1
|
Chen QY, Khil J, Keum N. Water Intake and Adiposity Outcomes among Overweight and Obese Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2024; 16:963. [PMID: 38612997 PMCID: PMC11013432 DOI: 10.3390/nu16070963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Water consumption is believed to be a key factor in weight management strategies, yet the existing literature on the subject yields inconsistent findings. To systematically assess the scientific evidence regarding the effect of water intake on adiposity, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) among overweight and obese populations. METHODS PubMed and Embase were searched for relevant articles published up to December 2023. The summary weighted mean difference (WMD) and 95% confidence interval (CI) were estimated using the DerSimonian-Laird random-effects model. RESULTS In this meta-analysis of eight RCTs, interventions to promote water intake or to substitute water for other beverages as compared to the control group resulted in a summary WMD of -0.33 kg (95% CI = -1.75-1.08, I2 = 78%) for body weight, -0.23 kg/m2 (95% CI = -0.55-0.09, I2 = 0%) for body mass index (BMI), and 0.05 cm (95% CI = -1.20-1.30, I2 = 40%) for waist circumference (WC). Among RCTs substituting water for artificially sweetened beverages, summary WMD was 1.82 kg (95% CI = 0.97-2.67, I2 = 0%) for body weight and 1.23 cm (95% CI = -0.03-2.48, I2 = 0%) for WC. Conversely, among RCTs substituting water for sugar-sweetened beverages, summary WMD was -0.81 kg (95% CI = -1.66-0.03, I2 = 2%) for body weight and -0.96 cm (95% CI = -2.06-0.13, I2 = 0%) for WC. CONCLUSIONS In conclusion, water intake may not significantly impact adiposity among overweight and obese individuals. However, replacing sugar-sweetened beverages with water might offer a modest benefit in inducing weight loss.
Collapse
Affiliation(s)
- Qiao-Yi Chen
- Department of Food Science and Biotechnology, Dongguk University, Goyang 10326, Republic of Korea; (Q.-Y.C.); (J.K.)
| | - Jaewon Khil
- Department of Food Science and Biotechnology, Dongguk University, Goyang 10326, Republic of Korea; (Q.-Y.C.); (J.K.)
| | - NaNa Keum
- Department of Food Science and Biotechnology, Dongguk University, Goyang 10326, Republic of Korea; (Q.-Y.C.); (J.K.)
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| |
Collapse
|
2
|
Khalil S, Haikal Y, Aoun A. Non-nutritive Sweeteners: Weight Loss or Weight Gain? Endocr Metab Immune Disord Drug Targets 2024; 24:749-757. [PMID: 37817660 DOI: 10.2174/0118715303245646230926054352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 10/12/2023]
Abstract
The consumption of non-nutritive sweeteners (NNS) is on the rise among different populations. In parallel, the debate about their potential health benefits and risks remains inconclusive. Numerous published studies elucidate the impact of NNS on general health, weight control, and the risk of certain diseases. However, no definitive conclusions regarding the effect of chronic NNS use on weight have been reached in humans. This review summarizes current evidence related to the biological role of NNS and their subsequent effects on weight. The mechanisms of action through which NNS impact weight are discussed, including their effect on sweet taste receptors, cognition, metabolic and endocrine functions, intestinal microbiota, and adiposity. Conflicting evidence is hindering the formulation of precise recommendations, but the evidence opposing the use of NNS remains weak, and the ultimate impact on weight largely relies on several other behavioral patterns.
Collapse
Affiliation(s)
- Sarah Khalil
- Department of Nursing and Health Sciences, Notre Dame University-Louaize, 72 Zouk Mikael, Zouk Mosbeh, Lebanon
| | - Yara Haikal
- Department of Nursing and Health Sciences, Notre Dame University-Louaize, 72 Zouk Mikael, Zouk Mosbeh, Lebanon
| | - Antoine Aoun
- Department of Nursing and Health Sciences, Notre Dame University-Louaize, 72 Zouk Mikael, Zouk Mosbeh, Lebanon
- Department of Nutrition, Centre Hospitalier Universitaire de Rouen, 76000, Rouen, France
- Department of Nutrition, Hôpital La Musse, 27180, Saint Sebastien de Morsent, Normandie, France
- INSERM U1073, UNIROUEN, Normandie University, 76000, Rouen, France
| |
Collapse
|
3
|
Harrold JA, Hill S, Radu C, Thomas P, Thorp P, Hardman CA, Christiansen P, Halford JCG. Non-nutritive sweetened beverages versus water after a 52-week weight management programme: a randomised controlled trial. Int J Obes (Lond) 2024; 48:83-93. [PMID: 37794246 PMCID: PMC10746539 DOI: 10.1038/s41366-023-01393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND/OBJECTIVE Sugar-sweetened beverages are a substantial source of dietary sugar that can contribute to weight gain and the risk of type 2 diabetes. Dietary guidelines recommend non-nutritive sweetened (NNS) beverages to reduce sugar consumption, however, there is a need for long-term randomised controlled trials on their use. We aimed to compare the effects of NNS beverages and water on body weight during weight loss and maintenance in a behavioural weight management programme. METHODS In this parallel-group, open-label, controlled equivalence trial, adults with a BMI of 27-35 kg/m2 who regularly consumed cold beverages were randomised 1:1 to water or NNS beverages. Participants underwent a group behavioural weight management programme comprising weekly (during the 12-week weight-loss phase) then monthly (during the 40-week weight-maintenance phase) meetings. The primary endpoint was weight change at week 52 (equivalence: two-sided P > 0.05). Secondary endpoints included changes in anthropometrics, cardiometabolic risk factors, appetite and activity levels. RESULTS Of 493 participants randomised (water: n = 246; NNS beverages: n = 247), 24.1% were NNS-naïve. At week 52, water and NNS beverages were non-equivalent, with significantly greater weight loss in the NNS beverages group. Participants consuming water maintained a weight loss of 6.1 kg over 52 weeks versus 7.5 kg with NNS beverages (difference [90% CI]: 1.4 kg [-2.6, -0.2]; p < 0.05). CONCLUSIONS During a 52-week behavioural weight management programme, water and NNS beverages were non-equivalent, with weight loss maintained to a statistically greater extent with NNS beverages compared with water. However, this difference was not clinically significant. CLINICAL TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov: NCT02591134.
Collapse
Affiliation(s)
- Joanne A Harrold
- Department of Psychology, University of Liverpool, Liverpool, UK.
| | - Scott Hill
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Cristina Radu
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Paul Thomas
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Paula Thorp
- Department of Psychology, University of Liverpool, Liverpool, UK
| | | | | | - Jason C G Halford
- Department of Psychology, University of Liverpool, Liverpool, UK
- School of Psychology, University of Leeds, Leeds, UK
| |
Collapse
|
4
|
Harrold JA, Hill S, Radu C, Thomas P, Thorp P, Hardman CA, Christiansen P, Halford JCG. Effects of non-nutritive sweetened beverages versus water after a 12-week weight-loss program: A randomized controlled trial. Obesity (Silver Spring) 2023; 31:1996-2008. [PMID: 37475684 DOI: 10.1002/oby.23796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The aim of this study was to compare non-nutritive sweetened (NNS) beverages versus water for weight loss after a 12-week behavioral weight-management program. METHODS This is an ongoing, 2-year, parallel-group, open-label, controlled equivalence trial; week-12 data are reported. Adults with BMI of 27 to 35 kg/m2 who regularly drank cold beverages were randomized 1:1 to intention-to-treat water or NNS beverages while undergoing a weekly 12-week group behavioral weight-management program. Weight change to week 12 was the primary end point (equivalence: two-sided p > 0.05); changes in waist and hip circumference, blood pressure, glycemic control markers, fasting lipid profiles, liver function tests, hunger (visual analog scale), sugar and sweetener consumption, and activity levels were secondary end points. RESULTS Overall, 493 participants were randomized (water: n = 246; NNS beverages: n = 247); 24.1% were NNS beverage naïve. Weight change was equivalent with water versus NNS beverages (-5.6 vs. -5.8 kg; difference [90% CI]: -0.2 kg [-0.7 to 0.4]). There were no significant differences between groups for secondary end points except reductions in waist circumference (greater with NNS beverages vs. water), glycated hemoglobin, and consumption of any type of sweetener (both greater with water vs. NNS beverages). CONCLUSIONS Weight loss was equivalent with NNS beverages and water following a 12-week behavioral weight-management program.
Collapse
Affiliation(s)
- Joanne A Harrold
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Scott Hill
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Cristina Radu
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Paul Thomas
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Paula Thorp
- Department of Psychology, University of Liverpool, Liverpool, UK
| | | | | | - Jason C G Halford
- Department of Psychology, University of Liverpool, Liverpool, UK
- School of Psychology, University of Leeds, Leeds, UK
| |
Collapse
|
5
|
Movahedian M, Golzan SA, Asbaghi O, Prabahar K, Hekmatdoost A. Assessing the impact of non-nutritive sweeteners on anthropometric indices and leptin levels in adults: A GRADE-assessed systematic review, meta-analysis, and meta-regression of randomized clinical trials. Crit Rev Food Sci Nutr 2023:1-18. [PMID: 37440689 DOI: 10.1080/10408398.2023.2233615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
In today's world, non-nutritive sweeteners (NNSs) are recognized as substitutes for sugar or other high-calorie sweeteners, and their consumption is increasing dramatically. However, there is ongoing debate regarding the impact of NNSs on anthropometric indices. To fill this gap in knowledge, the current GRADE-assessed systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the effects of artificial- and stevia-based sweeteners consumption on anthropometric indices and serum leptin level which is known as an appetite-regulating hormone. A comprehensive search was conducted on the Scopus, PubMed, and Embase databases up to November 2022 to identify randomized controlled trials (RCTs) investigating the effects of NNSs on anthropometric indices and serum leptin levels. Data extraction from qualified studies was performed independently by two researchers. A random- or fixed-effects model was used to estimate weighted mean differences (WMDs) and 95% confidence intervals (CIs) for anthropometric indices such as body weight (BW), body mass index (BMI), fat mass (FM), fat-free mass (FFM), waist circumference (WC) and serum leptin level. Heterogeneity between studies was assessed using Cochran's Q test and quantified using the I2 statistic. From a pool of 3212 studies initially identified, 20 studies with a total sample size of 2158 subjects were included in the analysis. Results of the pooled analysis showed that NNSs consumption had a significant reducing effect on BW (WMD: -1.02, 95% CI: -1.57, -0.46 Kg), FM (WMD: -1.09, 95% CI: -1.90, -0.29), and FFM (WMD: -0.83, 95% CI: -1.42, -0.23), but did not have any significant effect on BMI (WMD: -0.16, 95% CI: -0.35, 0.02), WC (WMD: -1.03, 95% CI: -2.77, 0.72), or serum leptin level (WMD: -2.17, 95% CI: -4.98, 0.65). The findings of this study indicate that the consumption of artificial- and stevia-based sweeteners may lead to a reduction in body weight, fat mass, and free fat mass.
Collapse
Affiliation(s)
- Mina Movahedian
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Omid Asbaghi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kousalya Prabahar
- Department of Pharmacy Practice, University of Tabuk, Tabuk, Saudi Arabia
| | - Azita Hekmatdoost
- Department of Clinical Nutrition & Dietetics, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Valicente VM, Peng CH, Pacheco KN, Lin L, Kielb EI, Dawoodani E, Abdollahi A, Mattes RD. Ultraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms. Adv Nutr 2023; 14:718-738. [PMID: 37080461 PMCID: PMC10334162 DOI: 10.1016/j.advnut.2023.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023] Open
Abstract
Epidemiologic evidence supports a positive association between ultraprocessed food (UPF) consumption and body mass index. This has led to recommendations to avoid UPFs despite very limited evidence establishing causality. Many mechanisms have been proposed, and this review critically aimed to evaluate selected possibilities for specificity, clarity, and consistency related to food choice (i.e., low cost, shelf-life, food packaging, hyperpalatability, and stimulation of hunger/suppression of fullness); food composition (i.e., macronutrients, food texture, added sugar, fat and salt, energy density, low-calorie sweeteners, and additives); and digestive processes (i.e., oral processing/eating rate, gastric emptying time, gastrointestinal transit time, and microbiome). For some purported mechanisms (e.g., fiber content, texture, gastric emptying, and intestinal transit time), data directly contrasting the effects of UPF and non-UPF intake on the indices of appetite, food intake, and adiposity are available and do not support a unique contribution of UPFs. In other instances, data are not available (e.g., microbiome and food additives) or are insufficient (e.g., packaging, food cost, shelf-life, macronutrient intake, and appetite stimulation) to judge the benefits versus the risks of UPF avoidance. There are yet other evoked mechanisms in which the preponderance of evidence indicates ingredients in UPFs actually moderate body weight (e.g., low-calorie sweetener use for weight management; beverage consumption as it dilutes energy density; and higher fat content because it reduces glycemic responses). Because avoidance of UPFs holds potential adverse effects (e.g., reduced diet quality, increased risk of food poisoning, and food wastage), it is imprudent to make recommendations regarding their role in diets before causality and plausible mechanisms have been verified.
Collapse
Affiliation(s)
- Vinicius M Valicente
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Ching-Hsuan Peng
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, United States
| | - Kathryn N Pacheco
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Luotao Lin
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Elizabeth I Kielb
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States
| | - Elina Dawoodani
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Afsoun Abdollahi
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Richard D Mattes
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States.
| |
Collapse
|
7
|
Tsai MJ, Li CH, Wu HT, Kuo HY, Wang CT, Pai HL, Chang CJ, Ou HY. Long-Term Consumption of Sucralose Induces Hepatic Insulin Resistance through an Extracellular Signal-Regulated Kinase 1/2-Dependent Pathway. Nutrients 2023; 15:2814. [PMID: 37375718 DOI: 10.3390/nu15122814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
Sugar substitutes have been recommended to be used for weight and glycemic control. However, numerous studies indicate that consumption of artificial sweeteners exerts adverse effects on glycemic homeostasis. Although sucralose is among the most extensively utilized sweeteners in food products, the effects and detailed mechanisms of sucralose on insulin sensitivity remain ambiguous. In this study, we found that bolus administration of sucralose by oral gavage enhanced insulin secretion to decrease plasma glucose levels in mice. In addition, mice were randomly allocated into three groups, chow diet, high-fat diet (HFD), and HFD supplemented with sucralose (HFSUC), to investigate the effects of long-term consumption of sucralose on glucose homeostasis. In contrast to the effects of sucralose with bolus administration, the supplement of sucralose augmented HFD-induced insulin resistance and glucose intolerance, determined by glucose and insulin tolerance tests. In addition, we found that administration of extracellular signal-regulated kinase (ERK)-1/2 inhibitor reversed the effects of sucralose on glucose intolerance and insulin resistance in mice. Moreover, blockade of taste receptor type 1 member 3 (T1R3) by lactisole or pretreatment of endoplasmic reticulum stress inhibitors diminished sucralose-induced insulin resistance in HepG2 cells. Taken together, sucralose augmented HFD-induced insulin resistance in mice, and interrupted insulin signals through a T1R3-ERK1/2-dependent pathway in the liver.
Collapse
Affiliation(s)
- Meng-Jie Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Chung-Hao Li
- Department of Family Medicine, An Nan Hospital, China Medical University, Tainan 70965, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Hung-Tsung Wu
- Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Hsin-Yu Kuo
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Chung-Teng Wang
- Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Hsiu-Ling Pai
- Graduated Institute of Metabolism and Obesity Science, College of Nutrition, Taipei Medical University, Taipei City 11031, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan
| | - Horng-Yih Ou
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| |
Collapse
|
8
|
Impact of dietary sucralose and sucrose-sweetened water intake on lipid and glucose metabolism in male mice. Eur J Nutr 2023; 62:199-211. [PMID: 35933635 DOI: 10.1007/s00394-022-02980-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/29/2022] [Indexed: 02/07/2023]
Abstract
AIMS Overconsumption of sugar-sweetened beverages (SSBs) is associated with an increased risk of metabolic disorders, including obesity and diabetes. However, accumulating evidence also suggests the potential negative impact of consuming nonnutritive sweeteners (NNSs) on weight and glycaemic control. The metabolic effects of sucralose, the most widely used NNS, remain controversial. This study aimed to compare the impact of intake of dietary sucralose (acceptable daily intake dose, ADI dose) and sucrose-sweetened water (at the same sweetness level) on lipid and glucose metabolism in male mice. MATERIALS AND METHODS Sucralose (0.1 mg/mL) or sucrose (60 mg/mL) was added to the drinking water of 8-week-old male C57BL/6 mice for 16 weeks, followed by oral glucose and intraperitoneal insulin tolerance tests, and measurements of bone mineral density, plasma lipids, and hormones. After the mice were sacrificed, the duodenum and ileum were used for examination of sweet taste receptors (STRs) and glucose transporters. RESULTS A significant increase in fat mass was observed in the sucrose group of mice after 16 weeks of sweetened water drinking. Sucrose consumption also led to increased levels of plasma LDL, insulin, lipid deposition in the liver, and increased glucose intolerance in mice. Compared with the sucrose group, mice consuming sucralose showed much lower fat accumulation, hyperlipidaemia, liver steatosis, and glucose intolerance. In addition, the daily dose of sucralose only had a moderate effect on T1R2/3 in the intestine, without affecting glucose transporters and plasma insulin levels. CONCLUSION Compared with mice consuming sucrose-sweetened water, daily drinking of sucralose within the ADI dose had a much lower impact on glucose and lipid homeostasis.
Collapse
|
9
|
Kjølbæk L, Manios Y, Blaak EE, Martínez JA, Feskens EJM, Finlayson G, Andersen SSH, Reppas K, Navas-Carretero S, Adam TC, Hodgkins CE, Del Álamo M, Lam T, Moshoyiannis H, Halford JCG, Harrold JA, Raben A. Protocol for a multicentre, parallel, randomised, controlled trial on the effect of sweeteners and sweetness enhancers on health, obesity and safety in overweight adults and children: the SWEET project. BMJ Open 2022; 12:e061075. [PMID: 36223962 PMCID: PMC9562305 DOI: 10.1136/bmjopen-2022-061075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim of this randomised controlled trial (RCT) is to investigate whether prolonged consumption of sweeteners and sweetness enhancers (S&SEs) within a healthy diet will improve weight loss maintenance and obesity-related risk factors and affect safety markers compared with sugar. METHODS AND ANALYSIS SWEET (S&SEs: prolonged effects on health, obesity and safety) is a 1-year multicentre RCT including at least 330 adults with overweight (18-65 years, body mass index (BMI) >25 kg/m2) and 40 children (6-12 years, BMI-for-age >85th percentile). In an initial 2-month period, adults will consume a low-energy diet with the aim to achieve ≥5% weight loss. Children are advised to consume a generally healthy diet to maintain body weight, thus reducing their BMI-for-age z-score. In the following 10 months, participants will be randomised to follow a healthy ad libitum diet with or without S&SE products. Clinical investigations are scheduled at baseline, after 2, 6 and 12 months. The primary outcomes are body weight for efficacy and gut microbiota composition (in relation to metabolic health) for safety, both in adults. Secondary outcomes include anthropometry, risk markers for type-2 diabetes and cardiovascular diseases, questionnaires including, for example, food preferences, craving and appetite and tests for allergenicity. ETHICS AND DISSEMINATION The trial protocol has been approved by the following national ethical committees; The research ethics committees of the capital region (Denmark), approval code: H-19040679, The medical ethics committee of the University Hospital Maastricht and Maastricht University (the Netherlands), approval code: NL70977.068.19/METC19-056s, Research Ethics Committee of the University of Navarra (Spain), approval code: 2019.146 mod1, Research Ethics Committee of Harokopio University (Greece), approval code: 1810/18-06-2019. The trial will be conducted in accordance with the Declaration of Helsinki. Results will be published in international peer-reviewed scientific journals regardless of whether the findings are positive, negative or inconclusive. TRIAL REGISTRATION NUMBER NCT04226911 (Clinicaltrials.gov).
Collapse
Affiliation(s)
- Louise Kjølbæk
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
- Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Ellen E Blaak
- Department of Human Biology, Maastricht University, Maastricht, Netherlands
| | - J Alfredo Martínez
- Center for Nutrition Research, University of Navarra, Pamplona, Navarra, Spain
- IMDEA Food Institute, Madrid, Spain
| | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | | | - Sabina S H Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Kyriakos Reppas
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Santiago Navas-Carretero
- Center for Nutrition Research, University of Navarra, Pamplona, Navarra, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Tanja C Adam
- Department of Nutrition & Movement Sciences, Maastricht University, Maastricht, Limburg, Netherlands
| | - Charo E Hodgkins
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Guildford, UK
| | - Marta Del Álamo
- European Clinical Research Infrastructure Network, Paris, France
| | - Tony Lam
- NetUnion sarl, Lausanne, Switzerland
| | | | - Jason C G Halford
- School of Psychology, University of Leeds, Leeds, UK
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Joanne A Harrold
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg C, Denmark
- Clinical Research, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark
| |
Collapse
|
10
|
Ostendorf DM, Caldwell AE, Zaman A, Pan Z, Bing K, Wayland LT, Creasy SA, Bessesen DH, MacLean P, Melanson EL, Catenacci VA. Comparison of weight loss induced by daily caloric restriction versus intermittent fasting (DRIFT) in individuals with obesity: study protocol for a 52-week randomized clinical trial. Trials 2022; 23:718. [PMID: 36038881 PMCID: PMC9421629 DOI: 10.1186/s13063-022-06523-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The standard of care for treating overweight and obesity is daily caloric restriction (DCR). While this approach produces modest weight loss, adherence to DCR declines over time and weight regain is common. Intermittent fasting (IMF) is an alternative dietary strategy for reducing energy intake (EI) that involves >60% energy restriction on 2-3 days per week, or on alternate days, with habitual intake on fed days. While numerous studies have evaluated IMF as a weight loss strategy, there are several limitations including lack of a standard-of-care DCR control, failure to provide guideline-based behavioral support, and failure to rigorously evaluate dietary and PA adherence using objective measures. To date, only three longer-term (52-week) trials have evaluated IMF as a weight loss strategy. None of these longer-duration studies reported significant differences between IMF and DCR in changes in weight. However, each of these studies has limitations that prohibit drawing generalizable conclusions about the relative long-term efficacy of IMF vs. DCR for obesity treatment. METHODS The Daily Caloric Restriction vs. Intermittent Fasting Trial (DRIFT) is a two-arm, 52-week block randomized (1:1) clinical weight loss trial. The two intervention arms (DCR and IMF) are designed to prescribe an equivalent average weekly energy deficit from baseline weight maintenance energy requirements. Both DCR and IMF will be provided guideline-based behavioral support and a PA prescription. The primary outcome is change in body weight at 52 weeks. Secondary outcomes include changes in body composition (dual-energy x-ray absorptiometry (DXA)), metabolic parameters, total daily energy expenditure (TDEE, doubly labeled water (DLW)), EI (DLW intake-balance method, 7-day diet diaries), and patterns of physical activity (PA, activPAL device). DISCUSSION Although DCR leads to modest weight loss success in the short-term, there is wide inter-individual variability in weight loss and poor long-term weight loss maintenance. Evidence-based dietary approaches to energy restriction that are effective long-term are needed to provide a range of evidence-based options to individuals seeking weight loss. The DRIFT study will evaluate the long-term effectiveness of IMF vs. DCR on changes in objectively measured weight, EI, and PA, when these approaches are delivered using guideline-based behavioral support and PA prescriptions.
Collapse
Affiliation(s)
- Danielle M. Ostendorf
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Ann E. Caldwell
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Adnin Zaman
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Zhaoxing Pan
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Kristen Bing
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Liza T. Wayland
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Seth A. Creasy
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Daniel H. Bessesen
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Paul MacLean
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Edward L. Melanson
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical Center, Denver, CO USA
| | - Victoria A. Catenacci
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| |
Collapse
|
11
|
Bayram HM, Ozturkcan A. Added sugars and non-nutritive sweeteners in the food supply: Are they a threat for consumers? Clin Nutr ESPEN 2022; 49:442-448. [DOI: 10.1016/j.clnesp.2022.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/26/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
|
12
|
Russell C, Baker P, Grimes C, Lawrence MA. What are the benefits and risks of nutrition policy actions to reduce added sugar consumption? An Australian case study. Public Health Nutr 2022; 25:1-18. [PMID: 35067254 PMCID: PMC9991626 DOI: 10.1017/s1368980022000234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/03/2021] [Accepted: 01/19/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to critically analyse Australia's current and proposed policy actions to reduce added sugar consumption. Over-consumption of added sugar is a significant public health nutrition issue. The competing interests, values and beliefs among stakeholders mean they have disparate views regarding which policy actions are preferable to reduce added sugar consumption. DESIGN Semi-structured interviews using purposive, snowball sampling and policy mapping. Policy actions were classified by two frameworks: NOURISHING (e.g. behaviour change communication, food environment and food system) and the Orders of Change (e.g. first order: technical adjustments, second order: reforming the system, third order: transforming the system). SETTING Australia. PARTICIPANTS Twenty-two stakeholders from the food industry, food regulation, government, public health groups and academia. RESULTS All proposed and existing policy actions targeted the food environment/behaviour change; most were assessed as first-order changes, and reductionist (nutrient specific) in nature. Influences on policy actions included industry power, stakeholder fragmentation, government ideology/political will and public pressure. Few stakeholders considered potential risks of policy actions, particularly of non-nutritive sweetener substitution or opportunity costs for other policies. CONCLUSIONS Most of Australia's policy actions to reduce added sugar consumption are reductionist. Preferencing nutrient specific, first-order policy actions could reflect the influence of vested interests, a historically dominant reductionist orientation to nutrition science and policy, and the perceived difficulty of pursuing second- or third-order changes. Pursuing only first-order policy actions could lead to 'regrettable' substitutions and creates an opportunity cost for more comprehensive policy aimed at adjusting the broader food system.
Collapse
Affiliation(s)
- Cherie Russell
- School of Exercise and Nutrition Sciences, Deakin University, Geelong3220, Australia
| | - Phillip Baker
- School of Exercise and Nutrition Sciences, Deakin University, Geelong3220, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Carley Grimes
- School of Exercise and Nutrition Sciences, Deakin University, Geelong3220, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Mark Andrew Lawrence
- School of Exercise and Nutrition Sciences, Deakin University, Geelong3220, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| |
Collapse
|
13
|
Hopp K, Catenacci VA, Dwivedi N, Kline TL, Wang W, You Z, Nguyen DT, Bing K, Poudyal B, Johnson GC, Jackman MR, Miller M, Steele CN, Serkova NJ, MacLean PS, Nemenoff RA, Gitomer B, Chonchol M, Nowak KL. Weight loss and cystic disease progression in autosomal dominant polycystic kidney disease. iScience 2022; 25:103697. [PMID: 35059607 PMCID: PMC8760407 DOI: 10.1016/j.isci.2021.103697] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/19/2021] [Accepted: 12/21/2021] [Indexed: 01/03/2023] Open
Abstract
Progression of autosomal dominant polycystic kidney disease (ADPKD) is modified by metabolic defects and obesity. Indeed, reduced food intake slows cyst growth in preclinical rodent studies. Here, we demonstrate the feasibility of daily caloric restriction (DCR) and intermittent fasting (IMF) in a cohort of overweight or obese patients with ADPKD. Clinically significant weight loss occurred with both DCR and IMF; however, weight loss was greater and adherence and tolerability were better with DCR. Further, slowed kidney growth correlated with body weight and visceral adiposity loss independent of dietary regimen. Similarly, we compared the therapeutic efficacy of DCR, IMF, and time restricted feeding (TRF) using an orthologous ADPKD mouse model. Only ADPKD animals on DCR lost significant weight and showed slowed cyst growth compared to ad libitum, IMF, or TRF feeding. Collectively, this supports therapeutic feasibility of caloric restriction in ADPKD, with potential efficacy benefits driven by weight loss.
Collapse
Affiliation(s)
- Katharina Hopp
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Corresponding author
| | - Victoria A. Catenacci
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nidhi Dwivedi
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Timothy L. Kline
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55901, USA
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN 55901, USA
| | - Wei Wang
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Zhiying You
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Dustin T. Nguyen
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kristen Bing
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bhavya Poudyal
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55901, USA
| | - Ginger C. Johnson
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Matthew R. Jackman
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Marsha Miller
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Cortney N. Steele
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Natalie J. Serkova
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Paul S. MacLean
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Raphael A. Nemenoff
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Berenice Gitomer
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Michel Chonchol
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kristen L. Nowak
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Corresponding author
| |
Collapse
|
14
|
Movahedian M, Golzan SA, Ashtary-Larky D, Clark CCT, Asbaghi O, Hekmatdoost A. The effects of artificial- and stevia-based sweeteners on lipid profile in adults: a GRADE-assessed systematic review, meta-analysis, and meta-regression of randomized clinical trials. Crit Rev Food Sci Nutr 2021:1-17. [PMID: 34882023 DOI: 10.1080/10408398.2021.2012641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
It has been posited that Non-nutritive sweeteners (NNS) intake may affect lipid profile. However, its proven effects on lipid profile are unclear, as clinical studies on this topic have produced inconsistent results. To fill this gap in knowledge, this systematic review and meta-analysis of randomized controlled trials (RCTs) sought to evaluate the effects of artificial- and stevia-based sweeteners consumption on lipid profile markers. To identify eligible RCTs, a systematic search up to April 2021 was completed in PubMed/Medline, Scopus, and EMBASE, using relevant keywords. A random-effect model was utilized to estimate the weighted mean difference (WMD) and 95% confidence (95% CI) for TG, TC, and LDL. On the other hand, a fixed-effect model was used to estimate the WMD and 95% CI for HDL. Fourteen RCTs were included in the present meta-analysis. The pooled analysis revealed that NNS did not affect TG (WMD:-1.31, 95% CI:-5.89, 3.27 mg/dl), TC (WMD:-2.27,95% CI:-7.61,3.07 mg/dl), LDL (WMD:1,95% CI: -2.72, 4.71 mg/dl), and HDL (WMD:0.06, 95% CI:-0.62,0.73 mg/dl). Subgroup analysis showed that NNS may be related to a small, but statistically significant, increase in LDL (WMD:4.23, 95% CI:0.50,7.96 mg/dl) in subjects with normal levels of LDL (<100 mg/dl). We found that consumption of artificial- and stevia-based sweeteners is not associated with lipid profile changes in adults. This study has been registered at PROSPERO (registration number: CRD42021250025).
Collapse
Affiliation(s)
- Mina Movahedian
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Amirhossein Golzan
- Student Research Committee, Department of Food Science and Technology, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Damoon Ashtary-Larky
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Omid Asbaghi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
15
|
Tan R, Chew S, Cleanthous X, Anastasiou K, Brooker PG, Pham T, Smith BPC. Assessment of artificial and natural sweeteners present in packaged non-alcoholic beverages (NABs) sold on the Singapore market. BMC Public Health 2021; 21:1866. [PMID: 34654404 PMCID: PMC8520227 DOI: 10.1186/s12889-021-11924-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/05/2021] [Indexed: 12/27/2022] Open
Abstract
Background New Nutri-Grade labelling, aimed at reducing Singaporeans’ sugar consumption will be implemented for all pre-packaged non-alcoholic beverages (NABs) sold in retail outlets from end 2021 onwards. It is expected such labelling will have a major impact on sugar content of beverages, as well as the replacement of sugar with non-caloric alternatives. Methods This study used product label data obtained from in-store surveys to investigate sugar and sweetener composition of NABs present on the Singapore market. Using this data we calculated products prospective Nutri-Grade classification in order to compare the current market composition with relation to sugar and/or sweetener use. Results Over half of the NABs on market were sweetened with sugar (59%) and were associated with less healthy Nutri-Grades of ‘C’ and ‘D’. The use of natural sweeteners; Stevia and Monk fruit, remains low (6%). Conclusion With continuous efforts by the government in promoting public health nutrition, it is expected that there will be a greater usage of sugar substitutes among NABs in response to the upcoming implementation of Nutri-Grade and ever-fluctuating consumers’ demands. The data collected in this study provide a point estimate (July–September 2020) on market composition and use of both sugar and artificial sweeteners in beverages prior to integration of the mandatory labelling requirements. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11924-0.
Collapse
Affiliation(s)
- Rebecca Tan
- Singapore Institute of Food and Biotechnology Innovation & Innovations in Food & Chemical Safety Programme, Agency for Science, Technology and Research, Singapore, 138671, Singapore.
| | - Sharon Chew
- Singapore Institute of Food and Biotechnology Innovation & Innovations in Food & Chemical Safety Programme, Agency for Science, Technology and Research, Singapore, 138671, Singapore
| | - Xenia Cleanthous
- Health & Biosecurity, The Commonwealth Scientific and Industrial Research Organisation, Canberra, ACT, 2601, Australia
| | - Kimberley Anastasiou
- Health & Biosecurity, The Commonwealth Scientific and Industrial Research Organisation, Canberra, ACT, 2601, Australia
| | - Paige G Brooker
- Health & Biosecurity, The Commonwealth Scientific and Industrial Research Organisation, Canberra, ACT, 2601, Australia
| | - Theresa Pham
- National Heart Foundation Australia, Docklands, VIC, 3008, Australia
| | - Benjamin P C Smith
- Singapore Institute of Food and Biotechnology Innovation & Innovations in Food & Chemical Safety Programme, Agency for Science, Technology and Research, Singapore, 138671, Singapore.,Future Ready Food Safety Hub, C/O School of Chemical & Biomedical Engineering, Nanyang Technical University, Singapore, 637459, Singapore
| |
Collapse
|
16
|
Webb MC, Chong D, Bawa S. Consumption patterns of nonnutritive sweeteners among university students at a Caribbean institution. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:719-724. [PMID: 31995445 DOI: 10.1080/07448481.2019.1706531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 10/25/2019] [Accepted: 12/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE(S) To determine whether there is an association between the consumption of nonnutritive sweeteners (NNS) and sex, as well as age. Also, to determine awareness of the health risks associated with the use of NNS. METHODS A cross-sectional study was conducted using a self-administered questionnaire. Descriptive statistics were used to compile the data collected. Data were presented using frequencies and percentages. A chi-squared tests were performed to test the association between NNS and gender/sex and age. The level of significance was set at the ≤ 0.05. RESULTS The majority of students [n = 108 (55.1%)] indicated that they have never used NNS. The NNS with the highest intake was sucralose. There were no significant associations between gender (p-value = 0.508) and age (p-value = 0.275) and use of NNS. For awareness of the association between NNS, weight gain, and cancer, 38.8% (n = 76) of the participants indicated that they were not aware that NNS are associated with weight gain. Less than half of the participants (n = 46, 23.5%) were not aware that NNS does cause cancer. CONCLUSION A large portion of university students do not use NNS. The majority of students were aware that NNS are associated with weight gain but did not link it to cancer development.
Collapse
Affiliation(s)
- Marquitta C Webb
- Department of Agricultural Economics and Extension, Faculty of Food and Agriculture, The University of the West Indies - St. Augustine, St. Augustine, Trinidad and Tobago
| | - Dana Chong
- Department of Agricultural Economics and Extension, Faculty of Food and Agriculture, The University of the West Indies - St. Augustine, St. Augustine, Trinidad and Tobago
| | - Sa'eed Bawa
- Department of Agricultural Economics and Extension, Faculty of Food and Agriculture, The University of the West Indies - St. Augustine, St. Augustine, Trinidad and Tobago
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, Warsaw, Poland
| |
Collapse
|
17
|
Stanislawski MA, Frank DN, Borengasser SJ, Ostendorf DM, Ir D, Jambal P, Bing K, Wayland L, Siebert JC, Bessesen DH, MacLean PS, Melanson EL, Catenacci VA. The Gut Microbiota during a Behavioral Weight Loss Intervention. Nutrients 2021; 13:3248. [PMID: 34579125 PMCID: PMC8471894 DOI: 10.3390/nu13093248] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
Altered gut microbiota has been linked to obesity and may influence weight loss. We are conducting an ongoing weight loss trial, comparing daily caloric restriction (DCR) to intermittent fasting (IMF) in adults who are overweight or obese. We report here an ancillary study of the gut microbiota and selected obesity-related parameters at the baseline and after the first three months of interventions. During this time, participants experienced significant improvements in clinical health measures, along with altered composition and diversity of fecal microbiota. We observed significant associations between the gut microbiota features and clinical measures, including weight and waist circumference, as well as changes in these clinical measures over time. Analysis by intervention group found between-group differences in the relative abundance of Akkermansia in response to the interventions. Our results provide insight into the impact of baseline gut microbiota on weight loss responsiveness as well as the early effects of DCR and IMF on gut microbiota.
Collapse
Affiliation(s)
- Maggie A. Stanislawski
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| | - Daniel N. Frank
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| | - Sarah J. Borengasser
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| | - Danielle M. Ostendorf
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| | - Diana Ir
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| | - Purevsuren Jambal
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| | - Kristen Bing
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| | - Liza Wayland
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| | - Janet C. Siebert
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| | - Daniel H. Bessesen
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| | - Paul S. MacLean
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| | - Edward L. Melanson
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
- Eastern Colorado Veterans Affairs Geriatric Research, Education and Clinical Center, Denver, CO 80045, USA
| | - Victoria A. Catenacci
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.N.F.); (S.J.B.); (D.M.O.); (D.I.); (P.J.); (K.B.); (L.W.); (J.C.S.); (D.H.B.); (P.S.M.); (E.L.M.); (V.A.C.)
| |
Collapse
|
18
|
Nadolsky KZ. COUNTERPOINT: Artificial Sweeteners for Obesity-Better than Sugary Alternatives; Potentially a Solution. Endocr Pract 2021; 27:1056-1061. [PMID: 34481971 DOI: 10.1016/j.eprac.2021.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Nonnutritive (NNSs) are used in place of sugars to reduce caloric and glycemic intake while providing desired sweetness, commonly replacing sugar-sweetened beverages (SSBs) with "diet" (zero-calorie) alternatives. Concern has developed due to observational data associating NNSs with obesity and adiposity-based chronic disease. This counterpoint argues that, in general, NNSs used in place of added or excess sugars in the diet are likely beneficial. METHODS A literature review was conducted on interventional trials investigating NNSs and obesity or type 2 diabetes mellitus. Key words used in the search included artificial sweeteners, nonnutritive sweeteners, saccharin, sucralose, aspartame, stevia/steviol, acesulfame potassium, meal replacements, type 2 diabetes mellitus, obesity, and weight. RESULTS Interventional data and indirect interventional data consistently showed beneficial effects on weight and cardiometabolic health, including glycemia, when SSBs or other energy-dense foods were replaced by artificially sweetened beverages or artificially sweetened meal replacements. CONCLUSION Although NNSs correlate with obesity and adiposity-based chronic disease, those data are fraught with confounding and error. Plausibility has been suggested on the basis of preclinical research on neuroendocrine control of appetite, satiety, and cravings plus the gut microbiome. However, interventional data reveal that replacing caloric/glycemic energy intake via NNSs creates an energy deficit resulting in weight loss and improvement in disease-especially dysglycemic disease. Intensive dietary intervention using artificially sweetened meal replacements shows a marked clinical benefit without detriment from their NNSs. Furthermore, beverages sweetened with NNSs rather than SSBs have been noted to be a critical component for those succeeding in maintaining weight loss. Although individual responses to the effects of NNSs are always warranted just like in any clinical situation, patients should not be advised to avoid NNSs in the context of dietary intervention to improve quality and energy deficit.
Collapse
Affiliation(s)
- Karl Z Nadolsky
- College of Human Medicine, Michigan State University, Grand Rapids, Michigan; Department of Endocrinology & Diabetes, Spectrum Health West Michigan, Grand Rapids, Michigan.
| |
Collapse
|
19
|
Lee HY, Jack M, Poon T, Noori D, Venditti C, Hamamji S, Musa-Veloso K. Effects of Unsweetened Preloads and Preloads Sweetened with Caloric or Low-/No-Calorie Sweeteners on Subsequent Energy Intakes: A Systematic Review and Meta-Analysis of Controlled Human Intervention Studies. Adv Nutr 2021; 12:1481-1499. [PMID: 33439973 PMCID: PMC8321874 DOI: 10.1093/advances/nmaa157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/02/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Abstract
Effects of isocaloric (sweetness differences but constant calories) preloads and isosweet (caloric differences but constant sweetness) preloads, as well as preloads that were neither isosweet nor isocaloric (sweetness and caloric differences) on subsequent ad libitum meal and total (preload + ad libitum) energy intakes were investigated. Thirty-five crossover studies were eligible for inclusion, representing 116 comparisons (41, isocaloric; 41, isosweet; and 34, neither isosweet nor isocaloric). References of existing reviews and literature from 4 databases were searched. The calculated raw mean differences in ad libitum and total energy intakes were pooled in meta-analyses using a random-effects model and the inverse of the variance as the weighting factor. Energy intakes at an ad libitum meal were significantly lower for low-/no-calorie sweetener (LNCS)-sweetened compared with unsweetened preloads in the isocaloric comparison (-55.5 kcal; 95% CI: -82.9, -28.0 kcal; P < 0.001); however, the difference in energy intake was not significant in additional sensitivity analyses (i.e., removal of comparisons where the matrix was a capsule and when xylitol was the LNCS). For the isosweet comparison, although the pooled energy intake at the ad libitum meal was significantly greater with the LNCS-sweetened preload compared with the caloric sweetener (CS)-sweetened preload (58.5 kcal; 95% CI: 35.4, 81.7 kcal; P < 0.001), the pattern was reversed when total energy intake was considered (-132.4 kcal; 95% CI: -163.2, -101.6 kcal; P < 0.001), explained by only partial compensation from the CS-sweetened preload. The results were similar when assessing ad libitum and total energy intakes when unsweetened compared with CS-sweetened preloads were consumed. Unsweetened or LNCS-sweetened preloads appear to have similar effects on intakes when compared with one another or with CS-sweetened preloads. These findings suggest that LNCS-sweetened foods and beverages are viable alternatives to CS-sweetened foods and beverages to manage short-term energy intake.
Collapse
Affiliation(s)
- Han Youl Lee
- Intertek Health Sciences, Inc., Mississauga, Ontario Canada
| | - Maia Jack
- American Beverage Association, Science and Regulatory Affairs, Washington, DC, USA
| | - Theresa Poon
- Intertek Health Sciences, Inc., Mississauga, Ontario Canada
| | - Daniel Noori
- Intertek Health Sciences, Inc., Mississauga, Ontario Canada
| | | | - Samer Hamamji
- Intertek Health Sciences, Inc., Mississauga, Ontario Canada
| | | |
Collapse
|
20
|
Normand M, Ritz C, Mela D, Raben A. Low-energy sweeteners and body weight: a citation network analysis. BMJ Nutr Prev Health 2021; 4:319-332. [PMID: 34308140 PMCID: PMC8258071 DOI: 10.1136/bmjnph-2020-000210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Reviews on the relationship of low-energy sweeteners (LES) with body weight (BW) have reached widely differing conclusions. To assess possible citation bias, citation analysis was used to quantify the relevant characteristics of cited articles, and explore citation patterns in relation to review conclusions. DESIGN A systematic search identified reviews published from January 2010 to March 2020. Different characteristics (for example, type of review or research, journal impact factor, conclusions) were extracted from the reviews and cited articles. Logistic regression was used to estimate likelihood of articles with particular characteristics being cited in reviews. A qualitative network analysis linked reviews sub-grouped by conclusions with the types of articles they cited. MAIN OUTCOME MEASURES (OR; 95% CI) for likelihood that articles with particular characteristics were cited as evidence in reviews. RESULTS From 33 reviews identified, 183 different articles were cited (including other reviews). Narrative reviews were 62% less likely to be cited than systematic reviews with meta-analysis (OR 0.38; 0.16 to 0.86; p=0.03). Likelihood of being cited was higher for evidence on children than adults (OR 2.27; 1.59 to 3.25; p<0.0001), and with increased journal impact factor (OR 1.15; 1.00 to 1.31; p=0.04). No other factors were statistically significant in the main analysis, and few factors were significant in subgroup analyses. Network analysis showed that reviews concluding a beneficial relationship of LES with BW cited mainly randomised controlled trials, whereas reviews concluding an adverse relationship cited mainly observational studies. CONCLUSIONS Overall reference to the available evidence across reviews appears largely arbitrary, making citation bias likely. Differences in the conclusions of individual reviews map onto different types of evidence cited. Overall, inconsistent and selective use of the available evidence may account for the diversity of conclusions in reviews on LES and BW. TRIAL REGISTRATION NUMBER Prior to data analysis, the protocol was registered with the Open Science Framework (https://osf.io/9ghws).
Collapse
Affiliation(s)
- Mie Normand
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | | | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| |
Collapse
|
21
|
Russell C, Dickie S, Baker P, Lawrence M. Does the Australian Health Star Rating System Encourage Added Sugar Reformulation? Trends in Sweetener Use in Australia. Nutrients 2021; 13:898. [PMID: 33802024 PMCID: PMC7998813 DOI: 10.3390/nu13030898] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
Dietary risk factors, including excess added sugar intake, are leading contributors to Australia's burden of disease. An objective of the Australian Health Star Rating (HSR) system is to encourage the reformulation of packaged foods. Manufacturers may improve a product's HSR by replacing added sugar with non-nutritive sweeteners (NNS). Concerns have been raised regarding the potential substitution effects of ultra-processed foods containing NNS for whole foods, and the long-term impact this may have on population health. The aim of this study was to determine whether the implementation of the HSR system has impacted the use of added sugars and NNS in the food supply. Four product categories were used: products with no added sweetener, products containing added sugar only, products containing NNS only, and products containing a combination of added sugar and NNS. Of 6477 newly released products analyzed displaying a HSR in Australia between 2014-2020, 63% contained added sugars. The proportion of new products sweetened with added sugars increased over time, while NNS use did not, despite a higher average and median HSR for products sweetened with NNS. These findings suggest that at the current time, the HSR system may not discourage the use of added sugars in new products or incentivize the reformulation of added sugar with NNS. As the health risks of NNS are questioned, increased reformulation of products with NNS to reduce the presence of added sugar in the food supply may not address broader health concerns. Instead, supporting the promotion of whole foods and drinks should be prioritized, as well as policy actions that reduce the proliferation and availability of UPFs.
Collapse
Affiliation(s)
- Cherie Russell
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3217, Australia; (S.D.); (P.B.); (M.L.)
| | - Sarah Dickie
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3217, Australia; (S.D.); (P.B.); (M.L.)
| | - Phillip Baker
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3217, Australia; (S.D.); (P.B.); (M.L.)
- Institute for Physical Activity and Nutrition, Deakin University, Geelong 3217, Australia
| | - Mark Lawrence
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3217, Australia; (S.D.); (P.B.); (M.L.)
- Institute for Physical Activity and Nutrition, Deakin University, Geelong 3217, Australia
| |
Collapse
|
22
|
Farr OM. Acute diet soda consumption alters brain responses to food cues in humans: A randomized, controlled, cross-over pilot study. Nutr Health 2021; 27:295-299. [PMID: 33588630 DOI: 10.1177/0260106021993753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diet soda consumption has frequently been linked to obesity and its comorbidities in epidemiological studies. Whether this link is causal and a potential mechanism remains to be determined. AIM/METHODS This randomized, cross-over, controlled pilot study sought to determine whether there may be changes in reward-related brain activations to visual food cues after acute consumption of diet soda versus regular soda or carbonated water using functional magnetic resonance imaging. RESULTS Diet soda as compared to carbonated water consumption increased activation of reward-related caudate to highly versus less desirable food cues. Diet soda as compared to regular soda increased reward-related insula and decreased activation of cognitive control-related dorsolateral prefrontal cortex to food cues versus non-food cues. No changes in ratings of hunger an hour after beverage consumption were observed. CONCLUSIONS These results may suggest a potential mechanism for diet soda to increase food palatability through activation of the reward system and suppression of inhibitory control that remains to be confirmed by future studies.
Collapse
Affiliation(s)
- Olivia M Farr
- Division of Endocrinology, Beth-Israel Deaconess Medical Center/1811Harvard Medical School, Boston, MA, USA
| |
Collapse
|
23
|
Gallagher AM, Ashwell M, Halford JCG, Hardman CA, Maloney NG, Raben A. Low-calorie sweeteners in the human diet: scientific evidence, recommendations, challenges and future needs. A symposium report from the FENS 2019 conference. J Nutr Sci 2021; 10:e7. [PMID: 33889390 PMCID: PMC8057368 DOI: 10.1017/jns.2020.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
Overconsumption of free sugars, particularly from sugar-sweetened beverages (SSB), has potential negative health impacts. Implementation of a range of public health strategies is needed to reduce intakes of free sugars, including reducing portion sizes, promoting healthier dietary choices and reformulating foods and beverages. Although low-calorie sweeteners (LCS) are a useful tool for reducing energy intake and control glucose response when consuming sweet foods and drinks, several opinions persist about the adverse health effects of LCS, many of which are based on poor, little or no scientific evidence. This symposium report summarises key messages of the presentations and related discussions delivered at a scientific symposium at the 13th European Nutrition Conference (FENS 2019). These presentations considered the scientific evidence and current recommendations about the use and potential benefits of LCS for human health, with a particular focus on current evidence in relation to body weight and glycaemic control. Many of the studies to date on LCS have focused on low-calorie sweetened beverages (LCSB); however, the psychological and behavioural factors influencing consumer beliefs and consumption of LCSB need to be further explored. Current recommendations for LCS use are described, including the conclusions from a recent expert consensus report identifying the challenges that remain with LCS research. Finally, existing knowledge gaps and future actions are described, as well as two large ongoing research projects: SWITCH and SWEET.
Collapse
Affiliation(s)
- Alison M. Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, Ulster University, ColeraineBT52 1SA, Northern Ireland, UK
| | | | | | | | - Niamh G. Maloney
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, FrederiksbergDK-1958, Denmark
| |
Collapse
|
24
|
Abstract
Introduction Non-nutritive sweeteners (NNS) are food additives that have been used as a possible tool to reduce energy and sugar intake. There is a scientific debate around the real benefits of their use. NNS are substances widely evaluated in the scientific literature. Their safety is reviewed by international regulatory health agencies. Health professionals and consumers often lack education and objective information about food additives based on the best scientific evidence. NNS have been used as a substitute for sucrose, especially by people with diabetes mellitus and obesity. However, concerns related to their possible association with preterm birth have been raised, and also with their use during pregnancy and lactation because of the possibility of metabolic or other consequences in both the mother and offspring. This analysis of the evidence in gynecology and obstetrics presents a review of the most commonly asked questions regarding this matter by health professionals and their patients. This document evaluates a diversity of scientific publications under the sieve of evidence-based medicine and the regulatory framework for food additives to elucidate whether the use of NNS in women in these critical stages of pregnancy and breastfeeding represents a potential risk.
Collapse
|
25
|
Changes in Non-Nutritive Sweetener Consumption Patterns in Response to a Sugar-Sweetened Beverage Reduction Intervention. Nutrients 2020; 12:nu12113428. [PMID: 33171645 PMCID: PMC7695198 DOI: 10.3390/nu12113428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023] Open
Abstract
Data are lacking on whether non-nutritive sweeteners (NNS) can be used as a strategy to support decreases in sugar-sweetened beverage (SSB) consumption. The purpose of this secondary analysis of a 6-month SSB-reduction intervention was to explore changes in NNS consumption patterns in Talking Health participants within the SIPsmartER (n = 101) intervention. Additionally, participant characteristics were compared for three SSB-NNS change groups (decrease SSB/increase NNS; decrease SSB/no increase in NNS; increase/no change in SSB/regardless of NNS). There was a significant increase in aspartame and total NNS intake for participants (mean daily mg increases of 37.2 ± 13.9 and 63.7 ± 18.5, respectively). With the exception of sex, no differences in participant characteristics were found between the three SSB-NNS change groups. Furthermore, no significant changes in weight or body mass index (BMI) were demonstrated between SSB-NNS change groups over time. Diet soda was the most commonly consumed source of NNS; however, other dietary sources of NNS also contributed to intake. At 6 months, intake of sucralose and saccharin were primarily from dietary sources other than diet sodas (94% and 100%, respectively). These findings suggest that NNS may be a feasible strategy to help reduce SSB consumption. This study supports the need to consistently quantify and identify NNS intake, beyond using diet soda intake as a proxy for NNS intake and grouping all NNS types into one variable, to more accurately address the potential health effects of NNS.
Collapse
|
26
|
The drivers, trends and dietary impacts of non-nutritive sweeteners in the food supply: a narrative review. Nutr Res Rev 2020; 34:185-208. [PMID: 33148371 DOI: 10.1017/s0954422420000268] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Poor diets, including excess added sugar consumption, contribute to the global burden of disease. Subsequently, many nutrition policies have been implemented to reduce added sugar intake and improve population health, including taxes, education, labelling and environmental interventions. A potential consequence of these policy actions is the substitution of added sugars with non-nutritive sweeteners (NNS) in a variety of foods and beverages. NNS are used to reduce the energy and sugar content of foods and beverages while maintaining their palatability. Evidence of the toxicological risks of NNS is inconsistent, though concerns have been raised over the potential substitution effects of ultra-processed foods containing NNS for whole foods. This review aimed to provide an overview of current NNS food supply and consumption patterns, assess added sugar-reduction policies and their impact on NNS, and determine the impact of NNS on food choice, energy intake and diet quality. NNS are widely available in a variety of products, though most commonly in carbonated beverages, dairy products, confectionery, table-top sweeteners and fruit drinks. However, the longitudinal trends of different product categories, and differences between geographies and economy-income levels, require further study. Few studies have examined NNS consumption trends globally, though an increase in NNS consumption in beverages has been observed in some regions. Research examining how the increased availability of low-sugar, NNS-containing products affects global dietary patterns is limited, particularly in terms of their potential substitution effects.
Collapse
|
27
|
Daily Eating Frequency in US Adults: Associations with Low-Calorie Sweeteners, Body Mass Index, and Nutrient Intake (NHANES 2007-2016). Nutrients 2020; 12:nu12092566. [PMID: 32847041 PMCID: PMC7551388 DOI: 10.3390/nu12092566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 11/16/2022] Open
Abstract
Studies of relationships between eating frequency and/or timing and energy intake have not examined associations with low-calorie sweeteners (LCS). We assessed the frequency of eating behavior related to LCS consumption emphasizing timing, calorie intake, and body mass index (BMI) among United States (US) adults aged ≥19 years. Using the National Health and Nutrition Examination Survey (NHANES) 2007-2016, we defined eating episodes as food and/or beverage intake within 15 min of one another over the first 24-h dietary recall. We coded items ingested during episodes (n = 136,938) and assessed LCS presence using US Department of Agriculture (USDA) food files. Episode analysis found intakes of foods only (27.4%), beverages only (29.5%), and foods with beverages (43.0%). LCS items were consumed without concurrent calories from other sources in fewer than 2.7% of all episodes. Within participants having normal weight (29.4%), overweight (33.6%) and obese (37.1%) BMIs, LCS consumers (35.2% overall) evidenced: more episodes/day; and fewer: calories, carbohydrates, fats, and protein per episode. Per person, those consuming LCS had lower total calories and higher fiber intake per day. LCS consumption was associated with higher BMI. Number of eating episodes/day and longer hours when eating episodes occurred were also consistently associated with higher BMI. Consuming LCS did not modify these relationships. These results did not show that LCS consumption was associated with increased caloric intake from other dietary sources.
Collapse
|
28
|
Moon RC, Brazzi-Smith G, Teixeira A, Jawad M. Preoperative Exposure to Low-Calorie Sweeteners and Bariatric Surgery Outcomes. Obes Surg 2020; 30:5012-5019. [PMID: 32827091 DOI: 10.1007/s11695-020-04931-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Low-calorie (LCSs) may be negatively associated with weight and metabolic health. We hypothesized that LCS exposure may hinder the effectiveness of bariatric procedures. The aim of this study was to examine the association between preoperative LCS use and weight loss/comorbidity remission following sleeve gastrectomy and gastric bypass. MATERIAL AND METHODS We performed a retrospective chart review of 653 patients who underwent one of the two bariatric procedures and provided preoperative diet information. Patients who selected LCS as one of their most commonly consumed sweeteners and/or included "diet" drinks or sugar-free foods in their 24-h diet recall were categorized as "LCS users." We used multiple logistic regression models to address the study objectives. RESULTS Of 653 patients, 470 (72.0%) regularly consumed LCSs. LCS users were more likely to be older, have lower preoperative BMI, diabetic, using insulin, and have hyperlipidemia than non-LCS users. LCS consumption was not associated with the odds of achieving BMI < 35 kg/m2 nor the odds of achieving TBWL ≥ 20% in the adjusted models. While 39.6% of diabetic LCS users did not show remission, only 22.7% of diabetic non-LCS users did so at their last follow-up (p = 0.04). However, this association was attenuated when adjusted for insulin dependency. CONCLUSIONS There is no clear harm or benefit of preoperative consumption of LCS on weight loss or comorbidity remission after bariatric procedures. Further study is needed to more accurately assess the effect of LCSs on bariatric surgery outcomes.
Collapse
Affiliation(s)
- Rena C Moon
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, Orlando, FL, 32806, USA.
| | - Gayle Brazzi-Smith
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, Orlando, FL, 32806, USA
| | - Andre Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, Orlando, FL, 32806, USA
| | - Muhammad Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, Orlando, FL, 32806, USA
| |
Collapse
|
29
|
Effects of Non-nutritive Sweeteners on Sweet Taste Processing and Neuroendocrine Regulation of Eating Behavior. Curr Nutr Rep 2020; 9:278-289. [PMID: 32588329 DOI: 10.1007/s13668-020-00323-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Non-nutritive sweeteners (NNS) are increasingly used as a replacement for nutritive sugars as means to quench the desire for "sweets" while contributing few or no dietary calories. However, there is concern that NNS may uncouple the evolved relationship between sweet taste and post-ingestive neuroendocrine signaling. In this review, we examine the effects of NNS exposure on neural and peripheral systems in humans. RECENT FINDINGS NNS exposure during early development may influence sweet taste preferences, and NNS consumption might increase motivation for sweet foods. Neuroimaging studies provide evidence that NNS elicit differential neuronal responsivity in areas related to reward and satiation, compared with caloric sweeteners. Findings are heterogenous regarding whether NNS affect physiological responses. Additional studies are warranted regarding the consequences of NNS on metabolic outcomes and neuroendocrine pathways. Given the widespread popularity of NNS, future studies are essential to establish their role in long-term health.
Collapse
|
30
|
Turner A, Veysey M, Keely S, Scarlett CJ, Lucock M, Beckett EL. Intense Sweeteners, Taste Receptors and the Gut Microbiome: A Metabolic Health Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114094. [PMID: 32521750 PMCID: PMC7312722 DOI: 10.3390/ijerph17114094] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 12/22/2022]
Abstract
Intense sweeteners (IS) are often marketed as a healthier alternative to sugars, with the potential to aid in combating the worldwide rise of diabetes and obesity. However, their use has been counterintuitively associated with impaired glucose homeostasis, weight gain and altered gut microbiota. The nature of these associations, and the mechanisms responsible, are yet to be fully elucidated. Differences in their interaction with taste receptors may be a potential explanatory factor. Like sugars, IS stimulate sweet taste receptors, but due to their diverse structures, some are also able to stimulate bitter taste receptors. These receptors are expressed in the oral cavity and extra-orally, including throughout the gastrointestinal tract. They are involved in the modulation of appetite, glucose homeostasis and gut motility. Therefore, taste genotypes resulting in functional receptor changes and altered receptor expression levels may be associated with metabolic conditions. IS and taste receptors may both interact with the gastrointestinal microbiome, and their interactions may potentially explain the relationship between IS use, obesity and metabolic outcomes. While these elements are often studied in isolation, the potential interactions remain unexplored. Here, the current evidence of the relationship between IS use, obesity and metabolic outcomes is presented, and the potential roles for interactions with taste receptors and the gastrointestinal microbiota in modulating these relationships are explored.
Collapse
Affiliation(s)
- Alexandria Turner
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (A.T.); (C.J.S.); (M.L.)
| | - Martin Veysey
- School of Medicine and Public Health, University of Newcastle, Ourimbah 2258, Australia;
- Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan 2308, Australia;
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia
| | - Christopher J. Scarlett
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (A.T.); (C.J.S.); (M.L.)
| | - Mark Lucock
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (A.T.); (C.J.S.); (M.L.)
| | - Emma L. Beckett
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (A.T.); (C.J.S.); (M.L.)
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia
- Correspondence:
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Schneider S, Mata J, Kadel P. Relations between sweetened beverage consumption and individual, interpersonal, and environmental factors: a 6-year longitudinal study in German children and adolescents. Int J Public Health 2020; 65:559-570. [PMID: 32561963 PMCID: PMC7360664 DOI: 10.1007/s00038-020-01397-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/28/2020] [Accepted: 05/20/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study aims to characterize the consumption of sweetened beverages (SB) among young people in Germany in terms of individual and interpersonal-environmental correlates. METHODS A representative sample of children and adolescents from Germany was assessed twice, 6 years apart (total longitudinal sample n = 11,691 children and adolescents aged between 0 and 17 years old; weighted). The relations between individual and interpersonal-environmental factors at baseline with SB intake 6 years later were analysed using bivariate and multivariate methods. RESULTS The majority of children and adolescents in Germany consume sweetened beverages weekly, 23% daily. SB consumption is particularly high in boys and often accompanied by other unhealthy lifestyle behaviours including a high level of tobacco and media consumption with a concurrent deficiency in fruit and vegetable consumption. Interpersonal factors associated with higher sweetened beverage consumption include low socio-economic status, tobacco consumption of parents, and older maternal age. CONCLUSIONS Research on factors that correlate with sweetened beverage consumption is crucial to design effective interventions. Our findings underline the importance of complex, multi-level interventions to target sweetened beverage intake and obesity.
Collapse
Affiliation(s)
- Sven Schneider
- Division Head Child and Health, Medical Faculty Mannheim, Mannheim Institute for Public Health, Social and Preventive Medicine, Heidelberg University, Ludolf-Krehl-Straße 7-11, 68167 Mannheim, Germany
| | - Jutta Mata
- Health Psychology, University of Mannheim, 68161 Mannheim, Germany
| | - Philipp Kadel
- Division Head Child and Health, Medical Faculty Mannheim, Mannheim Institute for Public Health, Social and Preventive Medicine, Heidelberg University, Ludolf-Krehl-Straße 7-11, 68167 Mannheim, Germany
- Health Psychology, University of Mannheim, 68161 Mannheim, Germany
| |
Collapse
|
33
|
Lohner S, Kuellenberg de Gaudry D, Toews I, Ferenci T, Meerpohl JJ. Non-nutritive sweeteners for diabetes mellitus. Cochrane Database Syst Rev 2020; 5:CD012885. [PMID: 32449201 PMCID: PMC7387865 DOI: 10.1002/14651858.cd012885.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Products sweetened with non-nutritive sweeteners (NNS) are widely available. Many people with type 1 or type 2 diabetes use NNS as a replacement for nutritive sweeteners to control their carbohydrate and energy intake. Health outcomes associated with NNS use in diabetes are unknown. OBJECTIVES To assess the effects of non-nutritive sweeteners in people with diabetes mellitus. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Scopus, the WHO ICTRP, and ClinicalTrials.gov. The date of the last search of all databases (except for Scopus) was May 2019. We last searched Scopus in January 2019. We did not apply any language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with a duration of four weeks or more comparing any type of NNS with usual diet, no intervention, placebo, water, a different NNS, or a nutritive sweetener in individuals with type 1 or type 2 diabetes. Trials with concomitant behaviour-changing interventions, such as diet, exercise, or both, were eligible for inclusion, given that the concomitant interventions were the same in the intervention and comparator groups. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, full texts, and records retrieved from trials registries, assessed the certainty of the evidence, and extracted data. We used a random-effects model to perform meta-analysis, and calculated effect estimates as risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, using 95% confidence intervals (CIs). We assessed risk of bias using the Cochrane 'Risk of bias' tool and the certainty of evidence using the GRADE approach. MAIN RESULTS We included nine RCTs that randomised a total of 979 people with type 1 or type 2 diabetes. The intervention duration ranged from 4 to 10 months. We judged none of these trials as at low risk of bias for all 'Risk of bias' domains; most of the included trials did not report the method of randomisation. Three trials compared the effects of a dietary supplement containing NNS with sugar: glycosylated haemoglobin A1c (HbA1c) was 0.4% higher in the NNS group (95% CI -0.5 to 1.2; P = 0.44; 3 trials; 72 participants; very low-certainty evidence). The MD in weight change was -0.1 kg (95% CI -2.7 to 2.6; P = 0.96; 3 trials; 72 participants; very low-certainty evidence). None of the trials with sugar as comparator reported on adverse events. Five trials compared NNS with placebo. The MD for HbA1c was 0%, 95% CI -0.1 to 0.1; P = 0.99; 4 trials; 360 participants; very low-certainty evidence. The 95% prediction interval ranged between -0.3% and 0.3%. The comparison of NNS versus placebo showed a MD in body weight of -0.2 kg, 95% CI -1 to 0.6; P = 0.64; 2 trials; 184 participants; very low-certainty evidence. Three trials reported the numbers of participants experiencing at least one non-serious adverse event: 36/113 participants (31.9%) in the NNS group versus 42/118 participants (35.6%) in the placebo group (RR 0.78, 95% CI 0.39 to 1.56; P = 0.48; 3 trials; 231 participants; very low-certainty evidence). One trial compared NNS with a nutritive low-calorie sweetener (tagatose). HbA1c was 0.3% higher in the NNS group (95% CI 0.1 to 0.4; P = 0.01; 1 trial; 354 participants; very low-certainty evidence). This trial did not report body weight data and adverse events. The included trials did not report data on health-related quality of life, diabetes complications, all-cause mortality, or socioeconomic effects. AUTHORS' CONCLUSIONS There is inconclusive evidence of very low certainty regarding the effects of NNS consumption compared with either sugar, placebo, or nutritive low-calorie sweetener consumption on clinically relevant benefit or harm for HbA1c, body weight, and adverse events in people with type 1 or type 2 diabetes. Data on health-related quality of life, diabetes complications, all-cause mortality, and socioeconomic effects are lacking.
Collapse
Affiliation(s)
- Szimonetta Lohner
- Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary
| | - Daniela Kuellenberg de Gaudry
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingrid Toews
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tamas Ferenci
- Physiological Controls Research Center, Obuda University, Budapest, Hungary
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane France, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes University, Paris, France
| |
Collapse
|
34
|
Lawman HG, Grossman S, Lofton X, Tasian G, Patel AI. Hydrate Philly: An Intervention to Increase Water Access and Appeal in Recreation Centers. Prev Chronic Dis 2020; 17:E15. [PMID: 32078503 PMCID: PMC7085906 DOI: 10.5888/pcd17.190277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Previous interventions to increase water access and consumption have focused on school settings, have shown mixed results on sugar-sweetened beverage (SSB) consumption, and have rarely addressed tap water safety. Our randomized controlled trial examined how improving access and appeal of water in recreation centers in low-income neighborhoods affected counts of SSBs carried by youth attending summer camp. Methods Recreation centers (N = 28) matched on their characteristics were randomly assigned to control or intervention groups. Intervention centers received a new water fountain with a bottle filler (hydration station), water testing services, reusable water bottles, and water promotion and education training and materials. Primary outcomes were 1-year changes in center-level average daily gallons of water from fountains and hydration stations (flowmeter readings). Secondary outcomes were counts of SSBs observed, use of bottled water and reusable water bottles, staff SSB consumption, and hydration station maintenance. Results Results showed increased water use (b = 8.6, 95% CI, 4.2–13.0) and reusable bottle counts (b = 10.2, 95% CI, 4.2–16.1) in intervention centers compared with control centers. No change occurred in youth carrying SSBs at camp, but center staff’s past 30-day SSB consumption frequency decreased (b = −34.8, 95% CI, −67.7 to −1.9). Intervention sites had marginally lower odds of maintenance problems (OR = 0.09; 95% CI, 0.004–0.76, P = .06) than control sites. Conclusion Although providing hydration stations along with water testing, reusable water bottles, education, and promotion increased water consumption among youth at recreation centers, it had no effect on the number of SSBs observed during camp. Future strategies to increase water consumption should also address reducing SSB intake.
Collapse
Affiliation(s)
- Hannah G Lawman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania.,Division of Chronic Disease Prevention, Philadelphia Department of Public Health, 1101 Market St, 9th Flr, Philadelphia, PA 19107.
| | - Sara Grossman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Xavier Lofton
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Gregory Tasian
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anisha I Patel
- School of Medicine, Stanford University, Stanford, California.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
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.
Collapse
Affiliation(s)
| | | | | | - Richard D. Mattes
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA; (S.R.H.); (E.J.R.); (E.C.)
| |
Collapse
|
37
|
Abebe L, Aman M, Asfaw S, Gebreyesus H, Teweldemedhin M, Mamo A. Formula-feeding practice and associated factors among urban and rural mothers with infants 0-6 months of age: a comparative study in Jimma zone Western Ethiopia. BMC Pediatr 2019; 19:408. [PMID: 31684900 PMCID: PMC6827217 DOI: 10.1186/s12887-019-1789-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infants are in a state of rapid development and maturation; the growth rate is most rapid during the first 4 to 6 months of life. Few studies indicated that in developing countries including Ethiopia the prevalence and duration of breastfeeding is declining and being replaced by formula milk. Therefore, this study aimed to assess the formula-feeding practice and its associated factors among urban and rural mothers with infants 0-6 months of age in the Jimma Zone, Western Ethiopia. METHODS A community-based cross-sectional study was conducted from November 7, 2015, to January 10, 2016, in the Jimma Zone. The quantitative data were collected from a sample of 714 respondents using a multistage sampling technique. Data were collected through a structured questionnaire and the multivariate logistic regression model was used to show predictors of the formula-feeding practice among mothers with infants 0-6 months of age. RESULT The proportion of mothers who feed their baby formula-based was 47.2%, of which 34.5% were living in rural areas and 65.5% were living in urban areas. Among the mothers living in urban areas, the likelihood of formula-feeding was significantly associated with maternal educational status and attitude towards formula-feeding. On the other hand, being attended by relatives/friends and the traditional birth attendant was significantly associated with the formula-feeding practice among mothers who live in rural areas. CONCLUSION Nearly half of the mothers in the study area practice formula-feeding for their infant. Therefore, sustained community based nutritional health education is recommended for pregnant and lactating mothers to reduce the practice of formula-feeding for infants.
Collapse
Affiliation(s)
- Lakew Abebe
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Mamusha Aman
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Shifera Asfaw
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Hailay Gebreyesus
- Department of Public Health, College of Health Sciences, Aksum University, P.O. Box 298, Aksum, Ethiopia
| | - Mebrahtu Teweldemedhin
- Department of Medical Laboratory Science, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Abebe Mamo
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| |
Collapse
|
38
|
Catenacci VA, Ostendorf DM, Pan Z, Bing K, Wayland LT, Seyoum E, Stauffer BL, Phelan S, Creasy SA, Caldwell AE, Wyatt HR, Bessesen DH, Melanson EL. The Impact of Timing of Exercise Initiation on Weight Loss: An 18-Month Randomized Clinical Trial. Obesity (Silver Spring) 2019; 27:1828-1838. [PMID: 31565869 PMCID: PMC6832769 DOI: 10.1002/oby.22624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of timing of exercise initiation on weight loss within a behavioral weight loss program. METHODS Adults with overweight or obesity (N = 170; age 18-55 years; BMI 25-42 kg/m2 ; 83.5% women) were enrolled in an 18-month behavioral weight loss program consisting of a reduced-calorie diet, exercise, and group-based support. The standard group (STD) received a supervised exercise program (progressing to 300 min/wk of moderate-intensity aerobic exercise) during months 0 to 6. The sequential group (SEQ) was asked to refrain from changing exercise during months 0 to 6 and received the supervised exercise program during months 7 to 12. On completion of supervised exercise, both groups were instructed to continue 300 min/wk of moderate-intensity exercise for the study duration. RESULTS At 6 months, the STD group exhibited greater reductions in body weight (-8.7 ± 0.7 kg) compared with the SEQ group (-6.9 ± 0.6 kg; P = 0.047). Between 6 and 18 months, the STD group regained more weight (2.5 ± 0.8 kg vs. 0.0 ± 0.8 kg; P = 0.02). At 18 months, there were no between-group differences in changes in weight (STD: -6.9 ± 1.2 kg; SEQ: -7.9 ± 1.2 kg), fat mass, lean mass, physical activity, or attrition. CONCLUSIONS Both immediate and delayed exercise initiation within a behavioral weight loss program resulted in clinically meaningful weight loss at 18 months. Thus, timing of exercise initiation can be personalized based on patient preference.
Collapse
Affiliation(s)
- Victoria A. Catenacci
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Danielle M. Ostendorf
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Zhaoxing Pan
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristen Bing
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Liza T. Wayland
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Emmanuel Seyoum
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brian L. Stauffer
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Suzanne Phelan
- California Polytechnic State University, San Luis Obispo CA
| | - Seth A. Creasy
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ann E. Caldwell
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Holly R. Wyatt
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel H. Bessesen
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Edward L. Melanson
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical Center, Denver, CO, USA
| |
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
Bueno-Hernández N, Vázquez-Frías R, Abreu y Abreu A, Almeda-Valdés P, Barajas-Nava L, Carmona-Sánchez R, Chávez-Sáenz J, Consuelo-Sánchez A, Espinosa-Flores A, Hernández-Rosiles V, Hernández-Vez G, Icaza-Chávez M, Noble-Lugo A, Romo-Romo A, Ruiz-Margaín A, Valdovinos-Díaz M, Zárate-Mondragón F. Review of the scientific evidence and technical opinion on noncaloric sweetener consumption in gastrointestinal diseases. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
41
|
Bueno-Hernández N, Vázquez-Frías R, Abreu Y Abreu AT, Almeda-Valdés P, Barajas-Nava LA, Carmona-Sánchez RI, Chávez-Sáenz J, Consuelo-Sánchez A, Espinosa-Flores AJ, Hernández-Rosiles V, Hernández-Vez G, Icaza-Chávez ME, Noble-Lugo A, Romo-Romo A, Ruiz-Margaín A, Valdovinos-Díaz MA, Zárate-Mondragón FE. Review of the scientific evidence and technical opinion on noncaloric sweetener consumption in gastrointestinal diseases. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2019; 84:492-510. [PMID: 31564473 DOI: 10.1016/j.rgmx.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/03/2019] [Accepted: 08/20/2019] [Indexed: 01/16/2023]
Abstract
The present review of noncaloric sweeteners (NCSs) by the Asociación Mexicana de Gastroenterología was carried out to analyze and answer some of the most frequent questions and concerns about NCS consumption in patients with gastrointestinal disorders, through a thorough review of the medical literature. A group of gastroenterologists and experts on nutrition, toxicology, microbiology, and endocrinology reviewed and analyzed the published literature on the topic. The working group formulated conclusions, based on the scientific evidence published, to give an opinion with respect to NCS ingestion. Current evidence does not confirm the carcinogenic potential of NCSs. However, the studies analyzed showed that saccharin could have a proinflammatory effect and that polyols can cause gastrointestinal symptoms and manifestations, depending on the dose and type of compound. The ingestion of xylitol, erythritol, sucralose, aspartame, acesulfame K, and saccharin could increase the secretion of the gastrointestinal hormones that regulate intestinal motility, and stevia and its derivatives could have a favorable effect on the percentage of liver fat. Caution should be taken in recommending aspartame consumption in patients with chronic liver disease because it reduces the ratio of branched-chain amino acids to aromatic amino acids. In addition, NCS ingestion could modify the composition of the intestinal microbiota, having an effect on gastrointestinal symptoms and manifestations. It is important to continue conducting causality studies on humans to be able to establish recommendations on NSC consumption.
Collapse
Affiliation(s)
- N Bueno-Hernández
- Dirección de Investigación, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México.
| | - R Vázquez-Frías
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - A T Abreu Y Abreu
- Gastroenterología, Hospital Ángeles Pedregal, Ciudad de México, México
| | - P Almeda-Valdés
- Departamento de Endocrinología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - L A Barajas-Nava
- Unidad de Investigación de Medicina Basada en Evidencia, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | | | - J Chávez-Sáenz
- Consulta privada de Gastroenterología Pediátrica, Hospital Puerta de Hierro Andares, Zapopan, Jalisco, México
| | - A Consuelo-Sánchez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - A J Espinosa-Flores
- Dirección de Investigación, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - V Hernández-Rosiles
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - G Hernández-Vez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - M E Icaza-Chávez
- Consulta privada de Gastroenterología, Hospital Star Médica, Mérida, Yucatán, México
| | - A Noble-Lugo
- Departamento de Enseñanza e Investigación, Hospital Español de México, Ciudad de México, México
| | - A Romo-Romo
- Departamento de Endocrinología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - A Ruiz-Margaín
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - M A Valdovinos-Díaz
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - F E Zárate-Mondragón
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| |
Collapse
|
42
|
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.
Collapse
|
43
|
von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev 2019; 6:CD012292. [PMID: 31194900 PMCID: PMC6564085 DOI: 10.1002/14651858.cd012292.pub2] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB. OBJECTIVES To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. SEARCH METHODS We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. SELECTION CRITERIA We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables. MAIN RESULTS We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption. AUTHORS' CONCLUSIONS The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.
Collapse
Affiliation(s)
- Peter von Philipsborn
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jan M Stratil
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Laura K Busert
- University College LondonGreat Ormond Street Institute of Child HealthLondonUK
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Christina Holzapfel
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Hans Hauner
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | | |
Collapse
|
44
|
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.
Collapse
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
| |
Collapse
|
45
|
Lawman HG, Lofton X, Grossman S, Root M, Perez M, Tasian G, Patel A. A randomized trial of a multi-level intervention to increase water access and appeal in community recreation centers. Contemp Clin Trials 2019; 79:14-20. [PMID: 30771559 PMCID: PMC6499604 DOI: 10.1016/j.cct.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Improving children's tap water intake and reducing sugar-sweetened beverage (SSB) consumption is beneficial for health and health equity, particularly in low-income communities and communities of color. Existing community level interventions to improve the intake of tap water have predominantly occurred in schools and have focused on promoting water consumption in cafeterias during lunch or snack periods. METHODS The "Hydrate Philly" intervention was developed to target multiple environmental and social factors to improve tap water consumption in community recreation centers in low-income communities: replacing old and unappealing water fountains with appealing water-bottle-filling "hydration stations", conducting water safety testing and publicizing results, disseminating reusable water bottles, promoting tap water, and discouraging SSB consumption. Efficacy of the intervention will be tested through a group-randomized controlled trial (n = 28 centers) of the intervention's impact on center-level water fountain/station use as measured by flow meters during a youth summer camp program primarily for children aged 6-12 years. Intervention impact on the primary outcome (use of drinking water sources) will be examined with a difference-in-differences approach using an ordinary least squares regression model for analysis at the center level. Secondary outcomes include SSBs brought to summer camp, reusable and single-use bottled water use, program trash, and recreation center staff SSB consumption. DISCUSSION Multilevel approaches are needed to increase tap water intake and decrease SSB consumption among low-income and minority youth beyond school and meal settings. The current study describes the Hydrate Philly intervention, the study design, and baseline characteristics of recreation centers participating in the study. ClinicalTrials.gov Registration: #NCT03637465.
Collapse
Affiliation(s)
- Hannah G Lawman
- Philadelphia Department of Public Health, Philadelphia, PA, USA.
| | - Xavier Lofton
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Sara Grossman
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Mica Root
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Meka Perez
- Philadelphia Department of Public Health, Philadelphia, PA, USA; Philadelphia Parks and Recreation Department, Philadelphia, PA, USA
| | - Gregory Tasian
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anisha Patel
- School of Medicine, Stanford University, Stanford, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| |
Collapse
|
46
|
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.
Collapse
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
| |
Collapse
|
47
|
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.
Collapse
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
| |
Collapse
|
48
|
Myers EA, Duncan SE, Wang A, Hedrick VE. Identifying an appropriate carrier for nonnutritive sweeteners in metabolic and controlled feeding investigations via sensory evaluation. J SENS STUD 2018. [DOI: 10.1111/joss.12488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Emily A. Myers
- Department of Human Nutrition, Foods, and ExerciseVirginia Tech Blacksburg Virginia
| | - Susan E. Duncan
- Department of Food Science and TechnologyVirginia Tech Blacksburg Virginia
| | - Aili Wang
- Department of Food Science and TechnologyVirginia Tech Blacksburg Virginia
| | - Valisa E. Hedrick
- Department of Human Nutrition, Foods, and ExerciseVirginia Tech Blacksburg Virginia
| |
Collapse
|
49
|
Fantino M, Fantino A, Matray M, Mistretta F. Reprint of "Beverages containing low energy sweeteners do not differ from water in their effects on appetite, energy intake and food choices in healthy, non-obese French adults". Appetite 2018; 129:103-112. [PMID: 30005211 DOI: 10.1016/j.appet.2018.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/07/2018] [Accepted: 03/07/2018] [Indexed: 10/28/2022]
Abstract
The usefulness of replacement of caloric sugars by low-calorie sweeteners (LCS) for weight management has been questioned on the grounds that the uncoupling of LCS sweet taste and dietary energy may confuse physiological mechanisms, leading potentially to higher energy and sugar intake. The aim of the present study was to determine whether LCS beverages compared to water, when consumed with meals, differ in their effects on energy and food intake in acute trials and after long-term habituation. Ad libitum food intake of 166 (80 women; 86 men) healthy non-obese adults (BMI between 19 and 28 kg/m2), infrequent consumers of LCS was measured in four 2-consecutive-day testing sessions (Day 1 in the laboratory, Day 2 free-living). During the first 3 sessions, held one-week apart, participants were required to drink either water or commercial non-carbonated LCS lemonade (330 ml) with their main meals (randomised cross-over design). On Day 1, motivational ratings were obtained using visual analogue scales and ad libitum food intakes (amounts and types of foods selected) were measured using the plate waste method. On Day 2, participants reported their ad libitum intakes using a food diary. After Session 3, participants were randomly assigned to the LCS habituation group or to the water control group. The habituation (660 ml LCS lemonade daily vs 660 ml water) lasted 5 weeks. The fourth and final test session measured food intakes and motivational ratings after habituation. Water and LCS beverage did not differ in their effects on total energy intake, macronutrient intakes or the selection of sweet foods and on motivational ratings. Similar results were obtained in both LCS-naïve and LCS-habituated individuals.
Collapse
Affiliation(s)
- Marc Fantino
- CreaBio-Rhône-Alpes Research Centre, Centre Hospitalier Régional de Montgelas, 9 Avenue Professeur Fleming, F-69700 Givors, France.
| | - Agnès Fantino
- CreaBio-Rhône-Alpes Research Centre, Centre Hospitalier Régional de Montgelas, 9 Avenue Professeur Fleming, F-69700 Givors, France
| | - Marie Matray
- CreaBio-Rhône-Alpes Research Centre, Centre Hospitalier Régional de Montgelas, 9 Avenue Professeur Fleming, F-69700 Givors, France
| | | |
Collapse
|
50
|
Sylvetsky AC. Metabolic Effects of Low-Calorie Sweeteners: A Brief Review. Obesity (Silver Spring) 2018; 26 Suppl 3:S25-S31. [PMID: 30070039 DOI: 10.1002/oby.22252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/07/2016] [Indexed: 12/12/2022]
Abstract
Low-calorie sweeteners (LCS) are found in a variety of foods and beverages, yet their role in diet, weight, and obesity-related chronic disease is controversial. This article summarizes proceedings from one of four presentations during a preconference session entitled "Low-Calorie Sweeteners and Weight Management," which took place at the 2017 Obesity Society Annual Meeting in Washington, District of Columbia. The objective of this brief review is to summarize findings of observational and interventional studies of LCS effects on weight and metabolic health and to provide potential explanations for their discrepant results. Key research priorities for advancing the understanding of the role of LCS in weight and chronic disease are also discussed. The existing literature suggests that LCS consumption is consistently associated with obesity, diabetes, and related cardiometabolic conditions in observational studies. Although several plausible mechanisms have been proposed to explain these associations and have received considerable support in cellular and rodent models, the relevance of these mechanisms to humans has yet to be confirmed. Meanwhile, randomized controlled trials demonstrate that NNS may benefit weight loss and weight maintenance. This is the case particularly when LCS are administered in the context of behavioral weight loss support and are consumed knowingly by habitual LCS consumers. Although these findings suggest that LCS may be useful for weight control among those cognitively engaged in weight loss and who are aware of their LCS consumption, LCS administration in these studies does not reflect typical consumption. Furthermore, few interventional studies have assessed the role of LCS on metabolic outcomes other than body weight. Additional factors must be considered before recommending LCS for weight management and chronic disease prevention and further study of LCS effects on a variety of cardiometabolic outcomes, including visceral adiposity and glucose homeostasis is warranted.
Collapse
Affiliation(s)
- Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, District of Columbia, Washington, USA
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, District of Columbia, Washington, USA
| |
Collapse
|