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Harrold JA, Hill S, Radu C, Thomas P, Thorp P, Hardman CA, Christiansen P, Halford JCG. Non-nutritive sweetened beverages versus water after a 52-week weight management programme: a randomised controlled trial. Int J Obes (Lond) 2024; 48:83-93. [PMID: 37794246 PMCID: PMC10746539 DOI: 10.1038/s41366-023-01393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND/OBJECTIVE Sugar-sweetened beverages are a substantial source of dietary sugar that can contribute to weight gain and the risk of type 2 diabetes. Dietary guidelines recommend non-nutritive sweetened (NNS) beverages to reduce sugar consumption, however, there is a need for long-term randomised controlled trials on their use. We aimed to compare the effects of NNS beverages and water on body weight during weight loss and maintenance in a behavioural weight management programme. METHODS In this parallel-group, open-label, controlled equivalence trial, adults with a BMI of 27-35 kg/m2 who regularly consumed cold beverages were randomised 1:1 to water or NNS beverages. Participants underwent a group behavioural weight management programme comprising weekly (during the 12-week weight-loss phase) then monthly (during the 40-week weight-maintenance phase) meetings. The primary endpoint was weight change at week 52 (equivalence: two-sided P > 0.05). Secondary endpoints included changes in anthropometrics, cardiometabolic risk factors, appetite and activity levels. RESULTS Of 493 participants randomised (water: n = 246; NNS beverages: n = 247), 24.1% were NNS-naïve. At week 52, water and NNS beverages were non-equivalent, with significantly greater weight loss in the NNS beverages group. Participants consuming water maintained a weight loss of 6.1 kg over 52 weeks versus 7.5 kg with NNS beverages (difference [90% CI]: 1.4 kg [-2.6, -0.2]; p < 0.05). CONCLUSIONS During a 52-week behavioural weight management programme, water and NNS beverages were non-equivalent, with weight loss maintained to a statistically greater extent with NNS beverages compared with water. However, this difference was not clinically significant. CLINICAL TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov: NCT02591134.
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Affiliation(s)
- Joanne A Harrold
- Department of Psychology, University of Liverpool, Liverpool, UK.
| | - Scott Hill
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Cristina Radu
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Paul Thomas
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Paula Thorp
- Department of Psychology, University of Liverpool, Liverpool, UK
| | | | | | - Jason C G Halford
- Department of Psychology, University of Liverpool, Liverpool, UK
- School of Psychology, University of Leeds, Leeds, UK
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Yang W, Jiang W, Guo S. Regulation of Macronutrients in Insulin Resistance and Glucose Homeostasis during Type 2 Diabetes Mellitus. Nutrients 2023; 15:4671. [PMID: 37960324 PMCID: PMC10647592 DOI: 10.3390/nu15214671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Insulin resistance is an important feature of metabolic syndrome and a precursor of type 2 diabetes mellitus (T2DM). Overnutrition-induced obesity is a major risk factor for the development of insulin resistance and T2DM. The intake of macronutrients plays a key role in maintaining energy balance. The components of macronutrients distinctly regulate insulin sensitivity and glucose homeostasis. Precisely adjusting the beneficial food compound intake is important for the prevention of insulin resistance and T2DM. Here, we reviewed the effects of different components of macronutrients on insulin sensitivity and their underlying mechanisms, including fructose, dietary fiber, saturated and unsaturated fatty acids, and amino acids. Understanding the diet-gene interaction will help us to better uncover the molecular mechanisms of T2DM and promote the application of precision nutrition in practice by integrating multi-omics analysis.
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Affiliation(s)
| | | | - Shaodong Guo
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX 77843, USA; (W.Y.); (W.J.)
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Steffen BT, Jacobs DR, Yi SY, Lees SJ, Shikany JM, Terry JG, Lewis CE, Carr JJ, Zhou X, Steffen LM. Long-term aspartame and saccharin intakes are related to greater volumes of visceral, intermuscular, and subcutaneous adipose tissue: the CARDIA study. Int J Obes (Lond) 2023; 47:939-947. [PMID: 37443272 PMCID: PMC10511315 DOI: 10.1038/s41366-023-01336-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Artificial sweetener (ArtSw) intakes have been previously associated with higher BMI in observational studies and may promote visceral and skeletal muscle adipose tissue (AT) accumulation. This study aimed to determine whether habitual, long-term ArtSw or diet beverage intakes are related to greater AT depot volumes and anthropometry-related outcomes. METHODS A validated diet history questionnaire was administered at baseline, year 7, and year 20 examinations in 3088 men and women enrolled in the Coronary Artery Risk Development in Young Adults cohort (CARDIA), mean age of 25.2 years and mean BMI of 24.5 kg/m2 at baseline. Volumes of visceral (VAT), intermuscular (IMAT), and subcutaneous adipose tissue (SAT) were assessed by computed tomography at year 25. Linear regression evaluated associations of aspartame, saccharin, sucralose, total ArtSw, and diet beverage intakes with AT volumes, anthropometric measures, and 25-year change in anthropometry. Cox regression estimated associations of ArtSw with obesity incidence. Adjustments were made for demographic and lifestyle factors, total energy intake, and the 2015 healthy eating index. RESULTS Total ArtSw, aspartame, saccharin, and diet beverage intakes were positively associated with VAT, SAT, and IMAT volumes (all ptrend ≤ 0.001), but no associations were observed for sucralose intake (all ptrend > 0.05). In addition, total ArtSw, saccharin, aspartame, and diet beverage intakes were associated with greater body mass index, body weight, waist circumference, and their increases over a 25-year period. Except for saccharin (ptrend = 0.13), ArtSw, including diet soda, was associated with greater risks of incident obesity over a median 17.5-year follow-up (all ptrend < 0.05). CONCLUSIONS Results suggest that long-term intakes of aspartame, saccharin, or diet soda may increase AT deposition and risk of incident obesity independent of diet quality or caloric intake. Coupled with previous evidence, alternatives to national recommendations to replace added sugar with ArtSw should be considered since both may have health consequences.
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Affiliation(s)
- Brian T Steffen
- Division of Computational Health Sciences, Department of Surgery, School of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - So-Yun Yi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Simon J Lees
- Medical Sciences Division, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | - James M Shikany
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James G Terry
- Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John J Carr
- Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Xia Zhou
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
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Sun Y, Yu B, Wang Y, Wang B, Tan X, Lu Y, Zhang K, Wang N. Associations of Sugar-Sweetened Beverages, Artificially Sweetened Beverages, and Pure Fruit Juice With Nonalcoholic Fatty Liver Disease: Cross-sectional and Longitudinal Study. Endocr Pract 2023; 29:735-742. [PMID: 37543090 DOI: 10.1016/j.eprac.2023.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE We aimed to test the associations of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), and pure fruit juice (PJ) consumption with the risk of nonalcoholic fatty liver disease (NAFLD). METHODS Data for 136 277 UK Biobank participants who completed the dietary questionnaire and did not have a history of liver disease were included. Logistic regression was used for the cross-sectional setting where NAFLD was defined by a fatty liver index (FLI) ≥60. Cox proportional hazard regression was used for the longitudinal setting where hospitalized NAFLD was defined as hospital admission with Internationl Classification of Diseases-10 codes K76.0 and K75.8. RESULTS Compared with 0 L/wk for corresponding beverages, multivariate-adjusted odds ratios (95% confidence intervals) for NAFLD in consumption ≤1, 1 to 2, and >2 L/wk were 1.06 (1.02-1.10), 1.24 (1.19-1.29), and 1.42 (1.35-1.49) for SSB; 1.43 (1.37-1.50), 1.73 (1.65-1.82), and 2.37 (2.25-2.50) for ASB, and 0.87 (0.84-0.89), 0.91 (0.88-0.94), and 1.07 (1.02-1.13) for PJ, respectively. Consumption of SSB and ASB were both positively correlated with FLI (P for line < .001). During a median follow-up of 10.2 years, 1043 cases of hospitalized NAFLD were recorded. ASB consumption of 1 to 2 and >2 L/wk was associated with a 22% (0.99-1.50) and 35% (1.11-1.65) increased risk of hospitalized NAFLD, respectively (P for trend = .002). However, the associations of SSB and PJ with the risk of hospitalized NAFLD were not significant. CONCLUSIONS Consumption of SSB, ASB, and PJ were all related to the risk of NAFLD. Excessive consumption of ASBs was associated with an increased risk of incident hospitalized NAFLD.
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Affiliation(s)
- Ying Sun
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Bowei Yu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Bin Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiao Tan
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; School of Public Health, Zhejiang University, Hangzhou, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Kun Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Gomez-Delgado F, Torres-Peña JD, Gutierrez-Lara G, Romero-Cabrera JL, Perez-Martinez P. Artificial sweeteners and cardiovascular risk. Curr Opin Cardiol 2023; 38:344-351. [PMID: 37115819 DOI: 10.1097/hco.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE OF REVIEW Globalization and the increase in consumption of ultra-processed foods have led to a need for greater knowledge on the health impacts of certain nutrients such as artificial sweeteners. This review aims to analyse the role of artificial sweeteners (nutritive and nonnutritive) and their impact on cardiometabolic and cardiovascular disease (CVD) risk. RECENT FINDINGS The detrimental effects of a high-calorie, high-sugar diet have been well established. In light of this, health authorities recommend limiting sugar consumption. This has led the food industry to develop different artificial sweeteners with specific properties, such as flavour and stability (nutritive artificial sweeteners: NAS), and others aimed at limiting sugar in the diet (nonnutritive artificial sweeteners: nNAS). Likewise, recent evidence explores the influence of artificial sweeteners (NAS and nNAS) on CVD risk through risk factors such as obesity and type 2 diabetes mellitus, among others. SUMMARY This review aims to provide an updated overview of the impact of NAS and nNAS on cardiovascular health and provide recommendations regarding their consumption.
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Affiliation(s)
- Francisco Gomez-Delgado
- Vascular Risk Unit, Internal Medicine Unit, Jaen University Hospital, Jaen
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose David Torres-Peña
- Lipids and Atherosclerosis Unit, IMIBIC, Reina Sofía University Hospital, University of Córdoba, Córdoba
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Juan Luis Romero-Cabrera
- Lipids and Atherosclerosis Unit, IMIBIC, Reina Sofía University Hospital, University of Córdoba, Córdoba
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo Perez-Martinez
- Lipids and Atherosclerosis Unit, IMIBIC, Reina Sofía University Hospital, University of Córdoba, Córdoba
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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Pearson RC, Green ES, Olenick AA, Jenkins NT. Comparison of aspartame- and sugar-sweetened soft drinks on postprandial metabolism. Nutr Health 2023; 29:115-128. [PMID: 34841959 DOI: 10.1177/02601060211057415] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: We compared the impact of artificially- and sugar-sweetened beverages co-ingested with a mixed meal on postprandial fat and carbohydrate oxidation, blood glucose, and plasma insulin and triglyceride concentrations. Methods: Eight college-aged, healthy males completed three randomly assigned trials, which consisted of a mixed macronutrient meal test with 20oz of Diet-Coke (AS), Coca-Cola (NS), or water (CON). One week separated each trial and each participant served as his own control. Resting energy expenditure (REE) via indirect calorimetry, blood pressure, and blood samples were obtained immediately before, 5, 10, 30, 60, 120, and 180 min after meal and beverage ingestion. A two-way (treatment × time) repeated-measures ANOVA was conducted to assess REE, fat and carbohydrate oxidation rates, blood glucose, and plasma insulin and triglyceride concentrations. Results: There was a significant main effect of treatment on total fat oxidation (P = 0.006), fat oxidation was significantly higher after AS (P = 0.006) and CON (P = 0.001) compared to following NS. There was a significant main effect of treatment on total carbohydrate oxidation (P = 0.005), carbohydrate oxidation was significantly lower after AS (P = 0.014) and CON (P = 0.001) compared to following NS. Plasma insulin concentration AUC was significantly lower after AS (P = 0.019) and trended lower in CON (P = 0.054) compared to following NS. Conclusion: Ingestion of a mixed meal with an artificially-sweetened beverage does not impact postprandial metabolism, whereas a sugar-sweetened beverage suppresses fat oxidation and increases carbohydrate oxidation compared to artificially-sweetened beverage and water.
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Affiliation(s)
- Regis C Pearson
- Graduate Research Assistant, Department of Kinesiology, 1355University of Georgia, Athens, GA USA
| | - Edward S Green
- Graduate Research Assistant, Department of Kinesiology, 1355University of Georgia, Athens, GA USA
| | - Alyssa A Olenick
- Graduate Teaching Assistant, Department of Kinesiology, 1355University of Georgia, Athens, GA USA
| | - Nathan T Jenkins
- Associate Professor, Department of Kinesiology, 1355University of Georgia, Athens, GA USA
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Muacevic A, Adler JR. Artificially Sweetened Beverages Beyond the Metabolic Risks: A Systematic Review of the Literature. Cureus 2023; 15:e33231. [PMID: 36741610 PMCID: PMC9891650 DOI: 10.7759/cureus.33231] [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] [Accepted: 01/01/2023] [Indexed: 01/04/2023] Open
Abstract
We carried out a review of the available literature on the effects that artificially sweetened beverages (ASBs) such as diet soda (DS) have on health, particularly those not related to incident diabetes mellitus, obesity, and metabolic syndrome. A search of scientific articles was carried out using 11 different databases: PubMed, Cochrane, LILACS, MEDLINE Ovid, JAMA Network, IBECS, Cumed, Scopus, SciELO, MEDLINE-EBSCO, and Taylor & Francis Online. Articles published in the last 10 years were considered, considering cross-sectional studies, retrospective or prospective cohort studies, case-control studies, and randomized controlled clinical trials. Only articles in Spanish or English were considered using the MeSH (Medical Subject Heading) and DeCS (Descriptores en Ciencias de la Salud) terms, including "Diet soda," "Health," "Artificial sweetener," "Gaseosa sin azúcar," "Refresco sin azúcar," and "Salud." Additionally, Boolean operators "AND" and "Y" were used. A total of 1,323 articles were obtained in the initial search, of which 21 main ones were selected for review, which included the topic of DS consumption and explored the health consequences that it poses on different organs. The question of whether ASBs such as DS are a preferred substitute is becoming more and more important in terms of public policy due to mounting evidence of the potential negative health effects of their excessive consumption. This systematic review, the first of its kind to our knowledge, sheds light on how excessive DS consumption can affect multiple organ systems, and associations have been made to mental health burden, delays in child neurodevelopment, cardiac remodeling, worsening retinopathy in diabetics, incidental end-stage renal disease, non-Hodgkin's lymphoma and multiple myeloma in men, rheumatoid arthritis in women, hip fractures, dental erosion, increases in breath alcohol concentration when used in alcoholic beverages, and accelerated cell aging. Further studies should delve further to understand the pathophysiologic mechanisms of these associations.
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Jones GS, Graubard BI, Ramirez Y, Liao LM, Huang WY, Alvarez CS, Yang W, Zhang X, Petrick JL, McGlynn KA. Sweetened beverage consumption and risk of liver cancer by diabetes status: A pooled analysis. Cancer Epidemiol 2022; 79:102201. [PMID: 35728406 DOI: 10.1016/j.canep.2022.102201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Consumption of sweetened beverages has been linked to several risk factors for liver cancer including diabetes. Studies investigating the role of sweetened beverage consumption and liver cancer, however, are limited. As persons with diabetes are advised against consumption of sugar, the objective of this study was to examine the role of sweetened beverage consumption and liver cancer risk by diabetes status. METHODS Data from two U.S. cohorts: the NIH-AARP Diet and Health Study, and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial were harmonized and pooled. Hazard ratios and 95%CI were estimated using Cox proportional hazard models stratified by median follow-up time. RESULTS Among persons without diabetes, there were no statistical evidence of associations between liver cancer and consumption of sweetened beverages overall, sugar sweetened beverages (SSB), or artificially sweetened beverages (ASB). Sugar sweetened (SS) soda consumption, however, was associated with liver cancer in the first follow-up interval (HR:1.18. 95%CI: 1.03, 1.35). In contrast, among persons with diabetes, there were significant associations between liver cancer and consumption of sweetened beverages overall (HR: 1.12, 95%CI 1.01, 1.24), ASBs (HR: 1.13, 95% CI: 1.02, 1.25), soda overall (HR: 1.13, 95% CI: 1.00, 1.26) and artificially sweetened (AS) soda (HR: 1.13, 95% CI: 1.01, 1.27) in the first follow-up interval. CONCLUSIONS Increased soda consumption may be associated with risk of liver cancer. The results suggest that decreasing consumption of SS soda by persons without diabetes, and AS soda by persons with diabetes, could be associated with reduced liver cancer risk.
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Affiliation(s)
- Gieira S Jones
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Yesenia Ramirez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Christian S Alvarez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Wanshui Yang
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, School of Public Heath, Anhui Medical University, Hefei, China
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Daher M, Fahd C, Nour AA, Sacre Y. Trends and amounts of consumption of low-calorie sweeteners: A cross-sectional study. Clin Nutr ESPEN 2022; 48:427-433. [PMID: 35331524 DOI: 10.1016/j.clnesp.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS White sugar has been blamed to cause health consequences including diabetes and obesity. With the increased need to decrease sugar intake, attention was shifted towards sugar alternatives also known as low-calorie sweeteners. Low-calorie sweeteners are ubiquitous within food products, but their consumption among Lebanese adults isn't well elucidated. Our study aims to investigate the trends and amounts of low-calorie sweeteners' consumption in addition to their main sources among a sample of Lebanese adults. METHODS A cross-sectional study was conducted over 384 adult Lebanese individuals from both genders residing in Beirut and Mount-Lebanon from February to August 2020. After excluding eight individuals, 376 completed the survey. To assess the trends, frequency and quantity of low-calorie sweeteners' consumption, a questionnaire was filled by trained and licensed dietitians in addition to a previously validated food frequency questionnaire adapted to the most widely known products in the Lebanese market. Food products were divided into categories, amount of sweeteners in each item was obtained from the label, and analysis was performed according to the type of sweetener they are made of. Frequencies were converted into numbers of servings per day and multiplied by the standard portion size. Daily individual consumption of each sweetener apart was obtained by multiplying the amount of sweetener in each item consumed by total daily consumption. The amount in mg/kg was obtained by dividing total consumption of each sweetener apart by the mean weight of our population. The Statistical Package for Social Sciences (SPSS) was used for data entry and analysis. RESULTS Results showed that 94.4% were consuming an artificially-sweetened item at least once in the last six months. While weight loss and healthy lifestyle constituted the main reasons for past and current consumption respectively, safety and unpleasant taste affected consumption trends. Pills and powders' consumption was significantly associated with gender (p = 0.032) and dieting (p = 0.000) but not with age (p = 0.831), educational level (p = 0.294), living district (p = 0.421) or income (p = 0.828) where women and dieters used significantly more pills and powders than their counterparts. "Food and beverages" consumption was independent of all factors except age (p = 0.001); it peaked at 26-40 and declined thereafter. Consumption of low-calorie sweeteners came mainly from beverages and was as follows while remaining within the acceptable daily intake limits: aspartame: 98.9 mg/d (1.38 mg/kg/d); sucralose: 22.19 mg/d (0.31 mg/kg/d); acesulfame-K: 39.12 mg/d (0.55 mg/kg/d); stevia 3.28 mg/d (0.05 mg/kg/d). Food and beverages were consumed more than pills and powders due to unintentional consumption. CONCLUSION Despite that safety and unpleasant taste affected consumption of low-calorie sweetened products, intake of such products was found to be highly prevalent in the studied population. While remaining within the acceptable daily intake limits, consumption of food and beverages exceeded that of pills and powders due to unintentional consumption making awareness a necessity to help consumers make an informed decision. Moreover, a nation-level study is needed to generalize the results.
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Affiliation(s)
- Mira Daher
- Faculty of Arts and Sciences, Department of Nutrition and Food Sciences, Holy Spirit University of Kaslik, P.O Box 446, Jounieh, Lebanon.
| | - Carla Fahd
- Faculty of Arts and Sciences, Department of Nutrition and Food Sciences, Holy Spirit University of Kaslik, P.O Box 446, Jounieh, Lebanon
| | - Afif Abdel Nour
- School of Engineering, Holy Spirit University of Kaslik, P.O Box 446, Jounieh, Lebanon
| | - Yonna Sacre
- Faculty of Arts and Sciences, Department of Nutrition and Food Sciences, Holy Spirit University of Kaslik, P.O Box 446, Jounieh, Lebanon
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10
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Viveros-Watty PE, López-Franco O, Zepeda RC, Aguirre G, Rodríguez-Alba JC, Gómez-Martínez MA, Castillo-Martínez L, Flores-Muñoz M. Effects on cardiometabolic risk factors after reduction of artificially sweetened beverage consumption in overweight subjects. A randomised controlled trial. ENDOCRINOL DIAB NUTR 2022; 69:168-177. [PMID: 35396115 DOI: 10.1016/j.endien.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/23/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The consumption of artificially sweetened beverages (ASBs) has been linked to metabolic alterations. The effect of reducing the regular consumption of these beverages on the metabolism is currently unknown. OBJECTIVE To evaluate the effect of reducing consumption of ASBs on the metabolism in overweight young adults. DESIGN A randomised, single-blind, controlled, 12-week, clinical trial was performed in overweight young adults who regularly consume ASBs. The 45 subjects who participated in the study were randomly divided into two groups: (1) control group (n=21) and (2) intervention group (no intake of ASBs, n=24). Body weight and composition, fasting plasma concentrations of glucose, triglycerides, insulin, cholesterol, low-density lipoproteins and high-density lipoproteins were measured at the beginning and end of the study. and the HOMA-IR was calculated. RESULTS At the end of 12 weeks, the intervention group showed a significant decrease (as opposed to an increase in the control group) in the percentage of change in body weight (-1.22% vs 1.31%, p<0.004), body fat (-6.28% vs 6.15%, p<0.001) and insulin resistance index (-12.06 vs 38.21%, p<0.00002), as well as in levels of glucose (-4.26% vs 0.51%, p<0.05), triglycerides (-14.74% vs 19.90%, p<0.006), insulin (-8.02% vs 39.23%, p<0.00005), cholesterol (-8.71% vs 0.77%, p<0.01) and LDL (-9.46% vs 9.92%, p<0.004). CONCLUSION A reduction in habitual consumption of ASBs in overweight young adults decreases biochemical measurements, body weight and composition, suggesting a participation in the metabolic processes.
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Affiliation(s)
- Paulina E Viveros-Watty
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Oscar López-Franco
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Rossana C Zepeda
- Laboratorio de Biomedicina Integral y Salud. Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa Enríquez, Xalapa, Veracruz, Mexico
| | - Gisela Aguirre
- Laboratorio de Innovación en Diagnóstico Molecular Hakken Enterprise, Morelos, Mexico
| | - Juan C Rodríguez-Alba
- Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Unidad de Citometría de Flujo, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Manuel A Gómez-Martínez
- Clínica de Insuficiencia Cardiaca y Respiratoria, Departamento de Cardiología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosio Villegas", Ciudad de México, Mexico
| | - Lilia Castillo-Martínez
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Mónica Flores-Muñoz
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico.
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11
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Nandi S, Layek S, Nandi PK, Bera N, Hazra R, Sarkar N. Self-assembly of artificial sweetener aspartame adversely affects phospholipid membranes: plausible reason for its deleterious effects. Chem Commun (Camb) 2021; 57:10532-10535. [PMID: 34553202 DOI: 10.1039/d1cc04482f] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The prolonged intake of the artificial sweetener aspartame is known to have deleterious effects. Our biophysical experimentations indicate that aspartame forms self-assembled cytotoxic fibrillar etiologies that affect the intrinsic integrity of the phospholipid membrane bilayer through electrostatic interaction and hydrophobic insertion, thereby making the membrane less rigid and more heterogeneous.
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Affiliation(s)
- Sourav Nandi
- Department of Chemistry, Indian Institute of Technology, Kharagpur 721302, India.
| | - Souvik Layek
- Department of Chemistry, Indian Institute of Technology, Kharagpur 721302, India.
| | - Pratyush Kiran Nandi
- Department of Chemistry, Indian Institute of Technology, Kharagpur 721302, India.
| | - Nanigopal Bera
- Department of Chemistry, Indian Institute of Technology, Kharagpur 721302, India.
| | - Ritwik Hazra
- Department of Chemistry, Indian Institute of Technology, Kharagpur 721302, India.
| | - Nilmoni Sarkar
- Department of Chemistry, Indian Institute of Technology, Kharagpur 721302, India.
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12
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Webb MC, Chong D, Bawa S. Consumption patterns of nonnutritive sweeteners among university students at a Caribbean institution. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:719-724. [PMID: 31995445 DOI: 10.1080/07448481.2019.1706531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 10/25/2019] [Accepted: 12/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE(S) To determine whether there is an association between the consumption of nonnutritive sweeteners (NNS) and sex, as well as age. Also, to determine awareness of the health risks associated with the use of NNS. METHODS A cross-sectional study was conducted using a self-administered questionnaire. Descriptive statistics were used to compile the data collected. Data were presented using frequencies and percentages. A chi-squared tests were performed to test the association between NNS and gender/sex and age. The level of significance was set at the ≤ 0.05. RESULTS The majority of students [n = 108 (55.1%)] indicated that they have never used NNS. The NNS with the highest intake was sucralose. There were no significant associations between gender (p-value = 0.508) and age (p-value = 0.275) and use of NNS. For awareness of the association between NNS, weight gain, and cancer, 38.8% (n = 76) of the participants indicated that they were not aware that NNS are associated with weight gain. Less than half of the participants (n = 46, 23.5%) were not aware that NNS does cause cancer. CONCLUSION A large portion of university students do not use NNS. The majority of students were aware that NNS are associated with weight gain but did not link it to cancer development.
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Affiliation(s)
- Marquitta C Webb
- Department of Agricultural Economics and Extension, Faculty of Food and Agriculture, The University of the West Indies - St. Augustine, St. Augustine, Trinidad and Tobago
| | - Dana Chong
- Department of Agricultural Economics and Extension, Faculty of Food and Agriculture, The University of the West Indies - St. Augustine, St. Augustine, Trinidad and Tobago
| | - Sa'eed Bawa
- Department of Agricultural Economics and Extension, Faculty of Food and Agriculture, The University of the West Indies - St. Augustine, St. Augustine, Trinidad and Tobago
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, Warsaw, Poland
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13
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Pang T, Alman AC, Gray HL, Basu A, Shi L, Snell-Bergeon JK. Empirical dietary inflammatory pattern and metabolic syndrome: prospective association in participants with and without type 1 diabetes mellitus in the coronary artery calcification in type 1 diabetes (CACTI) study. Nutr Res 2021; 94:1-9. [PMID: 34571214 DOI: 10.1016/j.nutres.2021.08.001] [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: 05/24/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022]
Abstract
The inflammatory potential of diet, assessed by Empirical Dietary Inflammatory Pattern (EDIP), may play a crucial role in the development of metabolic syndrome (MetS). However, limited research on this relationship is available. We hypothesized that EDIP is positively associated with MetS and its components. This longitudinal study included 1177 participants (526 with type 1 diabetes mellitus [T1DM] and 651 without) from the Coronary Artery Calcification in Type 1 Diabetes study. Dietary assessment and anthropometric and biochemical measurements were assessed at baseline and 14-year follow-up. MetS status was defined using the Harmonization criteria. EDIP scores were computed based on a food frequency questionnaire. Generalized linear mixed models were applied and subgroup analyses were performed by diabetes status. Mean age of study participants was 38 years and 48% were male at baseline. EDIP was positively associated with MetS (βT3 versus T1=0.81, P < .01) in T1DM but not in nondiabetic controls. Of the MetS components, low HDL-C and hypertriglyceridemia had positive associations with EDIP in both groups. Individuals with T1DM consumed more pro-inflammatory diets and had a greater risk of developing MetS than those without diabetes. The consumption of processed meat, red meat, high- and low- energy beverages was significantly higher in those with MetS than those without this condition (all P < .05). Reduced consumption of pro-inflammatory foods such as processed meat, red meat, sugar-sweetened beverages, and diet drinks may lower MetS risk in T1DM.
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Affiliation(s)
- Tiantian Pang
- College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Amy C Alman
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Arpita Basu
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Lu Shi
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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14
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Viveros-Watty PE, López-Franco O, Zepeda RC, Aguirre G, Rodríguez-Alba JC, Gómez-Martínez MA, Castillo-Martínez L, Flores-Muñoz M. Effects on cardiometabolic risk factors after reduction of artificially sweetened beverage consumption in overweight subjects. A randomised controlled trial. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00159-2. [PMID: 34274304 DOI: 10.1016/j.endinu.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The consumption of artificially sweetened beverages (ASBs) has been linked to metabolic alterations. The effect of reducing the regular consumption of these beverages on the metabolism is currently unknown. OBJECTIVE To evaluate the effect of reducing consumption of ASBs on the metabolism in overweight young adults. DESIGN A randomised, single-blind, controlled, 12-week, clinical trial was performed in overweight young adults who regularly consume ASBs. The 45 subjects who participated in the study were randomly divided into two groups: (1) control group (n=21) and (2) intervention group (no intake of ASBs, n=24). Body weight and composition, fasting plasma concentrations of glucose, triglycerides, insulin, cholesterol, low-density lipoproteins and high-density lipoproteins were measured at the beginning and end of the study. and the HOMA-IR was calculated. RESULTS At the end of 12 weeks, the intervention group showed a significant decrease (as opposed to an increase in the control group) in the percentage of change in body weight (-1.22% vs 1.31%, p<0.004), body fat (-6.28% vs 6.15%, p<0.001) and insulin resistance index (-12.06 vs 38.21%, p<0.00002), as well as in levels of glucose (-4.26% vs 0.51%, p<0.05), triglycerides (-14.74% vs 19.90%, p<0.006), insulin (-8.02% vs 39.23%, p<0.00005), cholesterol (-8.71% vs 0.77%, p<0.01) and LDL (-9.46% vs 9.92%, p<0.004). CONCLUSION A reduction in habitual consumption of ASBs in overweight young adults decreases biochemical measurements, body weight and composition, suggesting a participation in the metabolic processes.
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Affiliation(s)
- Paulina E Viveros-Watty
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Oscar López-Franco
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Rossana C Zepeda
- Laboratorio de Biomedicina Integral y Salud. Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa Enríquez, Xalapa, Veracruz, Mexico
| | - Gisela Aguirre
- Laboratorio de Innovación en Diagnóstico Molecular Hakken Enterprise, Morelos, Mexico
| | - Juan C Rodríguez-Alba
- Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Unidad de Citometría de Flujo, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Manuel A Gómez-Martínez
- Clínica de Insuficiencia Cardiaca y Respiratoria, Departamento de Cardiología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosio Villegas", Ciudad de México, Mexico
| | - Lilia Castillo-Martínez
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Mónica Flores-Muñoz
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico.
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15
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Agarwal D, Chandra S. Caution Against Overinterpreting Time-Restricted Eating Results. JAMA Intern Med 2021; 181:876-877. [PMID: 33616602 DOI: 10.1001/jamainternmed.2020.8931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dipti Agarwal
- Department of Emergency Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Subhash Chandra
- Division of Gastroenterology, Creighton University School of Medicine, Omaha, Nebraska
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Wang Y, Li C, Li D, Yang H, Li X, Jin D, Xie W, Guo B. Estimated assessment of dietary exposure to artificial sweeteners from processed food in Nanjing, China. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2021; 38:1105-1117. [PMID: 33989115 DOI: 10.1080/19440049.2021.1905883] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study was to measure the concentrations of three intensity sweeteners (Acesulfame-K, cyclamate and saccharin) in different categories of food available on the Nanjing market, and to investigate whether the Nanjing general population was at risk for exceeding the ADI of sweeteners. A set of 1885 foods was collected and analysed using the National Food Safety Standard procedure in order to establish the concentration levels of the sweeteners. Dietary exposure was estimated using probabilistic modelling software and compared directly with each sweetener's ADI. Consumption data from the China National Nutrition and Health Survey (conducted in 2010-2013) and the actual concentrations of sweeteners in the collected food products were used to perform the intake assessment. The results indicated that Acesulfame-K and cyclamate were commonly used in processed food, and processed nuts, preserved fruit, beverages, and bakery products are the main sources of sweeteners in Nanjing. The estimated exposure of sweeteners in Nanjing was well below the ADIs, as relative intakes at the 95th percentile were 29.7% for saccharin, 79.8% for cyclamate, and 35.9% for Acesulfame-K of the respective ADIs. It was concluded that adults were not at risk of exceeding ADIs for these sweeteners, but the intake of cyclamate at the higher percentiles by children may approach or slightly exceed ADI values.
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Affiliation(s)
- Yanli Wang
- Department of Nutrition and Food Hygiene, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Chengguo Li
- Department of Nutrition and Food Hygiene, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Dengkun Li
- Department of Nutrition and Food Hygiene, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Huamei Yang
- Department of Laboratory Detection, Taizhou Municipal Center for Disease Control and Prevention, Taizhou, Jiangsu, China
| | - Xiaocheng Li
- Department of Nutrition and Food Hygiene, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Di Jin
- Department of Nutrition and Food Hygiene, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Wei Xie
- Department of Nutrition and Food Hygiene., Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Baofu Guo
- Department of Nutrition and Food Hygiene, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China.,Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, Jiangsu, China
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17
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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).
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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
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Warshaw H, Edelman SV. Practical Strategies to Help Reduce Added Sugars Consumption to Support Glycemic and Weight Management Goals. Clin Diabetes 2021; 39:45-56. [PMID: 33551553 PMCID: PMC7839604 DOI: 10.2337/cd20-0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Overconsumption of added sugars is a key contributor to the growing obesity, prediabetes, and type 2 diabetes pandemics. The nutrition therapy guidance of the American Diabetes Association recognizes that using low- and no-calorie sweeteners (LNCS) to reduce consumption of added sugars can reduce low-nutrient-density sources of calories and carbohydrate to beneficially affect glycemia, weight, and cardiometabolic health. This article provides information for primary care providers, diabetes care and education specialists, and other diabetes clinicians on the safety of LNCS and summarizes research evidence on the role of LNCS in glycemic and weight management. It also provides practical strategies for counseling individuals about how to integrate LNCS into their healthy eating pattern.
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Affiliation(s)
| | - Steven V. Edelman
- University of California San Diego, San Diego, CA
- Taking Control of Your Diabetes, San Diego, CA
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19
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Kim Y, Keogh JB, Clifton PM. Consumption of a Beverage Containing Aspartame and Acesulfame K for Two Weeks Does Not Adversely Influence Glucose Metabolism in Adult Males and Females: A Randomized Crossover Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239049. [PMID: 33291649 PMCID: PMC7731387 DOI: 10.3390/ijerph17239049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023]
Abstract
There is an association between the consumption of artificial sweeteners and Type 2 diabetes in cohort studies, but intervention studies do not show a clear elevation of blood glucose after the use of artificial sweeteners. The objective of this study was to examine whether two commonly used artificial sweeteners had an adverse effect on glucose control in normal-weight subjects, and in overweight and obese subjects when consumed for 2 weeks. In the study, 39 healthy subjects (body-mass index, kg/m2) (18–45) without Type 2 diabetes with an age of 18–75 years were randomly assigned to 0.6 L/day of an artificially sweetened soft drink containing acesulfame K (950) and aspartame (951) or 0.6 L/day of mineral water for 2 weeks each in a crossover study. There was a 4 week washout period with no drinks consumed. Glucose levels were read by a continuous glucose monitor (CGM) during each 2 week period. A 75 g oral glucose-tolerance test (OGTT) was performed at the beginning and end of each intervention period. Blood samples were collected at baseline, and 1 and 2 h for glucose and insulin. A 2 week intake of artificially sweetened beverage (ASB) did not alter concentrations of fasting glucose and fasting insulin, the area under the curve (AUC) for OGTT glucose and insulin, the incremental area under the curve (iAUC) for OGTT glucose and insulin, the homeostatic model assessment for insulin resistance (HOMA-IR), and the Matsuda index compared with the baseline and with the changes after a 2 week intake of mineral water. Continuous 2 week glucose concentrations were not significantly different after a 2 week intake of ASB compared with a 2 week intake of mineral water. This study found no harmful effect of the artificially sweetened soft drink containing acesulfame K (950) and aspartame (951) on glucose control when consumed for 2 weeks by people without Type 2 diabetes.
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Affiliation(s)
- Yoona Kim
- Department of Food and Nutrition, Institute of Agriculture and Life Science, Gyeongsang National University, Jinju 52828, Korea;
| | - Jennifer B. Keogh
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia;
| | - Peter M. Clifton
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia;
- Correspondence: ; Tel.: +61-8-8302-1357
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Changes in Non-Nutritive Sweetener Consumption Patterns in Response to a Sugar-Sweetened Beverage Reduction Intervention. Nutrients 2020; 12:nu12113428. [PMID: 33171645 PMCID: PMC7695198 DOI: 10.3390/nu12113428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023] Open
Abstract
Data are lacking on whether non-nutritive sweeteners (NNS) can be used as a strategy to support decreases in sugar-sweetened beverage (SSB) consumption. The purpose of this secondary analysis of a 6-month SSB-reduction intervention was to explore changes in NNS consumption patterns in Talking Health participants within the SIPsmartER (n = 101) intervention. Additionally, participant characteristics were compared for three SSB-NNS change groups (decrease SSB/increase NNS; decrease SSB/no increase in NNS; increase/no change in SSB/regardless of NNS). There was a significant increase in aspartame and total NNS intake for participants (mean daily mg increases of 37.2 ± 13.9 and 63.7 ± 18.5, respectively). With the exception of sex, no differences in participant characteristics were found between the three SSB-NNS change groups. Furthermore, no significant changes in weight or body mass index (BMI) were demonstrated between SSB-NNS change groups over time. Diet soda was the most commonly consumed source of NNS; however, other dietary sources of NNS also contributed to intake. At 6 months, intake of sucralose and saccharin were primarily from dietary sources other than diet sodas (94% and 100%, respectively). These findings suggest that NNS may be a feasible strategy to help reduce SSB consumption. This study supports the need to consistently quantify and identify NNS intake, beyond using diet soda intake as a proxy for NNS intake and grouping all NNS types into one variable, to more accurately address the potential health effects of NNS.
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21
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Effects on weaned male Wistar rats after 104, 197, and 288 days of chronic consumption of nutritive and non-nutritive additives in water. Journal of Food Science and Technology 2020; 58:2349-2359. [PMID: 33967331 DOI: 10.1007/s13197-020-04746-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
Abstract
Abstract It has been suggested that the consumption of artificial sweeteners is related to greater body mass gain and diverse metabolic alterations. In this study, the effect of chronic consumption of nutritive sweeteners (fructose 7% and sucrose 10%) and non-nutritive or low-calorie sweeteners (acesulfame 0.015%, aspartame 0.3%, aspartame:acesulfame mixture 0.04%, saccharin 0.3%, and sucralose 0.19%), in drinking water, as well as a control group with no sweeteners, was evaluated. Body mass gain and glucose, insulin, triglycerides, and total cholesterol levels in blood were the parameters considered. For this purpose, 120 weaned male Wistar rats of the HsdHan:WIST line were used, 15 per group in first stage, then 10 and 5 per group for 2nd and 3rd stages, respectively. Body mass gain, food intake, and beverage consumption were daily quantified. After 104, 197, and 288 days of experimentation the concentrations of glucose, triglycerides, cholesterol, and insulin were determined. Only in the first stage there were significant differences in the body mass gain. In the three stages there were significant differences in the patterns of beverage intake and food consumption. The trend was the same in all 3 stages: rats drank more in the groups of drinks sweetened with nutritive sweeteners and ate more in the groups that drank non-nutritive artificial sweeteners. Regarding the biochemical profile, no sweetener either nutritive or non-nutritive caused that the serum levels of glucose, triglycerides, and cholesterol were at pathological levels. It is concluded that the sweeteners by themselves can modify certain biochemical parameters but not at a pathological level. Furthermore, by themselves they are not capable of triggering excess of body mass or obesity in the early and medium stages of life when consumed together with a balanced diet. Graphic abstract
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Avilés-Santa ML, Hsu L, Lam TK, Arteaga SS, Artiles L, Coady S, Cooper LS, Curry J, Desvigne-Nickens P, Nicastro HL, Rosario A. Funding of Hispanic/Latino Health-Related Research by the National Institutes of Health: An Analysis of the Portfolio of Research Program Grants on Six Health Topic Areas. Front Public Health 2020; 8:330. [PMID: 33014952 PMCID: PMC7493677 DOI: 10.3389/fpubh.2020.00330] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022] Open
Abstract
Hispanics/Latinos are expected to constitute 25% of the U.S. population by 2060. Differences in the prevalence of health risk factors, chronic diseases, and access to and utilization of health-care services between Hispanics/Latinos and other populations in the U.S. have been documented. This study aimed to describe and analyze the landscape of Research Program Grants (RPGs) funded by the National Institutes of Health (NIH) between 2008 and 2015 involving Hispanic/Latino health research in six health condition areas-asthma, cancer, dementia, diabetes, liver/gallbladder disease, and obesity-and to identify opportunities for continued research in these areas. Using an NIH internal search engine, we identified new and renewal Hispanic/Latino health RPGs searching for specific Hispanic/Latino identifiers in the Title, Abstract, and Specific Aims. We used descriptive statistics to examine the distribution of funded RPGs by NIH disease-based classification codes for the six health condition areas of interest, and other selected characteristics. The most prominent clusters of research subtopics were identified within each health condition area, and performance sites were mapped at the city level. Within the selected time frame, 3,221 Hispanic/Latino health-related unique RPGs were funded (constituting 4.4% of all funded RPGs), and of those 625 RPGs were eligible for review and coding in the present study. Cancer and obesity were the most commonly studied health condition areas (72%), while studies on mechanisms of disease-biological and non-biological-(72.6%), behavioral research (42.1%) and epidemiological studies (38.1%) were the most common types of research. Most of the primary performance sites were in California, Texas, the northeastern U.S., and Illinois. The predominance of mechanistic, behavioral, and epidemiological studies in our analysis poses opportunities to evaluate knowledge gained and their clinical application, explore new research questions, or to update some methods or instruments. The findings of the present study suggest opportunities to expand research in understudied mechanisms of disease that could explain differences in prevalence of conditions like diabetes and cancer among different heritage groups. In addition, our findings suggest that the impact of interventions or policies designed to reduce health disparities, innovative multi-level interventions, implementation and dissemination studies, the role of health information technology on health outcomes, and the intersectionality of individual, sociocultural, geographic, and other factors on health outcomes, among others, are understudied approaches, which could potentially advance research in Hispanic/Latino health and contribute to the achievement of better health outcomes in this diverse population.
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Affiliation(s)
- M. Larissa Avilés-Santa
- Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Laura Hsu
- Division of Extramural Research Activities, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Tram Kim Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
| | - S. Sonia Arteaga
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Ligia Artiles
- Division of Scientific Programs, National Institutes on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Sean Coady
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Lawton S. Cooper
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Jennifer Curry
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Holly L. Nicastro
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Adelaida Rosario
- Division of Scientific Programs, National Institutes on Minority Health and Health Disparities, Bethesda, MD, United States
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Moon RC, Brazzi-Smith G, Teixeira A, Jawad M. Preoperative Exposure to Low-Calorie Sweeteners and Bariatric Surgery Outcomes. Obes Surg 2020; 30:5012-5019. [PMID: 32827091 DOI: 10.1007/s11695-020-04931-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Low-calorie (LCSs) may be negatively associated with weight and metabolic health. We hypothesized that LCS exposure may hinder the effectiveness of bariatric procedures. The aim of this study was to examine the association between preoperative LCS use and weight loss/comorbidity remission following sleeve gastrectomy and gastric bypass. MATERIAL AND METHODS We performed a retrospective chart review of 653 patients who underwent one of the two bariatric procedures and provided preoperative diet information. Patients who selected LCS as one of their most commonly consumed sweeteners and/or included "diet" drinks or sugar-free foods in their 24-h diet recall were categorized as "LCS users." We used multiple logistic regression models to address the study objectives. RESULTS Of 653 patients, 470 (72.0%) regularly consumed LCSs. LCS users were more likely to be older, have lower preoperative BMI, diabetic, using insulin, and have hyperlipidemia than non-LCS users. LCS consumption was not associated with the odds of achieving BMI < 35 kg/m2 nor the odds of achieving TBWL ≥ 20% in the adjusted models. While 39.6% of diabetic LCS users did not show remission, only 22.7% of diabetic non-LCS users did so at their last follow-up (p = 0.04). However, this association was attenuated when adjusted for insulin dependency. CONCLUSIONS There is no clear harm or benefit of preoperative consumption of LCS on weight loss or comorbidity remission after bariatric procedures. Further study is needed to more accurately assess the effect of LCSs on bariatric surgery outcomes.
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Affiliation(s)
- Rena C Moon
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, Orlando, FL, 32806, USA.
| | - Gayle Brazzi-Smith
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, Orlando, FL, 32806, USA
| | - Andre Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, Orlando, FL, 32806, USA
| | - Muhammad Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, Orlando, FL, 32806, USA
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Turner A, Veysey M, Keely S, Scarlett CJ, Lucock M, Beckett EL. Intense Sweeteners, Taste Receptors and the Gut Microbiome: A Metabolic Health Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114094. [PMID: 32521750 PMCID: PMC7312722 DOI: 10.3390/ijerph17114094] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 12/22/2022]
Abstract
Intense sweeteners (IS) are often marketed as a healthier alternative to sugars, with the potential to aid in combating the worldwide rise of diabetes and obesity. However, their use has been counterintuitively associated with impaired glucose homeostasis, weight gain and altered gut microbiota. The nature of these associations, and the mechanisms responsible, are yet to be fully elucidated. Differences in their interaction with taste receptors may be a potential explanatory factor. Like sugars, IS stimulate sweet taste receptors, but due to their diverse structures, some are also able to stimulate bitter taste receptors. These receptors are expressed in the oral cavity and extra-orally, including throughout the gastrointestinal tract. They are involved in the modulation of appetite, glucose homeostasis and gut motility. Therefore, taste genotypes resulting in functional receptor changes and altered receptor expression levels may be associated with metabolic conditions. IS and taste receptors may both interact with the gastrointestinal microbiome, and their interactions may potentially explain the relationship between IS use, obesity and metabolic outcomes. While these elements are often studied in isolation, the potential interactions remain unexplored. Here, the current evidence of the relationship between IS use, obesity and metabolic outcomes is presented, and the potential roles for interactions with taste receptors and the gastrointestinal microbiota in modulating these relationships are explored.
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Affiliation(s)
- Alexandria Turner
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (A.T.); (C.J.S.); (M.L.)
| | - Martin Veysey
- School of Medicine and Public Health, University of Newcastle, Ourimbah 2258, Australia;
- Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan 2308, Australia;
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia
| | - Christopher J. Scarlett
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (A.T.); (C.J.S.); (M.L.)
| | - Mark Lucock
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (A.T.); (C.J.S.); (M.L.)
| | - Emma L. Beckett
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia; (A.T.); (C.J.S.); (M.L.)
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia
- Correspondence:
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Pfinder M, Heise TL, Hilton Boon M, Pega F, Fenton C, Griebler U, Gartlehner G, Sommer I, Katikireddi SV, Lhachimi SK. Taxation of unprocessed sugar or sugar-added foods for reducing their consumption and preventing obesity or other adverse health outcomes. Cochrane Database Syst Rev 2020; 4:CD012333. [PMID: 32270494 PMCID: PMC7141932 DOI: 10.1002/14651858.cd012333.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Global prevalence of overweight and obesity are alarming. For tackling this public health problem, preventive public health and policy actions are urgently needed. Some countries implemented food taxes in the past and some were subsequently abolished. Some countries, such as Norway, Hungary, Denmark, Bermuda, Dominica, St. Vincent and the Grenadines, and the Navajo Nation (USA), specifically implemented taxes on unprocessed sugar and sugar-added foods. These taxes on unprocessed sugar and sugar-added foods are fiscal policy interventions, implemented to decrease their consumption and in turn reduce adverse health-related, economic and social effects associated with these food products. OBJECTIVES To assess the effects of taxation of unprocessed sugar or sugar-added foods in the general population on the consumption of unprocessed sugar or sugar-added foods, the prevalence and incidence of overweight and obesity, and the prevalence and incidence of other diet-related health outcomes. SEARCH METHODS We searched CENTRAL, Cochrane Database of Systematic Reviews, MEDLINE, Embase and 15 other databases and trials registers on 12 September 2019. We handsearched the reference list of all records of included studies, searched websites of international organisations and institutions, and contacted review advisory group members to identify planned, ongoing or unpublished studies. SELECTION CRITERIA We included studies with the following populations: children (0 to 17 years) and adults (18 years or older) from any country and setting. Exclusion applied to studies with specific subgroups, such as people with any disease who were overweight or obese as a side-effect of the disease. The review included studies with taxes on or artificial increases of selling prices for unprocessed sugar or food products that contain added sugar (e.g. sweets, ice cream, confectionery, and bakery products), or both, as intervention, regardless of the taxation level or price increase. In line with Cochrane Effective Practice and Organisation of Care (EPOC) criteria, we included randomised controlled trials (RCTs), cluster-randomised controlled trials (cRCTs), non-randomised controlled trials (nRCTs), controlled before-after (CBA) studies, and interrupted time series (ITS) studies. We included controlled studies with more than one intervention or control site and ITS studies with a clearly defined intervention time and at least three data points before and three after the intervention. Our primary outcomes were consumption of unprocessed sugar or sugar-added foods, energy intake, overweight, and obesity. Our secondary outcomes were substitution and diet, expenditure, demand, and other health outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently screened all eligible records for inclusion, assessed the risk of bias, and performed data extraction.Two review authors independently assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We retrieved a total of 24,454 records. After deduplicating records, 18,767 records remained for title and abstract screening. Of 11 potentially relevant studies, we included one ITS study with 40,210 household-level observations from the Hungarian Household Budget and Living Conditions Survey. The baseline ranged from January 2008 to August 2011, the intervention was implemented on September 2011, and follow-up was until December 2012 (16 months). The intervention was a tax - the so-called 'Hungarian public health product tax' - on sugar-added foods, including selected foods exceeding a specific sugar threshold value. The intervention includes co-interventions: the taxation of sugar-sweetened beverages (SSBs) and of foods high in salt or caffeine. The study provides evidence on the effect of taxing foods exceeding a specific sugar threshold value on the consumption of sugar-added foods. After implementation of the Hungarian public health product tax, the mean consumption of taxed sugar-added foods (measured in units of kg) decreased by 4.0% (standardised mean difference (SMD) -0.040, 95% confidence interval (CI) -0.07 to -0.01; very low-certainty evidence). The study was at low risk of bias in terms of performance bias, detection bias and reporting bias, with the shape of effect pre-specified and the intervention unlikely to have any effect on data collection. The study was at unclear risk of attrition bias and at high risk in terms of other bias and the independence of the intervention. We rated the certainty of the evidence as very low for the primary and secondary outcomes. The Hungarian public health product tax included a tax on sugar-added foods but did not include a tax on unprocessed sugar. We did not find eligible studies reporting on the taxation of unprocessed sugar. No studies reported on the primary outcomes of consumption of unprocessed sugar, energy intake, overweight, and obesity. No studies reported on the secondary outcomes of substitution and diet, demand, and other health outcomes. No studies reported on differential effects across population subgroups. We could not perform meta-analyses or pool study results. AUTHORS' CONCLUSIONS There was very limited evidence and the certainty of the evidence was very low. Despite the reported reduction in consumption of taxed sugar-added foods, we are uncertain whether taxing unprocessed sugar or sugar-added foods has an effect on reducing their consumption and preventing obesity or other adverse health outcomes. Further robustly conducted studies are required to draw concrete conclusions on the effectiveness of taxing unprocessed sugar or sugar-added foods for reducing their consumption and preventing obesity or other adverse health outcomes.
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Affiliation(s)
- Manuela Pfinder
- AOK Baden‐WürttembergDepartment of Health PromotionPresselstr. 19StuttgartBaden‐WürttembergGermany70191
- University Hospital, University of HeidelbergDepartment of General Practice and Health Services ResearchVossstrasse 2HeidelbergBremenGermanyD‐69115
- University of BremenInstitute for Public Health and Nursing Research, Health Sciences BremenBibliothekstr. 1BremenBremenGermany28359
| | - Thomas L Heise
- University of BremenInstitute for Public Health and Nursing Research, Health Sciences BremenBibliothekstr. 1BremenBremenGermany28359
- Leibniz Institute for Prevention Research and EpidemiologyResearch Group for Evidence‐Based Public HealthAchterstr. 30BremenGermany28359
| | - Michele Hilton Boon
- University of GlasgowMRC/CSO Social and Public Health Sciences UnitGlasgowUK
| | - Frank Pega
- University of OtagoPublic Health23A Mein Street, NewtownWellingtonNew Zealand6242
| | - Candida Fenton
- University of EdinburghUsher Institute of Population Health Sciences and InformaticsMedical SchoolTeviot PlaceEdinburghUKEH8 9AG
| | - Ursula Griebler
- Danube University KremsCochrane Austria, Department for Evidence‐based Medicine and EvaluationDr.‐Karl‐Dorrek Str. 30KremsAustria3500
| | - Gerald Gartlehner
- Danube University KremsCochrane Austria, Department for Evidence‐based Medicine and EvaluationDr.‐Karl‐Dorrek Str. 30KremsAustria3500
| | - Isolde Sommer
- Danube University KremsCochrane Austria, Department for Evidence‐based Medicine and EvaluationDr.‐Karl‐Dorrek Str. 30KremsAustria3500
| | | | - Stefan K Lhachimi
- Leibniz Institute for Prevention Research and EpidemiologyResearch Group for Evidence‐Based Public HealthAchterstr. 30BremenGermany28359
- University of BremenDepartment for Health Services Research, Institute for Public Health and Nursing Research, Health Sciences BremenBibliotheksstr. 1BremenGermany28359
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Garduño‐Alanís A, Malyutina S, Pajak A, Stepaniak U, Kubinova R, Denisova D, Pikhart H, Peasey A, Bobak M, Stefler D. Association between soft drink, fruit juice consumption and obesity in Eastern Europe: cross-sectional and longitudinal analysis of the HAPIEE study. J Hum Nutr Diet 2020; 33:66-77. [PMID: 31475413 PMCID: PMC8425279 DOI: 10.1111/jhn.12696] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fruit juice and soft drink consumption have been shown to be related to obesity. However, this relationship has not been explored in Eastern Europe. The present study aimed to assess the cross-sectional and longitudinal relationships between fruit juice, soft drink consumption and body mass index (BMI) in Eastern European cohorts. METHODS Data from the Health, Alcohol and Psychosocial factors in Eastern Europe population-based prospective cohort study, based in Russia, Poland and the Czech Republic, were used. Intakes of sugar-sweetened beverage (SSB), artificially-sweetened beverage (ASB) and fruit juice were estimated from a food frequency questionnaire. Participant BMI values were assessed at baseline (n = 26 634) and after a 3-year follow-up (data available only for Russia, n = 5205). RESULTS Soft drink consumption was generally low, particularly in Russia. Compared to never drinkers of SSB, participants who drank SSB every day had a significantly higher BMI in the Czech [β-coefficient = 0.28; 95% confidence interval (CI) = 0.02-0.54], Russian (β-coefficient = 1.38; 95% CI = 0.62-2.15) and Polish (β-coefficient = 0.83; 95% CI = 0.29-1.37) cohorts. Occasional or daily ASB consumption was also positively associated with BMI in all three cohorts. Results for daily fruit juice intake were inconsistent, with a positive association amongst Russians (β-coefficient = 0.75; 95% CI = 0.28-1.21) but a negative trend in the Czech Republic (β-coefficient = -0.42; 95% CI = -0.86 to 0.02). Russians participants who drank SSB or ASB had an increased BMI after follow-up. CONCLUSIONS Our findings support previous studies suggesting that soft drink consumption (including SSBs and ASBs) is positively related to BMI, whereas our results for fruit juice were less consistent. Policies regarding these beverages should be considered in Eastern Europe to lower the risk of obesity.
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Affiliation(s)
- A. Garduño‐Alanís
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
- Research DepartmentUniversidad de la Salud del Estado de MéxicoTolucaMéxico
| | - S. Malyutina
- Research Institute of Internal and Preventive Medicine – Branch of the Institute of Cytology and GeneticsSiberian Branch of Russian Academy of SciencesNovosibirskRussia
- Novosibirsk State Medical UniversityNovosibirskRussia
| | - A. Pajak
- Department of Epidemiology and Population StudiesJagiellonian University Collegium MedicumKrakowPoland
| | - U. Stepaniak
- Department of Epidemiology and Population StudiesJagiellonian University Collegium MedicumKrakowPoland
| | - R. Kubinova
- National Institute of Public HealthPragueCzech Republic
| | - D. Denisova
- Research Institute of Internal and Preventive Medicine – Branch of the Institute of Cytology and GeneticsSiberian Branch of Russian Academy of SciencesNovosibirskRussia
| | - H. Pikhart
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - A. Peasey
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - M. Bobak
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - D. Stefler
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
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Abstract
PURPOSE OF REVIEW The consumption of foods and beverages containing non-nutritive sweeteners (NNS) has increased worldwide over the last three decades. Consumers' choice of NNS rather than sugar or other nutritive sweeteners may be attributable to their potential to reduce weight gain. RECENT FINDINGS It is not clear what the effects of NNS consumption are on glycaemic control and the incidence of type 2 diabetes. This review aims to examine this question in epidemiological, human intervention and animal studies. It is not clear that NNS consumption has an effect on the incidence of type 2 diabetes or on glycaemic control even though there is some evidence for the modification of the microbiome and for interaction with sweet taste receptors in the oral cavity and the intestines' modification of secretion of glucagon-like peptide-1 (GLP-1), peptide YY (PYY), ghrelin and glucose-dependent insulinotropic polypeptide (GIP), which may affect glycaemia following consumption of NNS. In conclusion, long-term studies of NNS consumption are required to draw a firm conclusion about the role of NNS consumption on glycaemic control.
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Affiliation(s)
- Yoona Kim
- Department of Food and Nutrition, College of Natural Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Jennifer B Keogh
- Division of Health Sciences, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5000, Australia
| | - Peter M Clifton
- Division of Health Sciences, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5000, Australia.
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Yin KJ, Xie DY, Zhao L, Fan G, Ren JN, Zhang LL, Pan SY. Effects of different sweeteners on behavior and neurotransmitters release in mice. Journal of Food Science and Technology 2019; 57:113-121. [PMID: 31975714 DOI: 10.1007/s13197-019-04036-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 01/03/2023]
Abstract
Four natural sweeteners (sucrose, stevioside, maltose and xylitol) and six artificial sweeteners (acesulfame, sucralose, aspartame, cyclamate, saccharin and neotame) were used to study the effects of different sweeteners on the behavior and neurotransmitter release of mice with two-bottle preference experiments. The results showed that very significant preference behavior for 8% sucrose solution, 0.3% stevioside solution, 10 mM acesulfame, 10 mM sucralose and 10 mM aspartame solutions (p < 0.01) was observed on mice. Long-term exposure of sucrose solution and acesulfame solution can affect the behavioral indicators such as solution consumption, feed intake, body weight and the release of neurotransmitters in mice. The solution consumption and the release of neurotransmitters were significantly greater (p < 0.05) than that of the control group (water group), but there was no significant difference in feed intake. The acesulfame-A and acesulfame-B groups had no significant difference on the consumption of solution and feed intake, but there was significant difference in the release of neurotransmitters. The result also showed that different sweetener solutions with similar sweetness had the same effect on the neurotransmitters release, and it can be inferred that mice have an addictive behavioral characteristic to sucrose.
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Affiliation(s)
- Kai-Jing Yin
- 1College of Food Science and Technology, Huazhong Agricultural University, Key Laboratory of Environment Correlative Dietology, Ministry of Education, Wuhan, 430070 China
| | - Ding-Yuan Xie
- 1College of Food Science and Technology, Huazhong Agricultural University, Key Laboratory of Environment Correlative Dietology, Ministry of Education, Wuhan, 430070 China
| | - Lei Zhao
- 2Food and Agriculture Standardization Institute, China National Institute of Standardization, Beijing, 102200 China
| | - Gang Fan
- 1College of Food Science and Technology, Huazhong Agricultural University, Key Laboratory of Environment Correlative Dietology, Ministry of Education, Wuhan, 430070 China
| | - Jing-Nan Ren
- 1College of Food Science and Technology, Huazhong Agricultural University, Key Laboratory of Environment Correlative Dietology, Ministry of Education, Wuhan, 430070 China
| | - Lu-Lu Zhang
- 1College of Food Science and Technology, Huazhong Agricultural University, Key Laboratory of Environment Correlative Dietology, Ministry of Education, Wuhan, 430070 China
| | - Si-Yi Pan
- 1College of Food Science and Technology, Huazhong Agricultural University, Key Laboratory of Environment Correlative Dietology, Ministry of Education, Wuhan, 430070 China
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29
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Green CH, Syn WK. Non-nutritive sweeteners and their association with the metabolic syndrome and non-alcoholic fatty liver disease: a review of the literature. Eur J Nutr 2019; 58:1785-1800. [PMID: 31119399 DOI: 10.1007/s00394-019-01996-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/11/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Non-alcoholic fatty liver disease (NAFLD) is increasing in incidence worldwide, paralleling epidemics in obesity and metabolic syndrome. Widely considered the hepatic manifestation of the metabolic syndrome, NAFLD is associated with significant morbidity, mortality, and increased healthcare costs. There is an abundance of data linking sugar-sweetened beverages, and fructose, in particular, to the metabolic syndrome and NAFLD. As a result, non-nutritive sweeteners (NNSs) are frequently substituted for sugar in drinks and a variety of foods. However, despite the widespread consumption of NNSs, there is growing concern about their impact on metabolic health. METHODS This review examines the experimental and clinical evidence on non-nutritive sweetener (NNS) consumption and features of the metabolic syndrome, including NAFLD. RESULTS Experimental animal studies show that NNS consumption can induce glucose intolerance, increased food consumption, and weight gain, with proposed mechanisms including altered gut microbiome, inhibition of protective intestinal enzymes, and increased appetite. The evidence from clinical studies is more controversial. Observational studies overwhelmingly show an association between NNS consumption and features of the metabolic syndrome, and this includes NAFLD when analyses are not adjusted for obesity. The evidence from randomized-controlled trials in humans is sparse and conflicting, and primarily evaluates weight-related outcomes. CONCLUSION Further research is urgently needed to evaluate NNS consumption and its relationship with NAFLD and the gut microbiome in humans.
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Affiliation(s)
- Caitlin H Green
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, 30 Courtenay Drive-STB Suit 249, MSC 702, Charleston, SC, 29425, USA.
| | - Wing-Kin Syn
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, 30 Courtenay Drive-STB Suit 249, MSC 702, Charleston, SC, 29425, USA.,Section of Gastroenterology, Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, USA.,Department of Physiology, Faculty of Medicine and Nursing, University of the Basque County, UPV/EHU, Leioa, Spain
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Myers EA, Duncan SE, Wang A, Hedrick VE. Identifying an appropriate carrier for nonnutritive sweeteners in metabolic and controlled feeding investigations via sensory evaluation. J SENS STUD 2018. [DOI: 10.1111/joss.12488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Emily A. Myers
- Department of Human Nutrition, Foods, and ExerciseVirginia Tech Blacksburg Virginia
| | - Susan E. Duncan
- Department of Food Science and TechnologyVirginia Tech Blacksburg Virginia
| | - Aili Wang
- Department of Food Science and TechnologyVirginia Tech Blacksburg Virginia
| | - Valisa E. Hedrick
- Department of Human Nutrition, Foods, and ExerciseVirginia Tech Blacksburg Virginia
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Effects of sucralose on insulin and glucagon-like peptide-1 secretion in healthy subjects: a randomized, double-blind, placebo-controlled trial. Nutrition 2018; 55-56:125-130. [DOI: 10.1016/j.nut.2018.04.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 03/31/2018] [Accepted: 04/08/2018] [Indexed: 01/16/2023]
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Sylvetsky AC. Metabolic Effects of Low-Calorie Sweeteners: A Brief Review. Obesity (Silver Spring) 2018; 26 Suppl 3:S25-S31. [PMID: 30070039 DOI: 10.1002/oby.22252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/07/2016] [Indexed: 12/12/2022]
Abstract
Low-calorie sweeteners (LCS) are found in a variety of foods and beverages, yet their role in diet, weight, and obesity-related chronic disease is controversial. This article summarizes proceedings from one of four presentations during a preconference session entitled "Low-Calorie Sweeteners and Weight Management," which took place at the 2017 Obesity Society Annual Meeting in Washington, District of Columbia. The objective of this brief review is to summarize findings of observational and interventional studies of LCS effects on weight and metabolic health and to provide potential explanations for their discrepant results. Key research priorities for advancing the understanding of the role of LCS in weight and chronic disease are also discussed. The existing literature suggests that LCS consumption is consistently associated with obesity, diabetes, and related cardiometabolic conditions in observational studies. Although several plausible mechanisms have been proposed to explain these associations and have received considerable support in cellular and rodent models, the relevance of these mechanisms to humans has yet to be confirmed. Meanwhile, randomized controlled trials demonstrate that NNS may benefit weight loss and weight maintenance. This is the case particularly when LCS are administered in the context of behavioral weight loss support and are consumed knowingly by habitual LCS consumers. Although these findings suggest that LCS may be useful for weight control among those cognitively engaged in weight loss and who are aware of their LCS consumption, LCS administration in these studies does not reflect typical consumption. Furthermore, few interventional studies have assessed the role of LCS on metabolic outcomes other than body weight. Additional factors must be considered before recommending LCS for weight management and chronic disease prevention and further study of LCS effects on a variety of cardiometabolic outcomes, including visceral adiposity and glucose homeostasis is warranted.
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Affiliation(s)
- Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, District of Columbia, Washington, USA
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, District of Columbia, Washington, USA
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Malek AM, Hunt KJ, DellaValle DM, Greenberg D, St. Peter JV, Marriott BP. Reported Consumption of Low-Calorie Sweetener in Foods, Beverages, and Food and Beverage Additions by US Adults: NHANES 2007-2012. Curr Dev Nutr 2018; 2:nzy054. [PMID: 30283913 PMCID: PMC6163106 DOI: 10.1093/cdn/nzy054] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Low-calorie sweeteners (LCSs), artificial sweeteners, or high-intensity sweeteners are incorporated into foods, beverages, and food and beverage additions (FBAs). Many prior studies have focused on LCS beverage consumption, but not included LCS consumption from foods or FBAs. OBJECTIVES We aimed to describe the prevalence of LCS consumption by US adults, and to examine the relation between intake of products containing LCSs and macronutrients. METHODS Two nonconsecutive 24-h dietary recalls from NHANES 2007-2012 and the National Cancer Institute usual intake method were used to estimate prevalence of LCS intake from foods, beverages, and FBAs, and macronutrients among US adults aged ≥19 y (n = 14,098, weighted n = 218,391,752) in a cross-sectional study. The prevalence of LCS consumption from reported foods, beverages, and FBAs among US adults was examined by sociodemographic characteristics and body mass index (BMI). Logistic regression estimated ORs and 95% CIs for associations between sociodemographic characteristics and LCS use (overall and in foods, beverages, and FBAs). RESULTS Among adults, 47.8% reported intake of ≥1 food, beverage, or FBA containing LCSs over 2 d. Intake was higher among: women non-Hispanic whites, college graduates or higher, and those with higher income and obese BMIs (P < 0.001). Intake of beverages containing LCSs was higher for ages 51-70 y than 19-30 y and those with overweight and obese BMIs (P < 0.001) than for normal-weight individuals. Calories, carbohydrate, and sugar intake were lower and fiber was higher in LCS-consumers than in nonconsumers. Specifically, calories from beverages were lower in those who reported LCS intake. CONCLUSIONS Individuals reporting LCS consumption demonstrated lower total energy intake than did individuals without LCS intake. Although the main source of LCSs in the US adult diet was beverages (31.9%), we found that FBAs also present a significant contribution (25.2%), surpassing food (9.3%). This enables targeted understanding of national consumption of these products as well as dietary education and intervention opportunities.
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Affiliation(s)
- Angela M Malek
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Kelly J Hunt
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Diane M DellaValle
- Departments of Medicine, Medical University of South Carolina, Charleston, SC
| | | | | | - Bernadette P Marriott
- Departments of Medicine, Medical University of South Carolina, Charleston, SC
- Departments of Psychiatry, Medical University of South Carolina, Charleston, SC
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Barrington WE, Beresford SAA. Applying Multiple Statistical Methods to Derive an Index of Dietary Behaviors Most Related to Obesity. Am J Epidemiol 2018. [PMID: 29538668 DOI: 10.1093/aje/kwx370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To evaluate the success of dietary interventions, we need measures that are more easily assessed and that closely align with intervention messaging. An index of obesogenic dietary behaviors (e.g., consumption of fast food and soft drinks, low fruit and vegetable consumption, and task eating (eating while engaging in other activities)) may serve this purpose and could be derived via data-driven methods typically used to describe nutrient intake. We used behavioral and physical measurement (i.e., body mass index, waist circumference) data from a subset of 2 independent cross-sectional samples of employees enrolled in the Promoting Activity and Changes in Eating (PACE) Study (Seattle, Washington) who were selected at baseline (2005-2007) (n = 561) and during follow-up (2007-2009) (n = 155). Index derivation methods, including principal components regression, partial least squares regression, and reduced rank regression, were compared. The best-fitting index for predicting physical measurements included consumption of fast food, French fries, and soft drinks. In linear mixed models, each 1-quartile increase in index score was associated with a 5% higher baseline body mass index (ratio of geometric means = 1.053, 95% confidence interval: 1.031, 1.075) and an approximately 4% higher baseline waist circumference (ratio = 1.036, 95% confidence interval: 1.019, 1.054) after adjustment for covariates. Results were similar at follow-up before and after adjustment for baseline measures. This index may be useful in evaluating public health or clinic-based dietary interventions to reduce obesity, especially given the ubiquity of these behaviors in the general population.
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Affiliation(s)
- Wendy E Barrington
- Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Shirley A A Beresford
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Gardener H, Moon YP, Rundek T, Elkind MSV, Sacco RL. Diet Soda and Sugar-Sweetened Soda Consumption in Relation to Incident Diabetes in the Northern Manhattan Study. Curr Dev Nutr 2018; 2:nzy008. [PMID: 29955723 PMCID: PMC5998368 DOI: 10.1093/cdn/nzy008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/17/2017] [Accepted: 01/16/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Artificially (diet) and sugar-sweetened (regular) soda consumption have been associated with an increased risk of diabetes, but the literature on diet soda is inconsistent and the mechanisms unclear. OBJECTIVE We examined the relation between diet soda and regular soda consumption with the risk of incident diabetes in a longitudinal multiethnic population-based cohort. METHODS The study population included 2019 participants (mean ± SD age: 69 ± 10 y; 64% women; 23% white, 22% black, 53% Hispanic) in the Northern Manhattan Study who were free of diabetes and stroke at baseline. Soda consumption was assessed by a food-frequency questionnaire at baseline and examined continuously and categorically (<1/mo: sugar-sweetened = 908, diet = 1615; 1/mo-6/wk: sugar-sweetened = 830, diet = 298; daily: sugar-sweetened = 281, diet = 106). Weibull regression models were used to estimate the associations between soda consumption and incident diabetes, adjusting for demographics and vascular risk factors including body mass index (BMI) and calorie consumption. RESULTS During a mean ± SD follow-up of 11 ± 5 y, 368 participants developed diabetes. Sugar-sweetened soda was positively associated with incident diabetes (per soda per day HR = 1.15, 95% CI: 1.02, 1.31). The observed association between diet soda and elevated risk of diabetes was largely explained by BMI at the time of diet assessment, though the association remained strong and independent of BMI among those who were overweight or obese (daily compared to <1/mo: HR = 1.63, 95% CI: 1.04, 2.55). CONCLUSIONS This study supports the importance of sugar-sweetened beverage consumption in the diabetes epidemic. However, the results support previous studies suggesting that switching to artificially sweetened diet beverages may not lower the risk of diabetes, as diet soda consumption cannot be ruled out as an independent diabetes risk factor.
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Affiliation(s)
- Hannah Gardener
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | - Yeseon P Moon
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Ralph L Sacco
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
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Sylvetsky AC, Rother KI. Nonnutritive Sweeteners in Weight Management and Chronic Disease: A Review. Obesity (Silver Spring) 2018; 26:635-640. [PMID: 29570245 PMCID: PMC5868411 DOI: 10.1002/oby.22139] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of this review was to critically review findings from recent studies evaluating the effects of nonnutritive sweeteners (NNSs) on metabolism, weight, and obesity-related chronic diseases. Biologic mechanisms that may explain NNS effects will also be addressed. METHODS A comprehensive review of the relevant scientific literature was conducted. RESULTS Most cross-sectional and prospective cohort studies report positive associations between NNS consumption, body weight, and health conditions, including type 2 diabetes, cardiovascular disease, and nonalcoholic fatty liver disease. Although findings in cellular and rodent models suggest that NNSs have harmful effects on metabolic health, most randomized controlled trials in humans demonstrate marginal benefits of NNS use on body weight, with little data available on other metabolic outcomes. CONCLUSIONS NNS consumption is associated with higher body weight and metabolic disease in observational studies. In contrast, randomized controlled trials demonstrate that NNSs may support weight loss, particularly when used alongside behavioral weight loss support. Additional long-term, well-controlled intervention studies in humans are needed to determine the effects of NNSs on weight, adiposity, and chronic disease under free-living conditions.
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Affiliation(s)
- Allison C. Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC 20052
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC 20052
- Section on Pediatric Diabetes and Metabolism, NIDDK, NIH, 9000 Rockville Pike, Building 10, Room 8C432A, Bethesda, MD 20892
| | - Kristina I. Rother
- Section on Pediatric Diabetes and Metabolism, NIDDK, NIH, 9000 Rockville Pike, Building 10, Room 8C432A, Bethesda, MD 20892
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Hess EL, Myers EA, Swithers SE, Hedrick VE. Associations Between Nonnutritive Sweetener Intake and Metabolic Syndrome in Adults. J Am Coll Nutr 2018; 37:487-493. [PMID: 29601264 DOI: 10.1080/07315724.2018.1440658] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Individuals looking to improve their health or weight status often use nonnutritive sweeteners (NNS), yet NNS consumption has been associated with increased risk factors for metabolic syndrome (MetS). Most studies examining NNS only assess total intake using diet soda as a proxy for NNS consumption, without distinguishing potential risks associated with individual sweeteners. The objective of this cross-sectional investigation was to identify whether there were associations between NNS consumption (total or individual) and risk factors for MetS in adults (n = 125) from Southwest Virginia. METHODS Participants provided three 24-hour dietary recalls and blood pressure, waist circumference, fasting glucose, triglycerides, and high-density lipoprotein cholesterol were assessed. Linear regression models, adjusted for age, sex, caloric intake, dietary quality, and physical activity, examined associations between total and individual types of NNS with MetS and MetS risk factors. RESULTS Sixty-three participants were classified as NNS consumers and eighteen met the criteria for MetS. While no significant associations between MetS and NNS consumption were found, waist circumference was positively associated with total NNS, saccharin, sucralose, and acesulfame potassium, and both fasting glucose and triglyceride values were positively associated with total NNS and aspartame consumption. CONCLUSION While these cross-sectional data are consistent with previous work implicating NNS in development of MetS, additional research using randomized controlled trials is needed to clarify whether and how NNS in general or specific NNS might contribute to risk factors for MetS. This trial was registered at clinicaltrials.gov (NCT03364452).
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Affiliation(s)
- Erica L Hess
- a Department of Human Nutrition, Foods, and Exercise , Virginia Tech , Blacksburg , Virginia , USA
| | - Emily A Myers
- a Department of Human Nutrition, Foods, and Exercise , Virginia Tech , Blacksburg , Virginia , USA
| | - Susan E Swithers
- b Department of Psychological Sciences , Purdue University , West Lafayette , Indiana , USA
| | - Valisa E Hedrick
- a Department of Human Nutrition, Foods, and Exercise , Virginia Tech , Blacksburg , Virginia , USA
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Myers EA, Passaro EM, Hedrick VE. The Comparative Reproducibility and Validity of a Non-Nutritive Sweetener Food Frequency Questionnaire. Nutrients 2018. [PMID: 29534454 PMCID: PMC5872752 DOI: 10.3390/nu10030334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In order to better assess non-nutritive sweetener (NNS) consumption, measurement tools with greater utility are needed. The objective of this investigation is to determine the reproducibility and validity of a newly developed NNS food frequency questionnaire (NNS-FFQ) that measures five types of NNS (saccharin, aspartame, acesulfame potassium, sucralose and erythritol). Adult participants (n = 123, 56% female, 75% Caucasian, mean age = 36.8 ± 16.6) completed the NNS-FFQ twice and had 24-h dietary recalls three times over a two-week study period. Reproducibility between two administrations of the NNS-FFQ was assessed via Bland–Altman plots, Spearman’s correlations (rs) and paired samples t-tests. Bland–Altman plots, Cohen’s κ, Spearman’s correlations (rs), and paired samples t-tests compared NNS intake between the two methods for validity. For reproducibility analyses, Bland–Altman analyses revealed agreement levels above the 95% acceptance level for total NNS (99.2%), erythritol (99.2%), and aspartame (96.7%). Agreement levels for acesulfame potassium (94.3%), saccharin (94.3%), and sucralose (94.3%) were slightly below the acceptable level. For validity analyses, Bland–Altman analyses revealed agreement levels above the 95% acceptance level for total NNS (95.1%), sucralose (95.9%), saccharin (95.9%), and erythritol (95.1%). Agreement levels for aspartame (94.3%) and acesulfame potassium (92.7%) were slightly below the acceptable level. Although less than desirable agreement was found between the methods for aspartame and acesulfame potassium, some variance was expected due to the habitual nature of the NNS-FFQ as compared to the recent intake reported by recalls. Within the context of this constraint, the NNS-FFQ demonstrates acceptable reproducibility and validity. The NNS-FFQ is a brief questionnaire that could be administered among diverse participants at the individual and population levels to measure habitual NNS intake.
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Affiliation(s)
- Emily A Myers
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, 295 West Campus Drive, Blacksburg, VA 24061, USA.
| | - Erin M Passaro
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, 295 West Campus Drive, Blacksburg, VA 24061, USA.
| | - Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, 295 West Campus Drive, Blacksburg, VA 24061, USA.
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Use of Table Sugar and Artificial Sweeteners in Brazil: National Dietary Survey 2008-2009. Nutrients 2018; 10:nu10030295. [PMID: 29494539 PMCID: PMC5872713 DOI: 10.3390/nu10030295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/17/2018] [Accepted: 02/23/2018] [Indexed: 02/02/2023] Open
Abstract
The study aimed to describe the use of table sugar and artificial sweeteners (AS) in Brazil. A representative sample (n = 32,749) of individuals aged > 10 years was examined from the Brazilian National Dietary Survey (2008–2009). Participants reported whether they use table sugar, AS, both, or none as sweeteners for their foods and beverages. Energy intake and the contribution of selected food groups to energy intake were evaluated according to the type of sweetener reported. Sample weights and design effects were considered in the analysis. The majority of the population (85.7%) used sugar to sweeten foods and beverages, 7.6% used AS, and 5.1% utilized both products. The use of AS was more frequent among the elderly (20%), women (10% versus 5.5%), overweight individuals (10% versus 6%), those who live in urban areas (8.5% versus 3%), and those who belong to the highest income quartile (14% versus 1.6%), compared with men, normal weight individuals, those who live in rural areas, and those who belong to the first income quartile, respectively. Overall, the mean daily energy intake of individuals using only sugar was approximately 16% higher than those who used AS exclusively. The contribution of staple foods to daily energy intake was higher in individuals who used sugar than those who used AS.
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Fenwick EK, Gan ATL, Man REK, Sabanayagam C, Gupta P, Khoo K, Aravindhan A, Wong TY, Lamoureux EL. Diet soft drink is associated with increased odds of proliferative diabetic retinopathy. Clin Exp Ophthalmol 2018; 46:767-776. [DOI: 10.1111/ceo.13154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Eva K Fenwick
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital University of Melbourne Melbourne Victoria Australia
- Singapore Eye Research Institute (SERI) Singapore National Eye Centre Singapore
- Duke–National University of Singapore Medical School Singapore
| | - Alfred TL Gan
- Singapore Eye Research Institute (SERI) Singapore National Eye Centre Singapore
| | - Ryan EK Man
- Singapore Eye Research Institute (SERI) Singapore National Eye Centre Singapore
- Duke–National University of Singapore Medical School Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute (SERI) Singapore National Eye Centre Singapore
- Duke–National University of Singapore Medical School Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute (SERI) Singapore National Eye Centre Singapore
| | - Krystal Khoo
- National University of Singapore Yong Loo Lin School of Medicine Singapore
| | - Amudha Aravindhan
- Singapore Eye Research Institute (SERI) Singapore National Eye Centre Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute (SERI) Singapore National Eye Centre Singapore
- Duke–National University of Singapore Medical School Singapore
- National University of Singapore Yong Loo Lin School of Medicine Singapore
| | - Ecosse L Lamoureux
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital University of Melbourne Melbourne Victoria Australia
- Singapore Eye Research Institute (SERI) Singapore National Eye Centre Singapore
- Duke–National University of Singapore Medical School Singapore
- National University of Singapore Yong Loo Lin School of Medicine Singapore
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Nonnutritive Sweeteners and Their Role in the Gastrointestinal Tract. REFERENCE SERIES IN PHYTOCHEMISTRY 2018. [DOI: 10.1007/978-3-319-27027-2_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Goryakin Y, Monsivais P, Suhrcke M. Soft drink prices, sales, body mass index and diabetes: Evidence from a panel of low-, middle- and high-income countries. FOOD POLICY 2017; 73:88-94. [PMID: 29276333 PMCID: PMC5727680 DOI: 10.1016/j.foodpol.2017.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 09/16/2017] [Accepted: 09/23/2017] [Indexed: 06/02/2023]
Abstract
We take advantage of four different cross-country datasets containing data on 78 countries for the period 1999-2014, in order to assess the relationship of carbonated soft drinks' sales, as well as their prices, with body mass index (BMI), overweight, obesity and diabetes. Using an ecological study design and multivariate regression longitudinal estimation approaches, we find that carbonated soft drink sales were significantly positively related to BMI, overweight and obesity - but only in the low and lower-middle income countries. This finding was robust to a number of sensitivity and falsification checks. In this sub-sample, an increase in per capita soft drink sales by 1 litre per year was related to an increase of BMI by about 0.009 kg/m2 (p < 0.1).. This is a small effect, implying that halving annual consumption per capita in this group of countries would result in a drop of BMI by only about 0.03 kg/m2. Although soft drink prices were negatively related to weight-related outcomes in the sample of higher middle income and high income countries, this finding was not robust to falsification checks. The results thus suggest that sales restrictions to steer consumers away from soft drinks could indeed have a beneficial health effects in poorer countries, although the effect magnitude appears to be very small. However, given potential limitations of using ecological research design, results from individual level studies would be required to further ascertain the role of soft drink sales and prices in obesity and diabetes.
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Affiliation(s)
- Yevgeniy Goryakin
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Pablo Monsivais
- UKCRC Centre for Diet and Activity Research, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
- Department of Nutrition and Exercise Physiology, Elson S Floyd College of Medicine, Washington State University, Spokane, WA 99210-1495, USA
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York YO10 5DD, UK
- Luxembourg Institute for Socio-Economic Research, L-4366 Esch-sur-Alzette/Belval, Luxembourg
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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.
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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
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Lohner S, Toews I, Meerpohl JJ. Health outcomes of non-nutritive sweeteners: analysis of the research landscape. Nutr J 2017; 16:55. [PMID: 28886707 PMCID: PMC5591507 DOI: 10.1186/s12937-017-0278-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 09/04/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Food products containing non-nutritive sweeteners (NNSs) instead of sugar have become increasingly popular in the last decades. Their appeal is obviously related to their calorie-free sweet taste. However, with the dramatic increase in their consumption, it is reasonable and timely to evaluate their potential health benefits and, more importantly, potential adverse effects. The main aim of this scoping review was to map the evidence about health outcomes possibly associated with regular NNS consumption by examining the extent, range, and nature of research activity in this area. METHODS We systematically searched Ovid MEDLINE, EMBASE and the Cochrane CENTRAL databases for studies on NNSs (artificial sweeteners or natural, non-caloric sweeteners, either used individually or in combination) using text terms with appropriate truncation and relevant indexing terms. All human studies investigating any health outcomes of a NNS intervention or exposure were eligible for inclusion. No studies were excluded based on language, study design or methodological quality. Data for each health outcome were summarized in tabular form and were discussed narratively. RESULTS Finally, we included 372 studies in our scoping review, comprising 15 systematic reviews, 155 randomized controlled trials (RCTs), 23 non-randomized controlled trials, 57 cohort studies, 52 case-control studies, 28 cross sectional studies and 42 case series/case reports. In healthy subjects, appetite and short term food intake, risk of cancer, risk of diabetes, risk of dental caries, weight gain and risk of obesity are the most investigated health outcomes. Overall there is no conclusive evidence for beneficial and harmful effects on those outcomes. Numerous health outcomes including headaches, depression, behavioral and cognitive effects, neurological effects, risk of preterm delivery, cardiovascular effects or risk of chronic kidney disease were investigated in fewer studies and further research is needed. In subjects with diabetes and hypertension, the evidence regarding health outcomes of NNS use is also inconsistent. CONCLUSIONS This scoping review identifies the needs for future research to address the numerous evidence gaps related to health effects of NNSs use.It also specifies the research questions and areas where a systematic review with meta-analyses is required for the proper evaluation of health outcomes associated to regular NNSs consumption.
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Affiliation(s)
| | - Ingrid Toews
- Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 153, Freiburg, 79110 Germany
| | - Joerg J. Meerpohl
- Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 153, Freiburg, 79110 Germany
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité – U1153, Inserm / Université Paris Descartes, Cochrane France, Hôpital Hôtel-Dieu, 1 place du Parvis Notre Dame, 75181 Paris, Cedex 04 France
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Subali D, Silo W, Listyani L, Endriani C, Kartawidjajaputra F, Suwanto A. The effect of sugar and artificial sweetener on molecular markers of metabolic syndrome: a mice study. FOOD RESEARCH 2017. [DOI: 10.26656/fr.2017.6.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Azad MB, Abou-Setta AM, Chauhan BF, Rabbani R, Lys J, Copstein L, Mann A, Jeyaraman MM, Reid AE, Fiander M, MacKay DS, McGavock J, Wicklow B, Zarychanski R. Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies. CMAJ 2017; 189:E929-E939. [PMID: 28716847 DOI: 10.1503/cmaj.161390] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nonnutritive sweeteners, such as aspartame, sucralose and stevioside, are widely consumed, yet their long-term health impact is uncertain. We synthesized evidence from prospective studies to determine whether routine consumption of non-nutritive sweeteners was associated with long-term adverse cardiometabolic effects. METHODS We searched MEDLINE, Embase and Cochrane Library (inception to January 2016) for randomized controlled trials (RCTs) that evaluated interventions for nonnutritive sweeteners and prospective cohort studies that reported on consumption of non-nutritive sweeteners among adults and adolescents. The primary outcome was body mass index (BMI). Secondary outcomes included weight, obesity and other cardiometabolic end points. RESULTS From 11 774 citations, we included 7 trials (1003 participants; median follow-up 6 mo) and 30 cohort studies (405 907 participants; median follow-up 10 yr). In the included RCTs, nonnutritive sweeteners had no significant effect on BMI (mean difference -0.37 kg/m2; 95% confidence interval [CI] -1.10 to 0.36; I2 9%; 242 participants). In the included cohort studies, consumption of nonnutritive sweeteners was associated with a modest increase in BMI (mean correlation 0.05, 95% CI 0.03 to 0.06; I2 0%; 21 256 participants). Data from RCTs showed no consistent effects of nonnutritive sweeteners on other measures of body composition and reported no further secondary outcomes. In the cohort studies, consumption of nonnutritive sweeteners was associated with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events. Publication bias was indicated for studies with diabetes as an outcome. INTERPRETATION Evidence from RCTs does not clearly support the intended benefits of nonnutritive sweeteners for weight management, and observational data suggest that routine intake of nonnutritive sweeteners may be associated with increased BMI and cardiometabolic risk. Further research is needed to fully characterize the long-term risks and benefits of nonnutritive sweeteners. Protocol registration: PROSPERO-CRD42015019749.
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Affiliation(s)
- Meghan B Azad
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man.
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Bhupendrasinh F Chauhan
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Rasheda Rabbani
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Justin Lys
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Leslie Copstein
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Amrinder Mann
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Maya M Jeyaraman
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Ashleigh E Reid
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Michelle Fiander
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Dylan S MacKay
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Jon McGavock
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Brandy Wicklow
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
| | - Ryan Zarychanski
- George & Fay Yee Centre for Healthcare Innovation (Azad, Abou-Setta, Chauhan, Rabbani, Lys, Copstein, Mann, Jeyaraman, Fiander, Zarychanski); Children's Hospital Research Institute of Manitoba (Azad, Chauhan, McGavock, Wicklow); Department of Pediatrics and Child Health (Azad, McGavock, Wicklow); Department of Community Health Sciences (Abou-Setta); College of Pharmacy (Chauhan); Max Rady College of Medicine (Reid); Department of Human Nutritional Sciences (Azad, MacKay); Department of Internal Medicine (Zarychanski), University of Manitoba; Department of Hematology and Medical Oncology, CancerCare Manitoba (Zarychan-ski), Winnipeg, Man
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Characterization of Non-Nutritive Sweetener Intake in Rural Southwest Virginian Adults Living in a Health-Disparate Region. Nutrients 2017; 9:nu9070757. [PMID: 28708096 PMCID: PMC5537871 DOI: 10.3390/nu9070757] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 01/16/2023] Open
Abstract
Few data assessing non-nutritive sweetener (NNS) intake are available, especially within rural, health-disparate populations, where obesity and related co-morbidities are prevalent. The objective of this study is to characterize NNS intake for this population and examine the variance in demographics, cardio-metabolic outcomes, and dietary intake between NNS consumers and non-consumers. A cross-sectional sample (n = 301) of Virginian adults from a randomized controlled trial (data collected from 2012 to 2014) targeting sugar-sweetened beverage (SSB) intake completed three 24-h dietary recalls, and demographics and cardio-metabolic measures were assessed. The frequency, types, and sources of NNS consumption were identified. Thirty-three percent of participants reported consuming NNS (n = 100). Sucralose was the largest contributor of mean daily NNS intake by weight (mg), followed by aspartame, acesulfame potassium, and saccharin. NNS in tabletop sweeteners, diet tea, and diet soda were the top contributors to absolute NNS intake. The most frequently consumed NNS sources were diet sodas, juice drinks, and tabletop sweeteners. Although mean body mass index (BMI) was greater for NNS consumers, they demonstrated significantly lower food, beverage, and SSB caloric intake and energy density, and higher overall dietary quality. It remains unclear whether NNS use plays a role in exacerbating weight gain. NNS consumers in this sample may have switched from drinking predominantly SSB to drinking some NNS beverages in an effort to cope with weight gain. Future studies should explore motivations for NNS use across a variety of weight and health categories.
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Abstract
PURPOSE OF REVIEW The current review summarizes and discusses current knowledge on sweeteners and sweetness enhancers. RECENT FINDINGS The perception of sweet taste is mediated by the type 1 taste receptor 2 (T1R2)/type 1 taste receptor 3 (T1R3) receptor, which is expressed in the oral cavity, where it provides input on the caloric and macronutrient contents of ingested food. This receptor recognizes all the compounds (natural or artificial) perceived as sweet by people. Sweeteners are highly chemically diverse including natural sugars, sugar alcohols, natural and synthetic sweeteners, and sweet-tasting proteins. This single receptor is also the target for developing novel sweet enhancers. Importantly, the expression of a functional T1R2/T1R3 receptor is described in numerous extraoral tissues. In this review, the physiological impact of sweeteners is discussed. SUMMARY Sweeteners and sweetness enhancers are perceived through the T1R2/T1R3 taste receptor present both in mouth and numerous extraoral tissues. The accumulated knowledge on sugar substitutes raises the issue of potential health effects.
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Affiliation(s)
- Christine Belloir
- AgroSup Dijon, CNRS, INRA, Université de Bourgogne-Franche Comté, Centre des Sciences du GoÛt et de l'Alimentation, Dijon, France
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Pase MP, Himali JJ, Beiser AS, Aparicio HJ, Satizabal CL, Vasan RS, Seshadri S, Jacques PF. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study. Stroke 2017; 48:1139-1146. [PMID: 28428346 DOI: 10.1161/strokeaha.116.016027] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/15/2017] [Accepted: 02/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Sugar- and artificially-sweetened beverage intake have been linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia. We examined whether sugar- or artificially sweetened beverage consumption was associated with the prospective risks of incident stroke or dementia in the community-based Framingham Heart Study Offspring cohort. METHODS We studied 2888 participants aged >45 years for incident stroke (mean age 62 [SD, 9] years; 45% men) and 1484 participants aged >60 years for incident dementia (mean age 69 [SD, 6] years; 46% men). Beverage intake was quantified using a food-frequency questionnaire at cohort examinations 5 (1991-1995), 6 (1995-1998), and 7 (1998-2001). We quantified recent consumption at examination 7 and cumulative consumption by averaging across examinations. Surveillance for incident events commenced at examination 7 and continued for 10 years. We observed 97 cases of incident stroke (82 ischemic) and 81 cases of incident dementia (63 consistent with Alzheimer's disease). RESULTS After adjustments for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity, and smoking, higher recent and higher cumulative intake of artificially sweetened soft drinks were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer's disease dementia. When comparing daily cumulative intake to 0 per week (reference), the hazard ratios were 2.96 (95% confidence interval, 1.26-6.97) for ischemic stroke and 2.89 (95% confidence interval, 1.18-7.07) for Alzheimer's disease. Sugar-sweetened beverages were not associated with stroke or dementia. CONCLUSIONS Artificially sweetened soft drink consumption was associated with a higher risk of stroke and dementia.
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Affiliation(s)
- Matthew P Pase
- From the Department of Neurology (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., S.S.) and Sections of Preventive Medicine and Epidemiology, Department of Medicine (R.S.V), Boston University School of Medicine, MA; Framingham Heart Study, MA (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., R.S.V., S.S., P.F.J.); Centre for Human Psychopharmacology, Swinburne University of Technology, Australia (M.P.P.); Department of Biostatistics (J.J.H., A.S.B.) and Department of Epidemiology (R.S.V.), Boston University School of Public Health, MA; and Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA (P.F.J.).
| | - Jayandra J Himali
- From the Department of Neurology (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., S.S.) and Sections of Preventive Medicine and Epidemiology, Department of Medicine (R.S.V), Boston University School of Medicine, MA; Framingham Heart Study, MA (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., R.S.V., S.S., P.F.J.); Centre for Human Psychopharmacology, Swinburne University of Technology, Australia (M.P.P.); Department of Biostatistics (J.J.H., A.S.B.) and Department of Epidemiology (R.S.V.), Boston University School of Public Health, MA; and Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA (P.F.J.)
| | - Alexa S Beiser
- From the Department of Neurology (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., S.S.) and Sections of Preventive Medicine and Epidemiology, Department of Medicine (R.S.V), Boston University School of Medicine, MA; Framingham Heart Study, MA (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., R.S.V., S.S., P.F.J.); Centre for Human Psychopharmacology, Swinburne University of Technology, Australia (M.P.P.); Department of Biostatistics (J.J.H., A.S.B.) and Department of Epidemiology (R.S.V.), Boston University School of Public Health, MA; and Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA (P.F.J.)
| | - Hugo J Aparicio
- From the Department of Neurology (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., S.S.) and Sections of Preventive Medicine and Epidemiology, Department of Medicine (R.S.V), Boston University School of Medicine, MA; Framingham Heart Study, MA (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., R.S.V., S.S., P.F.J.); Centre for Human Psychopharmacology, Swinburne University of Technology, Australia (M.P.P.); Department of Biostatistics (J.J.H., A.S.B.) and Department of Epidemiology (R.S.V.), Boston University School of Public Health, MA; and Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA (P.F.J.)
| | - Claudia L Satizabal
- From the Department of Neurology (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., S.S.) and Sections of Preventive Medicine and Epidemiology, Department of Medicine (R.S.V), Boston University School of Medicine, MA; Framingham Heart Study, MA (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., R.S.V., S.S., P.F.J.); Centre for Human Psychopharmacology, Swinburne University of Technology, Australia (M.P.P.); Department of Biostatistics (J.J.H., A.S.B.) and Department of Epidemiology (R.S.V.), Boston University School of Public Health, MA; and Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA (P.F.J.)
| | - Ramachandran S Vasan
- From the Department of Neurology (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., S.S.) and Sections of Preventive Medicine and Epidemiology, Department of Medicine (R.S.V), Boston University School of Medicine, MA; Framingham Heart Study, MA (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., R.S.V., S.S., P.F.J.); Centre for Human Psychopharmacology, Swinburne University of Technology, Australia (M.P.P.); Department of Biostatistics (J.J.H., A.S.B.) and Department of Epidemiology (R.S.V.), Boston University School of Public Health, MA; and Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA (P.F.J.)
| | - Sudha Seshadri
- From the Department of Neurology (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., S.S.) and Sections of Preventive Medicine and Epidemiology, Department of Medicine (R.S.V), Boston University School of Medicine, MA; Framingham Heart Study, MA (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., R.S.V., S.S., P.F.J.); Centre for Human Psychopharmacology, Swinburne University of Technology, Australia (M.P.P.); Department of Biostatistics (J.J.H., A.S.B.) and Department of Epidemiology (R.S.V.), Boston University School of Public Health, MA; and Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA (P.F.J.)
| | - Paul F Jacques
- From the Department of Neurology (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., S.S.) and Sections of Preventive Medicine and Epidemiology, Department of Medicine (R.S.V), Boston University School of Medicine, MA; Framingham Heart Study, MA (M.P.P., J.J.H., A.S.B., H.J.A., C.L.S., R.S.V., S.S., P.F.J.); Centre for Human Psychopharmacology, Swinburne University of Technology, Australia (M.P.P.); Department of Biostatistics (J.J.H., A.S.B.) and Department of Epidemiology (R.S.V.), Boston University School of Public Health, MA; and Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA (P.F.J.)
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Sylvetsky AC, Jin Y, Clark EJ, Welsh JA, Rother KI, Talegawkar SA. Consumption of Low-Calorie Sweeteners among Children and Adults in the United States. J Acad Nutr Diet 2017; 117:441-448.e2. [PMID: 28087414 DOI: 10.1016/j.jand.2016.11.004] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/08/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Consumption of low-calorie sweeteners (LCSs) has increased markedly during the past several decades, yet the prevalence of LCS consumption in recent years is currently unknown. OBJECTIVE The aim of this study was to describe LCS consumption in the United States and to characterize consumption by sociodemographic subgroups, source, frequency, eating occasion, and location. DESIGN Cross-sectional study using National Health and Nutrition Examination Survey data from 2009 to 2012. The prevalence of LCS consumption was assessed using two 24-hour dietary recalls, while the frequency (number of times per day), occasion (meal vs snack vs alone), and location of LCS consumption (at home vs away from home) was assessed using data from the one, in-person, 24-hour dietary recall. PARTICIPANTS National Health and Nutrition Examination Survey participants (2 years old or older) either in 2009-2010 (n=9,047) or in 2011-2012 (n=7,939). After excluding participants with implausible energy intake (n=44), the final sample size was 16,942. MAIN OUTCOME MEASURES The primary outcome was the proportion of individuals consuming one or more foods, beverages, or packets containing LCSs during at least one of their two dietary recalls. STATISTICAL ANALYSES PERFORMED Data were weighted to provide national estimates and Stata frequency procedures for complex survey design were used for all analyses. RESULTS Our findings were that 25.1% of children and 41.4% adults reported consuming LCSs. Most LCS consumers reported use once daily (80% of children, 56% of adults) and frequency of consumption increased with body weight in adults. LCS consumption was higher in females compared with males among adults, and in obese individuals, compared with overweight and normal-weight individuals. Individuals of non-Hispanic white race/ethnicity also had higher prevalence of consumption compared with non-Hispanic blacks and Hispanics and those in the highest tertile of income had higher LCS consumption compared with individuals of middle or low income across LCS product categories in adults, and for LCS beverages and LCS foods in children. Most LCS consumers reported consuming LCS with meals (64% of adults, 62% of children) and the majority of LCS consumption occurred at home (71% and 72% among adults and children, respectively). CONCLUSIONS LCS consumption is highly prevalent in the United States, among both children and adults. Well-controlled, prospective trials are required to understand the health impact of this widespread LCS exposure.
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