1
|
Boxall LR, Arden-Close E, James J, Appleton KM. Protocol: The effects of nutrient- vs food- vs food-substitution-based dietary recommendations for reducing free sugar intakes, on free sugar intakes, dietary profiles and sweet taste outcomes: A randomised controlled trial. Nutr Health 2024; 30:269-278. [PMID: 35818972 PMCID: PMC11141080 DOI: 10.1177/02601060221111234] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dietary guidelines are intended to inform and aid the general public, with the aim of improving healthy diets and reducing health risk. The effectiveness of these guidelines, however, is rarely investigated. AIM This work investigates the effects of three different types of dietary recommendations for reducing free sugars, on free sugar intakes over 12 weeks. Secondary aims will also investigate how these different recommendations affect secondary outcomes, outcomes in subsets of the trial population, and identify barriers and facilitators to dietary change. METHODS Using a randomised controlled parallel-group trial with three intervention and one control arms, 240 individuals consuming >5% total energy intake from free sugars will be randomized to receive: nutrient-based, nutrient- and food-based, nutrient-, food- and food-substitution-based recommendations or no recommendations, with outcomes assessed for the following 12 weeks. Our primary outcomes are free sugar intakes and adherence to the recommendations. Secondary outcomes are daily energy intake, dietary composition, anthropometry, sweet food perceptions and preferences, sweet food choice, attitudes towards sweet foods, eating behaviour and food choice, knowledge and lifestyle variables, quality of life, adverse events, and barriers and facilitators towards intervention adherence. RESULTS Data will contribute to three distinct analyses: 1) Analyses to investigate the effects of the three different dietary recommendations versus control; 2) Analyses of the effects of the dietary recommendations in different population subgroups, and 3) Investigation of the barriers and facilitators to success. CONCLUSION This work offers new perspectives on the effects of different dietary recommendations to enact behaviour change.
Collapse
|
2
|
Chiavaroli L, Cheung A, Ayoub-Charette S, Ahmed A, Lee D, Au-Yeung F, Qi X, Back S, McGlynn N, Ha V, Lai E, Khan TA, Blanco Mejia S, Zurbau A, Choo VL, de Souza RJ, Wolever TM, Leiter LA, Kendall CW, Jenkins DJ, Sievenpiper JL. Important food sources of fructose-containing sugars and adiposity: A systematic review and meta-analysis of controlled feeding trials. Am J Clin Nutr 2023; 117:741-765. [PMID: 36842451 DOI: 10.1016/j.ajcnut.2023.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/29/2022] [Accepted: 01/18/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Sugar-sweetened beverages (SSBs) providing excess energy increase adiposity. The effect of other food sources of sugars at different energy control levels is unclear. OBJECTIVES To determine the effect of food sources of fructose-containing sugars by energy control on adiposity. METHODS In this systematic review and meta-analysis, MEDLINE, Embase, and Cochrane Library were searched through April 2022 for controlled trials ≥2 wk. We prespecified 4 trial designs by energy control: substitution (energy-matched replacement of sugars), addition (energy from sugars added), subtraction (energy from sugars subtracted), and ad libitum (energy from sugars freely replaced). Independent authors extracted data. The primary outcome was body weight. Secondary outcomes included other adiposity measures. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. RESULTS We included 169 trials (255 trial comparisons, n = 10,357) assessing 14 food sources at 4 energy control levels over a median 12 wk. Total fructose-containing sugars increased body weight (MD: 0.28 kg; 95% CI: 0.06, 0.50 kg; PMD = 0.011) in addition trials and decreased body weight (MD: -0.96 kg; 95% CI: -1.78, -0.14 kg; PMD = 0.022) in subtraction trials with no effect in substitution or ad libitum trials. There was interaction/influence by food sources on body weight: substitution trials [fruits decreased; added nutritive sweeteners and mixed sources (with SSBs) increased]; addition trials [dried fruits, honey, fruits (≤10%E), and 100% fruit juice (≤10%E) decreased; SSBs, fruit drink, and mixed sources (with SSBs) increased]; subtraction trials [removal of mixed sources (with SSBs) decreased]; and ad libitum trials [mixed sources (with/without SSBs) increased]. GRADE scores were generally moderate. Results were similar across secondary outcomes. CONCLUSIONS Energy control and food sources mediate the effect of fructose-containing sugars on adiposity. The evidence provides a good indication that excess energy from sugars (particularly SSBs at high doses ≥20%E or 100 g/d) increase adiposity, whereas their removal decrease adiposity. Most other food sources had no effect, with some showing decreases (particularly fruits at lower doses ≤10%E or 50 g/d). This trial was registered at clinicaltrials.gov as NCT02558920 (https://clinicaltrials.gov/ct2/show/NCT02558920).
Collapse
Affiliation(s)
- Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sabrina Ayoub-Charette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fei Au-Yeung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - XinYe Qi
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Songhee Back
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Néma McGlynn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vanessa Ha
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ethan Lai
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Vivian L Choo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Russell J de Souza
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Thomas Ms Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril Wc Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David Ja Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
| |
Collapse
|
3
|
Nguyen M, Jarvis SE, Tinajero MG, Yu J, Chiavaroli L, Mejia SB, Khan TA, Tobias DK, Willett WC, Hu FB, Hanley AJ, Birken CS, Sievenpiper JL, Malik VS. Sugar-sweetened beverage consumption and weight gain in children and adults: a systematic review and meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr 2023; 117:160-174. [PMID: 36789935 DOI: 10.1016/j.ajcnut.2022.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sugar-sweetened beverages (SSBs) have been implicated in fueling the obesity epidemic. OBJECTIVES This study aimed to update a synthesis of the evidence on SSBs and weight gain in children and adults. METHODS MEDLINE, Embase, and Cochrane databases were searched through September 8, 2022, for prospective cohort studies and randomized controlled trials (RCTs) that evaluated intake of SSBs in relation to BMI and body weight in children and adults, respectively. Eligible interventions were compared against a noncaloric control. Study-level estimates were pooled using random-effects meta-analysis and presented as β-coefficients with 95% CIs for cohorts and weighted mean differences (MDs) with 95% CIs for RCTs. RESULTS We identified 85 articles including 48 in children (40 cohorts, n = 91,713; 8 RCTs, n = 2783) and 37 in adults (21 cohorts, n = 448,661; 16 RCTs, n = 1343). Among cohort studies, each serving/day increase in SSB intake was associated with a 0.07-kg/m2 (95% CI: 0.04 kg/m2, 0.10 kg/m2) higher BMI in children and a 0.42-kg (95% CI: 0.26 kg, 0.58 kg) higher body weight in adults. RCTs in children indicated less BMI gain with SSB reduction interventions compared with control (MD: -0.21 kg/m2; 95% CI: -0.40 kg/m2, -0.01 kg/m2). In adults, randomization to addition of SSBs to the diet led to greater body weight gain (MD: 0.83 kg; 95% CI: 0.47 kg, 1.19 kg), and subtraction of SSBs led to weight loss (MD: -0.49 kg; 95% CI: -0.66 kg, -0.32 kg) compared with the control groups. A positive linear dose-response association between SSB consumption and weight gain was found in all outcomes assessed. CONCLUSIONS Our updated systematic review and meta-analysis expands on prior evidence to confirm that SSB consumption promotes higher BMI and body weight in both children and adults, underscoring the importance of dietary guidance and public policy strategies to limit intake. This meta-analysis was registered at the International Prospective Register of Systematic Reviews as CRD42020209915.
Collapse
Affiliation(s)
- Michelle Nguyen
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E Jarvis
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Maria G Tinajero
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jiayue Yu
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Deirdre K Tobias
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Anthony J Hanley
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Endocrinology, University of Toronto, Toronto, ON, Canada; Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada
| | - Catherine S Birken
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology & Metabolism, St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Vasanti S Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| |
Collapse
|
4
|
McGlynn ND, Khan TA, Wang L, Zhang R, Chiavaroli L, Au-Yeung F, Lee JJ, Noronha JC, Comelli EM, Blanco Mejia S, Ahmed A, Malik VS, Hill JO, Leiter LA, Agarwal A, Jeppesen PB, Rahelić D, Kahleová H, Salas-Salvadó J, Kendall CWC, Sievenpiper JL. Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e222092. [PMID: 35285920 PMCID: PMC9907347 DOI: 10.1001/jamanetworkopen.2022.2092] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/20/2022] [Indexed: 11/14/2022] Open
Abstract
Importance There are concerns that low- and no-calorie sweetened beverages (LNCSBs) do not have established benefits, with major dietary guidelines recommending the use of water and not LNCSBs to replace sugar-sweetened beverages (SSBs). Whether LNCSB as a substitute can yield similar improvements in cardiometabolic risk factors vs water in their intended substitution for SSBs is unclear. Objective To assess the association of LNCSBs (using 3 prespecified substitutions of LNCSBs for SSBs, water for SSBs, and LNCSBs for water) with body weight and cardiometabolic risk factors in adults with and without diabetes. Data Sources Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception through December 26, 2021. Study Selection Randomized clinical trials (RCTs) with at least 2 weeks of interventions comparing LNCSBs, SSBs, and/or water were included. Data Extraction and Synthesis Data were extracted and risk of bias was assessed by 2 independent reviewers. A network meta-analysis was performed with data expressed as mean difference (MD) or standardized mean difference (SMD) with 95% CIs. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to assess the certainty of the evidence. Main Outcomes and Measures The primary outcome was body weight. Secondary outcomes were other measures of adiposity, glycemic control, blood lipids, blood pressure, measures of nonalcoholic fatty liver disease, and uric acid. Results A total of 17 RCTs with 24 trial comparisons were included, involving 1733 adults (mean [SD] age, 33.1 [6.6] years; 1341 women [77.4%]) with overweight or obesity who were at risk for or had diabetes. Overall, LNCSBs were a substitute for SSBs in 12 RCTs (n = 601 participants), water was a substitute for SSBs in 3 RCTs (n = 429), and LNCSBs were a substitute for water in 9 RCTs (n = 974). Substitution of LNCSBs for SSBs was associated with reduced body weight (MD, -1.06 kg; 95% CI, -1.71 to -0.41 kg), body mass index (MD, -0.32; 95% CI, -0.58 to -0.07), percentage of body fat (MD, -0.60%; 95% CI, -1.03% to -0.18%), and intrahepatocellular lipid (SMD, -0.42; 95% CI, -0.70 to -0.14). Substituting water for SSBs was not associated with any outcome. There was also no association found between substituting LNCSBs for water with any outcome except glycated hemoglobin A1c (MD, 0.21%; 95% CI, 0.02% to 0.40%) and systolic blood pressure (MD, -2.63 mm Hg; 95% CI, -4.71 to -0.55 mm Hg). The certainty of the evidence was moderate (substitution of LNCSBs for SSBs) and low (substitutions of water for SSBs and LNCSBs for water) for body weight and was generally moderate for all other outcomes across all substitutions. Conclusions and Relevance This systematic review and meta-analysis found that using LNCSBs as an intended substitute for SSBs was associated with small improvements in body weight and cardiometabolic risk factors without evidence of harm and had a similar direction of benefit as water substitution. The evidence supports the use of LNCSBs as an alternative replacement strategy for SSBs over the moderate term in adults with overweight or obesity who are at risk for or have diabetes.
Collapse
Affiliation(s)
- Néma D. McGlynn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tauseef Ahmad Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Lily Wang
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Roselyn Zhang
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Fei Au-Yeung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jennifer J. Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jarvis C. Noronha
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Elena M. Comelli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Vasanti S. Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - James O. Hill
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham
| | - Lawrence A. Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arnav Agarwal
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Per B. Jeppesen
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
- University of Osijek School of Medicine, Osijek, Croatia
| | - Hana Kahleová
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC
| | - Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Human Nutrition Department, Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Cyril W. C. Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Bergwall S, Johansson A, Sonestedt E, Acosta S. High versus low-added sugar consumption for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2022; 1:CD013320. [PMID: 34986271 PMCID: PMC8730703 DOI: 10.1002/14651858.cd013320.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND High intake of added sugar have been suggested to impact the risk for cardiovascular disease (CVD). Knowledge on the subject can contribute to preventing CVD. OBJECTIVES To assess the effects of a high versus low-added sugar consumption for primary prevention of CVD in the general population. SEARCH METHODS We searched Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase, Conference Proceedings Citation Index-Science (CPCI-S) on 2 July 2021. We also conducted a search of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) Search Portal for ongoing or unpublished trials. The search was performed together with reference checking, citation searching and contact with study authors to identify additional studies. We imposed no restriction on language of publication or publication status. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cross-over trials, that compared different levels of added sugar intake. Exclusion criteria were: participants aged below 18 years; diabetes mellitus (type 1 and 2); and previous CVD. Primary outcomes were incident cardiovascular events (coronary, carotid, cerebral and peripheral arterial disease) and all-cause mortality. Secondary outcomes were changes in systolic and diastolic blood pressure, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, fasting plasma glucose and adverse events (gastrointestinal symptoms and impaired dental health). DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included 21 RCTs (1110 participants completing the interventions) examining the effects of different levels of added sugar intake with a mean duration of 14 weeks. The study participants were generally described as healthy and the mean age ranged from 22 to 57 years. No studies reported on cardiovascular events or all-cause mortality. There was minimal effect of low intake of added sugar on total cholesterol levels (MD 0.11, 95% CI 0.01 to 0.21; I² = 0%; 16 studies; 763 participants; low certainty of evidence) and triglycerides (MD 0.10, 95% CI 0.03 to 0.17; I² = 3%; 14 studies; 725 participants) but no evidence of effect on LDL-cholesterol and HDL-cholesterol. There was minimal effect on diastolic blood pressure (MD 1.52, 95% CI 0.67 to 2.37; I² = 0%; 13 studies; 873 participants) and on systolic blood pressure (MD 1.44, 95% 0.08 to 2.80; I² = 27%, 14 studies; 873 participants; low certainty of evidence), but no evidence of effect on fasting plasma glucose. Only one study reported on dental health, with no events. No other trials reported adverse events (impaired dental health or gastrointestinal symptoms). All results were judged as low-quality evidence according to GRADE. The risk of bias was generally unclear, five studies were classified at an overall low risk of bias (low risk in at least four domains, not including other bias). AUTHORS' CONCLUSIONS No trials investigating the effect of added sugar on cardiovascular events or all-cause mortality were identified in our searches. Evidence is uncertain whether low intake of added sugar has an effect on risk factors for CVD; the effect was small and the clinical relevance is, therefore, uncertain. Practical ways to achieve reductions in dietary added sugar includes following current dietary recommendations. Future trials should have longer follow-up time and report on all-cause mortality and cardiovascular events in order to clarify the effect of added sugar on these outcomes. Future trials should also aim for more direct interventions and preferably be more independent of industry funding.
Collapse
Affiliation(s)
- Sara Bergwall
- Department of Clinical Sciences Malmö, Vascular Diseases, Lund University, Malmö, Sweden
| | - Anna Johansson
- Department of Clinical Sciences Malmö, Vascular Diseases, Lund University, Malmö, Sweden
| | - Emily Sonestedt
- Department of Clinical Sciences Malmö, Nutritional Epidemiology, Lund University, Malmö, Sweden
| | - Stefan Acosta
- Department of Vascular Diseases, Malmö University Hospital, Malmö, Sweden
| |
Collapse
|
6
|
Apolzan JW, Carmichael OT, Kirby KM, Ramakrishnapillai SR, Beyl RA, Martin CK. The effects of the form of sugar (solid vs. beverage) on body weight and fMRI activation: A randomized controlled pilot study. PLoS One 2021; 16:e0251700. [PMID: 33999960 PMCID: PMC8128228 DOI: 10.1371/journal.pone.0251700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 04/29/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To test if sugar sweetened beverages (SSBs) and sugar sweetened solids (SSSs) have differential effects on body weight and reward processing in the brain. Methods In a single blind randomized controlled pilot trial (RCT), twenty participants with BMI between 20 and 40 kg/m2 were randomized to consume a 20 fluid ounce soda (SSB, 248 kcal) or the equivalent in solid form (SSS; similar to thick gelatin or gummy candy) daily. At baseline and day 28, fasting body weight and fed-state BOLD fMRI of the brain were assessed. Differences in fMRI signals between views of low-fat (LF (<30%)) high sugar (HS (>30%)) food, and non-food images were calculated in brain regions implicated in energy homeostasis, taste, and reward. Results All participants in the SSB (6F 4M; 8 Caucasian; 36±14 y, 28.2±5.5 kg/m2; Mean±SD) and SSS (3F 7M; 6 Caucasian; 39±12; 26.3±4.4) groups completed the study. Weight change was 0.27±0.78 kg between SSB and SSS participants. Changes in the fMRI response to LF/HS foods in reward, homeostatic and taste regions tended to not be different between the groups over the four weeks. However, activation of the right substantia nigra increased following the SSB but decreased activation following the SSS in response to LF/HS foods over 28 days (-0.32±0.12). Ratings of wanting for LF/HS foods were correlated with activation in several brain regions, including the OFC. Conclusions Change in weight was modest between the groups in this study. Daily consumption of a SSB over 28 days led to mixed responses to LF/HS foods in areas of the brain associated with reward. Ratings of wanting are correlated with fMRI activation inside an MRI scanner.
Collapse
Affiliation(s)
- John W. Apolzan
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States of America
- * E-mail:
| | - Owen T. Carmichael
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States of America
| | - Krystal M. Kirby
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States of America
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, United States of America
| | - Sreekrishna R. Ramakrishnapillai
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States of America
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, United States of America
| | - Robbie A. Beyl
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States of America
| | - Corby K. Martin
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States of America
| |
Collapse
|
7
|
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
|
8
|
Rogers PJ, Appleton KM. The effects of low-calorie sweeteners on energy intake and body weight: a systematic review and meta-analyses of sustained intervention studies. Int J Obes (Lond) 2021; 45:464-478. [PMID: 33168917 DOI: 10.1038/s41366-020-00704-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Previous meta-analyses of intervention studies have come to different conclusions about effects of consumption of low-calorie sweeteners (LCS) on body weight. The present review included 60 articles reporting 88 parallel-groups and cross-over studies ≥1 week in duration that reported either body weight (BW), BMI and/or energy intake (EI) outcomes. Studies were analysed according to whether they compared (1) LCS with sugar, (2) LCS with water or nothing, or (3) LCS capsules with placebo capsules. Results showed an effect in favour of LCS vs sugar for BW (29 parallel-groups studies, 2267 participants: BW change, -1.06 kg, 95% CI -1.50 to -0.62, I2 = 51%), BMI and EI. Effect on BW change increased with 'dose' of sugar replaced by LCS, whereas there were no differences in study outcome as a function of duration of the intervention or participant blinding. Overall, results showed no difference in effects of LCS vs water/nothing for BW (11 parallel-groups studies, 1068 participants: BW change, 0.10 kg, 95% CI -0.87 to 1.07, I2 = 82%), BMI and EI; and inconsistent effects for LCS consumed in capsules (BW change: -0.28 kg, 95% CI -0.80 to 0.25, I2 = 0%; BMI change: 0.20 kg/m2, 95% CI 0.04 to 0.36, I2 = 0%). Occurrence of adverse events was not affected by the consumption of LCS. The studies available did not permit robust analysis of effects by LCS type. In summary, outcomes were not clearly affected when the treatments differed in sweetness, nor when LCS were consumed in capsules without tasting; however, when treatments differed in energy value (LCS vs sugar), there were consistent effects in favour of LCS. The evidence from human intervention studies supports the use of LCS in weight management, constrained primarily by the amount of added sugar that LCS can displace in the diet.
Collapse
Affiliation(s)
- Peter J Rogers
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, UK.
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, BS8 1TU, UK.
| | - Katherine M Appleton
- Department of Psychology, Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK
| |
Collapse
|
9
|
Laviada-Molina H, Molina-Segui F, Pérez-Gaxiola G, Cuello-García C, Arjona-Villicaña R, Espinosa-Marrón A, Martinez-Portilla RJ. Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: Systematic review and meta-analysis. Obes Rev 2020; 21:e13020. [PMID: 32216045 DOI: 10.1111/obr.13020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
There is an ongoing debate about the possible influences of nonnutritive sweeteners (NNS) on body weight. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) with NNS to assess their impact on body weight. We systematically searched for RCTs at least 4 weeks in duration, evaluating the effect of NNS on body weight, both in subjects with healthy weight and in subjects with overweight/obesity at any age, and compared the effects of NNS vs caloric and noncaloric comparators. The primary outcome was the difference in body weight between NNS and comparators. Twenty studies were eligible (n = 2914). Participants consuming NNS showed significant weight/BMI differences favouring NNS compared with nonusers. Grouping by nature of comparator revealed that NNS vs placebo/no intervention and NNS vs water produced no effect. When comparing NNS vs sucrose, significant weight/BMI differences appeared favouring NNS. Consumption of NNS led to significantly negative weight/BMI differences in unrestricted energy diets, but not in weight-reduction diets. Participants with overweight/obesity and adults showed significant favourable weight/BMI differences with NNS. Data suggest that replacing sugar with NNS leads to weight reduction, particularly in participants with overweight/obesity under an unrestricted diet, information that could be utilized for evidence-based public policy decisions.
Collapse
Affiliation(s)
- Hugo Laviada-Molina
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Merida, Mérida, Mexico
| | - Fernanda Molina-Segui
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Merida, Mérida, Mexico
| | | | - Carlos Cuello-García
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ruy Arjona-Villicaña
- Endocrinology Service, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida, Mexico
| | - Alan Espinosa-Marrón
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Merida, Mérida, Mexico
| | - Raigam Jafet Martinez-Portilla
- Nuffield Department of Primary Health Sciences, Radcliffe Observatory Quarter, University of Oxford Centre for Evidence-Based Medicine, Oxford, UK
| |
Collapse
|
10
|
González-Morales R, Canto-Osorio F, Stern D, Sánchez-Romero LM, Torres-Ibarra L, Hernández-López R, Rivera-Paredez B, Vidaña-Pérez D, Ramírez-Palacios P, Salmerón J, Popkin BM, Barrientos-Gutiérrez T. Soft drink intake is associated with weight gain, regardless of physical activity levels: the health workers cohort study. Int J Behav Nutr Phys Act 2020; 17:60. [PMID: 32398158 PMCID: PMC7216416 DOI: 10.1186/s12966-020-00963-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background While soft drink intake is positively associated with weight gain, no previous study has investigated whether leisure-time physical activity modifies this association. We estimated the association between soft drink intake and body weight, and explored if this association differed by levels of leisure-time physical activity. Methods We used data from the health workers cohort study, a prospective study of Mexican adults (20 to 85y old), including 1268 health workers and their families, who were assessed at baseline (2004–2006) and follow-up (2010–2012). We assessed soft drink intake (cola and flavored soda) using a validated food frequency questionnaire. We measured leisure-time physical activity using a self-report questionnaire, and categorized according to the 2010 World Health Organization (WHO) recommendations. Body weight was measured by trained personnel. The association between changes in soft drink intake and weight change, and if such association varied by levels of physical activity was estimated through fixed-effect models. Results An increase in one serving per day of soft drink was associated with 0.10 kg (95% CI 0.00, 0.19) increase in weight per year. This association was not modified by leisure-time physical activity, as demonstrated by the magnitude of the coefficient of the interaction between soft drink, leisure-time physical activity, and time (− 0.03 kg, 95% CI − 0.27 to 0.21); people who complied with the WHO physical activity recommendations gained 0.36 kg/year per serving of soft drink, compared to 0.48 kg/year for people without sufficient physical activity. Conclusions Soft drink intake was associated with weight gain. Leisure-time physical activity did not modify the association between soft drink intake and weight gain. This finding challenges the idea that leisure-time physical activity is sufficient to counterbalance weight gain associated to soft drink intake.
Collapse
Affiliation(s)
- Romina González-Morales
- Center for Population Health Research, National Institute of Public Health, 62100, Cuernavaca, Mor., Mexico
| | - Francisco Canto-Osorio
- Center for Population Health Research, National Institute of Public Health, 62100, Cuernavaca, Mor., Mexico
| | - Dalia Stern
- CONACyT- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mor., Mexico
| | - Luz María Sánchez-Romero
- Center for Population Health Research, National Institute of Public Health, 62100, Cuernavaca, Mor., Mexico
| | - Leticia Torres-Ibarra
- Center for Population Health Research, National Institute of Public Health, 62100, Cuernavaca, Mor., Mexico
| | - Rubí Hernández-López
- Center for Research in Policies, Population and Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico city, Mexico
| | - Berenice Rivera-Paredez
- Center for Research in Policies, Population and Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico city, Mexico
| | - Dèsirée Vidaña-Pérez
- Center for Population Health Research, National Institute of Public Health, 62100, Cuernavaca, Mor., Mexico
| | - Paula Ramírez-Palacios
- Epidemiological Research and Health Services Unit, Mexican Institute of Social Security, Cuernavaca, Mor., Mexico
| | - Jorge Salmerón
- Center for Research in Policies, Population and Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico city, Mexico
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | |
Collapse
|
11
|
Wang Y(F, Chiavaroli L, Roke K, DiAngelo C, Marsden S, Sievenpiper J. Canadian Adults with Moderate Intakes of Total Sugars have Greater Intakes of Fibre and Key Micronutrients: Results from the Canadian Community Health Survey 2015 Public Use Microdata File. Nutrients 2020; 12:E1124. [PMID: 32316582 PMCID: PMC7230278 DOI: 10.3390/nu12041124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Global dietary guidelines recommend reducing free sugars intake, which may affect choices of sugars-containing foods, including important sources of key micronutrients. The purpose of the study was to compare the intakes of nutrients stratified by intakes of sugars in Canadian adults. Methods: The first-day 24-h dietary recalls from adults (n = 11,817) in the 2015 Canadian Community Health Survey-Nutrition were used to compare macronutrients, micronutrients and food categories across quintiles of total sugars [by %energy (%E)], adjusted for misreporting status and covariates. Results: Canadian adults consumed on average 86.9 g/day (18.8 %E) from total sugars and 47.5 g/day (9.9 %E) from free sugars. Mean intakes for the 1st (Q1), 3rd (Q3) and 5th (Q5) quintiles of total sugars were 7.9%E, 18.3%E and 33.3%E, respectively. Q3 had higher fibre, calcium, vitamin D, vitamin A, vitamin C and potassium intakes than Q1 (p < 0.001), reflecting higher fruit, milk and yogurt (p < 0.001) consumption. Compared to Q5, Q3 had higher intakes of folate, vitamin B12, iron and zinc. Conclusion: This study provides the first detailed analyses of Canadian adults' macro- and micro-nutrient intakes stratified by different intakes of total sugars. Moderate intakes of total sugars may result in greater intakes of fibre and micronutrients. Overall nutrient intake should be considered when making food choices.
Collapse
Affiliation(s)
- Ye (Flora) Wang
- Nutrition Information Service, Canadian Sugar Institute, Toronto, ON M5V 3E4, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5B 1W8, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON M5B 1W8, Canada
| | - Kaitlin Roke
- Nutrition Information Service, Canadian Sugar Institute, Toronto, ON M5V 3E4, Canada
| | - Chiara DiAngelo
- Nutrition Information Service, Canadian Sugar Institute, Toronto, ON M5V 3E4, Canada
| | - Sandra Marsden
- Nutrition Information Service, Canadian Sugar Institute, Toronto, ON M5V 3E4, Canada
| | - John Sievenpiper
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5B 1W8, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON M5B 1W8, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Division of Endocrinology and Metabolism, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| |
Collapse
|
12
|
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
|
13
|
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: 104] [Impact Index Per Article: 20.8] [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
|
14
|
Toews I, Lohner S, Küllenberg de Gaudry D, Sommer H, Meerpohl JJ. Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ 2019; 364:k4718. [PMID: 30602577 PMCID: PMC6313893 DOI: 10.1136/bmj.k4718] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the association between intake of non-sugar sweeteners (NSS) and important health outcomes in generally healthy or overweight/obese adults and children. DESIGN Systematic review following standard Cochrane review methodology. DATA SOURCES Medline (Ovid), Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and reference lists of relevant publications. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies including generally healthy adults or children with or without overweight or obesity were eligible. Included study designs allowed for a direct comparison of no intake or lower intake of NSS with higher NSS intake. NSSs had to be clearly named, the dose had to be within the acceptable daily intake, and the intervention duration had to be at least seven days. MAIN OUTCOME MEASURES Body weight or body mass index, glycaemic control, oral health, eating behaviour, preference for sweet taste, cancer, cardiovascular disease, kidney disease, mood, behaviour, neurocognition, and adverse effects. RESULTS The search resulted in 13 941 unique records. Of 56 individual studies that provided data for this review, 35 were observational studies. In adults, evidence of very low and low certainty from a limited number of small studies indicated a small beneficial effect of NSSs on body mass index (mean difference -0.6, 95% confidence interval -1.19 to -0.01; two studies, n=174) and fasting blood glucose (-0.16 mmol/L, -0.26 to -0.06; two, n=52). Lower doses of NSSs were associated with lower weight gain (-0.09 kg, -0.13 to -0.05; one, n=17 934) compared with higher doses of NSSs (very low certainty of evidence). For all other outcomes, no differences were detected between the use and non-use of NSSs, or between different doses of NSSs. No evidence of any effect of NSSs was seen on overweight or obese adults or children actively trying to lose weight (very low to moderate certainty). In children, a smaller increase in body mass index z score was observed with NSS intake compared with sugar intake (-0.15, -0.17 to -0.12; two, n=528, moderate certainty of evidence), but no significant differences were observed in body weight (-0.60 kg, -1.33 to 0.14; two, n=467, low certainty of evidence), or between different doses of NSSs (very low to moderate certainty). CONCLUSIONS Most health outcomes did not seem to have differences between the NSS exposed and unexposed groups. Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited. Future studies should assess the effects of NSSs with an appropriate intervention duration. Detailed descriptions of interventions, comparators, and outcomes should be included in all reports. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42017047668.
Collapse
Affiliation(s)
- Ingrid Toews
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Centre of the University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany
| | - Szimonetta Lohner
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary
| | - Daniela Küllenberg de Gaudry
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Centre of the University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany
| | - Harriet Sommer
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Centre of the University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany
- Institute for Medical Biometry and Statistics, Medical Centre of the University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Centre of the University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany
- Centre of Epidemiological and Statistical Research, Sorbonne Paris Cité, Inserm/Université Paris Descartes, Cochrane France, Paris, France
| |
Collapse
|
15
|
Does an increased intake of added sugar affect appetite in overweight or obese adults, when compared with lower intakes? A systematic review of the literature. Br J Nutr 2018; 121:232-240. [PMID: 30489234 DOI: 10.1017/s0007114518003239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Changes in added sugar intake have been associated with corresponding changes in body weight. Potential mechanisms, particularly the impact of added sugar intake on appetite, warrant exploration. A systematic literature review of randomised controlled trials investigated the association between added sugar consumption and appetite in overweight and obese adults. A systematic search of Medline, Cochrane CENTRAL, Web of Science and CINAHL included studies that examined the relationship between added sugar intake and appetite markers, in comparison with a group with lower added sugar intake. A total of twenty-one articles describing nineteen studies were included in the review. The effect of added sugar on appetite was explored separately by reported comparisons of added sugar type and their effect to three study outcomes: energy consumption (n 20 comparisons); satiety (n 18); and appetite hormones, leptin (n 4) or ghrelin (n 7). Increased added sugar consumption did not impact subsequent energy intake (n 9), nor did it influence satiety (n 12) or ghrelin levels (n 4). Differences in the total daily energy intake were comparable with the differences in energy values of tested products (n 3). Added sugar intake was reported to increase leptin levels (n 3). This review did not find a consistent relationship between added sugar intake and appetite measures, which may be partially explained by variations in study methodologies. There is a need for randomised controlled trials examining a range of added sugar sources and doses on appetite in overweight and obese adults to better understand implications for weight gain.
Collapse
|
16
|
Stern D, Middaugh N, Rice MS, Laden F, López-Ridaura R, Rosner B, Willett W, Lajous M. Changes in Sugar-Sweetened Soda Consumption, Weight, and Waist Circumference: 2-Year Cohort of Mexican Women. Am J Public Health 2017; 107:1801-1808. [PMID: 28933937 DOI: 10.2105/ajph.2017.304008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To evaluate 2-year changes in soda consumption, weight, and waist circumference. METHODS We followed 11 218 women from the Mexican Teachers' Cohort from 2006 to 2008. Dietary data were collected using a semiquantitative food frequency questionnaire. Weight was self-reported, and waist circumference was self-measured. We used linear regression to evaluate changes in sugar-sweetened and sugar-free soda consumption in relation to changes in weight and waist circumference, adjusting for lifestyle and other dietary factors. RESULTS Compared with no change, a decrease in sugar-sweetened soda consumption by more than 1 serving per week was associated with less weight gain (-0.4 kg; 95% confidence interval [CI] = -0.6, -0.2). Conversely, relative to no change, an increase in sugar-sweetened soda by more than 1 serving per week was associated with a 0.3-kilogram (95% CI = 0.2, 0.5) increase in weight. An increase of 1 serving per day of sugar-sweetened soda was associated with a 1.0 kg (95% CI = 0.7, 1.2; P < .001) increase in weight. The results for waist circumference were similar. CONCLUSIONS Moderate changes in consumption of sugar-sweetened soda over a 2-year period were associated with corresponding changes in weight and waist circumference among Mexican women.
Collapse
Affiliation(s)
- Dalia Stern
- Dalia Stern is with the Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico. Nicole Middaugh and Francine Laden are with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA. Megan S. Rice is with the Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston. Ruy López-Ridaura and Martin Lajous are with the Center for Research on Population Health, National Institute of Public Health. Bernard Rosner is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health. Walter Willett is with the Department of Nutrition, Harvard T. H. Chan School of Public Health
| | - Nicole Middaugh
- Dalia Stern is with the Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico. Nicole Middaugh and Francine Laden are with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA. Megan S. Rice is with the Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston. Ruy López-Ridaura and Martin Lajous are with the Center for Research on Population Health, National Institute of Public Health. Bernard Rosner is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health. Walter Willett is with the Department of Nutrition, Harvard T. H. Chan School of Public Health
| | - Megan S Rice
- Dalia Stern is with the Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico. Nicole Middaugh and Francine Laden are with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA. Megan S. Rice is with the Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston. Ruy López-Ridaura and Martin Lajous are with the Center for Research on Population Health, National Institute of Public Health. Bernard Rosner is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health. Walter Willett is with the Department of Nutrition, Harvard T. H. Chan School of Public Health
| | - Francine Laden
- Dalia Stern is with the Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico. Nicole Middaugh and Francine Laden are with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA. Megan S. Rice is with the Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston. Ruy López-Ridaura and Martin Lajous are with the Center for Research on Population Health, National Institute of Public Health. Bernard Rosner is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health. Walter Willett is with the Department of Nutrition, Harvard T. H. Chan School of Public Health
| | - Ruy López-Ridaura
- Dalia Stern is with the Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico. Nicole Middaugh and Francine Laden are with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA. Megan S. Rice is with the Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston. Ruy López-Ridaura and Martin Lajous are with the Center for Research on Population Health, National Institute of Public Health. Bernard Rosner is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health. Walter Willett is with the Department of Nutrition, Harvard T. H. Chan School of Public Health
| | - Bernard Rosner
- Dalia Stern is with the Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico. Nicole Middaugh and Francine Laden are with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA. Megan S. Rice is with the Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston. Ruy López-Ridaura and Martin Lajous are with the Center for Research on Population Health, National Institute of Public Health. Bernard Rosner is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health. Walter Willett is with the Department of Nutrition, Harvard T. H. Chan School of Public Health
| | - Walter Willett
- Dalia Stern is with the Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico. Nicole Middaugh and Francine Laden are with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA. Megan S. Rice is with the Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston. Ruy López-Ridaura and Martin Lajous are with the Center for Research on Population Health, National Institute of Public Health. Bernard Rosner is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health. Walter Willett is with the Department of Nutrition, Harvard T. H. Chan School of Public Health
| | - Martin Lajous
- Dalia Stern is with the Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico. Nicole Middaugh and Francine Laden are with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA. Megan S. Rice is with the Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston. Ruy López-Ridaura and Martin Lajous are with the Center for Research on Population Health, National Institute of Public Health. Bernard Rosner is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health. Walter Willett is with the Department of Nutrition, Harvard T. H. Chan School of Public Health
| |
Collapse
|
17
|
Pyne V, Macdonald IA. Update on carbohydrates and health: the relevance of the Scientific Advisory Committee on Nutrition report for children. Arch Dis Child 2016; 101:876-80. [PMID: 27246067 DOI: 10.1136/archdischild-2015-310200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/18/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Vicki Pyne
- Diet and Obesity Division, Public Health England, London, UK
| | - Ian Andrew Macdonald
- School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| |
Collapse
|
18
|
Markey O, Le Jeune J, Lovegrove JA. Energy compensation following consumption of sugar-reduced products: a randomized controlled trial. Eur J Nutr 2016; 55:2137-49. [PMID: 26349919 PMCID: PMC5009173 DOI: 10.1007/s00394-015-1028-5] [Citation(s) in RCA: 16] [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: 01/15/2015] [Accepted: 08/26/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE Consumption of sugar-reformulated products (commercially available foods and beverages that have been reduced in sugar content through reformulation) is a potential strategy for lowering sugar intake at a population level. The impact of sugar-reformulated products on body weight, energy balance (EB) dynamics and cardiovascular disease risk indicators has yet to be established. The REFORMulated foods (REFORM) study examined the impact of an 8-week sugar-reformulated product exchange on body weight, EB dynamics, blood pressure, arterial stiffness, glycemia and lipemia. METHODS A randomized, controlled, double-blind, crossover dietary intervention study was performed with fifty healthy normal to overweight men and women (age 32.0 ± 9.8 year, BMI 23.5 ± 3.0 kg/m(2)) who were randomly assigned to consume either regular sugar or sugar-reduced foods and beverages for 8 weeks, separated by 4-week washout period. Body weight, energy intake (EI), energy expenditure and vascular markers were assessed at baseline and after both interventions. RESULTS We found that carbohydrate (P < 0.001), total sugars (P < 0.001) and non-milk extrinsic sugars (P < 0.001) (% EI) were lower, whereas fat (P = 0.001) and protein (P = 0.038) intakes (% EI) were higher on the sugar-reduced than the regular diet. No effects on body weight, blood pressure, arterial stiffness, fasting glycemia or lipemia were observed. CONCLUSIONS Consumption of sugar-reduced products, as part of a blinded dietary exchange for an 8-week period, resulted in a significant reduction in sugar intake. Body weight did not change significantly, which we propose was due to energy compensation.
Collapse
Affiliation(s)
- Oonagh Markey
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading, Berkshire, RG6 6AP, UK
- Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Reading, Berkshire, RG6 6AP, UK
| | - Julia Le Jeune
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading, Berkshire, RG6 6AP, UK
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading, Berkshire, RG6 6AP, UK.
- Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Reading, Berkshire, RG6 6AP, UK.
| |
Collapse
|
19
|
Clemens RA, Jones JM, Kern M, Lee SY, Mayhew EJ, Slavin JL, Zivanovic S. Functionality of Sugars in Foods and Health. Compr Rev Food Sci Food Saf 2016; 15:433-470. [DOI: 10.1111/1541-4337.12194] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/21/2015] [Accepted: 12/31/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Roger A. Clemens
- USC School of Pharmacy; Intl. Center for Regulatory Science; 1540 Alcazar St., CHP 140 Los Angeles CA 90089 U.S.A
| | - Julie M. Jones
- St. Catherine Univ; 4030 Valentine Court; Arden Hills Minnesota 55112 U.S.A
| | - Mark Kern
- San Diego State Univ; School of Exercise and Nutritional Sciences; 5500 Campanile Dr. San Diego CA 92182-7251 U.S.A
| | - Soo-Yeun Lee
- Univ. of Illinois at Urbana Champaign; 351 Bevier Hall MC-182, 905 S Goodwin Ave. Urbana IL 61801 U.S.A
| | - Emily J. Mayhew
- Univ. of Illinois at Urbana Champaign; 399A Bevier Hall; 905 S Goodwin Ave. Urbana IL 61801 U.S.A
| | - Joanne L. Slavin
- Univ. of Minnesota; 166 Food Science & Nutrition; 1354 Eckles Ave. Saint Paul MN 55108-1038 U.S.A
| | - Svetlana Zivanovic
- Mars Petcare; Global Applied Science and Technology; 315 Cool Springs Boulevard Franklin TN 37067 U.S.A
| |
Collapse
|
20
|
Abstract
Mood is widely assessed in nutrition research, usually with rating scales. A core assumption is that positive mood reinforces ingestion, so it is important to measure mood well. Four relevant theoretical issues are reviewed: (i) the distinction between protracted and transient mood; (ii) the distinction between mood and emotion; (iii) the phenomenology of mood as an unstable tint to consciousness rather than a distinct state of consciousness; (iv) moods can be caused by social and cognitive processes as well as physiological ones. Consequently, mood is difficult to measure and mood rating is easily influenced by non-nutritive aspects of feeding, the psychological, social and physical environment where feeding occurs, and the nature of the rating system employed. Some of the difficulties are illustrated by reviewing experiments looking at the impact of food on mood. The mood-rating systems in common use in nutrition research are then reviewed, the requirements of a better mood-rating system are described, and guidelines are provided for a considered choice of mood-rating system including that assessment should: have two main dimensions; be brief; balance simplicity and comprehensiveness; be easy to use repeatedly. Also mood should be assessed only under conditions where cognitive biases have been considered and controlled.
Collapse
|
21
|
Reid M, Hammersley R. Sugars and obesity: Meta-analysis establishes the strength of the correlation, not the cause. NUTR BULL 2014. [DOI: 10.1111/nbu.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marie Reid
- Clinical and Health Psychology, Department of Psychology; University of Hull; UK
| | | |
Collapse
|
22
|
Abstract
A causal role of fructose intake in the aetiology of the global obesity epidemic has been proposed in recent years. This proposition, however, rests on controversial interpretations of two distinct lines of research. On one hand, in mechanistic intervention studies, detrimental metabolic effects have been observed after excessive isolated fructose intakes in animals and human subjects. On the other hand, food disappearance data indicate that fructose consumption from added sugars has increased over the past decades and paralleled the increase in obesity. Both lines of research are presently insufficient to demonstrate a causal role of fructose in metabolic diseases, however. Most mechanistic intervention studies were performed on subjects fed large amounts of pure fructose, while fructose is ordinarily ingested together with glucose. The use of food disappearance data does not accurately reflect food consumption, and hence cannot be used as evidence of a causal link between fructose intake and obesity. Based on a thorough review of the literature, we demonstrate that fructose, as commonly consumed in mixed carbohydrate sources, does not exert specific metabolic effects that can account for an increase in body weight. Consequently, public health recommendations and policies aiming at reducing fructose consumption only, without additional diet and lifestyle targets, would be disputable and impractical. Although the available evidence indicates that the consumption of sugar-sweetened beverages is associated with body-weight gain, and it may be that fructose is among the main constituents of these beverages, energy overconsumption is much more important to consider in terms of the obesity epidemic.
Collapse
|
23
|
Liquid calories, energy compensation and weight: what we know and what we still need to learn. Br J Nutr 2013; 111:384-6. [PMID: 24164833 DOI: 10.1017/s0007114513003309] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|