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Otero-Losada M, Cao G, González J, Muller A, Ottaviano G, Lillig C, Capani F, Ambrosio G, Milei J. Functional and morphological changes in endocrine pancreas following cola drink consumption in rats. PLoS One 2015; 10:e0118700. [PMID: 25790473 PMCID: PMC4366068 DOI: 10.1371/journal.pone.0118700] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 01/22/2015] [Indexed: 12/26/2022] Open
Abstract
Aim We report the effects of long-term cola beverage drinking on glucose homeostasis, endocrine pancreas function and morphology in rats. Methods Wistar rats drank: water (group W), regular cola beverage (group C, sucrose sweetened) or “light” cola beverage (group L, artificially sweetened). After 6 months, 50% of the animals in each group were euthanized and the remaining animals consumed water for the next 6 months when euthanasia was performed. Biochemical assays, insulinemia determination, estimation of insulin resistance (HOMA-IR), morphometry and immunohistochemistry evaluations were performed in pancreas. Results Hyperglycemia (16%, p<0.05), CoQ10 (coenzyme-Q10) decrease (−52%,p<0.01), strong hypertriglyceridemia (2.8-fold, p<0.01), hyperinsulinemia (2.4 fold, p<0.005) and HOMA-IR increase (2.7 fold, p<0.01) were observed in C. Group C showed a decrease in number of α cells (−42%, p<0.01) and β cells (−58%, p<0.001) and a moderate increase in α cells’ size after wash-out (+14%, p<0.001). Group L showed reduction in β cells’ size (−9%, p<0.001) and only after wash-out (L12) a 19% increase in size (p<0.0001) with 35% decrease in number of α cells (p<0.01). Groups C and L showed increase in α/β-cell ratio which was irreversible only in C (α/β = +38% in C6,+30% in C12, p<0.001vs.W6). Regular cola induced a striking increase in the cytoplasmic expression of Trx1 (Thioredoxin-1) (2.25-fold in C6 vs. W6; 2.7-fold in C12 vs. W12, p<0.0001) and Prx2 (Peroxiredoxin-2) (3-fold in C6 vs. W6; 2-fold in C12 vs. W12, p<0.0001). Light cola induced increase in Trx1 (3-fold) and Prx2 (2-fold) after wash-out (p<0.0001, L12 vs. W12). Conclusion Glucotoxicity may contribute to the loss of β cell function with depletion of insulin content. Oxidative stress, suggested by increased expression of thioredoxins and low circulating levels of CoQ10, may follow sustained hyperglycemia. A likely similar panorama may result from the effects of artificially sweetened cola though via other downstream routes.
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Affiliation(s)
- Matilde Otero-Losada
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
- * E-mail:
| | - Gabriel Cao
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
| | - Julián González
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
| | - Angélica Muller
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
| | - Graciela Ottaviano
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
| | - Christopher Lillig
- Institut für Biochemie und Molekularbiologie, Universitätsmedizin Greifswald KdöR, Ernst Moritz Arndt Universität, Greifswald, Germany
| | - Francisco Capani
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
| | - Giuseppe Ambrosio
- Università di Perugia, Cardiologia e Fisiopatologia Cardiovascolare, Perugia, Italy
| | - José Milei
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, ININCA.UBA.CONICET, Buenos Aires, Argentina
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Simopoulos AP. The impact of the Bellagio Report on healthy agriculture, healthy nutrition, healthy people: scientific and policy aspects and the International Network of Centers for Genetics, Nutrition and Fitness for Health. JOURNAL OF NUTRIGENETICS AND NUTRIGENOMICS 2015; 7:191-211. [PMID: 25766457 DOI: 10.1159/000375495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 01/24/2015] [Indexed: 11/19/2022]
Abstract
The Bellagio Report on Healthy Agriculture, Healthy Nutrition, Healthy People was the result of a meeting held at the Rockefeller Foundation Bellagio Center in the fall of 2012. The meeting was science based but policy oriented. The Bellagio Report concluded that: (1) sugar consumption, especially in the form of high-energy fructose in soft drinks, poses a major and insidious health threat, particularly for children; (2) current diets in most populations, albeit with regional differences, are deficient in omega-3 fatty acids but too high in omega-6 fatty acid intake, and (3) not all calories are the same since calories from different sources (i.e. glucose or fructose or omega-6 or omega-3 fatty acids) have different metabolic and neurohormonal effects. This paper summarizes the scientific progress and policy actions that have occurred in these three areas. Genetic variation in populations and gene-nutrient interactions are fundamental concepts that need to be taken into consideration in growth and development and in the prevention and management of chronic noncommunicable diseases since there is enormous variation in both the frequency of genetic variants and dietary composition worldwide. Furthermore, this paper updates the Bellagio Report in terms of the scientific and policy aspects, both of which have expanded over the past 2 years, and describes the progress made in establishing an International Network of Centers for Genetics, Nutrition and Fitness for Health.
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153
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Gibbons H, McNulty BA, Nugent AP, Walton J, Flynn A, Gibney MJ, Brennan L. A metabolomics approach to the identification of biomarkers of sugar-sweetened beverage intake. Am J Clin Nutr 2015; 101:471-7. [PMID: 25733631 DOI: 10.3945/ajcn.114.095604] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The association between sugar-sweetened beverages (SSBs) and health risks remains controversial. To clarify proposed links, reliable and accurate dietary assessment methods of food intakes are essential. OBJECTIVE The aim of this present work was to use a metabolomics approach to identify a panel of urinary biomarkers indicative of SSB consumption from a national food consumption survey and subsequently validate this panel in an acute intervention study. DESIGN Heat map analysis was performed to identify correlations between ¹H nuclear magnetic resonance (NMR) spectral regions and SSB intakes in participants of the National Adult Nutrition Survey (n = 565). Metabolites were identified and receiver operating characteristic (ROC) analysis was performed to assess sensitivity and specificity of biomarkers. The panel of biomarkers was validated in an acute study (n = 10). A fasting first-void urine sample and postprandial samples (2, 4, 6 h) were collected after SSB consumption. After NMR spectroscopic profiling of the urine samples, multivariate data analysis was applied. RESULTS A panel of 4 biomarkers-formate, citrulline, taurine, and isocitrate-were identified as markers of SSB intake. This panel of biomarkers had an area under the curve of 0.8 for ROC analysis and a sensitivity and specificity of 0.7 and 0.8, respectively. All 4 biomarkers were identified in the SSB sample. After acute consumption of an SSB drink, all 4 metabolites increased in the urine. CONCLUSIONS The present metabolomics-based strategy proved to be successful in the identification of SSB biomarkers. Future work will ascertain how to translate this panel of markers for use in nutrition epidemiology.
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Affiliation(s)
- Helena Gibbons
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Breige A McNulty
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Anne P Nugent
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Janette Walton
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Albert Flynn
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Michael J Gibney
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
| | - Lorraine Brennan
- From the Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland (HG, BAM, APN, MJG, and LB), and the School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland (JW and AF)
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154
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Affiliation(s)
- R. Miller
- British Nutrition Foundation; London UK
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155
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Gunes A, Ozmen O, Saygın M, Ascı H, Tok L, Tok O, Dıncoglu D. Lens and cornea lesions of rats fed corn syrup and the protective effects of alpha lipoic acid. Cutan Ocul Toxicol 2015; 35:31-5. [DOI: 10.3109/15569527.2015.1004584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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156
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Lowndes J, Kawiecki D, Yu Z, Rippe JM. No Dose Response Relationship in the Effects of Commonly Consumed Sugars on Risk Factors for Diabetes across a Range of Typical Human Consumption Levels. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/fns.2015.61011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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157
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Gulati S, Misra A. Sugar intake, obesity, and diabetes in India. Nutrients 2014; 6:5955-74. [PMID: 25533007 PMCID: PMC4277009 DOI: 10.3390/nu6125955] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/20/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
Sugar and sweet consumption have been popular and intrinsic to Indian culture, traditions, and religion from ancient times. In this article, we review the data showing increasing sugar consumption in India, including traditional sources (jaggery and khandsari) and from sugar-sweetened beverages (SSBs). Along with decreasing physical activity, this increasing trend of per capita sugar consumption assumes significance in view of the high tendency for Indians to develop insulin resistance, abdominal adiposity, and hepatic steatosis, and the increasing "epidemic" of type 2 diabetes (T2DM) and cardiovascular diseases. Importantly, there are preliminary data to show that incidence of obesity and T2DM could be decreased by increasing taxation on SSBs. Other prevention strategies, encompassing multiple stakeholders (government, industry, and consumers), should target on decreasing sugar consumption in the Indian population. In this context, dietary guidelines for Indians show that sugar consumption should be less than 10% of total daily energy intake, but it is suggested that this limit be decreased.
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Affiliation(s)
- Seema Gulati
- Diabetes Foundation (India), Safdarjung Development Area, New Delhi 110016, India.
| | - Anoop Misra
- Diabetes Foundation (India), Safdarjung Development Area, New Delhi 110016, India.
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158
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Wang M, Yu M, Fang L, Hu RY. Association between sugar-sweetened beverages and type 2 diabetes: A meta-analysis. J Diabetes Investig 2014; 6:360-6. [PMID: 25969723 PMCID: PMC4420570 DOI: 10.1111/jdi.12309] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/15/2014] [Accepted: 11/05/2014] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION Many studies have been carried out to examine the association between sugar-sweetened beverages and the incident of type 2 diabetes, but results are mixed. The aim of the present study was to estimate the association between sugar-sweetened beverage intake and the risk of type 2 diabetes. MATERIALS AND METHODS PubMed, Springer Link and Elsevier databases were searched up to July 2014. Prospective studies published on the association between sugar-sweetened beverage intake and the risk of type 2 diabetes were included. The pooled relative risks (RRs) and 95% confidence intervals (CIs) for highest versus lowest category of sugar-sweetened beverages were estimated using a random-effects model. RESULTS The pooled effect estimate of sugar-sweetened beverage intake was 1.30 (95% confidence interval [CI] 1.21-1.39) for type 2 diabetes; stratified by geographic region of the studies, the pooled effect estimates were 1.34 (95% CI 0.74-2.43), 1.30 (95% CI 1.20-1.40), 1.29 (95% CI 1.09-1.53) in Asia, the USA and Europe,respectively; the pooled effect estimates were 1.26 (95% CI 1.16-1.36) with adjusting body mass index and 1.38 (95% CI 1.23-1.56) without adjusting body mass index. CONCLUSIONS Our findings suggested that sugar-sweetened beverage intake was associated with an increased risk of type 2 diabetes, and the association was attenuated by adjustment for body mass index. Specifically, the associations were also found to be significantly positive in the USA and Europe.
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Affiliation(s)
- Meng Wang
- Zhejiang Provincial Center for Disease Control and Prevention Hangzhou City, China
| | - Min Yu
- Zhejiang Provincial Center for Disease Control and Prevention Hangzhou City, China
| | - Le Fang
- Zhejiang Provincial Center for Disease Control and Prevention Hangzhou City, China
| | - Ru-Ying Hu
- Zhejiang Provincial Center for Disease Control and Prevention Hangzhou City, China
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Abstract
The disease burden related to diabetes is high and rising in every country, fuelled by the global rise in the prevalence of obesity and unhealthy lifestyles. The latest estimates show a global prevalence of 382 million people with diabetes in 2013, expected to rise to 592 million by 2035. The aetiological classification of diabetes has now been widely accepted. Type 1 and type 2 diabetes are the two main types, with type 2 diabetes accounting for the majority (>85%) of total diabetes prevalence. Both forms of diabetes can lead to multisystem complications of microvascular endpoints, including retinopathy, nephropathy and neuropathy, and macrovascular endpoints including ischaemic heart disease, stroke and peripheral vascular disease. The premature morbidity, mortality, reduced life expectancy and financial and other costs of diabetes make it an important public health condition.
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Affiliation(s)
- Nita Gandhi Forouhi
- is Programme Leader and Honorary Public Health Physician at the MRC Epidemiology Unit, University of Cambridge, UK. Competing interests: none declared
| | - Nicholas J Wareham
- is Programme Leader and Honorary Public Health Physician at the MRC Epidemiology Unit, University of Cambridge, UK. Competing interests: none declared
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Effect of physical activity level on biomarkers of inflammation and insulin resistance over 5 years in outpatients with coronary heart disease (from the Heart and Soul Study). Am J Cardiol 2014; 114:1192-7. [PMID: 25173442 DOI: 10.1016/j.amjcard.2014.07.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 02/01/2023]
Abstract
Higher levels of physical activity are associated with lower rates of coronary heart disease (CHD). Previous studies have suggested that this is due partly to lower levels of inflammation and insulin resistance. The aim of this study was to determine whether physical activity level was associated with inflammation or insulin resistance during a 5-year period in outpatients with known CHD. A total of 656 participants from the Heart and Soul Study, a prospective cohort study of outpatients with documented CHD, were evaluated. Self-reported physical activity frequency was assessed at baseline and after 5 years of follow-up. Participants were classified as low versus high activity at each visit, yielding 4 physical activity groups: stable low activity, decreasing activity (high at baseline to low at year 5), increasing activity (low at baseline to high at year 5), and stable high activity. Year 5 markers of inflammation (C-reactive protein [CRP], interleukin-6, and fibrinogen) and insulin resistance (insulin, glucose, and glycated hemoglobin) were compared across the 4 activity groups. After 5 years of follow-up, higher activity was associated with lower mean levels of all biomarkers. In the fully adjusted regression models, CRP, interleukin-6, and glucose remained independently associated with physical activity frequency (log CRP, p for trend across activity groups = 0.03; log interleukin-6, p for trend = 0.01; log glucose, p for trend = 0.003). Subjects with stable high activity typically had the lowest levels of biomarkers. In conclusion, in this novel population of outpatients with known CHD followed for 5 years, higher physical activity frequency was independently associated with lower levels of CRP, interleukin-6, and glucose.
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161
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Factors associated with low consumption of fruits and vegetables by preschoolers of low socio‐economic level. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Packard AEB, Ghosal S, Herman JP, Woods SC, Ulrich-Lai YM. Chronic variable stress improves glucose tolerance in rats with sucrose-induced prediabetes. Psychoneuroendocrinology 2014; 47:178-88. [PMID: 25001967 PMCID: PMC4090605 DOI: 10.1016/j.psyneuen.2014.05.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/29/2014] [Accepted: 05/20/2014] [Indexed: 02/08/2023]
Abstract
The incidence of type-2 diabetes (T2D) and the burden it places on individuals, as well as society as a whole, compels research into the causes, factors and progression of this disease. Epidemiological studies suggest that chronic stress exposure may contribute to the development and progression of T2D in human patients. To address the interaction between chronic stress and the progression of T2D, we developed a dietary model of the prediabetic state in rats utilizing unlimited access to 30% sucrose solution (in addition to unlimited access to normal chow and water), which led to impaired glucose tolerance despite elevated insulin levels. We then investigated the effects of a chronic variable stress paradigm (CVS; twice daily exposure to an unpredictable stressor for 2 weeks) on metabolic outcomes in this prediabetic model. Chronic stress improved glucose tolerance in prediabetic rats following a glucose challenge. Importantly, pair-fed control groups revealed that the beneficial effect of chronic stress did not result from the decreased food intake or body weight gain that occurred during chronic stress. The present work suggests that chronic stress in rodents can ameliorate the progression of diet-induced prediabetic disease independent of chronic stress-induced decreases in food intake and body weight.
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Abstract
PURPOSE OF REVIEW The consumption of low-calorie beverages has increased worldwide, mainly because of their combination of sweet taste without adding significant calories to the diet. However, some epidemiological studies have linked the higher consumption of low-calorie beverages with increased body weight gain. RECENT FINDINGS Although a matter of debate, this paradoxical association between low-calorie beverages and weight gain has been attributed to their effect on the enteral-brain axis. More specifically, artificial sweeteners present in low-calorie beverages could induce appetite increase, probably due to an ambiguous psychobiological signal (uncoupling sweet taste from calorie intake) that confounds the appetite's regulatory mechanisms, promoting overeating and, ultimately, leading to weight gain. However, many studies do not support this assumption, and the mechanisms underlying the interaction between low-calorie beverages and the enteral-brain axis remain to be defined. SUMMARY The understanding of the effects of low-calorie drinks on the enteral-brain axis still remains in its infancy and needs to be unveiled. The consumption of low-calorie beverages reduces the calories from that drink, but compensatory phenomena may increase energy intake, and if so must be recognized and avoided.
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Affiliation(s)
- Adaliene V M Ferreira
- aNutrition Department, Universidade Federal de Minas Gerais bInterdisciplinary Laboratory of Medical Investigation, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Valmórbida JL, Vitolo MR. Factors associated with low consumption of fruits and vegetables by preschoolers of low socio-economic level. J Pediatr (Rio J) 2014; 90:464-71. [PMID: 24656872 DOI: 10.1016/j.jped.2014.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 02/07/2014] [Accepted: 02/19/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate factors associated with low consumption of fruits and vegetables among preschoolers from families treated at basic health centers in Porto Alegre, RS, Brazil. METHODS This was a cohort study nested in a randomized field trial. Data collection was performed through structured questionnaires to obtain demographic and dietary data, combined with two 24-hour recalls in the age groups 12-16 months and again at 2-3 years of age. Data on the consumption of one daily serving of fruits (80 g) and vegetables (60 g) were evaluated, as well as consumption of non-recommended foods such as candy, chocolate, and soft drinks. Statistical analyses were performed using Poisson regression with robust estimation. RESULTS A total of 388 children aged 2-3 years were evaluated; of these, 58% and 87.4% did not consume one daily serving of fruits and vegetables, respectively. The following factors were negatively associated with fruit consumption: family income higher than four minimum wages, (p=0.024), lower paternal educational level (p=0.03), and lower fruit consumption at 12-16 months (p=0.002). Factors negatively associated with the consumption of vegetables were low paternal educational level (p=0.033) and consumption of high-sugar content beverages at 12-16 months (p=0.014). CONCLUSION This study demonstrated a high prevalence of children who consumed less than one daily serving of fruit and vegetables; early feeding practices, parental education, and family income were associated with this process.
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Affiliation(s)
- Julia L Valmórbida
- Center for Research in Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| | - Márcia R Vitolo
- Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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165
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Patel PS, Cooper AJM, O'Connell TC, Kuhnle GGC, Kneale CK, Mulligan AM, Luben RN, Brage S, Khaw KT, Wareham NJ, Forouhi NG. Serum carbon and nitrogen stable isotopes as potential biomarkers of dietary intake and their relation with incident type 2 diabetes: the EPIC-Norfolk study. Am J Clin Nutr 2014; 100:708-18. [PMID: 24990425 PMCID: PMC4095667 DOI: 10.3945/ajcn.113.068577] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Stable-isotope ratios of carbon (¹³C/¹²C, expressed as δ¹³C) and nitrogen (¹⁵N/¹⁴N, or δ¹⁵N) have been proposed as potential nutritional biomarkers to distinguish between meat, fish, and plant-based foods. OBJECTIVE The objective was to investigate dietary correlates of δ¹³C and δ¹⁵N and examine the association of these biomarkers with incident type 2 diabetes in a prospective study. DESIGN Serum δ¹³C and δ¹⁵N (‰) were measured by using isotope ratio mass spectrometry in a case-cohort study (n = 476 diabetes cases; n = 718 subcohort) nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk population-based cohort. We examined dietary (food-frequency questionnaire) correlates of δ¹³C and δ¹⁵N in the subcohort. HRs and 95% CIs were estimated by using Prentice-weighted Cox regression. RESULTS Mean (±SD) δ¹³C and δ¹⁵N were -22.8 ± 0.4‰ and 10.2 ± 0.4‰, respectively, and δ¹³C (r = 0.22) and δ¹⁵N (r = 0.20) were positively correlated (P < 0.001) with fish protein intake. Animal protein was not correlated with δ¹³C but was significantly correlated with δ¹⁵N (dairy protein: r = 0.11; meat protein: r = 0.09; terrestrial animal protein: r = 0.12, P ≤ 0.013). δ¹³C was inversely associated with diabetes in adjusted analyses (HR per tertile: 0.74; 95% CI: 0.65, 0.83; P-trend < 0.001], whereas δ¹⁵N was positively associated (HR: 1.23; 95% CI: 1.09, 1.38; P-trend = 0.001). CONCLUSIONS The isotope ratios δ¹³C and δ¹⁵N may both serve as potential biomarkers of fish protein intake, whereas only δ¹⁵N may reflect broader animal-source protein intake in a European population. The inverse association of δ¹³C but a positive association of δ¹⁵N with incident diabetes should be interpreted in the light of knowledge of dietary intake and may assist in identifying dietary components that are associated with health risks and benefits.
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Affiliation(s)
- Pinal S Patel
- From the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom (PSP, AJMC, SB, NJW, and NGF); the Department of Archaeology & Anthropology, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO); the McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO and CKK); the University of Reading, Reading, United Kingdom (GGCK); and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (AMM, RNL, K-TK, and GGCK)
| | - Andrew J M Cooper
- From the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom (PSP, AJMC, SB, NJW, and NGF); the Department of Archaeology & Anthropology, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO); the McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO and CKK); the University of Reading, Reading, United Kingdom (GGCK); and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (AMM, RNL, K-TK, and GGCK)
| | - Tamsin C O'Connell
- From the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom (PSP, AJMC, SB, NJW, and NGF); the Department of Archaeology & Anthropology, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO); the McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO and CKK); the University of Reading, Reading, United Kingdom (GGCK); and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (AMM, RNL, K-TK, and GGCK)
| | - Gunter G C Kuhnle
- From the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom (PSP, AJMC, SB, NJW, and NGF); the Department of Archaeology & Anthropology, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO); the McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO and CKK); the University of Reading, Reading, United Kingdom (GGCK); and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (AMM, RNL, K-TK, and GGCK)
| | - Catherine K Kneale
- From the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom (PSP, AJMC, SB, NJW, and NGF); the Department of Archaeology & Anthropology, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO); the McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO and CKK); the University of Reading, Reading, United Kingdom (GGCK); and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (AMM, RNL, K-TK, and GGCK)
| | - Angela M Mulligan
- From the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom (PSP, AJMC, SB, NJW, and NGF); the Department of Archaeology & Anthropology, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO); the McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO and CKK); the University of Reading, Reading, United Kingdom (GGCK); and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (AMM, RNL, K-TK, and GGCK)
| | - Robert N Luben
- From the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom (PSP, AJMC, SB, NJW, and NGF); the Department of Archaeology & Anthropology, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO); the McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO and CKK); the University of Reading, Reading, United Kingdom (GGCK); and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (AMM, RNL, K-TK, and GGCK)
| | - Soren Brage
- From the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom (PSP, AJMC, SB, NJW, and NGF); the Department of Archaeology & Anthropology, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO); the McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO and CKK); the University of Reading, Reading, United Kingdom (GGCK); and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (AMM, RNL, K-TK, and GGCK)
| | - Kay-Tee Khaw
- From the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom (PSP, AJMC, SB, NJW, and NGF); the Department of Archaeology & Anthropology, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO); the McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO and CKK); the University of Reading, Reading, United Kingdom (GGCK); and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (AMM, RNL, K-TK, and GGCK)
| | - Nicholas J Wareham
- From the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom (PSP, AJMC, SB, NJW, and NGF); the Department of Archaeology & Anthropology, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO); the McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO and CKK); the University of Reading, Reading, United Kingdom (GGCK); and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (AMM, RNL, K-TK, and GGCK)
| | - Nita G Forouhi
- From the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom (PSP, AJMC, SB, NJW, and NGF); the Department of Archaeology & Anthropology, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO); the McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, United Kingdom (TCO and CKK); the University of Reading, Reading, United Kingdom (GGCK); and the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom (AMM, RNL, K-TK, and GGCK)
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Koopman KE, Caan MWA, Nederveen AJ, Pels A, Ackermans MT, Fliers E, la Fleur SE, Serlie MJ. Hypercaloric diets with increased meal frequency, but not meal size, increase intrahepatic triglycerides: a randomized controlled trial. Hepatology 2014; 60:545-53. [PMID: 24668862 PMCID: PMC4265261 DOI: 10.1002/hep.27149] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/23/2014] [Indexed: 12/13/2022]
Abstract
UNLABELLED American children consume up to 27% of calories from high-fat and high-sugar snacks. Both sugar and fat consumption have been implicated as a cause of hepatic steatosis and obesity but the effect of meal pattern is largely understudied. We hypothesized that a high meal frequency, compared to consuming large meals, is detrimental in the accumulation of intrahepatic and abdominal fat. To test this hypothesis, we randomized 36 lean, healthy men to a 40% hypercaloric diet for 6 weeks or a eucaloric control diet and measured intrahepatic triglyceride content (IHTG) using proton magnetic resonance spectroscopy ((1) H-MRS), abdominal fat using magnetic resonance imaging (MRI), and insulin sensitivity using a hyperinsulinemic euglycemic clamp with a glucose isotope tracer before and after the diet intervention. The caloric surplus consisted of fat and sugar (high-fat-high-sugar; HFHS) or sugar only (high-sugar; HS) and was consumed together with, or between, the three main meals, thereby increasing meal size or meal frequency. All hypercaloric diets similarly increased body mass index (BMI). Increasing meal frequency significantly increased IHTG (HFHS mean relative increase of 45%; P = 0.016 and HS mean relative increase of 110%; P = 0.047), whereas increasing meal size did not (2-way analysis of variance [ANOVA] size versus frequency P = 0.03). Abdominal fat increased in the HFHS-frequency group (+63.3 ± 42.8 mL; P = 0.004) and tended to increase in the HS-frequency group (+46.5 ± 50.7 mL; P = 0.08). Hepatic insulin sensitivity tended to decrease in the HFHS-frequency group while peripheral insulin sensitivity was not affected. CONCLUSION A hypercaloric diet with high meal frequency increased IHTG and abdominal fat independent of caloric content and body weight gain, whereas increasing meal size did not. This study suggests that snacking, a common feature in the Western diet, independently contributes to hepatic steatosis and obesity. ( TRIAL REGISTRATION www.clinicaltrials.gov; nr.NCT01297738.)
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Affiliation(s)
- Karin E Koopman
- Department of Endocrinology & Metabolism, Academic Medical Centre AmsterdamNetherlands
| | - Matthan WA Caan
- Department of Radiology, Academic Medical Centre AmsterdamNetherlands
| | - Aart J Nederveen
- Department of Radiology, Academic Medical Centre AmsterdamNetherlands
| | - Anouk Pels
- Department of Endocrinology & Metabolism, Academic Medical Centre AmsterdamNetherlands
| | - Mariette T Ackermans
- Department of Clinical Chemistry, Laboratory of Endocrinology, Academic Medical Centre AmsterdamNetherlands
| | - Eric Fliers
- Department of Endocrinology & Metabolism, Academic Medical Centre AmsterdamNetherlands
| | - Susanne E la Fleur
- Department of Endocrinology & Metabolism, Academic Medical Centre AmsterdamNetherlands,* These authors contributed equally to this work
| | - Mireille J Serlie
- Department of Endocrinology & Metabolism, Academic Medical Centre AmsterdamNetherlands,* These authors contributed equally to this work
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167
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Althuis MD, Weed DL, Frankenfeld CL. Evidence-based mapping of design heterogeneity prior to meta-analysis: a systematic review and evidence synthesis. Syst Rev 2014; 3:80. [PMID: 25055879 PMCID: PMC4128504 DOI: 10.1186/2046-4053-3-80] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessment of design heterogeneity conducted prior to meta-analysis is infrequently reported; it is often presented post hoc to explain statistical heterogeneity. However, design heterogeneity determines the mix of included studies and how they are analyzed in a meta-analysis, which in turn can importantly influence the results. The goal of this work is to introduce ways to improve the assessment and reporting of design heterogeneity prior to statistical summarization of epidemiologic studies. METHODS In this paper, we use an assessment of sugar-sweetened beverages (SSB) and type 2 diabetes (T2D) as an example to show how a technique called 'evidence mapping' can be used to organize studies and evaluate design heterogeneity prior to meta-analysis.. Employing a systematic and reproducible approach, we evaluated the following elements across 11 selected cohort studies: variation in definitions of SSB, T2D, and co-variables, design features and population characteristics associated with specific definitions of SSB, and diversity in modeling strategies. RESULTS Evidence mapping strategies effectively organized complex data and clearly depicted design heterogeneity. For example, across 11 studies of SSB and T2D, 7 measured diet only once (with 7 to 16 years of disease follow-up), 5 included primarily low SSB consumers, and 3 defined the study variable (SSB) as consumption of either sugar or artificially-sweetened beverages. This exercise also identified diversity in analysis strategies, such as adjustment for 11 to 17 co-variables and a large degree of fluctuation in SSB-T2D risk estimates depending on variables selected for multivariable models (2 to 95% change in the risk estimate from the age-adjusted model). CONCLUSIONS Meta-analysis seeks to understand heterogeneity in addition to computing a summary risk estimate. This strategy effectively documents design heterogeneity, thus improving the practice of meta-analysis by aiding in: 1) protocol and analysis planning, 2) transparent reporting of differences in study designs, and 3) interpretation of pooled estimates. We recommend expanding the practice of meta-analysis reporting to include a table that summarizes design heterogeneity. This would provide readers with more evidence to interpret the summary risk estimates.
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Affiliation(s)
| | - Douglas L Weed
- DLW Consulting Services, LLC, Salt Lake City, UT 84103, USA
| | - Cara L Frankenfeld
- Department of Global and Community Health, George Mason University, 4400 University Drive, MS 5B7, Fairfax, VA 22030, USA
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168
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Association between sugar-sweetened and artificially sweetened soft drinks and type 2 diabetes: systematic review and dose-response meta-analysis of prospective studies. Br J Nutr 2014; 112:725-34. [PMID: 24932880 DOI: 10.1017/s0007114514001329] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The intake of sugar-sweetened soft drinks has been reported to be associated with an increased risk of type 2 diabetes, but it is unclear whether this is because of the sugar content or related lifestyle factors, whether similar associations hold for artificially sweetened soft drinks, and how these associations are related to BMI. We aimed to conduct a systematic literature review and dose-response meta-analysis of evidence from prospective cohorts to explore these issues. We searched multiple sources for prospective studies on sugar-sweetened and artificially sweetened soft drinks in relation to the risk of type 2 diabetes. Data were extracted from eleven publications on nine cohorts. Consumption values were converted to ml/d, permitting the exploration of linear and non-linear dose-response trends. Summary relative risks (RR) were estimated using a random-effects meta-analysis. The summary RR for sugar-sweetened and artificially sweetened soft drinks were 1·20/330 ml per d (95 % CI 1·12, 1·29, P< 0·001) and 1·13/330 ml per d (95 % CI 1·02, 1·25, P= 0·02), respectively. The association with sugar-sweetened soft drinks was slightly lower in studies adjusting for BMI, consistent with BMI being involved in the causal pathway. There was no evidence of effect modification, though both these comparisons lacked power. Overall between-study heterogeneity was high. The included studies were observational, so their results should be interpreted cautiously, but findings indicate a positive association between sugar-sweetened soft drink intake and type 2 diabetes risk, attenuated by adjustment for BMI. The trend was less consistent for artificially sweetened soft drinks. This may indicate an alternative explanation, such as lifestyle factors or reverse causality. Future research should focus on the temporal nature of the association and whether BMI modifies or mediates the association.
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169
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Abstract
In the past couple of decades, evidence from prospective observational studies and clinical trials has converged to support the importance of individual nutrients, foods, and dietary patterns in the prevention and management of type 2 diabetes. The quality of dietary fats and carbohydrates consumed is more crucial than is the quantity of these macronutrients. Diets rich in wholegrains, fruits, vegetables, legumes, and nuts; moderate in alcohol consumption; and lower in refined grains, red or processed meats, and sugar-sweetened beverages have been shown to reduce the risk of diabetes and improve glycaemic control and blood lipids in patients with diabetes. With an emphasis on overall diet quality, several dietary patterns such as Mediterranean, low glycaemic index, moderately low carbohydrate, and vegetarian diets can be tailored to personal and cultural food preferences and appropriate calorie needs for weight control and diabetes prevention and management. Although much progress has been made in development and implementation of evidence-based nutrition recommendations in developed countries, concerted worldwide efforts and policies are warranted to alleviate regional disparities.
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Affiliation(s)
- Sylvia H Ley
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | | | - Viswanathan Mohan
- Dr Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Frank B Hu
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
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170
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Tasevska N, Park Y, Jiao L, Hollenbeck A, Subar AF, Potischman N. Sugars and risk of mortality in the NIH-AARP Diet and Health Study. Am J Clin Nutr 2014; 99:1077-88. [PMID: 24552754 PMCID: PMC3985213 DOI: 10.3945/ajcn.113.069369] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/29/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although previous studies have linked intake of sugars with incidence of cancer and other chronic diseases, its association with mortality remains unknown. OBJECTIVE We investigated the association of total sugars, added sugars, total fructose, added fructose, sucrose, and added sucrose with the risk of all-cause, cardiovascular disease, cancer, and other-cause mortality in the NIH-AARP Diet and Health Study. DESIGN The participants (n = 353,751), aged 50-71 y, were followed for up to 13 y. Intake of individual sugars over the previous 12 mo was assessed at baseline by using a 124-item NIH Diet History Questionnaire. RESULTS In fully adjusted models (fifth quartile compared with first quartile), all-cause mortality was positively associated with the intake of total sugars [HR (95% CI): 1.13 (1.06, 1.20); P-trend < 0.0001], total fructose [1.10 (1.04, 1.17); P-trend < 0.0001], and added fructose [1.07 (1.01, 1.13); P-trend = 0.005) in women and total fructose [1.06 (1.01, 1.10); P-trend = 0.002] in men. In men, a weak inverse association was found between other-cause mortality and dietary added sugars (P-trend = 0.04), sucrose (P-trend = 0.03), and added sucrose (P-trend = 0.006). Investigation of consumption of sugars by source showed that the positive association with mortality risk was confined only to sugars from beverages, whereas the inverse association was confined to sugars from solid foods. CONCLUSIONS In this large prospective study, total fructose intake was weakly positively associated with all-cause mortality in both women and men, whereas added sugar, sucrose, and added sucrose intakes were inversely associated with other-cause mortality in men. In our analyses, intake of added sugars was not associated with an increased risk of mortality. The NIH-AARP Diet and Health Study was registered at clinicaltrials.gov as NCT00340015.
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Affiliation(s)
- Natasha Tasevska
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, MD (NT, AFS, and NP); the Nutrition Program, School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ (NT); the Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD (YP and LJ); the Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX (LJ); and the AARP, Washington, DC (AH)
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171
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Walker RW, Dumke KA, Goran MI. Fructose content in popular beverages made with and without high-fructose corn syrup. Nutrition 2014; 30:928-35. [PMID: 24985013 DOI: 10.1016/j.nut.2014.04.003] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Excess fructose consumption is hypothesized to be associated with risk for metabolic disease. Actual fructose consumption levels are difficult to estimate because of the unlabeled quantity of fructose in beverages. The aims of this study were threefold: 1) re-examine the fructose content in previously tested beverages using two additional assay methods capable of detecting other sugars, especially maltose, 2) compare data across all methods to determine the actual free fructose-to-glucose ratio in beverages made either with or without high-fructose corn syrup (HFCS), and 3) expand the analysis to determine fructose content in commonly consumed juice products. METHODS Sugar-sweetened beverages (SSBs) and fruit juice drinks that were either made with or without HFCS were analyzed in separate, independent laboratories via three different methods to determine sugar profiles. RESULTS For SSBs, the three independent laboratory methods showed consistent and reproducible results. In SSBs made with HFCS, fructose constituted 60.6% ± 2.7% of sugar content. In juices sweetened with HFCS, fructose accounted for 52.1% ± 5.9% of sugar content, although in some juices made from 100% fruit, fructose concentration reached 65.35 g/L accounting for 67% of sugars. CONCLUSION Our results provide evidence of higher than expected amounts of free fructose in some beverages. Popular beverages made with HFCS have a fructose-to-glucose ratio of approximately 60:40, and thus contain 50% more fructose than glucose. Some pure fruit juices have twice as much fructose as glucose. These findings suggest that beverages made with HFCS and some juices have a sugar profile very different than sucrose, in which amounts of fructose and glucose are equivalent. Current dietary analyses may underestimate actual fructose consumption.
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Affiliation(s)
- Ryan W Walker
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kelly A Dumke
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Michael I Goran
- Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
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172
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Xi B, Li S, Liu Z, Tian H, Yin X, Huai P, Tang W, Zhou D, Steffen LM. Intake of fruit juice and incidence of type 2 diabetes: a systematic review and meta-analysis. PLoS One 2014; 9:e93471. [PMID: 24682091 PMCID: PMC3969361 DOI: 10.1371/journal.pone.0093471] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/05/2014] [Indexed: 02/07/2023] Open
Abstract
Background Several prospective studies have been conducted to examine the relationship between fruit juice intake and risk of incident type 2 diabetes, but results have been mixed. In the present study, we aimed to estimate the association between fruit juice intake and risk of type 2 diabetes. Methods PubMed and Embase databases were searched up to December 2013. All prospective cohort studies of fruit juice intake with risk of type 2 diabetes were included. The pooled relative risks (RRs) with 95% confidence intervals (CIs) for highest vs. lowest category of fruit juice intake were estimated using a random-effects model. Results A total of four studies (191,686 participants, including 12,375 with type 2 diabetes) investigated the association between sugar-sweetened fruit juice and risk of incident type 2 diabetes, and four studies (137,663 participants and 4,906 cases) investigated the association between 100% fruit juice and risk of incident type 2 diabetes. A higher intake of sugar-sweetened fruit juice was significantly associated with risk of type 2 diabetes (RR = 1.28, 95%CI = 1.04–1.59, p = 0.02), while intake of 100% fruit juice was not associated with risk of developing type 2 diabetes (RR = 1.03, 95% CI = 0.91–1.18, p = 0.62). Conclusions Our findings support dietary recommendations to limit sugar-sweetened beverages, such as fruit juice with added sugar, to prevent the development of type 2 diabetes.
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Affiliation(s)
- Bo Xi
- Department of Maternal and Child Health, School of Public Health, Shandong University, Jinan, China
| | - Shuangshuang Li
- Department of Maternal and Child Health, School of Public Health, Shandong University, Jinan, China
| | - Zhaolu Liu
- Department of Maternal and Child Health, School of Public Health, Shandong University, Jinan, China
| | - Huan Tian
- Department of Maternal and Child Health, School of Public Health, Shandong University, Jinan, China
| | - Xiuxiu Yin
- Department of Maternal and Child Health, School of Public Health, Shandong University, Jinan, China
| | - Pengcheng Huai
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China
| | - Weihong Tang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, United States of America
| | - Donghao Zhou
- Department of Endocrinology, Linyi People's Hospital, Linyi, China
- * E-mail: (DZ); (LMS)
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, United States of America
- * E-mail: (DZ); (LMS)
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173
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Davidson TL, Sample CH, Swithers SE. An application of Pavlovian principles to the problems of obesity and cognitive decline. Neurobiol Learn Mem 2014; 108:172-84. [PMID: 23887140 PMCID: PMC3899105 DOI: 10.1016/j.nlm.2013.07.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/12/2013] [Accepted: 07/15/2013] [Indexed: 12/18/2022]
Abstract
An enormous amount of research has been aimed at identifying biological and environmental factors that are contributing to the current global obesity pandemic. The present paper reviews recent findings which suggest that obesity is attributable, at least in part, to a disruption of the Pavlovian control of energy regulation. Within our framework, this disruption occurs when (a) consumption of sweet-tasting, but low calorie or noncaloric, foods and beverages reduces the ability of sweet tastes to predict the postingestive caloric consequences of intake and (b) consuming diets high in saturated fat and sugar (a.k.a., Western diet) impairs hippocampal-dependent learning and memory processes that are involved with the use of interoceptive "satiety" signals to anticipate when food and eating are not followed by appetitive postingestive outcomes. The paper concludes with discussion of a "vicious-cycle" model which links obesity to cognitive decline.
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Affiliation(s)
- T L Davidson
- American University, Washington, DC, United States.
| | - C H Sample
- American University, Washington, DC, United States
| | - S E Swithers
- Purdue University, West Lafayette, IN, United States
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174
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Tamayo T, Rosenbauer J, Wild SH, Spijkerman AMW, Baan C, Forouhi NG, Herder C, Rathmann W. Diabetes in Europe: an update. Diabetes Res Clin Pract 2014; 103:206-17. [PMID: 24300019 DOI: 10.1016/j.diabres.2013.11.007] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes is among the leading causes of death in the IDF Europe Region (EUR), continues to increase in prevalence with diabetic macro- and microvascular complications resulting in increased disability and enormous healthcare costs. In 2013, the number of people with diabetes is estimated to be 56 million in EUR with an overall estimated prevalence of 8.5%. However, estimates of diabetes prevalence in 2013 vary widely in the 56 diverse countries in EUR from 2.4% in Moldova to 14.9% in Turkey. Trends in diabetes prevalence also vary between countries with stable prevalence since 2002 for many countries but a doubling of diabetes prevalence in Turkey. For 2035, a further increase of nearly 10 million people with diabetes is projected for the EUR. Prevalence of type 1 has also increased over the past 20 years in EUR and there was estimated to be 129,350 cases in children aged 0-14 years in 2013. Registries provide valid information on incidence of type 1 diabetes with more complete data available for children than for adults. There are large differences in distribution of risk factors for diabetes at the population level in EUR. Modifiable risk factors such as obesity, physical inactivity, smoking behaviour (including secondhand smoking), environmental pollutants, psychosocial factors and socioeconomic deprivation could be tackled to reduce the incidence of type 2 diabetes in Europe. In addition, diabetes management is a major challenge to health services in the European countries. Improved networking practices of health professionals and other stakeholders in combination with empowerment of people with diabetes and continuous quality monitoring need to be further developed in Europe.
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Affiliation(s)
- T Tamayo
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - J Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - S H Wild
- Centre for Population Health Sciences, University of Edinburgh, UK
| | - A M W Spijkerman
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - C Baan
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - N G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - C Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - W Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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175
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Identification of biomarkers of sugar sweetened beverage intake. Proc Nutr Soc 2014. [DOI: 10.1017/s0029665114000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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176
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Forouhi NG, Wareham NJ. The EPIC-InterAct Study: A Study of the Interplay between Genetic and Lifestyle Behavioral Factors on the Risk of Type 2 Diabetes in European Populations. Curr Nutr Rep 2014; 3:355-363. [PMID: 25383255 PMCID: PMC4218968 DOI: 10.1007/s13668-014-0098-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The rising prevalence of type 2 diabetes around the world and the global pattern of variation in risk between countries have been widely attributed to an interplay between rising rates of obesity and poor lifestyles, and genetic or developmental susceptibility to disease. Although this general hypothesis has been in existence for more than 50 years, the precise mechanisms that may explain it have remained uncertain. Advances in technology and the application of new methods in large scale population studies have made it possible to study these mechanisms. The InterAct project, funded by the European Commission, is a large case-cohort study which has verified 12,403 incident cases of type 2 diabetes, facilitating the study of genetic and lifestyle factors on the risk of type 2 diabetes among European populations.
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Affiliation(s)
- Nita G. Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Nicholas J. Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
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Basu S, Vellakkal S, Agrawal S, Stuckler D, Popkin B, Ebrahim S. Averting obesity and type 2 diabetes in India through sugar-sweetened beverage taxation: an economic-epidemiologic modeling study. PLoS Med 2014; 11:e1001582. [PMID: 24409102 PMCID: PMC3883641 DOI: 10.1371/journal.pmed.1001582] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/19/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Taxing sugar-sweetened beverages (SSBs) has been proposed in high-income countries to reduce obesity and type 2 diabetes. We sought to estimate the potential health effects of such a fiscal strategy in the middle-income country of India, where there is heterogeneity in SSB consumption, patterns of substitution between SSBs and other beverages after tax increases, and vast differences in chronic disease risk within the population. METHODS AND FINDINGS Using consumption and price variations data from a nationally representative survey of 100,855 Indian households, we first calculated how changes in SSB price alter per capita consumption of SSBs and substitution with other beverages. We then incorporated SSB sales trends, body mass index (BMI), and diabetes incidence data stratified by age, sex, income, and urban/rural residence into a validated microsimulation of caloric consumption, glycemic load, overweight/obesity prevalence, and type 2 diabetes incidence among Indian subpopulations facing a 20% SSB excise tax. The 20% SSB tax was anticipated to reduce overweight and obesity prevalence by 3.0% (95% CI 1.6%-5.9%) and type 2 diabetes incidence by 1.6% (95% CI 1.2%-1.9%) among various Indian subpopulations over the period 2014-2023, if SSB consumption continued to increase linearly in accordance with secular trends. However, acceleration in SSB consumption trends consistent with industry marketing models would be expected to increase the impact efficacy of taxation, averting 4.2% of prevalent overweight/obesity (95% CI 2.5-10.0%) and 2.5% (95% CI 1.0-2.8%) of incident type 2 diabetes from 2014-2023. Given current consumption and BMI distributions, our results suggest the largest relative effect would be expected among young rural men, refuting our a priori hypothesis that urban populations would be isolated beneficiaries of SSB taxation. Key limitations of this estimation approach include the assumption that consumer expenditure behavior from prior years, captured in price elasticities, will reflect future behavior among consumers, and potential underreporting of consumption in dietary recall data used to inform our calculations. CONCLUSION Sustained SSB taxation at a high tax rate could mitigate rising obesity and type 2 diabetes in India among both urban and rural subpopulations.
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Affiliation(s)
- Sanjay Basu
- Prevention Research Center; Centers for Health Policy, Primary Care and Outcomes Research; Center on Poverty and Inequality; and Cardiovascular Institute, Stanford University, Stanford, California, United States of America
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sukumar Vellakkal
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India
| | - Sutapa Agrawal
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India
| | - David Stuckler
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Sociology, Oxford University, Oxford, United Kingdom
| | - Barry Popkin
- School of Public Health, University of North Carolina at Chapel Hill and the Carolina Population Center, Chapel Hill, North Carolina, United States of America
| | - Shah Ebrahim
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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178
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Health benefits of reducing sugar-sweetened beverage intake in high risk populations of California: results from the cardiovascular disease (CVD) policy model. PLoS One 2013; 8:e81723. [PMID: 24349119 PMCID: PMC3859539 DOI: 10.1371/journal.pone.0081723] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 10/20/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Consumption of sugar-sweetened beverage (SSB) has risen over the past two decades, with over 10 million Californians drinking one or more SSB per day. High SSB intake is associated with risk of type 2 diabetes, obesity, hypertension, and coronary heart disease (CHD). Reduction of SSB intake and the potential impact on health outcomes in California and among racial, ethnic, and low-income sub-groups has not been quantified. METHODS We projected the impact of reduced SSB consumption on health outcomes among all Californians and California subpopulations from 2013 to 2022. We used the CVD Policy Model - CA, an established computer simulation of diabetes and heart disease adapted to California. We modeled a reduction in SSB intake by 10-20% as has been projected to result from proposed penny-per-ounce excise tax on SSB and modeled varying effects of this reduction on health parameters including body mass index, blood pressure, and diabetes risk. We projected avoided cases of diabetes and CHD, and associated health care cost savings in 2012 US dollars. RESULTS Over the next decade, a 10-20% SSB consumption reduction is projected to result in a 1.8-3.4% decline in the new cases of diabetes and an additional drop of 0.5-1% in incident CHD cases and 0.5-0.9% in total myocardial infarctions. The greatest reductions are expected in African Americans, Mexican Americans, and those with limited income regardless of race and ethnicity. This reduction in SSB consumption is projected to yield $320-620 million in medical cost savings associated with diabetes cases averted and an additional savings of $14-27 million in diabetes-related CHD costs avoided. CONCLUSIONS A reduction of SSB consumption could yield substantial population health benefits and cost savings for California. In particular, racial, ethnic, and low-income subgroups of California could reap the greatest health benefits.
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Alzaid A, Schlaeger C, Hinzmann R. 6(th) Annual Symposium on Self-Monitoring of Blood Glucose (SMBG) applications and beyond, April 25-27, 2013, Riga, Latvia. Diabetes Technol Ther 2013; 15:1033-52. [PMID: 24074038 PMCID: PMC3868282 DOI: 10.1089/dia.2013.0260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
International experts in the fields of diabetes, diabetes technology, endocrinology, and pediatrics gathered for the 6(th) Annual Symposium on Self-Monitoring of Blood Glucose (SMBG) Applications and beyond. The aim of this meeting was to continue setting up a global network of experts in this field and provide an international platform for exchange of ideas to improve life for people with diabetes. The 2013 meeting comprised a comprehensive scientific program, parallel interactive workshops, and two keynote lectures. All these discussions were intended to help identify gaps and areas where further scientific work and clinical studies are warranted.
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Affiliation(s)
- Aus Alzaid
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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180
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Boyko EJ. Observational research--opportunities and limitations. J Diabetes Complications 2013; 27:642-8. [PMID: 24055326 PMCID: PMC3818421 DOI: 10.1016/j.jdiacomp.2013.07.007] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 07/30/2013] [Accepted: 07/31/2013] [Indexed: 12/25/2022]
Abstract
Medical research continues to progress in its ability to identify treatments and characteristics associated with benefits and adverse outcomes. The principal engine for the evaluation of treatment efficacy is the randomized controlled trial (RCT). Due to the cost and other considerations, RCTs cannot address all clinically important decisions. Observational research often is used to address issues not addressed or not addressable by RCTs. This article provides an overview of the benefits and limitations of observational research to serve as a guide to the interpretation of this category of research designs in diabetes investigations. The potential for bias is higher in observational research but there are design and analysis features that can address these concerns although not completely eliminate them. Pharmacoepidemiologic research may provide important information regarding relative safety and effectiveness of diabetes pharmaceuticals. Such research must effectively address the important issue of confounding by indication in order to produce clinically meaningful results. Other methods such as instrumental variable analysis are being employed to enable stronger causal inference but these methods also require fulfillment of several key assumptions that may or may not be realistic. Nearly all clinical decisions involve probabilistic reasoning and confronting uncertainly, so a realistic goal for observational research may not be the high standard set by RCTs but instead the level of certainty needed to influence a diagnostic or treatment decision.
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Affiliation(s)
- Edward J Boyko
- Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA USA; University of Washington School of Medicine, Seattle, WA.
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181
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Swithers SE. Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements. Trends Endocrinol Metab 2013; 24:431-41. [PMID: 23850261 PMCID: PMC3772345 DOI: 10.1016/j.tem.2013.05.005] [Citation(s) in RCA: 260] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/29/2013] [Accepted: 05/21/2013] [Indexed: 02/06/2023]
Abstract
The negative impact of consuming sugar-sweetened beverages on weight and other health outcomes has been increasingly recognized; therefore, many people have turned to high-intensity sweeteners like aspartame, sucralose, and saccharin as a way to reduce the risk of these consequences. However, accumulating evidence suggests that frequent consumers of these sugar substitutes may also be at increased risk of excessive weight gain, metabolic syndrome, type 2 diabetes, and cardiovascular disease. This paper discusses these findings and considers the hypothesis that consuming sweet-tasting but noncaloric or reduced-calorie food and beverages interferes with learned responses that normally contribute to glucose and energy homeostasis. Because of this interference, frequent consumption of high-intensity sweeteners may have the counterintuitive effect of inducing metabolic derangements.
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Affiliation(s)
- Susan E Swithers
- Department of Psychological Sciences and Ingestive Behavior Research Center, Purdue University, 703 Third Street, West Lafayette, IN 47907, USA.
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182
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Affiliation(s)
- G. Livesey
- Independent Nutrition Logic Ltd; Norfolk; UK
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183
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Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct. Br Dent J 2013. [DOI: 10.1038/sj.bdj.2013.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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