralose intake is not associated with changes in fasting concentrations of glucagon-like peptide 1, ghrelin, peptide tyrosine tyrosine, or leptin. An increase in the homeostasis model assessment of insulin resistance observed only at 1 week postdosing is of unknown clinical significance, if any.
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102
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Moriconi E, Feraco A, Marzolla V, Infante M, Lombardo M, Fabbri A, Caprio M. Neuroendocrine and Metabolic Effects of Low-Calorie and Non-Calorie Sweeteners. Front Endocrinol (Lausanne) 2020; 11:444. [PMID: 32765425 PMCID: PMC7378387 DOI: 10.3389/fendo.2020.00444] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022] Open
Abstract
Since excessive sugar consumption has been related to the development of chronic metabolic diseases prevalent in the western world, the use of sweeteners has gradually increased worldwide over the last few years. Although low- and non-calorie sweeteners may represent a valuable tool to reduce calorie intake and prevent weight gain, studies investigating the safety and efficacy of these compounds in the short- and long-term period are scarce and controversial. Therefore, future studies will need to elucidate the potential beneficial and/or detrimental effects of different types of sweeteners on metabolic health (energy balance, appetite, body weight, cardiometabolic risk factors) in healthy subjects and patients with diabetes, obesity and metabolic syndrome. In this regard, the impact of different sweeteners on central nervous system, gut hormones and gut microbiota is important, given the strong implications that changes in such systems may have for human health. The aim of this narrative review is to summarize the current evidence for the neuroendocrine and metabolic effects of sweeteners, as well as their impact on gut microbiota. Finally, we briefly discuss the advantages of the use of sweeteners in the context of very-low calorie ketogenic diets.
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Affiliation(s)
- Eleonora Moriconi
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandra Feraco
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Vincenzo Marzolla
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Marco Infante
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Andrea Fabbri
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Massimiliano Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
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103
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Brouns F. Saccharide Characteristics and Their Potential Health Effects in Perspective. Front Nutr 2020; 7:75. [PMID: 32733909 PMCID: PMC7357269 DOI: 10.3389/fnut.2020.00075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/01/2020] [Indexed: 12/31/2022] Open
Abstract
To understand the effects of saccharides on our metabolism and health, we need a clear understanding of what they are, how they differ, and why some types are deemed "less healthy" and others "better for health." There are various ways to look at this topic. Firstly, saccharides can be classified according to their degree of polymerization (DP). This classification is useful when qualitative or quantitative analysis and calculation of intakes are required or for food-labeling definitions. However, it does not account for the fact that saccharides with a similar DP can differ in molecular composition, which will influence digestion, absorption, and metabolism. Secondly, another approach widely used in the biomedical and nutritional sciences is therefore a physiological classification, which addresses the rate and degree of digestibility and absorption, the glycemic response, and the metabolic fate. The individual health status also plays a role in this respect. An active, lean person will have a metabolic response that differs from an inactive person with overweight and insulin resistance. However, this approach will not give a complete answer either because the characteristics of the matrix/meal in which these carbohydrates (CHOs) are present will also influence the responses of our body. Thirdly, one can also rank CHOs by comparing their functional/technological properties, such as relative sweetness, viscosity, and solubility. Understanding CHO characteristics and related physiological responses will help understand health and disease implications. Therefore, a brief outline of different carbohydrate classifications is presented. This outline will be placed in the context of potential overall effects after consumption. The answer to the question whether we should we eat less of certain sugars depends on the angle from which you look at this matter; for example, do you address this question from a single molecular characteristic point of view or from a meal quality perspective? Looking at one particular CHO characteristic will almost always lead to a different conclusion (e.g., the labeling of fructose as toxic) than evaluating from a "total perspective" (fructose has adverse effects in certain conditions). Examples are given to help understand this matter for the benefit of justified dietary/food-based recommendations.
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Affiliation(s)
- Fred Brouns
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
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104
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The Importance of Sweet Beverage Definitions When Targeting Health Policies-The Case of Switzerland. Nutrients 2020; 12:nu12071976. [PMID: 32635195 PMCID: PMC7399802 DOI: 10.3390/nu12071976] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/13/2023] Open
Abstract
Since high-sweet beverage intake is associated with health risks, defining what this term encompasses is relevant to the strategies confronting this problem. This study assessed both the sociodemographic factors associated with sweet beverage consumption in Switzerland and the amount consumed. According to the current definition in Switzerland (SB–CUR), sweet beverages include soft drinks, juices with added-sugar, and low-calorie sweet beverages. Using this definition and the representative menuCH survey (n = 2057; ages 18–75), the average daily sweet beverage intake was determined and compared with a new sweet beverage definition (SB–NEW), which included all beverages with free sugars and low-calorie sweeteners. A generalized linear model was used to investigate correlates of sweet beverage consumption. Sweet beverage consumption under the SB–CUR and SB–NEW definition was 240.6 g/day and 329.7 g/day, respectively, with 100% juice consumption accounting for 66% of the difference. Carbonated drinks (sodas), low-calorie sweet beverages, and 100% juices were the highest contributors, each around 60 g/day. SB–NEW intake was higher in individuals who were male, young adults (aged 18–29), from German-speaking regions, obese, or had a lower level of education. As sweet beverage consumption was much higher under the SB–NEW definition, this could have implications for health policies aimed at reducing sugar intake.
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105
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Laviada-Molina H, Molina-Segui F, Pérez-Gaxiola G, Cuello-García C, Arjona-Villicaña R, Espinosa-Marrón A, Martinez-Portilla RJ. Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: Systematic review and meta-analysis. Obes Rev 2020; 21:e13020. [PMID: 32216045 DOI: 10.1111/obr.13020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
There is an ongoing debate about the possible influences of nonnutritive sweeteners (NNS) on body weight. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) with NNS to assess their impact on body weight. We systematically searched for RCTs at least 4 weeks in duration, evaluating the effect of NNS on body weight, both in subjects with healthy weight and in subjects with overweight/obesity at any age, and compared the effects of NNS vs caloric and noncaloric comparators. The primary outcome was the difference in body weight between NNS and comparators. Twenty studies were eligible (n = 2914). Participants consuming NNS showed significant weight/BMI differences favouring NNS compared with nonusers. Grouping by nature of comparator revealed that NNS vs placebo/no intervention and NNS vs water produced no effect. When comparing NNS vs sucrose, significant weight/BMI differences appeared favouring NNS. Consumption of NNS led to significantly negative weight/BMI differences in unrestricted energy diets, but not in weight-reduction diets. Participants with overweight/obesity and adults showed significant favourable weight/BMI differences with NNS. Data suggest that replacing sugar with NNS leads to weight reduction, particularly in participants with overweight/obesity under an unrestricted diet, information that could be utilized for evidence-based public policy decisions.
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Affiliation(s)
- Hugo Laviada-Molina
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Merida, Mérida, Mexico
| | - Fernanda Molina-Segui
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Merida, Mérida, Mexico
| | | | - Carlos Cuello-García
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ruy Arjona-Villicaña
- Endocrinology Service, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida, Mexico
| | - Alan Espinosa-Marrón
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Merida, Mérida, Mexico
| | - Raigam Jafet Martinez-Portilla
- Nuffield Department of Primary Health Sciences, Radcliffe Observatory Quarter, University of Oxford Centre for Evidence-Based Medicine, Oxford, UK
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106
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Walbolt J, Koh Y. Non-nutritive Sweeteners and Their Associations with Obesity and Type 2 Diabetes. J Obes Metab Syndr 2020; 29:114-123. [PMID: 32482914 PMCID: PMC7338497 DOI: 10.7570/jomes19079] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/18/2020] [Accepted: 04/09/2020] [Indexed: 12/25/2022] Open
Abstract
Evidence linking the excessive consumption of nutritive sweeteners (NS) to adverse metabolic health outcomes has led to an increase in consumption of non-nutritive sweeteners (NNS), particularly among the obese and individuals with diabetes. NNS are characterized by having zero-to-negligible caloric load, while also having a sweet taste. They are utilized as a replacement for traditional NS to reduce energy intake and to limit carbohydrate-related negative health outcomes. However, recent studies have suggested that NNS may actually contribute to the development or worsening of metabolic diseases, including metabolic syndrome, obesity, type 2 diabetes, and cardiovascular disease. Thus, it is imperative to understand the NNS efficacy and the relationship between NNS and metabolic diseases.
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Affiliation(s)
- Jarrett Walbolt
- Department of Health, Human Performance, and Recreation, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Yunsuk Koh
- Department of Health, Human Performance, and Recreation, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
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107
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Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Sukhareva OY, Galstyan GR, Tokmakova AY, Nikonova TV, Surkova EV, Kononenko IV, Egorova DN, Ibragimova LI, Shestakova EA, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Bondarenko IZ, Gomova IS, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Mkrtumyan AM, Petunina NA, Ruyatkina LA, Suplotova LA, Ushakova OV, Khalimov YS. Diabetes mellitus type 2 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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108
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Ashwell M, Gibson S, Bellisle F, Buttriss J, Drewnowski A, Fantino M, Gallagher AM, de Graaf K, Goscinny S, Hardman CA, Laviada-Molina H, López-García R, Magnuson B, Mellor D, Rogers PJ, Rowland I, Russell W, Sievenpiper JL, la Vecchia C. Expert consensus on low-calorie sweeteners: facts, research gaps and suggested actions. Nutr Res Rev 2020; 33:145-154. [PMID: 31928558 PMCID: PMC7282854 DOI: 10.1017/s0954422419000283] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 09/09/2019] [Accepted: 11/01/2019] [Indexed: 01/29/2023]
Abstract
A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy substitution). The available evidence suggests no grounds for concerns about adverse effects of LCS on sweet preference, appetite or glucose control; indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality and developing effective communication strategies to foster informed choice. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation.
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Affiliation(s)
| | | | | | | | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA
| | - Marc Fantino
- Fantino Consulting SAS, F-69230 Saint Genis Laval, France
| | - Alison M. Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, UK
| | - Kees de Graaf
- Division of Human Nutrition and Health, Wageningen, The Netherlands
| | - Séverine Goscinny
- Service Organic Contaminants and Additives (SCIENSANO), Brussels, Belgium
| | | | - Hugo Laviada-Molina
- Escuela de Ciencias de la Salud, Universidad Marista de Mérida, Merida, Mexico
| | | | - Berna Magnuson
- Health Science Consultants, Inc., Mississauga, Ontario, Canada
| | - Duane Mellor
- Aston Medical School, Aston University, Birmingham, UK
| | - Peter J. Rogers
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, UK
| | - Ian Rowland
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Wendy Russell
- University of Aberdeen Rowett Institute, Aberdeen, UK
| | - John L. Sievenpiper
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s, Toronto, Canada
| | - Carlo la Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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109
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Pepin A, Imbeault P. [The controversial effects of low-calorie sweeteners]. Med Sci (Paris) 2020; 36:472-478. [PMID: 32452369 DOI: 10.1051/medsci/2020079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Substantial reviews of the most recent evidence report a strong relationship between the consumption of sugar-sweetened beverages and adverse health effects, such as the prevalence of obesity and metabolic diseases. Various public policies were recently undertaken by many countries in the hope of reducing sugar-sweetened beverage consumption amongst their population. This has led the food industries to promote low-calorie sweeteners (sugar substitutes) as a healthy alternative that would limit caloric intake without compromising the sweet taste of food and beverages. However, is the use of low-calorie sweeteners as a means of limiting or reducing energy intake without consequences for our health? This review aims to discuss the effects of low-calorie sweeteners consumption on health and to elucidate whether their use should be recommended by health professionals to their patients as part of weight management.
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Affiliation(s)
- Alexandra Pepin
- Unité de recherche sur le comportement et le métabolisme, École des Sciences de l'Activité Physique, Faculté des Sciences de la Santé, Université d'Ottawa, 125 rue Université, K1N 6N5 Ottawa, Ontario, Canada
| | - Pascal Imbeault
- Unité de recherche sur le comportement et le métabolisme, École des Sciences de l'Activité Physique, Faculté des Sciences de la Santé, Université d'Ottawa, 125 rue Université, K1N 6N5 Ottawa, Ontario, Canada
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110
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Stamataki NS, Scott C, Elliott R, McKie S, Bosscher D, McLaughlin JT. Stevia Beverage Consumption prior to Lunch Reduces Appetite and Total Energy Intake without Affecting Glycemia or Attentional Bias to Food Cues: A Double-Blind Randomized Controlled Trial in Healthy Adults. J Nutr 2020; 150:1126-1134. [PMID: 32125421 DOI: 10.1093/jn/nxaa038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/21/2019] [Accepted: 02/04/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Stevia is a zero-calorie alternative to caloric sugars. Substituting caloric sweeteners with noncaloric sweeteners reduces available energy, but their effects on appetite, subsequent food intake, and neurocognitive responses are still unclear. OBJECTIVE The aim was to examine whether sweetness with or without calories influences food intake, appetite, blood glucose concentrations, and attentional bias (AB) to food cues. METHODS This was a randomized, controlled, double-blind crossover study. Healthy participants [n = 20; aged 27 ± 5 y, 55% female; BMI (kg/m2): 21.8 ± 1.5] completed 5 visits, consuming 5 study beverages: 330 mL water (control, no sweet taste, no calories) and either 330 mL water containing 40 g glucose or sucrose (sweet taste; calories, both 160 kcal), maltodextrin (no sweet taste; calories, 160 kcal), or 240 ppm stevia (sweet taste, no calories). Glucose and stevia beverages were matched for sweetness. Subjective appetite ratings and blood glucose were measured at baseline and at 15, 30, and 60 min postprandially. At 15 min participants performed a visual-dot probe task to assess AB to food cues; at 30 min, participants were offered an ad libitum lunch; food intake was measured. RESULTS Subjective appetite ratings showed that preload sweetness and calorie content both affected appetite. The total AUC for glycemia was significantly higher after the caloric beverages (mean ± SD: maltodextrin, 441 ± 57.6; glucose, 462 ± 68.1; sucrose, 425 ± 53.6 mmol × min × L-1 ) compared with both stevia (320 ± 34.2 mmol × min × L-1) and water (304 ± 32.0 mmol × min × L-1) (all P < 0.001). Total energy intake (beverage and meal) was significantly lower after the stevia beverage (727 ± 239 kcal) compared with water (832 ± 198 kcal, P = 0.013), with no significant difference between the water and caloric beverages (P = 1.00 for water vs. maltodextrin, glucose, and sucrose). However, food-related AB did not differ across conditions (P = 0.140). CONCLUSIONS This study found a beneficial and specific effect of a stevia beverage consumed prior to a meal on appetite and energy intake in healthy adults. This trial is registered at clinicaltrials.gov as NCT03711084.
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Affiliation(s)
- Nikoleta S Stamataki
- Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Corey Scott
- Cargill R&D Center North America, Minneapolis, MN, USA
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Shane McKie
- Faculty of Biology, Medicine and Health Platform Sciences, Enabling Technologies and Infrastructure, Faculty of Biology, Medicine and Health Research and Innovation, The University of Manchester, Manchester, United Kingdom
| | | | - John T McLaughlin
- Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Department of Gastroenterology, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
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111
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Mela DJ, McLaughlin J, Rogers PJ. Perspective: Standards for Research and Reporting on Low-Energy ("Artificial") Sweeteners. Adv Nutr 2020; 11:484-491. [PMID: 31925418 PMCID: PMC7231577 DOI: 10.1093/advances/nmz137] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/20/2019] [Accepted: 12/31/2019] [Indexed: 12/15/2022] Open
Abstract
Widely differing views exist among experts, policy makers, and the general public with regard to the potential risks and benefits of reduced- or low-energy sweeteners (LES) in the diet. These views are informed and influenced by different types of research in LES, with differing hypotheses, designs, interpretation, and communication. Given the high level of interest in LES, and the public health relevance of the research evidence base, it is important that all aspects of the research process are framed and reported in an appropriate and balanced manner. In this Perspective, we identify and give examples of a number of issues relating to research and reviews on LES, which may contribute toward apparent inconsistencies in the content and understanding of the totality of evidence. We conclude with a set of recommendations for authors, reviewers and journal editors, as general guidance to improve and better standardize the quality of LES research design, interpretation, and reporting. These focus on clarity of underlying hypotheses, characterization of exposures, and the placement and weighting of new research within the wider context of related prior work.
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Affiliation(s)
| | - John McLaughlin
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Peter J Rogers
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
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112
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Factors Influencing Purchase Intention for Low-Sodium and Low-Sugar Products. Foods 2020; 9:foods9030351. [PMID: 32197361 PMCID: PMC7143532 DOI: 10.3390/foods9030351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 11/18/2022] Open
Abstract
As sodium and sugar intake in South Korea exceed recommended levels, the government and food industry have been attempting to reduce the amount of sodium and sugar in the food products. In line with these efforts, this study sought to examine how the purchase intention for low-sodium/low-sugar products vary based on consumers’ previous choices of low-sodium/low-sugar products and other consumer-related factors. For this study, two online survey-based experiments were conducted: one using soy sauce to represent a sodium-based product and the other using yogurt to represent a sugar-based product. The significant variables that influenced the purchase intention for both were the consumers’ previous low-sodium/low-sugar product choices and their propensity for food neophobia. Consumers who had previously selected regular products showed a lower intention to purchase low-sodium soy sauce or low-sugar yogurt. In addition, those who had a strong tendency toward food neophobia also had a significantly lower purchase intention for these products. Moreover, the lower the consumer′s unhealthy = tasty intuition (UTI), the higher the purchase intention for the low-sodium soy sauce, but UTI did not act as a significant variable for the low-sugar yogurt. These results demonstrate that government interventions for low-sodium products and low-sugar products should be differentiated.
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113
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Dalenberg JR, Patel BP, Denis R, Veldhuizen MG, Nakamura Y, Vinke PC, Luquet S, Small DM. Short-Term Consumption of Sucralose with, but Not without, Carbohydrate Impairs Neural and Metabolic Sensitivity to Sugar in Humans. Cell Metab 2020; 31:493-502.e7. [PMID: 32130881 PMCID: PMC7784207 DOI: 10.1016/j.cmet.2020.01.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 11/07/2019] [Accepted: 01/28/2020] [Indexed: 02/08/2023]
Abstract
There is a general consensus that overconsumption of sugar-sweetened beverages contributes to the prevalence of obesity and related comorbidities such as type 2 diabetes (T2D). Whether a similar relationship exists for no- or low-calorie "diet" drinks is a subject of intensive debate and controversy. Here, we demonstrate that consuming seven sucralose-sweetened beverages with, but not without, a carbohydrate over 10 days decreases insulin sensitivity in healthy human participants, an effect that correlates with reductions in midbrain, insular, and cingulate responses to sweet, but not sour, salty, or savory, taste as assessed with fMRI. Taste perception was unaltered and consuming the carbohydrate alone had no effect. These findings indicate that consumption of sucralose in the presence of a carbohydrate rapidly impairs glucose metabolism and results in longer-term decreases in brain, but not perceptual sensitivity to sweet taste, suggesting dysregulation of gut-brain control of glucose metabolism.
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Affiliation(s)
- Jelle R Dalenberg
- Modern Diet and Physiology Research Center (MDPRC), Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Barkha P Patel
- Modern Diet and Physiology Research Center (MDPRC), Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; Division of Endocrinology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Raphael Denis
- Unite de Biologie Fonctionnelle et Adaptative, Centre National la Recherche Scientifique, Unité Mixte de Recherche 8251, Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France
| | - Maria G Veldhuizen
- Modern Diet and Physiology Research Center (MDPRC), Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Yuko Nakamura
- Modern Diet and Physiology Research Center (MDPRC), Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; The UTokyo Center for Integrative Science of Human Behavior, Tokyo, Japan
| | - Petra C Vinke
- Modern Diet and Physiology Research Center (MDPRC), Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; Department of Neuroendocrinology, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, the Netherlands
| | - Serge Luquet
- Unite de Biologie Fonctionnelle et Adaptative, Centre National la Recherche Scientifique, Unité Mixte de Recherche 8251, Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France
| | - Dana M Small
- Modern Diet and Physiology Research Center (MDPRC), Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; Department of Psychology, Yale University, New Haven, CT 06510, USA; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Otfried Müller Strasse 47, Tübingen 72076, Germany.
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114
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Forde CG, Mars M, de Graaf K. Ultra-Processing or Oral Processing? A Role for Energy Density and Eating Rate in Moderating Energy Intake from Processed Foods. Curr Dev Nutr 2020; 4:nzaa019. [PMID: 32110771 PMCID: PMC7042610 DOI: 10.1093/cdn/nzaa019] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Recent observational data and a controlled in-patient crossover feeding trial show that consumption of "ultra-processed foods" (UPFs), as defined by the NOVA classification system, is associated with higher energy intake, adiposity, and at a population level, higher prevalence of obesity. A drawback of the NOVA classification is the lack of evidence supporting a causal mechanism for why UPFs lead to overconsumption of energy. In a recent study by Hall the energy intake rate in the UPF condition (48 kcal/min) was >50% higher than in the unprocessed condition (31 kcal/min). Extensive empirical evidence has shown the impact that higher energy density has on increasing ad libitum energy intake and body weight. A significant body of research has shown that consuming foods at higher eating rates is related to higher energy intake and a higher prevalence of obesity. Energy density can be combined with eating rate to create a measure of energy intake rate (kcal/min), providing an index of a food's potential to promote increased energy intake. OBJECTIVE The current paper compared the association between measured energy intake rate and level of processing as defined by the NOVA classification. METHODS Data were pooled from 5 published studies that measured energy intake rates across a total sample of 327 foods. RESULTS We show that going from unprocessed, to processed, to UPFs that the average energy intake rate increases from 35.5 ± 4.4, to 53.7 ± 4.3, to 69.4 ± 3.1 kcal/min (P < 0.05). However, within each processing category there is wide variability in the energy intake rate. CONCLUSIONS We conclude that reported relations between UPF consumption and obesity should account for differences in energy intake rates when comparing unprocessed and ultra-processed diets. Future research requires well-controlled human feeding trials to establish the causal mechanisms for why certain UPFs can promote higher energy intake.
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Affiliation(s)
- Ciarán G Forde
- Clinical Nutrition Research Center, A*STAR Singapore Institute for Clinical Sciences, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Monica Mars
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Kees de Graaf
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
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115
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MALULY HDB, JOHNSTON C, GIGLIO ND, SCHREINER LL, ROBERTS A, ABEGAZ EG. Low- and No- Calorie Sweeteners (LNCS): critical evaluation of their safety and health risks. FOOD SCIENCE AND TECHNOLOGY 2020. [DOI: 10.1590/fst.36818] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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116
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Evidence that novel flavors unconditionally suppress weight gain in the absence of flavor-calorie associations. Learn Behav 2020; 48:351-363. [DOI: 10.3758/s13420-020-00419-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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117
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Rogers PJ, Ferriday D, Irani B, Hei Hoi JK, England CY, Bajwa KK, Gough T. Sweet satiation: Acute effects of consumption of sweet drinks on appetite for and intake of sweet and non-sweet foods. Appetite 2020; 149:104631. [PMID: 32057842 DOI: 10.1016/j.appet.2020.104631] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 01/07/2023]
Abstract
Sensory-specific satiety (SSS) describes a reduction in the pleasantness of the taste of (momentary liking) and desire to consume a food that occurs with eating, compared with the relative preservation of liking and desire for uneaten foods. We conducted three studies in healthy female and male participants to test whether SSS generalises from sweet drinks to sweet foods. Studies 1 (n = 40) and 2 (n = 64) used a two-condition cross-over design. Participants consumed non-carbonated, fruit squash drinks sweetened with low-calorie sweeteners (LCS) versus water and evaluated various food and drink samples (stimuli). Generalisation of SSS was evident across all sweet stimuli, without having an effect on non-sweet (savoury) stimuli. These SSS effects were present when measured shortly after consumption of the sweet drink, but not 2 h later. There was no evidence of a 'rebound' increase above baseline in liking or desire to consume sweet foods 2 h after the sweet drink versus water. In study 3, 51 participants consumed labelled and branded 500 ml cola and water drinks (4 conditions, cross-over design) immediately before and during ad libitum consumption of sweet and non-sweet snack foods. Compared with still water, 'diet' (LCS-sweetened) cola reduced sweet food intake, but not total ad libitum intake. Carbonated water decreased hunger and increased fullness compared with still water, without differentially affecting thirst. Energy compensation from the ad libitum snacks for consumption of sugar-containing cola averaged only 20%. Together, these results demonstrate that consumption of LCS drinks acutely decreases desire for sweet foods, which supports their use in place of sugar-sweetened drinks. Further studies on the effects of carbonation of appetite are warranted.
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Affiliation(s)
- Peter J Rogers
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.
| | - Danielle Ferriday
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK
| | - Beyrom Irani
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK
| | - Julianne Ka Hei Hoi
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK
| | - Clare Y England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| | - Kimran K Bajwa
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK
| | - Thomas Gough
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK
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118
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020; 43:S48-S65. [PMID: 31862748 DOI: 10.2337/dc20-s005] [Citation(s) in RCA: 213] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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119
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Metabolic and behavioural effects of prenatal exposure to non-nutritive sweeteners: A systematic review and meta-analysis of rodent models. Physiol Behav 2020; 213:112696. [DOI: 10.1016/j.physbeh.2019.112696] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/17/2019] [Accepted: 09/27/2019] [Indexed: 12/19/2022]
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120
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McCrickerd K, Tay PPS, Tang CS, Forde CG. Using Sensory Cues to Optimise the Satiety Value of a Reduced-Calorie Product Labelled 'Healthier Choice'. Nutrients 2019; 12:nu12010107. [PMID: 31905979 PMCID: PMC7019941 DOI: 10.3390/nu12010107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 01/09/2023] Open
Abstract
Reformulation strategies to reduce the energy density of commonly consumed foods and beverages are intended to support weight management, but expectations generated by labelling these as 'healthier' alternatives can have unintended effects on the product's sensory evaluations and consumption behaviours. We compared the impact of four different strategies for presenting a lower-calorie beverage to consumers on product perceptions, short-term appetite and energy intake. Participants (N = 112) consumed higher- (211 kcal/portion) and lower-calorie (98 kcal/portion) fixed-portion soymilks in the morning across two test days, with the lower-calorie version presented in one of four contexts varying in label information and sensory quality: (1) sensory-matched/unlabelled, (2) sensory-matched/labelled, (3) sensory-reduced (less sweet and creamy)/labelled, and (4) sensory-enhanced (sweeter and creamier)/labelled. The label was Singapore's Healthier Choice Symbol, which also highlighted that the soymilk was lower calorie. Changes in reported appetite, ad libitum lunch intake, and self-reported intake for the rest of the text day were recorded. Results indicated that total energy intake was consistently lower on the days the lower calorie beverages were consumed, regardless of how they were presented. However, the 'healthier choice' label increased hunger prior to lunch and reduced the soymilks' perceived thickness and sweetness compared to the same unlabelled version. Increasing the product's sensory intensity successfully maintained liking, experienced sensory quality and appetite. Results suggest that food companies wanting to explicitly label product reformulations could combine messages of 'lower calorie' and 'healthier choice' with appropriate taste and texture enhancements to maintain acceptance and avoid negative effects on appetite.
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Affiliation(s)
- Keri McCrickerd
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), A*STAR Research Entities and National University Health System, Singapore 117599, Singapore
- Correspondence: ; Tel.: +65-64074376
| | - Priscilla Pei Sian Tay
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), A*STAR Research Entities and National University Health System, Singapore 117599, Singapore
| | - Claudia Shuning Tang
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), A*STAR Research Entities and National University Health System, Singapore 117599, Singapore
| | - Ciarán Gerard Forde
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), A*STAR Research Entities and National University Health System, Singapore 117599, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117593, Singapore
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121
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Effects of Stevia Extract on Postprandial Glucose Response, Satiety and Energy Intake: A Three-Arm Crossover Trial. Nutrients 2019; 11:nu11123036. [PMID: 31842388 PMCID: PMC6950708 DOI: 10.3390/nu11123036] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 01/03/2023] Open
Abstract
Non-nutritive sweeteners (NNS) are suggested to lower energy intake in the diet, but they have been paradoxically involved in the epidemic of obesity and Type 2 diabetes. Stevia is the least studied sweetener. This study aims to investigate the effect of stevia on postprandial glucose levels, appetite and food intake. METHODS 30 participants (20 females/10 males; 26.1 (10.56) years; body mass index (BMI) 23.44 (3.42) Kg/m2) took part in a three-arm crossover trial where they received preloads of water, sugar (60 g) and stevia (1 g) on three different days, followed by an ad libitum pizza lunch. Breakfast was standardised. A one-day diet diary was collected on each test day. Visual analogue scales (VAS) were used to assess subjective feelings of appetite. Blood glucose samples were collected at 30-min intervals until 120 min post lunch. RESULTS Energy intake did not significantly differ between preloads for ad libitum meals (p = 0.78) and overall day (p = 0.33). VAS scores for hunger and desire to eat (DTE) were lower following stevia preload compared to water (p < 0.05). After adjusting for the sugar preload and calorie content, postprandial glucose levels did not significantly differ between interventions. CONCLUSION Stevia lowers appetite sensation and does not further increase food intake and postprandial glucose levels. It could be a useful strategy in obesity and diabetes prevention and management.
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122
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Drouin-Chartier JP, Zheng Y, Li Y, Malik V, Pan A, Bhupathiraju SN, Tobias DK, Manson JE, Willett WC, Hu FB. Changes in Consumption of Sugary Beverages and Artificially Sweetened Beverages and Subsequent Risk of Type 2 Diabetes: Results From Three Large Prospective U.S. Cohorts of Women and Men. Diabetes Care 2019; 42:2181-2189. [PMID: 31582428 PMCID: PMC6868459 DOI: 10.2337/dc19-0734] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/31/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We evaluated the associations of long-term changes in consumption of sugary beverages (including sugar-sweetened beverages and 100% fruit juices) and artificially sweetened beverages (ASBs) with subsequent risk of type 2 diabetes. RESEARCH DESIGN AND METHODS We followed up 76,531 women in the Nurses' Health Study (1986-2012), 81,597 women in the Nurses' Health Study II (1991-2013), and 34,224 men in the Health Professionals' Follow-up Study (1986-2012). Changes in beverage consumption (in 8-ounce servings/day) were calculated from food frequency questionnaires administered every 4 years. Multivariable Cox proportional regression models were used to calculate hazard ratios for diabetes associated with changes in beverage consumption. Results of the three cohorts were pooled using an inverse variance-weighted, fixed-effect meta-analysis. RESULTS During 2,783,210 person-years of follow-up, we documented 11,906 incident cases of type 2 diabetes. After adjustment for BMI and initial and changes in diet and lifestyle covariates, increasing total sugary beverage intake (including both sugar-sweetened beverages and 100% fruit juices) by >0.50 serving/day over a 4-year period was associated with a 16% (95% CI 1%, 34%) higher diabetes risk in the subsequent 4 years. Increasing ASB consumption by >0.50 serving/day was associated with 18% (2%, 36%) higher diabetes risk. Replacing one daily serving of sugary beverage with water, coffee, or tea, but not ASB, was associated with a 2-10% lower diabetes risk. CONCLUSIONS Increasing consumption of sugary beverages or ASBs was associated with a higher risk of type 2 diabetes, albeit the latter association may be affected by reverse causation and surveillance bias.
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Affiliation(s)
| | - Yan Zheng
- State Key Laboratory of Genetic Engineering, Human Phenome Institute and School of Life Sciences, Fudan University, Shanghai, China
| | - Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Vasanti Malik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shilpa N Bhupathiraju
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Deirdre K Tobias
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - JoAnn E Manson
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA .,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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123
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Hunter SR, Reister EJ, Cheon E, Mattes RD. Low Calorie Sweeteners Differ in Their Physiological Effects in Humans. Nutrients 2019; 11:E2717. [PMID: 31717525 PMCID: PMC6893706 DOI: 10.3390/nu11112717] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022] Open
Abstract
Low calorie sweeteners (LCS) are prevalent in the food supply for their primary functional property of providing sweetness with little or no energy. Though tested for safety individually, there has been extremely limited work on the efficacy of each LCS. It is commonly assumed all LCS act similarly in their behavioral and physiological effects. However, each LCS has its own chemical structure that influences its metabolism, making each LCS unique in its potential effects on body weight, energy intake, and appetite. LCS may have different behavioral and physiological effects mediated at the sweet taste receptor, in brain activation, with gut hormones, at the microbiota and on appetitive responses. Further elucidation of the unique effects of the different commercially available LCS may hold important implications for recommendations about their use for different health outcomes.
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Affiliation(s)
| | | | | | - Richard D. Mattes
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA; (S.R.H.); (E.J.R.); (E.C.)
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124
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Glendinning JI, Hart S, Lee H, Maleh J, Ortiz G, Ryu YS, Sanchez A, Shelling S, Williams N. Low-calorie sweeteners cause only limited metabolic effects in mice. Am J Physiol Regul Integr Comp Physiol 2019; 318:R70-R80. [PMID: 31693385 DOI: 10.1152/ajpregu.00245.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There are widespread concerns that low-calorie sweeteners (LCSs) cause metabolic derangement. These concerns stem in part from prior studies linking LCS consumption to impaired glucose tolerance in humans and rodents. Here, we examined this linkage in mice. In experiment 1, we provided mice with chow, water, and an LCS-sweetened solution (saccharin, sucralose, or acesulfame K) for 28 days and measured glucose tolerance and body weight across the exposure period. Exposure to the LCS solutions did not impair glucose tolerance or alter weight gain. In experiment 2, we provided mice with chow, water, and a solution containing saccharin, glucose, or a mixture of both for 28 days, and tested for metabolic changes. Exposure to the saccharin solution increased the insulinemic response of mice to the glucose challenge, and exposure to the saccharin + glucose solution increased the rate of glucose uptake during the glucose challenge. However, neither of these test solutions altered glucose tolerance, insulin sensitivity, plasma triglycerides, or percent body fat. In contrast, exposure to the glucose solution increased glucose tolerance, early insulin response, insulin sensitivity, and percent body fat. We conclude that whereas the LCS-containing solutions induced a few metabolic changes, they were modest compared with those induced by the glucose solution.
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Affiliation(s)
- John I Glendinning
- Department of Biology, Barnard College, Columbia University, New York, New York.,Department of Neuroscience and Behavior, Barnard College, Columbia University, New York, New York
| | - Stephanie Hart
- Department of Biology, Barnard College, Columbia University, New York, New York.,Institute of Human Nutrition, Columbia University, New York, New York
| | - Hyunseo Lee
- Department of Biology, Barnard College, Columbia University, New York, New York.,Department of Neuroscience and Behavior, Barnard College, Columbia University, New York, New York
| | - Jennifer Maleh
- Department of Biology, Barnard College, Columbia University, New York, New York.,Department of Neuroscience and Behavior, Barnard College, Columbia University, New York, New York
| | - Gabriella Ortiz
- Department of Biology, Barnard College, Columbia University, New York, New York.,Department of Neuroscience and Behavior, Barnard College, Columbia University, New York, New York
| | - Young Sang Ryu
- Department of Biology, Barnard College, Columbia University, New York, New York.,Institute of Human Nutrition, Columbia University, New York, New York
| | - Abdias Sanchez
- Department of Biology, Barnard College, Columbia University, New York, New York.,Department of Neuroscience and Behavior, Barnard College, Columbia University, New York, New York
| | - Sarah Shelling
- Department of Biology, Barnard College, Columbia University, New York, New York.,Department of Neuroscience and Behavior, Barnard College, Columbia University, New York, New York
| | - Niki Williams
- Department of Biology, Barnard College, Columbia University, New York, New York.,Department of Neuroscience and Behavior, Barnard College, Columbia University, New York, New York
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125
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Baker-Smith CM, de Ferranti SD, Cochran WJ. The Use of Nonnutritive Sweeteners in Children. Pediatrics 2019; 144:peds.2019-2765. [PMID: 31659005 DOI: 10.1542/peds.2019-2765] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The prevalence of nonnutritive sweeteners (NNSs) in the food supply has increased over time. Not only are more children and adolescents consuming NNSs, but they are also consuming a larger quantity of NNSs in the absence of strong scientific evidence to refute or support the safety of these agents. This policy statement from the American Academy of Pediatrics is intended to provide the pediatric provider with a review of (1) previous steps taken for approved use of NNSs, (2) existing data regarding the safety of NNS use in the general pediatric population, (3) what is known regarding the potential benefits and/or adverse effects of NNS use in children and adolescents, (4) identified gaps in existing knowledge and potential areas of future research, and (5) suggested talking points that pediatricians may use when discussing NNS use with families.
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126
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Sánchez-Delgado M, Estrada JA, Paredes-Cervantes V, Kaufer-Horwitz M, Contreras I. Changes in nutrient and calorie intake, adipose mass, triglycerides and TNF-α concentrations after non-caloric sweetener intake: A pilot study. INT J VITAM NUTR RES 2019; 91:87-98. [PMID: 31656130 DOI: 10.1024/0300-9831/a000611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Establishing the safety of non-caloric sweetener consumption in humans is a difficult task, since many contradictory results have been reported. The objective of this study was to compare the effect of frequent intake of sucrose, sucralose or steviol glycosides, on selected anthropometric, biochemical and immunological parameters in healthy, young adults. 38 individuals with normal body mass index were recruited and randomly divided into three experimental groups. After a washout week (where food with added sweeteners was restricted), each group was supplemented with sucrose (8 × 5 g packets/day), sucralose or steviol glycosides (4 × 1 g packets/day each) for 6 weeks. Selected variables were measured before and after treatment in each group and differences within and among groups were assessed. Our results showed that, compared to baseline, there was a modest but significant increase in weight (p = 0.0293) in the sucralose group, while the steviol glycosides group reduced their fat mass (p = 0.0390). No differences were observed in glycaemia; however, there was a significant increase in serum triglycerides (77.8-110.8 mg/dL) and cholesterol (162.0-172.3 mg/dL) in the sucrose group, whereas the steviol glycosides group presented lower triglycerides (104.7-92.8 mg/dL) and TNF-α concentrations (51.1-47.5 pg/mL). Comparison among groups showed differences in serum triglycerides (p = 0.0226), TNF-α (p = 0.0460) and IL-β (p = 0.0008). Our results suggest that, even in a short time span, frequent intake of steviol glycosides may have positive effects on metabolic parameters that may be relevant for human health.
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Affiliation(s)
- Marcela Sánchez-Delgado
- Laboratorio de Neuroquímica, Facultad de Medicina, Universidad Autónoma del Estado de México, México
| | - José Antonio Estrada
- Laboratorio de Neuroquímica, Facultad de Medicina, Universidad Autónoma del Estado de México, México
| | | | - Martha Kaufer-Horwitz
- Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
| | - Irazú Contreras
- Laboratorio de Neuroquímica, Facultad de Medicina, Universidad Autónoma del Estado de México, México
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Johnson RK, Lichtenstein AH, Anderson CAM, Carson JA, Després JP, Hu FB, Kris-Etherton PM, Otten JJ, Towfighi A, Wylie-Rosett J. Low-Calorie Sweetened Beverages and Cardiometabolic Health: A Science Advisory From the American Heart Association. Circulation 2019; 138:e126-e140. [PMID: 30354445 DOI: 10.1161/cir.0000000000000569] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In the United States, 32% of beverages consumed by adults and 19% of beverages consumed by children in 2007 to 2010 contained low-calorie sweeteners (LCSs). Among all foods and beverages containing LCSs, beverages represent the largest proportion of LCS consumption worldwide. The term LCS includes the 6 high-intensity sweeteners currently approved by the US Food and Drug Administration and 2 additional high-intensity sweeteners for which the US Food and Drug Administration has issued no objection letters. Because of a lack of data on specific LCSs, this advisory does not distinguish among these LCSs. Furthermore, the advisory does not address foods sweetened with LCSs. This advisory reviews evidence from observational studies and clinical trials assessing the cardiometabolic outcomes of LCS beverages. It summarizes the positions of government agencies and other health organizations on LCS beverages and identifies research needs on the effects of LCS beverages on energy balance and cardiometabolic health. The use of LCS beverages may be an effective strategy to help control energy intake and promote weight loss. Nonetheless, there is a dearth of evidence on the potential adverse effects of LCS beverages relative to potential benefits. On the basis of the available evidence, the writing group concluded that, at this time, it is prudent to advise against prolonged consumption of LCS beverages by children. (Although water is the optimal beverage choice, children with diabetes mellitus who consume a balanced diet and closely monitor their blood glucose may be able to prevent excessive glucose excursions by substituting LCS beverages for sugar-sweetened beverages [SSBs] when needed.) For adults who are habitually high consumers of SSBs, the writing group concluded that LCS beverages may be a useful replacement strategy to reduce intake of SSBs. This approach may be particularly helpful for persons who are habituated to a sweet-tasting beverage and for whom water, at least initially, is an undesirable option. Encouragingly, self-reported consumption of both SSBs and LCS beverages has been declining in the United States, suggesting that it is feasible to reduce SSB intake without necessarily substituting LCS beverages for SSBs. Thus, the use of other alternatives to SSBs, with a focus on water (plain, carbonated, and unsweetened flavored), should be encouraged.
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128
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Hashem KM, He FJ, MacGregor GA. Labelling changes in response to a tax on sugar-sweetened beverages, United Kingdom of Great Britain and Northern Ireland. Bull World Health Organ 2019; 97:818-827. [PMID: 31819290 PMCID: PMC6883278 DOI: 10.2471/blt.19.234542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/06/2019] [Accepted: 08/19/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the changes in sugar and energy labelling of carbonated sugar-sweetened soft drinks after the implementation of a tax on sugar-sweetened drinks in the United Kingdom of Great Britain and Northern Ireland. Methods We visited nine main supermarkets before (May 2014) and after (April 2018) the tax came into effect and obtained data from product packaging and nutrition information panels of carbonated sugar-sweetened soft drinks. We used the paired t-test to assess differences in sugar and energy content of the same products between 2014 and 2018. Findings We obtained data from 166 products in 2014 and 464 products in 2018, of which 83 products were the same in both years. Large variations in stated sugar content were found between the different carbonated sugar-sweetened soft drinks in both 2014 and 2018 for all products and for the 83 products. The mean sugar content of the 83 products decreased by 42% between 2014 and 2018, from 9.1 g/100 mL (standard deviation, SD: 3.3) to 5.3 g/100 mL (SD: 3.5; P < 0.001). The mean energy content decreased by 40%, from 38 kcal/100 mL (SD: 13) in 2014 to 23 kcal/100 mL (SD: 15) in 2018 (P < 0.001). Conclusion The significant decreases in the labelling of sugar and energy content of carbonated sugar-sweetened soft drinks after the levy came into effect suggest this tax has been effective. The sugar content of drinks still varied considerably in 2018, suggesting further reductions in sugar content of these drinks is possible. The levy thresholds should be reduced and the tax increased to drive further reformulation of soft drinks to reduce their sugar content.
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Affiliation(s)
- Kawther M Hashem
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, England
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129
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Hirahatake KM, Jacobs DR, Shikany JM, Jiang L, Wong ND, Steffen LM, Odegaard AO. Cumulative intake of artificially sweetened and sugar-sweetened beverages and risk of incident type 2 diabetes in young adults: the Coronary Artery Risk Development In Young Adults (CARDIA) Study. Am J Clin Nutr 2019; 110:733-741. [PMID: 31374564 PMCID: PMC6736196 DOI: 10.1093/ajcn/nqz154] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/24/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Epidemiological evidence has demonstrated a positive association between artificially sweetened beverage (ASB) and sugar-sweetened beverage (SSB) consumption and type 2 diabetes (T2D) risk. However, research informing this topic in young adults is limited. OBJECTIVE This study examined the association between ASB, SSB, and total sweetened beverage (TSB; combined ASB and SSB) consumption and T2D risk in young adults. METHODS A prospective analysis of 4719 Black and White men and women aged 18-30 y at baseline was conducted from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Each participant's beverage intake was assessed using the CARDIA Diet History at baseline and at study Years 7 and 20. Multivariable Cox proportional hazards regression models were used to examine cumulative average ASB, SSB, and TSB intakes and risk of T2D. RESULTS During the 30-y follow-up period, 680 participants developed T2D. ASB consumption was associated with a 12% greater risk of T2D per serving/day (HR 1.12, 95% CI 1.04-1.20) in a model adjusted for lifestyle factors, diet quality, and dieting behavior. Further adjustments for baseline BMI (HR 1.07, 95% CI 0.99-1.14) and weight change during follow-up (HR 1.04, 95% CI 0.97-1.12) attenuated the association. SSB and TSB consumption as continuous variables per 1 serving/day of intake were associated with 6% and 5% increased risks of T2D, respectively (HRSSB 1.06, 95% CI 1.01-1.10; HRTSB 1.05, 95% CI 1.01-1.09), in the model accounting for lifestyle factors, dieting behavior, baseline BMI, and weight change. Results were consistent when the exposures were modeled in categories of consumption and quintiles. CONCLUSIONS In young adults, long-term ASB, SSB, and TSB consumption were associated with increased risks of T2D. However, the estimates for ASB were attenuated when accounting for weight changes.
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Affiliation(s)
- Kristin M Hirahatake
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - James M Shikany
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA,Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, AL, USA
| | - Luohua Jiang
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA, USA
| | - Nathan D Wong
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA, USA,Heart Disease Prevention Program, Department of Medicine, University of California, Irvine, CA, USA
| | - Lyn M Steffen
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA, USA
| | - Andrew O Odegaard
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA, USA,Address correspondence to AOO (E-mail: )
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130
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Cavagnari BM. [Non-caloric sweeteners in pregnancy and lactation]. Rev Esp Salud Publica 2019; 93:e201908052. [PMID: 31358725 PMCID: PMC10308837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/13/2019] [Indexed: 06/10/2023] Open
Abstract
Many pregnancies have a weight gain that is higher than recommended, situation that carries several risks for the mother and her child. As a strategy to achieve a lower weight gain, the replacement of sugar-sweetened foods and beverages by those with non-caloric sweeteners could be a choice for pregnant or puerperal mothers. The objective of this article is to review the available evidence regarding the use of non-caloric sweeteners during pregnancy and lactation. Pregnancy is not a period to lose weight, so it would not be advisable to perform hypocaloric diets. However, to achieve an adequate weight gain during pregnancy, many women choose to consume food and beverages with non-caloric sweeteners. During pregnancy, the consumption of cyclamate, saccharin and crude stevia leaf should be avoided, as well as that of stevia infusions or extracts of the whole leaf. Regarding the rest of the approved non-caloric sweeteners, their consumption during pregnancy and lactation is considered to be safe, as long as they are consumed in moderation, adhering to their admissible daily intake levels. Aspartame does not reach breast milk. While saccharin, sucralose, and acesulfame-K are detectable in breast milk, their concentration is several orders of magnitude below their admissible daily intake levels.
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Affiliation(s)
- Brian M Cavagnari
- Escuela de Nutrición. Facultad de Ciencias de la Salud de la Pontificia Universidad Católica Argentina. Buenos Aires. Argentina
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131
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Machek SB, Willoughby DS. Non-nutritive Sweeteners: Implications for Consumption in Athletic Populations. Strength Cond J 2019. [DOI: 10.1519/ssc.0000000000000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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132
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Chern C, Tan SY. Energy Expenditure, Carbohydrate Oxidation and Appetitive Responses to Sucrose or Sucralose in Humans: A Pilot Study. Nutrients 2019; 11:nu11081782. [PMID: 31374985 PMCID: PMC6723924 DOI: 10.3390/nu11081782] [Citation(s) in RCA: 6] [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] [Received: 06/26/2019] [Revised: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 01/22/2023] Open
Abstract
Background: In light of obesity, replacing sugar with non-nutritive sweeteners is commonly used to reduce sugar content of food products. This study aimed to compare human energy expenditure (EE), carbohydrate oxidation and food intake after the ingestion of test foods sweetened with sucrose or a non-nutritive sweetener. Methods: This was an acute crossover feeding study that entailed consumption of three test foods: jelly sweetened with 50 g sucrose (SUCROSE), with 120 mg of sucralose only (NNS), or 120 mg sucralose but matched in carbohydrate with 50 g maltodextrin (MALT). On test days, participants arrived at the research facility after an overnight fast. Resting energy expenditure (indirect calorimeter) was measured for 30 min followed by jelly consumption. Participants’ EE and substrate oxidation were measured for 90 min subsequently. After EE assessment, participants completed a meal challenge before leaving the research facility, and recorded food intake for the remaining day. Subjective appetite ratings were assessed before and after test foods and meal challenge. Results: Eleven participants completed the study. EE was higher in SUCROSE and MALT than NNS, but not statistically significant. Carbohydrate oxidation was SUCROSE > MALT > NNS (p < 0.001). Earlier and bigger rise in carbohydrate oxidation was observed in SUCROSE than MALT, although both were carbohydrate-matched. NNS did not promote energy expenditure, carbohydrate oxidation or stimulate appetite. Conclusions: Foods sweetened with sucrose or non-nutritive sweeteners but matched in carbohydrate content have different effects on human EE and carbohydrate oxidation. Sucralose alone did not affect EE, but lower energy in the test food from sugar replacement was eventually fully compensated. Findings from this pilot study should be verified with bigger clinical studies in the future to establish clinical relevance.
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Affiliation(s)
- Christine Chern
- School of Pharmacy and Medical sciences, University of South Australia, SA 5001, Australia
| | - Sze-Yen Tan
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia.
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133
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Van Opstal AM, Hafkemeijer A, van den Berg-Huysmans AA, Hoeksma M, Mulder TPJ, Pijl H, Rombouts SARB, van der Grond J. Brain activity and connectivity changes in response to nutritive natural sugars, non-nutritive natural sugar replacements and artificial sweeteners. Nutr Neurosci 2019; 24:395-405. [PMID: 31288630 DOI: 10.1080/1028415x.2019.1639306] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The brain plays an important regulatory role in directing energy homeostasis and eating behavior. The increased ingestion of sugars and sweeteners over the last decades makes investigating the effects of these substances on the regulatory function of the brain of particular interest. We investigated whole brain functional response to the ingestion of nutrient shakes sweetened with either the nutritive natural sugars glucose and fructose, the low- nutritive natural sugar replacement allulose or the non-nutritive artificial sweetener sucralose. METHODS Twenty healthy, normal weight, adult males underwent functional MRI on four separate visits. In a double-blind randomized study setup, participants received shakes sweetened with glucose, fructose, allulose or sucralose. Resting state functional MRI was performed before and after ingestion. Changes in Blood Oxygen Level Dependent (BOLD) signal, functional network connectivity and voxel based connectivity by Eigenvector Centrality Mapping (ECM) were measured. RESULTS Glucose and fructose led to significant decreased BOLD signal in the cingulate cortex, insula and the basal ganglia. Glucose led to a significant increase in eigen vector centrality throughout the brain and a significant decrease in eigen vector centrality in the midbrain. Sucralose and allulose had no effect on BOLD signal or network connectivity but sucralose did lead to a significant increase in eigen vector centrality values in the cingulate cortex, central gyri and temporal lobe. DISCUSSION Taken together our findings show that even in a shake containing fat and protein, the type of sweetener can affect brain responses and might thus affect reward and satiety responses and feeding behavior. The sweet taste without the corresponding energy content of the non-nutritive sweeteners appeared to have only small effects on the brain. Indicating that the while ingestion of nutritive sugars could have a strong effect on feeding behavior, both in a satiety aspect as well as rewarding aspects, non-nutritive sweeteners appear to not have these effects. TRIAL REGISTRATION This study is registered at clinicaltrials.gov under number NCT02745730.
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Affiliation(s)
- Anna M Van Opstal
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne Hafkemeijer
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
| | | | - Marco Hoeksma
- Unilever Research & Development, Vlaardingen, The Netherlands
| | - Theo P J Mulder
- Unilever Research & Development, Vlaardingen, The Netherlands
| | - Hanno Pijl
- Department of Internal Medicine, Leiden University Medical Center, Section Endocrinology, Leiden, The Netherlands
| | - Serge A R B Rombouts
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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134
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Fernandes AC, Rieger DK, Proença RPC. Perspective: Public Health Nutrition Policies Should Focus on Healthy Eating, Not on Calorie Counting, Even to Decrease Obesity. Adv Nutr 2019; 10:549-556. [PMID: 31305908 PMCID: PMC6628875 DOI: 10.1093/advances/nmz025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/07/2018] [Accepted: 02/19/2019] [Indexed: 02/06/2023] Open
Abstract
Calorie-focused policies, such as calorie menu labeling, seem to result in minor shifts toward healthier choices and public health improvement. This paper discusses the (lack of) relations between energy intake and healthy eating and the rationale for shifting the focus of public health nutrition policies to healthier foods and meals. We argue that the benefits of reducing caloric intake from low-quality foods might not result from the calorie reduction but rather from the reduced consumption of low-quality foods. It is better to consume a given number of calories from high-quality foods than a smaller number of calories from low-quality foods. It is not possible to choose a healthy diet solely based on the caloric value of foods because calories are not equal; they differ in nutritional quality according to their source. Foods are more than just a collection of calories and nutrients, and nutrients interact differently when presented as foods. Different subtypes of a macronutrient, although they have the same caloric value, are metabolized and influence health in different ways. For instance, industrial trans fats increase lipogenesis and the risk of heart diseases, whereas monounsaturated fats have the opposite effect. Food processing and cooking methods also influence the nutritional value of foods. Thus, public health nutrition policies should stop encouraging people to focus mainly on calorie counting to fight noncommunicable diseases. Instead, policies should focus on ingredients, dietary sources, and food processing and cooking methods.
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Affiliation(s)
- Ana C Fernandes
- Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição),Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições, NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil,Address correspondence to ACF (e-mail: )
| | - Débora K Rieger
- Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição)
| | - Rossana P C Proença
- Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição),Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições, NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
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135
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Hinkle SN, Rawal S, Bjerregaard AA, Halldorsson TI, Li M, Ley SH, Wu J, Zhu Y, Chen L, Liu A, Grunnet LG, Rahman ML, Kampmann FB, Mills JL, Olsen SF, Zhang C. A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk. Am J Clin Nutr 2019; 110:221-232. [PMID: 31172169 PMCID: PMC6599744 DOI: 10.1093/ajcn/nqz094] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Artificially sweetened beverages (ASBs) are commonly consumed and recommended for individuals at high risk for cardiometabolic diseases; however, the health effects of ASBs remain contradictory. Given that cross-sectional analyses are subject to reverse causation, prospective studies with long-term follow-up are needed to evaluate associations between ASBs and cardiometabolic health, especially among high-risk individuals. OBJECTIVE The aim of this study was to examine associations of ASB intake and cardiometabolic health among high-risk women with prior gestational diabetes mellitus (GDM). METHODS We included 607 women with GDM from the Danish National Birth Cohort (DNBC; 1996-2002) who completed a clinical exam 9-16 y after the DNBC pregnancy for the Diabetes & Women's Health (DWH) Study (2012-2014). We assessed ASB intake using FFQs completed during the DNBC pregnancy and at the DWH Study clinical exam. We examined cardiometabolic outcomes at the DWH clinical exam. We estimated percentage differences in continuous cardiometabolic markers and RRs for clinical endpoints in association with ASB intake both during pregnancy and at follow-up adjusted for prepregnancy BMI, diet, and lifestyle factors. Sensitivity analyses to account for reverse causation were performed. RESULTS In pregnancy and at follow-up, 30.4% and 36.4% of women regularly (≥2 servings/wk) consumed ASB, respectively. Consumption of ASBs, both during pregnancy and at follow-up, was associated with higher glycated hemoglobin (HbA1c), insulin, HOMA-IR, triglycerides, liver fat, and adiposity and with lower HDL at follow-up. After adjustment for covariates, particularly prepregnancy BMI, the majority of associations between ASB intake in pregnancy and outcomes at follow-up became null with the exception of HbA1c. ASB intake at follow-up (≥1 serving/d compared with <1 serving/mo) was associated with higher HbA1c (6.5%; 95% CI: 1.9, 11.3; P-trend = 0.007); however, associations were not upheld in sensitivity analyses for reverse causation. CONCLUSIONS Among Danish women with a history of GDM, ASB intake was not significantly associated with cardiometabolic profiles.
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Affiliation(s)
| | - Shristi Rawal
- Department of Nutritional Sciences, School of Health Professions, Rutgers University, Newark, NJ
| | - Anne Ahrendt Bjerregaard
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Thor I Halldorsson
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Sylvia H Ley
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Aiyi Liu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Louise Groth Grunnet
- Department of Endocrinology, Diabetes and Bone-Metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | | | - Freja Bach Kampmann
- Department of Endocrinology, Diabetes and Bone-Metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense, Denmark
- Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | - Sjurdur F Olsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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136
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A Single 48 mg Sucralose Sip Unbalances Monocyte Subpopulations and Stimulates Insulin Secretion in Healthy Young Adults. J Immunol Res 2019; 2019:6105059. [PMID: 31183389 PMCID: PMC6512026 DOI: 10.1155/2019/6105059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/25/2019] [Accepted: 03/14/2019] [Indexed: 12/17/2022] Open
Abstract
Sucralose is a noncaloric artificial sweetener that is widely consumed worldwide and has been associated with alteration in glucose and insulin homeostasis. Unbalance in monocyte subpopulations expressing CD11c and CD206 hallmarks metabolic dysfunction but has not yet been studied in response to sucralose. Our goal was to examine the effect of a single sucralose sip on serum insulin and blood glucose and the percentages of classical, intermediate, and nonclassical monocytes in healthy young adults subjected to an oral glucose tolerance test (OGTT). This study was a randomized, placebo-controlled clinical trial. Volunteers randomly received 60 mL water as placebo (n = 20) or 48 mg sucralose dissolved in 60 mL water (n = 25), fifteen minutes prior to an OGTT. Blood samples were individually drawn every 15 minutes for 180 minutes for quantifying glucose and insulin concentrations. Monocyte subsets expressing CD11c and CD206 were measured at -15 and 180 minutes by flow cytometry. As compared to controls, volunteers receiving sucralose exhibited significant increases in serum insulin at 30, 45, and 180 minutes, whereas blood glucose values showed no significant differences. Sucralose consumption caused a significant 7% increase in classical monocytes and 63% decrease in nonclassical monocytes with respect to placebo controls. Pearson's correlation models revealed a strong association of insulin with sucralose-induced monocyte subpopulation unbalance whereas glucose values did not show significant correlations. Sucralose ingestion decreased CD11c expression in all monocyte subsets and reduced CD206 expression in nonclassical monocytes suggesting that sucralose does not only unbalance monocyte subpopulations but also alter their expression pattern of cell surface molecules. This work demonstrates for the first time that a 48 mg sucralose sip increases serum insulin and unbalances monocyte subpopulations expressing CD11c and CD206 in noninsulin-resistant healthy young adults subjected to an OGTT. The apparently innocuous consumption of sucralose should be reexamined in light of these results.
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137
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Pyrogianni V, La Vecchia C. Letter by Pyrogianni and La Vecchia Regarding Article, “Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women’s Health Initiative”. Stroke 2019; 50:e169. [DOI: 10.1161/strokeaha.119.025555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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138
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Sylvetsky AC, Hiedacavage A, Shah N, Pokorney P, Baldauf S, Merrigan K, Smith V, Long MW, Black R, Robien K, Avena N, Gaine C, Greenberg D, Wootan MG, Talegawkar S, Colon‐Ramos U, Leahy M, Ohmes A, Mennella JA, Sacheck J, Dietz WH. From biology to behavior: a cross-disciplinary seminar series surrounding added sugar and low-calorie sweetener consumption. Obes Sci Pract 2019; 5:203-219. [PMID: 31275594 PMCID: PMC6587329 DOI: 10.1002/osp4.334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION This report presents a synopsis of a three-part, cross-sector, seminar series held at the George Washington University (GWU) in Washington, DC from February-April, 2018. The overarching goal of the seminar series was to provide a neutral forum for diverse stakeholders to discuss and critically evaluate approaches to address added sugar intake, with a key focus on the role of low-calorie sweeteners (LCS). METHODS During three seminars, twelve speakers from academic institutions, federal agencies, non-profit organizations, and the food and beverage industries participated in six interactive panel discussions to address: 1) Do Farm Bill Policies Impact Population Sugar Intake? 2) What is the Impact of Sugar-sweetened Beverage (SSB) Taxes on Health and Business? 3) Is Sugar Addictive? 4) Product Reformulation Efforts: Progress, Challenges, and Concerns? 5) Low-calorie Sweeteners: Helpful or Harmful, and 6) Are Novel Sweeteners a Plausible Solution? Discussion of each topic involved brief 15-minute presentations from the speakers, which were followed by a 25-minute panel discussion moderated by GWU faculty members and addressed questions generated by the audience. Sessions were designed to represent opposing views and stimulate meaningful debate. Given the provocative nature of the seminar series, attendee questions were gathered anonymously using Pigeonhole™, an interactive, online, question and answer platform. RESULTS This report summarizes each presentation and recapitulates key perspectives offered by the speakers and moderators. CONCLUSIONS The seminar series set the foundation for robust cross-sector dialogue necessary to inform meaningful future research, and ultimately, effective policies for lowering added sugar intakes.
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Affiliation(s)
- A. C. Sylvetsky
- Milken Institute School of Public HealthThe George Washington University
| | - A. Hiedacavage
- Milken Institute School of Public HealthThe George Washington University
| | - N. Shah
- Milken Institute School of Public HealthThe George Washington University
| | - P. Pokorney
- Milken Institute School of Public HealthThe George Washington University
| | - S. Baldauf
- Milken Institute School of Public HealthThe George Washington University
| | - K. Merrigan
- Milken Institute School of Public HealthThe George Washington University
- Swette Center for Sustainable Food SystemsArizona State University
| | - V. Smith
- Department of Agricultural EconomicsMontana State University
| | - M. W. Long
- Milken Institute School of Public HealthThe George Washington University
| | - R. Black
- Quadrant D Consulting, LLCTufts University Friedman School of Nutrition Science & Policy
| | - K. Robien
- Milken Institute School of Public HealthThe George Washington University
| | - N. Avena
- Department of NeuroscienceMount Sinai School of Medicine
- Department of PsychologyPrinceton University
| | | | - D. Greenberg
- PepsiCo Inc. (Current affiliation NutriSci Inc.)
| | | | - S. Talegawkar
- Milken Institute School of Public HealthThe George Washington University
| | - U. Colon‐Ramos
- Milken Institute School of Public HealthThe George Washington University
| | - M. Leahy
- Food, Nutrition & Policy Solutions LLC
| | | | | | - J. Sacheck
- Milken Institute School of Public HealthThe George Washington University
| | - W. H. Dietz
- Milken Institute School of Public HealthThe George Washington University
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139
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Higgins KA, Mattes RD. A randomized controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesity. Am J Clin Nutr 2019; 109:1288-1301. [PMID: 30997499 DOI: 10.1093/ajcn/nqy381] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/11/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Low-calorie sweeteners (LCSs) provide sweetness with little or no energy. However, each LCS's unique chemical structure has potential to elicit different sensory, physiological, and behavioral responses that affect body weight. OBJECTIVE The purpose of this trial was to compare the effects of consumption of 4 LCSs and sucrose on body weight, ingestive behaviors, and glucose tolerance over a 12-wk intervention in adults (18-60 y old) with overweight or obesity (body mass index 25-40 kg/m2). METHODS In a parallel-arm design, 154 participants were randomly assigned to consume 1.25-1.75 L of beverage sweetened with sucrose (n = 39), aspartame (n = 30), saccharin (n = 29), sucralose (n = 28), or rebaudioside A (rebA) (n = 28) daily for 12 wk. The beverages contained 400-560 kcal/d (sucrose treatments) or <5 kcal/d (LCS treatments). Anthropometric indexes, energy intake, energy expenditure, appetite, and glucose tolerance were measured at baseline. Body weight was measured every 2 wk with energy intake, expenditure, and appetite assessed every 4 wk. Twenty-four-hour urine collections were completed every 4 wk to determine study compliance via para-aminobenzoic acid excretion. RESULTS Of the participants enrolled in the trial, 123 completed the 12-wk intervention. Sucrose and saccharin consumption led to increased body weight across the 12-wk intervention (Δweight = +1.85 ± 0.36 kg and +1.18 ± 0.36 kg, respectively; P ≤ 0.02) and did not differ from each other. There was no significant change in body weight with consumption of the other LCS treatments compared with baseline, but change in body weight for sucralose was negative and significantly lower compared with all other LCSs at week 12 (weight difference ≥ 1.37 ± 0.52 kg, P ≤ 0.008). Energy intake decreased with sucralose consumption (P = 0.02) and ingestive frequency was lower for sucralose than for saccharin (P = 0.045). Glucose tolerance was not significantly affected by any of the sweetener treatments. CONCLUSIONS Sucrose and saccharin consumption significantly increase body weight compared with aspartame, rebA, and sucralose, whereas weight change was directionally negative and lower for sucralose compared with saccharin, aspartame, and rebA consumption. LCSs should be categorized as distinct entities because of their differing effects on body weight. This trial was registered at clinicaltrials.gov as NCT02928653.
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Affiliation(s)
- Kelly A Higgins
- Departments of Food Science and Nutrition Science, Purdue University, West Lafayette, IN
| | - Richard D Mattes
- Departments of Nutrition Science, Purdue University, West Lafayette, IN
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140
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Ferrar J, Griggs RL, Stuijfzand BG, Rogers PJ. Food portion size influences accompanying beverage selection in adults. Appetite 2019; 136:103-113. [PMID: 30685316 DOI: 10.1016/j.appet.2019.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 11/30/2022]
Abstract
When trying to reduce food portion size, it is important that meal satisfaction is, as far as possible, preserved. Otherwise, individuals may select accompaniments to the meal (e.g., snacks, beverages) to achieve satisfaction and, in doing so, negate any benefit of the original portion size reduction. This study investigated whether varying portion sizes of food would influence choice of accompanying beverages. That is, when presented with a food portion size that is smaller or larger than their ideal, an individual may compensate by choosing a beverage based on its satiating and/or orosensory properties to balance the expected satiation and satisfaction of a meal. Data from an online interactive study (n = 93) was analysed using multilevel ordinal logistic regression models. Food portion size (100, 300, 500, 700, or 900 kcal) predicted beverage choice (water, low-energy sweetened beverage, high-energy sweetened beverage). For example, the sweetened beverages were more likely to be selected with small food portion sizes (p < .001). Participant ideal food portion size did not interact with this relationship. Participants appear to have recognised that sweetened beverages provide flavour and/or energy, and used them to compensate for a smaller meal. While switching to a low-energy beverage with an increased food portion size is advantageous for energy balance, choosing a high-energy beverage with a decreased food portion size is likely to be detrimental for those attempting to reduce energy intake and body weight.
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Affiliation(s)
- Jennifer Ferrar
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom.
| | - Rebecca L Griggs
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom
| | - Bobby G Stuijfzand
- Jean Golding Institute for Data-Intensive Research, University of Bristol, Royal Fort House, Bristol, BS8 1UH, United Kingdom
| | - Peter J Rogers
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, United Kingdom
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141
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Malik VS, Li Y, Pan A, De Koning L, Schernhammer E, Willett WC, Hu FB. Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation 2019; 139:2113-2125. [DOI: 10.1161/circulationaha.118.037401] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Vasanti S. Malik
- Departments of Nutrition (V.S.M., Y.L., W.C.W., F.B.H.), Harvard T.H. School of Public Health, Boston, MA
| | - Yanping Li
- Departments of Nutrition (V.S.M., Y.L., W.C.W., F.B.H.), Harvard T.H. School of Public Health, Boston, MA
| | - An Pan
- Department of Epidemiology and Biostatistics, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (A.P.)
| | - Lawrence De Koning
- Departments of Pathology and Laboratory Medicine, Community Health Sciences and Pediatrics, University of Calgary, Alberta, Canada (L.D.K.)
| | - Eva Schernhammer
- Epidemiology (E.S., W.C.W., F.B.H.), Harvard T.H. School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (E.S., W.C.W., F.B.H.)
| | - Walter C. Willett
- Departments of Nutrition (V.S.M., Y.L., W.C.W., F.B.H.), Harvard T.H. School of Public Health, Boston, MA
- Epidemiology (E.S., W.C.W., F.B.H.), Harvard T.H. School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (E.S., W.C.W., F.B.H.)
| | - Frank B. Hu
- Departments of Nutrition (V.S.M., Y.L., W.C.W., F.B.H.), Harvard T.H. School of Public Health, Boston, MA
- Epidemiology (E.S., W.C.W., F.B.H.), Harvard T.H. School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (E.S., W.C.W., F.B.H.)
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142
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Biomarker approaches to assessing intakes and health impacts of sweeteners: challenges and opportunities. Proc Nutr Soc 2019; 78:463-472. [PMID: 31023397 DOI: 10.1017/s0029665119000594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The term 'sweeteners' encompasses both nutritive and non-nutritive sweeteners, which when added to food/beverages, can enhance the flavour and other functional properties of food/beverage products. This review considers how dietary biomarker approaches may enhance current understanding of nutritive sweetener (namely free sugars) and non-nutritive or low-energy sweetener (LES) intakes and how these may impact health. Recent public health strategies to reduce free sugar consumption will help contribute to challenging sugar intake targets. Robust evaluation is needed to determine the effectiveness of these approaches to reducing free sugar consumption. LES provides a sweet taste without the addition of appreciable energy and can help maintain the palatability of reformulated products. All LES undergo rigorous safety evaluations prior to approval for use. Whilst intervention data suggest LES can be beneficial for health (relating to weight status and glycaemic control), debate persists on their use and findings from population-based research are mixed, in part because of potential contributing factors such as reverse causality. Additionally, assessments often consider only certain sources of LES (e.g. LES-beverages) and/or LES as a homogeneous group despite differing biological fates, thus not adequately capturing intakes of individual LES or allowing for reliable estimation of overall intakes. Urinary biomarker approaches developed/investigated for sweetener consumption have the potential to overcome existing limitations of dietary data by providing more objective intake data, thereby enhancing population-based research. In conclusion, such biomarker approaches to the concomitant study of free sugars and LES intakes are timely and represent interesting developments in an area of significant public health interest.
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143
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Sylvetsky AC, Figueroa J, Rother KI, Goran MI, Welsh JA. Trends in Low-Calorie Sweetener Consumption Among Pregnant Women in the United States. Curr Dev Nutr 2019; 3:nzz004. [PMID: 30931427 PMCID: PMC6435448 DOI: 10.1093/cdn/nzz004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/29/2018] [Accepted: 12/04/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Minimizing consumption of added sugars is recommended to prevent excessive weight gain among pregnant women. A common approach to lowering sugar intake is the use of low-calorie sweeteners (LCSs), yet little is known about LCS use during pregnancy or its effects on infant weight and health. OBJECTIVE The aim of the study was to investigate temporal trends in LCS consumption by source (foods, beverages, or packets) among pregnant women in the United States from 1999 to 2014 and to compare recent LCS consumption patterns across sociodemographic subgroups and product categories. METHODS Data were collected from pregnant women aged 20-39 y (n = 1,265) who participated in the NHANES from 1999-2000 through 2013-2014. Prevalence of LCS consumption was assessed using two 24-h dietary recalls. Analytical procedures for complex survey design were used, and sampling weights were applied to estimate national prevalence of LCS use. Rao-Scott modified chi-square tests were used to compare consumption prevalence across sociodemographic subgroups, and logistic regression was used to examine trends in LCS use over time. RESULTS The prevalence of LCS consumption among pregnant women increased by approximately 50% rising from 16.2% in 1999-2004 to 24.0% in 2007-2014, P = 0.04, with the highest prevalence observed in 2005-2006 (38.4%). This trend was driven predominantly by increases in LCS beverage use (9.9% in 1999-2004 compared with 18.3% in 2007-2014, P = 0.02). Prevalence of LCS consumption was highest among non-Hispanic white women and increased with education and income. No differences were observed based on prepregnancy weight status or trimester of pregnancy. CONCLUSIONS Approximately one-quarter of pregnant women in the United States reported consumption of LCS during at least 1 of 2 dietary recalls. Given the widespread LCS consumption during pregnancy, research to elucidate potential effects of early life LCS exposure on taste preferences, weight trajectory, and risk of later metabolic disease is needed.
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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, Washington, DC
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Emory University, Atlanta, GA
| | - Kristina I Rother
- Section on Pediatric Diabetes and Metabolism, NIDDK, National Institutes of Health, Bethesda, MD
| | - Michael I Goran
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jean A Welsh
- Department of Pediatrics, Emory University School of Medicine, Emory University, Atlanta, GA
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144
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van Opstal A, Kaal I, van den Berg-Huysmans A, Hoeksma M, Blonk C, Pijl H, Rombouts S, van der Grond J. Dietary sugars and non-caloric sweeteners elicit different homeostatic and hedonic responses in the brain. Nutrition 2019; 60:80-86. [DOI: 10.1016/j.nut.2018.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/10/2018] [Accepted: 09/10/2018] [Indexed: 01/16/2023]
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145
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Visek AJ, Blake EF, Otterbein M, Chandran A, Sylvetsky AC. SWEET MAPS: A Conceptualization of Low-Calorie Sweetener Consumption Among Young Adults. Curr Dev Nutr 2019; 3:nzy103. [PMID: 30937422 PMCID: PMC6437264 DOI: 10.1093/cdn/nzy103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/13/2018] [Accepted: 12/21/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The extent to which low-calorie sweeteners (LCSs) are helpful or harmful for weight management and metabolic health is unclear, because LCS effects may depend on the context in which they are consumed. OBJECTIVE To develop a conceptual framework for LCS consumption. METHODS Young adults ages 18-35 y, who reported LCS consumption, were recruited from a private, urban, university in the mid-Atlantic United States. Concept mapping, a mixed-method approach was used to identify, organize, and quantify determinants of LCS consumption. First, participants (n = 68) identified reasons for their LCS consumption through brainstorming; content analysis of those reasons identified 37 specific determinants of LCS consumption. Second, participants (n = 93) sorted all 37 determinants conceptually. Third, participants (n = 97) rated the extent to which each of the 37 determinants was reflective of their own consumption. Similarity matrices, multidimensional scaling, and hierarchical cluster analysis produced a series of 2-dimensional concept maps (SWEET MAPS). RESULTS The SWEET MAPS identified 37 determinants, organized within 8 factors reflective of 3 overarching motives: perceived health benefits, palatability, and accessibility of LCSs. At the determinant level, the most highly rated determinants that exceeded the boundary (rating >3.0) were: "I want something that tastes sweet," "I am trying to maintain/control my weight," "They contain fewer calories," "They are available," and "I want to save calories because I am eating a high-calorie meal." CONCLUSIONS LCS consumption is a function of many inter-related determinants spanning biological, psychological, and social domains. The SWEET MAPS are an important and novel use of concept mapping methods that can be used to inform the design and interpretation of future studies evaluating LCS effects.
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Affiliation(s)
- Amanda J Visek
- Department of Exercise and Nutrition Sciences, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC 20052
| | - Emily F Blake
- Department of Exercise and Nutrition Sciences, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC 20052
| | - Melissa Otterbein
- Department of Exercise and Nutrition Sciences, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC 20052
| | - Avinash Chandran
- Department of Exercise and Nutrition Sciences, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC 20052
- Matthew Gfeller Sport-Related TBI Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, 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
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146
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Maloney NG, Christiansen P, Harrold JA, Halford JCG, Hardman CA. Do low-calorie sweetened beverages help to control food cravings? Two experimental studies. Physiol Behav 2019; 208:112500. [PMID: 30902635 DOI: 10.1016/j.physbeh.2019.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/26/2019] [Accepted: 03/18/2019] [Indexed: 12/31/2022]
Abstract
Low-calorie sweetened (LCS) beverages may help consumers to satisfy hedonic food cravings without violating dieting goals, however this remains unexplored. The present research investigated the effect of priming hedonic eating motivations on ad libitum energy intake in frequent and non-consumers of LCS beverages. It was hypothesised that energy intake would be greater after the hedonic eating prime relative to a control prime in non-consumers, but that frequent LCS beverage consumers would be protected from this effect. In Study 1 (N = 120), frequent and non-consumers were exposed to either chocolate or neutral cues (craving vs. control condition) and then completed a beverage-related visual probe task with concurrent eye-tracking. Ad libitum energy intake from sweet and savoury snacks and beverages (including LCS) was then assessed. Study 2 followed a similar protocol, but included only frequent consumers (N = 172) and manipulated the availability of LCS beverages in the ad libitum eating context (available vs. unavailable). Measures of guilt and perceived behavioural control were also included. In Study 1, as hypothesised, non-consumers showed greater energy intake in the craving condition relative to the control condition, but frequent consumers had similar energy intake in both conditions. Frequent consumers (but not non-consumers) also demonstrated an attentional bias for LCS beverage stimuli compared to both sugar and water stimuli. In contrast, in Study 2 frequent consumers showed greater energy intake in the craving condition relative to the control condition; however, overall energy intake was significantly greater when LCS beverages were unavailable compared to when they were available. Ratings of guilt were higher and perceived control was lower in the LCS-unavailable condition relative to the LCS-available condition. Conclusions: LCS beverages did not consistently protect consumers from craving-induced increases in energy intake. However, frequent consumers consumed fewer calories overall when LCS beverages were available (relative to unavailable), as well as perceiving more control over their food intake and feeling less guilty.
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Affiliation(s)
- Niamh G Maloney
- Department of Psychological Sciences, University of Liverpool, UK.
| | | | - Joanne A Harrold
- Department of Psychological Sciences, University of Liverpool, UK
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147
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Abstract
PURPOSE OF REVIEW Adopting an addiction perspective on eating disorders and obesity may have practical implications for diagnostic classification, prevention, and treatment of these disorders. The present article critically examines these implications derived from the food addiction concept. RECENT FINDINGS Introducing food addiction as a new disorder in diagnostic classification system seems redundant as most individuals with an addiction-like eating behavior are already covered by established eating disorder diagnoses. Food addiction may be a useful metaphor in the treatment of binge eating, but would be inappropriate for the majority of obese individuals. Implying an addiction to certain foods is not necessary when applying certain approaches inspired by the addiction field for prevention and treatment of obesity. The usefulness of abstinence models in the treatment of eating disorders and obesity needs to be rigorously tested in future studies. Some practical implications derived from the food addiction concept provide promising avenues for future research (e.g., using an addiction framework in the treatment of binge eating or applying abstinence models). For others, however, the necessity of implying an addiction to some foods needs to be scrutinized.
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Affiliation(s)
- Adrian Meule
- Department of Psychology, University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria.
- Center for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.
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148
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Ratliff JC, Riedt CS, Fulgoni VL. Consumption of low-calorie sweetened beverages and water is associated with lower intake of carbohydrates and sugars and not associated with glycemic response in U.S. non-diabetic adolescents: Results from the 2001-2014 National Health and Nutrition Examination Surveys. Nutrition 2019; 67-68S:100003. [PMID: 34332713 DOI: 10.1016/j.nutx.2019.100003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/03/2019] [Accepted: 06/23/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Consumption of no- and low-calorie sweetened beverages (LCSBs) in the United States appears to be on the rise. To our knowledge, the relationships between LCSB consumption and dietary intake and metabolic outcomes in adolescents have not been thoroughly investigated. The aim of this study was to evaluate possible associations between LCSB and water consumption with nutrient intake and prediabetes criteria among adolescents who were free of diabetes. METHODS This cross-sectional study evaluated possible associations between LCSB consumption and water consumption using a 24-h diet recall from the National Health and Nutrition Examination Survey (NHANES) 2001-2014 in 8868 adolescents 12 to 18 y of age who were free of diabetes. RESULTS Compared with consuming <1 serving/d, consuming ≥1 serving/d of either LCSB or water was significantly associated with lower consumption of carbohydrates (LCSB: -22 g; water: -15 g), total sugars (LCSB: -29 g; water: -20 g), and added sugars (LCSB: -5.7 tsp eq; water: -6 tsp eq). Neither LCSB nor water intake were associated with any measures of glycemic response. CONCLUSIONS These findings suggest that consuming ≥1 serving/d of either LCSB or water is not associated with an increased risk for prediabetes. Confirmation of these findings with a larger sample within the context of a randomized clinical trial would further suggest that LCSBs may represent an additional beverage option other than water for adolescents to help moderate overall dietary sugar intake.
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149
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Scapin T, Fernandes AC, dos Anjos A, Proença RPDC. Use of added sugars in packaged foods sold in Brazil. Public Health Nutr 2018; 21:3328-3334. [PMID: 30157986 PMCID: PMC10261071 DOI: 10.1017/s1368980018002148] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 06/27/2018] [Accepted: 07/31/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Studies have shown that the consumption of added sugars may be associated with harmful health effects. The present study investigated the presence and types of added sugars in packaged foods. DESIGN Cross-sectional analysis of the presence and types of added sugars in the ingredients lists of packaged foods sold in a major Brazilian supermarket. The nomenclature of ingredients classified as added sugars and their frequency were identified. Data were organised and analysed through descriptive statistics: absolute and relative frequencies of the presence of added sugars categorised by food groups were calculated, and ingredients were analysed by text mining using R statistical environment. SETTING A supermarket in Florianópolis, a metropolis in southern Brazil. SUBJECTS Packaged food products (n 4539) classified into eight groups. RESULTS Of the 4539 products, 71 % had some type of added sugar. The group with the highest frequency of added sugars was 'products in which carbohydrates and fats are the main energy source' (93 %). Food groups containing predominantly salty foods had a high frequency of added sugars, such as 'meats and eggs' (61 %). In total, 179 different terms for added sugars were identified, of which sugar, maltodextrin and glucose syrup were the most frequent. CONCLUSIONS Most of the packaged foods sold in Brazil contain added sugars, which may hamper adherence to the recommendation of limiting added sugars intake. The data may be useful for monitoring tendencies in the use of added sugars in packaged foods and as supplementary information to support the improvement of food label regulations.
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Affiliation(s)
- Tailane Scapin
- Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição – PPGN) and Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições – NUPPRE), Federal University of Santa Catarina (Universidade Federal de Santa Catarina – UFSC), Health Sciences Centre, Reitor João David Ferreira Lima Campus, Florianópolis– SC, 88040-900, Brazil
| | - Ana Carolina Fernandes
- Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição – PPGN) and Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições – NUPPRE), Federal University of Santa Catarina (Universidade Federal de Santa Catarina – UFSC), Health Sciences Centre, Reitor João David Ferreira Lima Campus, Florianópolis– SC, 88040-900, Brazil
- Department of Nutrition (Departamento de Nutrição), Federal University of Santa Catarina (Universidade Federal de Santa Catarina – UFSC), Health Sciences Centre, Florianópolis, SC, Brazil
| | - Adilson dos Anjos
- Department of Statistics (Departamento de Estatística), Federal University of Paraná (Universidade Federal do Paraná – UFPR), Curitiba, PR, Brazil
| | - Rossana Pacheco da Costa Proença
- Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição – PPGN) and Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições – NUPPRE), Federal University of Santa Catarina (Universidade Federal de Santa Catarina – UFSC), Health Sciences Centre, Reitor João David Ferreira Lima Campus, Florianópolis– SC, 88040-900, Brazil
- Department of Nutrition (Departamento de Nutrição), Federal University of Santa Catarina (Universidade Federal de Santa Catarina – UFSC), Health Sciences Centre, Florianópolis, SC, Brazil
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