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Bracchi I, Morais J, Coelho JA, Ferreira AF, Alves I, Mendes C, Correia B, Gonçalves A, Guimarães JT, Pires IF, Keating E, Negrão R. The Cardiometabolic Impact of Rebaudioside A Exposure during the Reproductive Stage. BIOLOGY 2024; 13:163. [PMID: 38534433 PMCID: PMC10967885 DOI: 10.3390/biology13030163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/03/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
The consumption of non-sugar sweeteners (NSS) has increased during pregnancy. The European Food Safety Agency suggested that steviol glycosides, such as Rebaudioside A (RebA), the major sweetener component of stevia, are safe for humans up to a dose of 4 mg/kg body weight/day. However, the World Health Organization recommended in 2023 the restraint of using NSS, including stevia, at any life stage, highlighting the need to study NSS safety in early periods of development. We aimed to study the mitochondrial and cardiometabolic effects of long-term RebA consumption during the reproductive stage of the life cycle. Female rats were exposed to RebA (4 mg steviol equivalents/kg body weight/day) in the drinking water from 4 weeks before mating until weaning. Morphometry, food and water consumption, glucose and lipid homeostasis, heart structure, function, and mitochondrial function were assessed. RebA showed an atrophic effect in the heart, decreasing cardiomyocyte cross-sectional area and myocardial fibrosis without repercussions on cardiac function. Mitochondrial and myofilamentary functions were not altered. Glucose tolerance and insulin sensitivity were not affected, but fasting glycemia and total plasma cholesterol decreased. This work suggests that this RebA dose is safe for female consumption during the reproductive stage, from a cardiometabolic perspective. However, studies on the effects of RebA exposure on the offspring are mandatory.
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Affiliation(s)
- Isabella Bracchi
- Unit of Biochemistry, Department Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (I.B.); (E.K.)
- CINTESIS, Center for Health Technology and Services Research, 4200-319 Porto, Portugal;
- Department of Functional Sciences, School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - Juliana Morais
- CINTESIS, Center for Health Technology and Services Research, 4200-319 Porto, Portugal;
- Department of Functional Sciences, School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (J.A.C.); (C.M.)
| | - João Almeida Coelho
- Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (J.A.C.); (C.M.)
- UniC@RISE, Unidade de Investigação e Desenvolvimento Cardiovascular, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Ana Filipa Ferreira
- Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (J.A.C.); (C.M.)
- UniC@RISE, Unidade de Investigação e Desenvolvimento Cardiovascular, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Inês Alves
- Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (J.A.C.); (C.M.)
- UniC@RISE, Unidade de Investigação e Desenvolvimento Cardiovascular, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Cláudia Mendes
- Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (J.A.C.); (C.M.)
- UniC@RISE, Unidade de Investigação e Desenvolvimento Cardiovascular, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Beatriz Correia
- Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (J.A.C.); (C.M.)
- Nutrition & Metabolism, NOVA Medical School|FCM, NOVA University Lisbon, 1169-056 Lisbon, Portugal
| | - Alexandre Gonçalves
- Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (J.A.C.); (C.M.)
- UniC@RISE, Unidade de Investigação e Desenvolvimento Cardiovascular, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - João Tiago Guimarães
- Unit of Biochemistry, Department Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (I.B.); (E.K.)
- Clinical Pathology, São João University Hospital Center, 4200-319 Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, 4200-319 Porto, Portugal
| | - Inês Falcão Pires
- Department of Surgery and Physiology, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (J.A.C.); (C.M.)
- UniC@RISE, Unidade de Investigação e Desenvolvimento Cardiovascular, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Elisa Keating
- Unit of Biochemistry, Department Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (I.B.); (E.K.)
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Rita Negrão
- Unit of Biochemistry, Department Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (I.B.); (E.K.)
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Langevin B, Gopalakrishnan M, Kuttamperoor J, Van Den Anker J, Murphy J, Arcaro KF, Daines D, Sylvetsky AC. The MILK study: Investigating intergenerational transmission of low-calorie sweeteners in breast milk. Contemp Clin Trials Commun 2023; 36:101212. [PMID: 37881407 PMCID: PMC10594547 DOI: 10.1016/j.conctc.2023.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/27/2023] [Accepted: 10/01/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Forty-four percent of lactating women in the United States consume beverages containing low calorie sweeteners (LCS), and the presence of LCS in the food supply has continued to increase in recent years. While LCS are approved by the United States Food and Drug Administration (FDA) and are believed to be safe for human consumption, intergenerational LCS transmission and the health impacts of early life LCS exposure are severely understudied. Methods and analysis In a tightly controlled, single site, prospective interventional study, mothers' plasma and breast milk, and infants' plasma will be collected from 40 mother-infant dyads over the course of 72 h, with rich sampling following maternal ingestion of a LCS sweetened beverage containing sucralose and acesulfame potassium (ace-K). Concentration-time data will be used to build maternal and infant pharmacokinetic models for future simulations and analysis. Conclusion This study aims to measure LCS concentrations in breast milk, maternal plasma, and infant plasma, to gain insight into infant exposure and inform recommendations for LCS consumption during breastfeeding.
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Affiliation(s)
- Brooke Langevin
- Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, USA
| | - Mathangi Gopalakrishnan
- Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, USA
| | - Janae Kuttamperoor
- Department of Exercise and Nutrition Sciences, The George Washington University, Washington D.C., USA
| | - John Van Den Anker
- Division of Clinical Pharmacology, Children's National Medical Center, Washington D.C., USA
| | - Jeanne Murphy
- School of Nursing, The George Washington University, Washington D.C., USA
| | - Kathleen F. Arcaro
- Department of Veterinary and Animal Sciences, University of Massachusetts Amherst, Amherst, USA
| | - Dina Daines
- Department of Obstetrics and Gynecology, The George Washington University, Washington D.C., USA
| | - Allison C. Sylvetsky
- Department of Exercise and Nutrition Sciences, The George Washington University, Washington D.C., USA
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Hedrick VE, Nieto C, Grilo MF, Sylvetsky AC. Non-sugar sweeteners: helpful or harmful? The challenge of developing intake recommendations with the available research. BMJ 2023; 383:e075293. [PMID: 37813435 DOI: 10.1136/bmj-2023-075293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Affiliation(s)
- Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, USA
| | - Claudia Nieto
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública de México, Mexico
- Global Food Research Program, University of North Carolina, USA
| | - Mariana Fagundes Grilo
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, USA
- Sumner M Redstone Global Center for Prevention and Wellness, George Washington University, USA
| | - Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, USA
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Gebremichael B, Lassi ZS, Begum M, Mittinty M, Zhou SJ. Patterns and Predictors of Low-Calorie Sweetener Consumption during Pregnancy: Findings from a National Survey. Nutrients 2023; 15:4196. [PMID: 37836480 PMCID: PMC10574556 DOI: 10.3390/nu15194196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
Recently, the World Health Organization recommended avoiding low-calorie sweeteners (LCS) during pregnancy due to concerns that it may be linked to adverse pregnancy outcomes and offspring wellbeing. This study examined the patterns and predictors of LCS consumption among pregnant women in Australia. A survey was conducted among 422 pregnant women aged 18-50 years. Sociodemographic, lifestyle, dietary intake including LCS consumption, pregnancy-related characteristics, and awareness about the health effects of LCS were assessed. We used latent class analysis and multinomial logistic regression to identify LCS consumption patterns and predictors of consumption patterns, respectively. The mean (SD) age of the women was 30 (4.6) years. Three LCS consumption patterns were identified: infrequent or non-consumers representing 50% of the women, moderate consumers encompassing 40% of the women, and the remaining were habitual consumers. Over two-thirds (71%) of women were not aware of the potential adverse effects of LCS, and only a quarter of them were concerned about the possible adverse effects on their health and their offspring. Increasing age and living with a medical condition decreased the likelihood of moderate consumption by 7% and 55%, respectively. Frequent sugar-sweetened beverage consumption and gestational diabetes predicted habitual LCS consumption. This research suggested widespread LCS consumption among pregnant women in Australia, but lower awareness of its potential adverse health effects. Interventions to increase awareness of potential adverse effects are warranted.
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Affiliation(s)
- Bereket Gebremichael
- Department of Food and Nutrition, School of Agriculture, Food and Wine, The University of Adelaide, Glen Osmond, Adelaide, SA 5064, Australia;
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5006, Australia; (Z.S.L.); (M.B.)
- College of Health Science, Addis Ababa University, Addis Ababa AA 1000, Ethiopia
| | - Zohra S. Lassi
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5006, Australia; (Z.S.L.); (M.B.)
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Mumtaz Begum
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5006, Australia; (Z.S.L.); (M.B.)
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Murthy Mittinty
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia;
| | - Shao-Jia Zhou
- Department of Food and Nutrition, School of Agriculture, Food and Wine, The University of Adelaide, Glen Osmond, Adelaide, SA 5064, Australia;
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5006, Australia; (Z.S.L.); (M.B.)
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Halasa BC, Sylvetsky AC, Conway EM, Shouppe EL, Walter MF, Walter PJ, Cai H, Hui L, Rother KI. Non-Nutritive Sweeteners in Human Amniotic Fluid and Cord Blood: Evidence of Transplacental Fetal Exposure. Am J Perinatol 2023; 40:1286-1291. [PMID: 34500483 DOI: 10.1055/s-0041-1735555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to investigate human fetal exposure to non-nutritive sweeteners (NNS) by analyzing amniotic fluid and umbilical cord blood. STUDY DESIGN Concentrations of four NNS (acesulfame-potassium [ace-K], saccharin, steviol glucuronide, and sucralose) were measured in amniotic fluid (n = 13) and cord blood samples (n = 15) using liquid chromatography-mass spectrometry. Amniotic fluid samples were obtained for research purposes at the time of term elective cesarean birth or clinically indicated third trimester amnioreduction at Mercy Hospital for Women (Melbourne, Australia). All except four women were in the fasting state. Cord blood samples were obtained from an independent cohort of newborns whose mothers were enrolled in a separate clinical trial at the National Institutes of Health. RESULTS Ten of 13 amniotic fluid samples contained at least one NNS (ace-K, saccharin, steviol glucuronide, and/or sucralose). Maximum amniotic fluid NNS concentrations of ace-K, saccharin, steviol glucuronide, and sucralose were 78.9, 55.9, 93.5, and 30.6 ng/mL, respectively. Ace-K and saccharin were present in 100% and 80% of the cord blood samples, with maximal concentrations of 6.5 and 2.7 ng/mL, respectively. Sucralose was not detected and steviol glucuronide was not measurable in any of the cord blood samples. CONCLUSION Our results provide evidence of human transplacental transmission of NNS. Based on results predominantly obtained from rodent models, we speculate that NNS exposure may adversely influence the offsprings' metabolic health. Well-designed, prospective clinical trials are necessary to understand the impact of NNS intake during pregnancy on human development and long-term health. KEY POINTS · NNS consumption during pregnancy has increased in recent years.. · Maternal NNS intake during pregnancy is associated with preterm birth and higher infant weight gain in epidemiologic studies.. · In rodents, in utero NNS exposure induces metabolic abnormalities in mothers and their offspring, alters offspring gut microbiota composition, and promotes sweet taste preference in adulthood.. · It is presently unknown whether and to what degree maternal NNS ingestion in humans leads to direct in utero exposure.. · This study provides the first evidence of in utero NNS exposure in humans and highlights the urgent need to investigate clinical consequences of early life NNS exposure on metabolism, weight, taste preference, and general health..
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Affiliation(s)
- Brianna C Halasa
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, George Washington University, Washington, District of Columbia
| | - Ellen M Conway
- National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Eileen L Shouppe
- National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Mary F Walter
- National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Peter J Walter
- National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Hongyi Cai
- National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Lisa Hui
- Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Kristina I Rother
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Fowler SP, Gimeno Ruiz de Porras D, Swartz MD, Stigler Granados P, Heilbrun LP, Palmer RF. Daily Early-Life Exposures to Diet Soda and Aspartame Are Associated with Autism in Males: A Case-Control Study. Nutrients 2023; 15:3772. [PMID: 37686804 PMCID: PMC10490529 DOI: 10.3390/nu15173772] [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: 08/07/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Since its introduction, aspartame-the leading sweetener in U.S. diet sodas (DS)-has been reported to cause neurological problems in some users. In prospective studies, the offspring of mothers who consumed diet sodas/beverages (DSB) daily during pregnancy experienced increased health problems. We hypothesized that gestational/early-life exposure to ≥1 DS/day (DSearly) or equivalent aspartame (ASPearly: ≥177 mg/day) increases autism risk. The case-control Autism Tooth Fairy Study obtained retrospective dietary recalls for DSB and aspartame consumption during pregnancy/breastfeeding from the mothers of 235 offspring with autism spectrum disorder (ASD: cases) and 121 neurotypically developing offspring (controls). The exposure odds ratios (ORs) for DSearly and ASPearly were computed for autism, ASD, and the non-regressive conditions of each. Among males, the DSearly odds were tripled for autism (OR = 3.1; 95% CI: 1.02, 9.7) and non-regressive autism (OR = 3.5; 95% CI: 1.1, 11.1); the ASPearly odds were even higher: OR = 3.4 (95% CI: 1.1, 10.4) and 3.7 (95% CI: 1.2, 11.8), respectively (p < 0.05 for each). The ORs for non-regressive ASD in males were almost tripled but were not statistically significant: DSearly OR = 2.7 (95% CI: 0.9, 8.4); ASPearly OR = 2.9 (95% CI: 0.9, 8.8). No statistically significant associations were found in females. Our findings contribute to the growing literature raising concerns about potential offspring harm from maternal DSB/aspartame intake in pregnancy.
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Affiliation(s)
- Sharon Parten Fowler
- Department of Medicine, Joe R. & Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health in San Antonio, The University of Texas Health Science Center at Houston, 7411 John Smith Drive, San Antonio, TX 78229, USA;
- Center for Research in Occupational Health, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- CIBER of Epidemiology and Public Health, 28029 Madrid, Spain
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX 77030, USA;
| | - Paula Stigler Granados
- Divisions of Environmental Health and Global Health, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA;
| | - Lynne Parsons Heilbrun
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health in San Antonio, The University of Texas Health Science Center at Houston, 7411 John Smith Drive, San Antonio, TX 78229, USA;
| | - Raymond F. Palmer
- Department of Family Practice and Community Medicine, Joe R. & Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA;
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Consumption of Non-Nutritive Sweetener during Pregnancy and Weight Gain in Offspring: Evidence from Human Studies. Nutrients 2022; 14:nu14235098. [PMID: 36501127 PMCID: PMC9739060 DOI: 10.3390/nu14235098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022] Open
Abstract
The relationship between the consumption of maternal non-nutritive sweeteners (NNS) during pregnancy and the risk of obesity in offspring remains inconsistent. We aimed to systematically evaluate and clarify the relationship between NNS intake during pregnancy and weight gain in offspring based on evidence from population and clinical research. Databases including PubMed (via Medline), EMBASE, and the Cochrane Library were systematically searched for eligible human studies. The primary outcome was the differences in body mass index (BMI) z-scores between offspring at 1 year of age who were with and without NNS intake during pregnancy or between offspring with different NNS intake levels during pregnancy. A random-effects meta-analysis was conducted for data synthesis to calculate the weighted mean difference (WMD). A total of six prospective cohort studies were eligible for inclusion, among which three were used for pooled analysis of the BMI z-score. A significant increase was found in an offspring's weight at 1 year of age in the NNS group when compared with the control group: WMD in BMI z-score = 0.19 (95% CI: 0.07, 0.31), p-value = 0.002. Results from the dose-response analysis showed a linear relationship between NNS intake during pregnancy and WMD at 1 year of age: beta = 0.02 (95% CI: 0.001, 0.04) for per serving/week increase in NNS consumption. The whole body of evidence for the review was rated as low quality. In summary, maternal NNS intake during pregnancy was found to be associated with increased weight gain in offspring based on evidence from human studies. Further well-designed and adequately powered studies are needed to confirm this relationship.
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Tsan L, Chometton S, Hayes AM, Klug ME, Zuo Y, Sun S, Bridi L, Lan R, Fodor AA, Noble EE, Yang X, Kanoski SE, Schier LA. Early-life low-calorie sweetener consumption disrupts glucose regulation, sugar-motivated behavior, and memory function in rats. JCI Insight 2022; 7:e157714. [PMID: 36099052 PMCID: PMC9714783 DOI: 10.1172/jci.insight.157714] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/12/2022] [Indexed: 01/12/2023] Open
Abstract
Low-calorie sweetener (LCS) consumption in children has increased dramatically due to its widespread presence in the food environment and efforts to mitigate obesity through sugar replacement. However, mechanistic studies on the long-term impact of early-life LCS consumption on cognitive function and physiological processes are lacking. Here, we developed a rodent model to evaluate the effects of daily LCS consumption (acesulfame potassium, saccharin, or stevia) during adolescence on adult metabolic, behavioral, gut microbiome, and brain transcriptomic outcomes. Results reveal that habitual early-life LCS consumption impacts normal postoral glucose handling and impairs hippocampal-dependent memory in the absence of weight gain. Furthermore, adolescent LCS consumption yielded long-term reductions in lingual sweet taste receptor expression and brought about alterations in sugar-motivated appetitive and consummatory responses. While early-life LCS consumption did not produce robust changes in the gut microbiome, brain region-specific RNA-Seq analyses reveal LCS-induced changes in collagen- and synaptic signaling-related gene pathways in the hippocampus and nucleus accumbens, respectively, in a sex-dependent manner. Collectively, these results reveal that habitual early-life LCS consumption has long-lasting implications for glucoregulation, sugar-motivated behavior, and hippocampal-dependent memory in rats, which may be based in part on changes in nutrient transporter, sweet taste receptor, and central gene pathway expression.
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Affiliation(s)
- Linda Tsan
- Neuroscience Graduate Program and
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, California, USA
| | - Sandrine Chometton
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, California, USA
| | - Anna M.R. Hayes
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, California, USA
| | - Molly E. Klug
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, California, USA
| | - Yanning Zuo
- Department of Integrative Biology and Physiology, University of California at Los Angeles, Los Angeles, California, USA
| | - Shan Sun
- Department of Bioinformatics and Genomics at the University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Lana Bridi
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, California, USA
| | - Rae Lan
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, California, USA
| | - Anthony A. Fodor
- Department of Bioinformatics and Genomics at the University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Emily E. Noble
- Department of Nutritional Sciences, University of Georgia, Athens, Georgia, USA
| | - Xia Yang
- Department of Integrative Biology and Physiology, University of California at Los Angeles, Los Angeles, California, USA
| | - Scott E. Kanoski
- Neuroscience Graduate Program and
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, California, USA
| | - Lindsey A. Schier
- Neuroscience Graduate Program and
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, California, USA
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The effects of aspartame on the HTR8/SVneo extravillous trophoblast cell line. Reprod Biol 2022; 22:100678. [PMID: 35963112 DOI: 10.1016/j.repbio.2022.100678] [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: 03/28/2022] [Revised: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 11/21/2022]
Abstract
Extravillous trophoblasts (EVTs) are a key cell type involved in placentation. Aspartame is an artificial sweetener with a widespread use. In rodents, aspartame ingestion during pregnancy was found to cause a reduction in placental and fetal weights, but its effect in placentation at a cellular level has not been studied. Aspartame is completely hydrolyzed in the gastrointestinal tract into L-phenylalanine, L-aspartic acid, and methanol. We aimed to study the effects of aspartame and its metabolites on placentation related characteristics of EVTs. For this, we exposed HTR-8/SVneo cells to aspartame (0.001, 0.01, 0.1, 0.5 and 1 mM), L-phenylalanine (0.14 and 0.5 mM), L-aspartic acid (0.82, 2.8 and 10 mM) or methanol (0.14 and 0.8 mM) for 24 h. Aspartame had an anti-proliferative effect, decreased the number of metabolically active cells and glucose cellular uptake and increased the number of cells arrested in S phase. L-aspartic acid significantly reduced glucose uptake and whole-cell protein content. L-phenylalanine had an anti-proliferative effect and increased the number of metabolically active cells. Interestingly, methanol exerted very marked effects on HTR8/SVneo cells: it showed an anti-proliferative effect, decreased glucose uptake, the migratory ability and the number of cells in the G2/M phase and increased oxidative stress levels, in concentrations corresponding to the blood levels after the 99th percentile of projected daily ingestion of aspartame. Overall, our results demonstrate that aspartame and its metabolites can affect several characteristics of EVTs and support the conclusion that the effect of aspartame in the placenta should be further evaluated.
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Cai C, Sivak A, Davenport MH. Effects of prenatal artificial sweeteners consumption on birth outcomes: a systematic review and meta-analysis. Public Health Nutr 2021; 24:5024-5033. [PMID: 33441213 PMCID: PMC11082813 DOI: 10.1017/s1368980021000173] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/21/2020] [Accepted: 01/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the influence of prenatal artificial sweetener (AS) consumption on birth outcomes. DESIGN Systematic review and meta-analysis. SETTING Online databases (Medline, CINAHL, Embase, Cochrane Library, Scopus, Web of Science, FSTA - the food resource database, and ClinicalTrials.gov) were searched up to 9 April 2020. Studies of all designs (except case studies and reviews) were eligible, which contained information on the relevant population (pregnant women), intervention/exposure (any AS consumption), comparator (no AS consumption) and birth outcomes (preterm delivery, gestational age, birth weight). RESULTS From 677 citations, ten cohort studies and one randomised controlled trial (n 138 007 women) were included. 'Low' to 'very low' certainty evidence revealed that daily consumption of AS was associated with an increased risk of preterm delivery (three studies, n 129 009; risk ratio = 1·18, 95 % CI 1·09, 1·28, I2 = 9 %), a 24 g increase in birth weight (three studies, n 64 417; mean difference (MD): 23·74 g, 95 % CI 0·89, 45·58, I2 = 0 %) and a 0·11 week decrease in gestational age (three studies, n 64 417; MD: -0·11 weeks, 95 % CI -0·19, -0·03, I2 = 0 %). CONCLUSIONS 'Low' to 'very low' certainty evidence suggests daily AS consumption during pregnancy is associated with an increased risk of preterm delivery, increased birth weight and decreased gestational age. Additional 'high'-quality research is urgently needed to further assess these relationships.PROSPERO registration number: CRD42019136728.
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Affiliation(s)
- Chenxi Cai
- School of Public Heath, Xiamen University, Xiamen, Fujian, China
- Program for Pregnancy and Postpartum Health, Edmonton, Alberta, Canada
- Physical Activity and Diabetes Laboratory, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Sivak
- H.T. Coutts Education & Physical Education Library, University of Alberta, Edmonton, Alberta, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Edmonton, Alberta, Canada
- Physical Activity and Diabetes Laboratory, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
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11
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Diet Beverage Intake during Lactation and Associations with Infant Outcomes in the Infant Feeding Practices Study II. Nutrients 2021; 13:nu13093154. [PMID: 34579031 PMCID: PMC8472746 DOI: 10.3390/nu13093154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
Consumption of diet beverages (DB) containing low-calorie sweeteners (LCS) is widespread in the United States. LCS are ingested by nursing infants upon maternal DB consumption, which may impact infants' weight and health. This study aims to examine cross-sectional associations between infants' LCS exposure via maternal DB intake during lactation and infants' health outcomes. Six hundred and eighty-two mother-infant dyads at three months postpartum, from the Infant Feeding Practices Study II, 2005-2007, were included in the analysis. Maternal DB consumption during lactation was estimated using the serving size and frequency of DB consumption reported on the diet history questionnaire. Infants' LCS exposure was estimated by multiplying maternal DB consumption and breastfeeding intensity. Infant outcomes included weight, weight-for-age and BMI-for-age z-scores, overweight, and gastrointestinal (GI) symptoms including diarrhea, reflux, and vomiting. Associations between infants' LCS exposure and continuous and categorical outcomes were examined using linear and logistic regressions adjusting for confounders, respectively. Forty-three percent of lactating women reported DB consumption. While no significant associations were observed between infants' LCS exposure and BMI-for-age or risk of overweight, infants' LCS exposure was associated with a 2.78-fold increased risk of vomiting (95% confidence interval 1.05-7.34). Potential adverse effects of LCS exposure on GI symptoms require further study, and null findings on infant weight should be interpreted with caution, given the small sample size. Additional research is needed to inform recommendations for or against DB consumption during lactation.
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12
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Andrade L, Lee KM, Sylvetsky AC, Kirkpatrick SI. Low-calorie sweeteners and human health: a rapid review of systematic reviews. Nutr Rev 2021; 79:1145-1164. [PMID: 33236063 DOI: 10.1093/nutrit/nuaa123] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Low-calorie sweeteners are increasingly prevalent in the food supply and their consumption has increased in recent decades. Although low-calorie sweeteners approved for use are considered safe from a toxicological perspective, their short- and long-term impacts on chronic disease risk remain uncertain. The aim of this review was to summarize the evidence from systematic reviews on low-calorie sweetener use and chronic conditions and risk factors in children and adults. METHODS MEDLINE and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews of randomized and nonrandomized studies that considered low-calorie sweeteners in relation to type 2 diabetes, cardiovascular disease, cancer, anthropometric measures, hypertension, hyperglycemia, hyperlipidemia, insulin resistance, and dental caries. Data were extracted from 9 reviews deemed of moderate or high quality on the basis of AMSTAR-2. RESULTS Narrative synthesis suggested inconsistent evidence on low-calorie sweetener use in relation to chronic conditions and associated risk factors, with nonrandomized studies suggesting positive associations and randomized studies suggesting negative or no associations. CONCLUSION Continued research on the long-term health impacts of low-calorie sweeteners across all life stages is warranted.
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Affiliation(s)
- Lesley Andrade
- the School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kirsten M Lee
- the School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Allison C Sylvetsky
- the Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Sharon I Kirkpatrick
- the School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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13
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Nicolì F, Prete A, Citro F, Bertolotto A, Aragona M, de Gennaro G, Del Prato S, Bianchi C. Use of non-nutritive-sweetened soft drink and risk of gestational diabetes. Diabetes Res Clin Pract 2021; 178:108943. [PMID: 34245795 DOI: 10.1016/j.diabres.2021.108943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/25/2021] [Accepted: 07/03/2021] [Indexed: 12/16/2022]
Abstract
In this observational study, we assessed the association between use of non-nutritive-sweetened soft drink (NNSSD) and risk of gestational diabetes (GDM) in 376 pregnant women consecutively screened for GDM, observing that NNSSD consumption is common among pregnant women and is associated with an increased risk of GDM, independently from traditional risk factors.
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Affiliation(s)
- Francesca Nicolì
- Section of Diabetes, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Prete
- Section of Diabetes, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabrizia Citro
- Section of Diabetes, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Michele Aragona
- Section of Diabetes, Azienda-Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giovanni de Gennaro
- Section of Diabetes, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Section of Diabetes, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy; Section of Diabetes, Azienda-Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Cristina Bianchi
- Section of Diabetes, Azienda-Ospedaliero Universitaria Pisana, Pisa, Italy.
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14
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Conway MC, Cawley S, Geraghty AA, Walsh NM, O'Brien EC, McAuliffe FM. The consumption of low-calorie sweetener containing foods during pregnancy: results from the ROLO study. Eur J Clin Nutr 2021; 76:227-234. [PMID: 34040198 PMCID: PMC8821016 DOI: 10.1038/s41430-021-00935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
Background/objectives Women with gestational diabetes (GDM) are advised to adapt a low glycaemic index (GI) diet, which may impact consumption of low-calorie sweeteners (LCS). LCS are increasingly popular as they add sweetness without contributing calories. This study aims to investigate the reported intakes of LCS-containing foods in women during pregnancy. Subjects/methods Pregnant women recruited for the ROLO study were included in this analysis (n = 571). Women were randomised to receive either an intervention of low-GI dietary advice or usual antenatal care. Women completed a 3-day food diary in each trimester. Nine LCS-containing food groups were identified, and the quantity (g/day) consumed was calculated. Results One-third of all pregnant women consumed LCS across each trimester of pregnancy. Of those in the intervention group who were LCS consumers in trimester 1, 71.6% were consumers in trimester 2, and 54.1% remained consumers in trimester 3. In the control group, less women remained consumers in trimester 2 and 3 at 58.1% and 41.9%, respectively. In trimester 2, following the dietary intervention, the proportion of LCS consumers in the intervention group was significantly higher than the proportion of consumers who were in the control group (p < 0.001). The most commonly consumed food groups were low-calorie fruit drinks, diet-cola drinks, and low-calorie yoghurts. Conclusions One-third of pregnant women consumed LCS. The proportion of LCS consumers increased in the intervention group compared to the control group. Further research is needed to determine exposure levels to individual LCS, and the effect of prenatal exposure to LCS on maternal and child health outcomes.
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Affiliation(s)
- Marie C Conway
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Shona Cawley
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Aisling A Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Niamh M Walsh
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Eileen C O'Brien
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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15
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Diet and Healthy Lifestyle in the Management of Gestational Diabetes Mellitus. Nutrients 2020; 12:nu12103050. [PMID: 33036170 PMCID: PMC7599681 DOI: 10.3390/nu12103050] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) among pregnant women increases the risk of both short-term and long-term complications, such as birth complications, babies large for gestational age (LGA), and type 2 diabetes in both mother and offspring. Lifestyle changes are essential in the management of GDM. In this review, we seek to provide an overview of the lifestyle changes which can be recommended in the management of GDM. The diet recommended for women with GDM should contain sufficient macronutrients and micronutrients to support the growth of the foetus and, at the same time, limit postprandial glucose excursions and encourage appropriate maternal gestational weight gain. Blood glucose excursions and hyperglycaemic episodes depend on carbohydrate-intake. Therefore, nutritional counselling should focus on the type, amount, and distribution of carbohydrates in the diet. Further, physical activity has beneficial effects on glucose and insulin levels and it can contribute to a better glycaemic control.
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16
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Consumption of non-nutritive sweeteners during pregnancy. Am J Obstet Gynecol 2020; 223:211-218. [PMID: 32275895 DOI: 10.1016/j.ajog.2020.03.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/15/2023]
Abstract
In an effort to reduce sugar consumption to prevent diabetes mellitus and cardiovascular diseases, "sugar-free" or "no added sugar" products that substitute sugar with non-nutritive sweeteners (NNSs) (eg, Splenda, Sweet'N Low, and Stevia) have become increasingly popular. The use of these products during pregnancy has also increased, with approximately 30% of pregnant women reporting intentional NNS consumption. In clinical studies with nonpregnant participants and animal models, NNSs were shown to alter gut hormonal secretion, glucose absorption, appetite, kidney function, in vitro insulin secretion, adipogenesis, and microbiome dysbiosis of gut bacteria. In pregnant animal models, NNS consumption has been associated with altered sweet taste preference later in life and metabolic dysregulations in the offspring (eg, elevated body mass index, increased risk of obesity, microbiome dysbiosis, and abnormal liver function tests). Despite the accumulating evidence, no specific guidelines for NNS consumption are available for pregnant women. Furthermore, there are limited clinical studies on the effects of NNS consumption during pregnancy and postpartum and long-term outcomes in the offspring.
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17
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Nonnutritive sweetener consumption during pregnancy, adiposity, and adipocyte differentiation in offspring: evidence from humans, mice, and cells. Int J Obes (Lond) 2020; 44:2137-2148. [PMID: 32366959 DOI: 10.1038/s41366-020-0575-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/16/2020] [Accepted: 03/27/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity often originates in early life, and is linked to excess sugar intake. Nonnutritive sweeteners (NNS) are widely consumed as "healthier" alternatives to sugar, yet recent evidence suggests NNS may adversely influence weight gain and metabolic health. The impact of NNS during critical periods of early development has rarely been studied. We investigated the effect of prenatal NNS exposure on postnatal adiposity and adipocyte development. METHODS In the CHILD birth cohort (N = 2298), we assessed maternal NNS beverage intake during pregnancy and child body composition at 3 years, controlling for maternal BMI and other potential confounders. To investigate causal mechanisms, we fed NNS to pregnant C57BL6J mice at doses relevant to human consumption (42 mg/kg/day aspartame or 6.3 mg/kg/day sucralose), and assessed offspring until 12 weeks of age for: body weight, adiposity, adipose tissue morphology and gene expression, glucose and insulin tolerance. We also studied the effect of sucralose on lipid accumulation and gene expression in cultured 3T3-L1 pre-adipocyte cells. RESULTS In the CHILD cohort, children born to mothers who regularly consumed NNS beverages had elevated body mass index (mean z-score difference +0.23, 95% CI 0.05-0.42 for daily vs. no consumption, adjusted for maternal BMI). In mice, maternal NNS caused elevated body weight, adiposity, and insulin resistance in offspring, especially in males (e.g., 47% and 15% increase in body fat for aspartame and sucralose vs. controls, p < 0.001). In cultured adipocytes, sucralose exposure at early stages of differentiation caused increased lipid accumulation and expression of adipocyte differentiation genes (e.g., C/EBP-α, FABP4, and FASN). These genes were also upregulated in adipose tissue of male mouse offspring born to sucralose-fed dams. CONCLUSION By triangulating evidence from humans, mice, and cultured adipocytes, this study provides new evidence that maternal NNS consumption during pregnancy may program obesity risk in offspring through effects on adiposity and adipocyte differentiation.
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18
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Cavagnari BM. [Non-caloric sweeteners in pregnancy and lactation]. Rev Esp Salud Publica 2019; 93:e201908052. [PMID: 31358725 PMCID: PMC10308837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/13/2019] [Indexed: 06/10/2023] Open
Abstract
Many pregnancies have a weight gain that is higher than recommended, situation that carries several risks for the mother and her child. As a strategy to achieve a lower weight gain, the replacement of sugar-sweetened foods and beverages by those with non-caloric sweeteners could be a choice for pregnant or puerperal mothers. The objective of this article is to review the available evidence regarding the use of non-caloric sweeteners during pregnancy and lactation. Pregnancy is not a period to lose weight, so it would not be advisable to perform hypocaloric diets. However, to achieve an adequate weight gain during pregnancy, many women choose to consume food and beverages with non-caloric sweeteners. During pregnancy, the consumption of cyclamate, saccharin and crude stevia leaf should be avoided, as well as that of stevia infusions or extracts of the whole leaf. Regarding the rest of the approved non-caloric sweeteners, their consumption during pregnancy and lactation is considered to be safe, as long as they are consumed in moderation, adhering to their admissible daily intake levels. Aspartame does not reach breast milk. While saccharin, sucralose, and acesulfame-K are detectable in breast milk, their concentration is several orders of magnitude below their admissible daily intake levels.
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Affiliation(s)
- Brian M Cavagnari
- Escuela de Nutrición. Facultad de Ciencias de la Salud de la Pontificia Universidad Católica Argentina. Buenos Aires. Argentina
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19
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Hinkle SN, Rawal S, Bjerregaard AA, Halldorsson TI, Li M, Ley SH, Wu J, Zhu Y, Chen L, Liu A, Grunnet LG, Rahman ML, Kampmann FB, Mills JL, Olsen SF, Zhang C. A prospective study of artificially sweetened beverage intake and cardiometabolic health among women at high risk. Am J Clin Nutr 2019; 110:221-232. [PMID: 31172169 PMCID: PMC6599744 DOI: 10.1093/ajcn/nqz094] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Artificially sweetened beverages (ASBs) are commonly consumed and recommended for individuals at high risk for cardiometabolic diseases; however, the health effects of ASBs remain contradictory. Given that cross-sectional analyses are subject to reverse causation, prospective studies with long-term follow-up are needed to evaluate associations between ASBs and cardiometabolic health, especially among high-risk individuals. OBJECTIVE The aim of this study was to examine associations of ASB intake and cardiometabolic health among high-risk women with prior gestational diabetes mellitus (GDM). METHODS We included 607 women with GDM from the Danish National Birth Cohort (DNBC; 1996-2002) who completed a clinical exam 9-16 y after the DNBC pregnancy for the Diabetes & Women's Health (DWH) Study (2012-2014). We assessed ASB intake using FFQs completed during the DNBC pregnancy and at the DWH Study clinical exam. We examined cardiometabolic outcomes at the DWH clinical exam. We estimated percentage differences in continuous cardiometabolic markers and RRs for clinical endpoints in association with ASB intake both during pregnancy and at follow-up adjusted for prepregnancy BMI, diet, and lifestyle factors. Sensitivity analyses to account for reverse causation were performed. RESULTS In pregnancy and at follow-up, 30.4% and 36.4% of women regularly (≥2 servings/wk) consumed ASB, respectively. Consumption of ASBs, both during pregnancy and at follow-up, was associated with higher glycated hemoglobin (HbA1c), insulin, HOMA-IR, triglycerides, liver fat, and adiposity and with lower HDL at follow-up. After adjustment for covariates, particularly prepregnancy BMI, the majority of associations between ASB intake in pregnancy and outcomes at follow-up became null with the exception of HbA1c. ASB intake at follow-up (≥1 serving/d compared with <1 serving/mo) was associated with higher HbA1c (6.5%; 95% CI: 1.9, 11.3; P-trend = 0.007); however, associations were not upheld in sensitivity analyses for reverse causation. CONCLUSIONS Among Danish women with a history of GDM, ASB intake was not significantly associated with cardiometabolic profiles.
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Affiliation(s)
| | - Shristi Rawal
- Department of Nutritional Sciences, School of Health Professions, Rutgers University, Newark, NJ
| | - Anne Ahrendt Bjerregaard
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Thor I Halldorsson
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Sylvia H Ley
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Aiyi Liu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Louise Groth Grunnet
- Department of Endocrinology, Diabetes and Bone-Metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | | | - Freja Bach Kampmann
- Department of Endocrinology, Diabetes and Bone-Metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense, Denmark
- Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | - Sjurdur F Olsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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