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Campos P, Rebolledo N, Durán S, Flores M, Reyes M, Garmendia ML. Association between consumption of non-nutritive sweeteners and gestational diabetes mellitus in Chilean pregnant women: A secondary data analysis of the CHiMINCs-II cohort. Nutrition 2024; 128:112560. [PMID: 39299048 DOI: 10.1016/j.nut.2024.112560] [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: 04/08/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE To evaluate the association between consumed non-nutritive sweeteners (NNS) and gestational diabetes mellitus (GDM) in a cohort of pregnant women from Santiago, Chile. METHODS This secondary data analysis of a cohort.involved 1,472 pregnant women from the Chilean Maternal-Infant Cohort Study-II (CHiMINCs-II). These women received care at primary health care centers in Puente Alto county, South-Eastern Metropolitan Health Service of Santiago, Chile. NNS consumption was estimated using 24-h dietary recalls and linked to the packaged foods nutrition facts panel. Plasma glucose values were extracted from clinical records. GDM was defined according to national criteria: 1) fasting plasma glucose (FPG) ≥100 and <126 mg/dL at the first antenatal visit; 2) FPG ≥100 mg/dL or 2-hour plasma glucose ≥140 mg/dL in the 75 g oral glucose tolerance test at 24-28 weeks. Cases with a GDM diagnosis in their medical records were also considered regardless of test results. The association between each NNS and GDM was assessed using logistic regression models. RESULTS A total of 77.8% of the participants consumed NNS. The most consumed was sucralose (66%), followed by acesulfame-K (43.6%), and steviol glycosides (41.1%). Beverages (82%), dairy (12.4%) and candy products (4.4%) were the primary dietary sources of NNS. The GDM incidence was 18.9%, higher among consumers of any NNS compared to non-consumers (20.3% vs. 14.2%, p < 0.05). The adjusted model showed a significant association between the consumption of any NNS and sucralose and the risk of GDM (OR for any NNS = 1.58; 95% CI: 1.10-2.26; P = 0.014; OR sucralose = 1.44; 95% CI 1.06-1.95; P = 0.020). CONCLUSIONS The consumption of NNS, particularly sucralose, is associated with an increased risk of GDM in pregnant women. Further studies are essential to validate these results in other contexts and to guide future recommendations for healthier dietary practices among pregnant populations.
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Affiliation(s)
- Paola Campos
- Center for Research in Food Environments and Prevention of Nutrition-Related Chronic Diseases (CIAPEC)(,) Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Natalia Rebolledo
- Center for Research in Food Environments and Prevention of Nutrition-Related Chronic Diseases (CIAPEC)(,) Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Samuel Durán
- Faculty of Health Sciences, Universidad San Sebastián, Santiago, Chile
| | - Marcela Flores
- Municipal Health Corporation of Puente Alto, Santiago, Chile
| | - Marcela Reyes
- Center for Research in Food Environments and Prevention of Nutrition-Related Chronic Diseases (CIAPEC)(,) Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - María Luisa Garmendia
- Center for Research in Food Environments and Prevention of Nutrition-Related Chronic Diseases (CIAPEC)(,) Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile.
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Khalil S, Haikal Y, Aoun A. Non-nutritive Sweeteners: Weight Loss or Weight Gain? Endocr Metab Immune Disord Drug Targets 2024; 24:749-757. [PMID: 37817660 DOI: 10.2174/0118715303245646230926054352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 10/12/2023]
Abstract
The consumption of non-nutritive sweeteners (NNS) is on the rise among different populations. In parallel, the debate about their potential health benefits and risks remains inconclusive. Numerous published studies elucidate the impact of NNS on general health, weight control, and the risk of certain diseases. However, no definitive conclusions regarding the effect of chronic NNS use on weight have been reached in humans. This review summarizes current evidence related to the biological role of NNS and their subsequent effects on weight. The mechanisms of action through which NNS impact weight are discussed, including their effect on sweet taste receptors, cognition, metabolic and endocrine functions, intestinal microbiota, and adiposity. Conflicting evidence is hindering the formulation of precise recommendations, but the evidence opposing the use of NNS remains weak, and the ultimate impact on weight largely relies on several other behavioral patterns.
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Affiliation(s)
- Sarah Khalil
- Department of Nursing and Health Sciences, Notre Dame University-Louaize, 72 Zouk Mikael, Zouk Mosbeh, Lebanon
| | - Yara Haikal
- Department of Nursing and Health Sciences, Notre Dame University-Louaize, 72 Zouk Mikael, Zouk Mosbeh, Lebanon
| | - Antoine Aoun
- Department of Nursing and Health Sciences, Notre Dame University-Louaize, 72 Zouk Mikael, Zouk Mosbeh, Lebanon
- Department of Nutrition, Centre Hospitalier Universitaire de Rouen, 76000, Rouen, France
- Department of Nutrition, Hôpital La Musse, 27180, Saint Sebastien de Morsent, Normandie, France
- INSERM U1073, UNIROUEN, Normandie University, 76000, Rouen, France
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3
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Debras C, Deschasaux-Tanguy M, Chazelas E, Sellem L, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, Agaësse C, De Sa A, Lutchia R, Julia C, Kesse-Guyot E, Allès B, Galan P, Hercberg S, Huybrechts I, Cosson E, Tatulashvili S, Srour B, Touvier M. Artificial Sweeteners and Risk of Type 2 Diabetes in the Prospective NutriNet-Santé Cohort. Diabetes Care 2023; 46:1681-1690. [PMID: 37490630 PMCID: PMC10465821 DOI: 10.2337/dc23-0206] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/09/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To study the relationships between artificial sweeteners, accounting for all dietary sources (total and by type of artificial sweetener) and risk of type 2 diabetes (T2D), in a large-scale prospective cohort. RESEARCH DESIGN AND METHODS The analyses included 105,588 participants from the web-based NutriNet-Santé study (France, 2009-2022; mean age 42.5 ± 14.6 years, 79.2% women). Repeated 24-h dietary records, including brands and commercial names of industrial products, merged with qualitative and quantitative food additive composition data, enabled artificial sweetener intakes to be accurately assessed from all dietary sources. Associations between artificial sweeteners (total, aspartame, acesulfame potassium [K], and sucralose) and T2D were investigated using Cox proportional hazard models adjusted for potential confounders, including weight variation during follow-up. RESULTS During a median follow-up of 9.1 years (946,650 person-years, 972 incident T2D), compared with nonconsumers, higher consumers of artificial sweeteners (i.e., above the sex-specific medians of 16.4 mg/day in men and 18.5 mg/day in women) had higher risks of developing T2D (hazard ratio [HR] 1.69; 95% CI 1.45-1.97; P-trend <0.001). Positive associations were also observed for individual artificial sweeteners: aspartame (HR 1.63 [95% CI 1.38-1.93], P-trend <0.001), acesulfame-K (HR 1.70 [1.42-2.04], P-trend <0.001), and sucralose (HR 1.34 [1.07-1.69], P-trend = 0.013). CONCLUSIONS Potential for reverse causality cannot be eliminated; however, many sensitivity analyses were computed to limit this and other potential biases. These findings of positive associations between artificial sweetener intakes and increased T2D risk strengthen the evidence that these additives may not be safe sugar alternatives. This study provides important insights in the context of on-going reevaluation of artificial sweeteners by health authorities worldwide.
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Affiliation(s)
- Charlotte Debras
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Mélanie Deschasaux-Tanguy
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Eloi Chazelas
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Laury Sellem
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Nathalie Druesne-Pecollo
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Younes Esseddik
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Fabien Szabo de Edelenyi
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Cédric Agaësse
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Alexandre De Sa
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Rebecca Lutchia
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Chantal Julia
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
- Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Benjamin Allès
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Pilar Galan
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Serge Hercberg
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
- Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Inge Huybrechts
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Emmanuel Cosson
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
- Diabetology, Endocrinology and Nutrition Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Sopio Tatulashvili
- Diabetology, Endocrinology and Nutrition Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Bernard Srour
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
| | - Mathilde Touvier
- Nutritional Epidemiology Research Team (EREN), INSERM U1153, INRAE U1125, CNAM, Sorbonne Paris Nord University, Epidemiology and Statistics Research Centre, University of Paris Cité (CRESS), Bobigny, France
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Andersen SSH, Zhu R, Kjølbæk L, Raben A. Effect of Non- and Low-Caloric Sweeteners on Substrate Oxidation, Energy Expenditure, and Catecholamines in Humans-A Systematic Review. Nutrients 2023; 15:2711. [PMID: 37375615 DOI: 10.3390/nu15122711] [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: 05/08/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
The use of non- and low-caloric sweetener(s) (NCS and LCS) as a means to prevent overweight and obesity is highly debated, as both NCS and LCS have been proposed to have a negative impact on energy homeostasis. This systematic review aimed to assess the impact of NCS and LCS on fasting and postprandial substrate oxidation, energy expenditure, and catecholamines, compared to caloric sweeteners or water, across different doses and types of NCS and LCS, acutely and in the longer-term. A total of 20 studies were eligible: 16 studies for substrate oxidation and energy expenditure and four studies for catecholamines. Most studies compared the acute effects of NCS or LCS with caloric sweeteners under non-isoenergetic conditions. These studies generally found higher fat oxidation and lower carbohydrate oxidation with NCS or LCS than with caloric sweeteners. Findings for energy expenditure were inconsistent. With the limited number of studies, no convincing pattern for the remaining outcomes and comparisons could be seen. In conclusion, drinks or meals with NCS or LCS resulted in higher fat and lower carbohydrate oxidation compared to caloric sweeteners. No other conclusions could be drawn due to insufficient or inconsistent results. Further studies in this research field are warranted.
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Affiliation(s)
- Sabina S H Andersen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Ruixin Zhu
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Louise Kjølbæk
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Clinical Research, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
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5
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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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Rubin D, Bosy-Westphal A, Kabisch S, Kronsbein P, Simon MC, Tombek A, Weber KS, Skurk T. Nutritional Recommendations for People with Type 1 Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2023; 131:33-50. [PMID: 36638807 DOI: 10.1055/a-1946-3753] [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: 01/15/2023]
Affiliation(s)
- Diana Rubin
- Vivantes Hospital Spandau, Berlin, Germany.,Vivantes Humboldt Hospital, Berlin, Germany
| | - Anja Bosy-Westphal
- Institute of Human Nutrition, Faculty of Agriculture and Nutritional Sciences, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Stefan Kabisch
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Center for Diabetes Research (DZD), Munich, Germany
| | - Peter Kronsbein
- Faculty of Nutrition and Food Sciences, Niederrhein University of Applied Sciences, Mönchengladbach, Germany
| | - Marie-Christine Simon
- Institute of Nutrition and Food Sciences, Rhenish Friedrich Wilhelm University of Bonn, Bonn, Germany
| | - Astrid Tombek
- Diabetes Center Bad Mergentheim, Bad Mergentheim, Germany
| | - Katharina S Weber
- Institute for Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Thomas Skurk
- ZIEL - Institute for Food & Health, Technical University Munich, Freising, Germany
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Orku SE, Suyen G, Bas M. The effect of regular consumption of four low- or no-calorie sweeteners on glycemic response in healthy women: A randomized controlled trial. Nutrition 2023; 106:111885. [PMID: 36470113 DOI: 10.1016/j.nut.2022.111885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 09/03/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to determine the effects of regular exposure to certain low- or no-calorie sweeteners (LNCS) on glucose tolerance and glucagon-like peptide 1 (GLP-1) release in healthy individuals. METHODS It was designed as a randomized, single-blinded, controlled study. Healthy and normoglycemic adults who did not have regular consumption of LNCS were recruited. Participants underwent a 75-g oral glucose tolerance test (OGTT) at baseline and were randomly assigned to consume 330 mL water sweetened with saccharine, sucralose, or aspartame + acesulfame-K (Asp+Ace-K), or plain water for the control group, daily for 4 wk. Fasting plasma glucose, insulin, GLP-1, and glycated hemoglobin A1c (HbA1c) levels and 1-h, 2-h, and 3-h plasma glucose and insulin levels during OGTT were obtained at baseline. The change in insulin sensitivity was assessed by both the Homeostatic Model Assessment Insulin Resistance (HOMA-IR) Index and the Matsuda Index. Anthropometric measurements and dietary intakes were determined at baseline. Baseline measurements were repeated at week 4. RESULTS Of the participants enrolled in the study, 42 (age, 21.24 ± 2.26 y; body mass index, 20.65 ± 2.88 kg/m2) completed the 4-wk intervention period. There were no differences for glucose, insulin, GLP-1, or HbA1c levels or HOMA-IR scores at baseline or at week 4 when compared with the control group. The area under the curve of mean glucose and insulin values during OGTT were also found to be similar between groups at baseline and week 4. There were also no effects of LNCS intake on body weight, body composition, and waist circumference. CONCLUSIONS These results suggest that regular consumption of LNCS-sweetened water similar to doses consumed in daily life over 4 wk had no significant effect on glycemic response, insulin sensitivity, GLP-1 release, and body weight in healthy individuals. This trial was registered at www. CLINICALTRIALS gov as NCT04904133.
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Affiliation(s)
- Saziye E Orku
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Nutrition and Dietetics, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - Guldal Suyen
- Department of Physiology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Murat Bas
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Mehat K, Chen Y, Corpe CP. The Combined Effects of Aspartame and Acesulfame-K Blends on Appetite: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Adv Nutr 2022; 13:2329-2340. [PMID: 36056917 PMCID: PMC9776645 DOI: 10.1093/advances/nmac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 03/18/2022] [Accepted: 06/13/2022] [Indexed: 01/29/2023] Open
Abstract
Aspartame (Asp) and acesulfame-K (Ace-K) are nonnutritive sweeteners (NNSs) commonly used in combination to replace added sugars in reduced- or low-calorie foods and beverages. Despite Asp/Ace-K blends having negligible calories, their effects on appetite have not been reviewed systematically. We therefore undertook a systematic review and meta-analysis of the metabolic effects of Asp/Ace-K blends on energy intake (EI), subjective appetite scores, blood glucose, and the incretin hormones glucose-dependent insulinotropic peptide and glucagon-like peptide. MEDLINE, Web of Science, and Cochrane CENTRAL databases (Embase, PubMed, and CINAHL) were searched (May 2021) for randomized controlled trials (RCTs). Human RCTs using Asp/Ace-K blends compared with sugar and water controls were included, whereas isolated cell and animal studies were excluded. An overall 4829 publications were identified and 8 studies, including 274 participants, were retrieved for review. The Asp/Ace-K group's EI was significantly reduced compared with sugar [mean difference (MD): -196.56 kcal/meal; 95% CI: -332.01, -61.11 kcal/meal; P = 0.004] and water (MD: -213.42 kcal/meal; 95% CI: -345.4, -81.44 kcal/meal; P = 0.002). Meta-analysis of subjective appetite scores and incretins could not be undertaken due to inconsistencies in data reporting and insufficient data, respectively, but of the 4 studies identified, no differences were observed between Asp/Ace-K blends and controls. The Asp/Ace-K group's blood glucose was nonsignificantly reduced compared with sugar (MD: -1.48 mmol/L; 95% CI: -3.26, 0.3 mmol/L; P = 0.1) and water (MD: -0.08 mmol/L; 95% CI: -0.62, 0.47 mmol/L; P = 0.78). Lower EI in participants who were predominantly healthy and assigned to Asp/Ace-K blends could not be reliably attributed to changes in subjective appetite scores. Blood glucose and incretins were also generally not affected by Asp/Ace-K blends when compared with controls. Additional short- and long-term RCTs using NNSs and sugars at dietarily relevant levels are needed. This trial was registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42017061015).
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Affiliation(s)
- Kirnjot Mehat
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, School of Life Courses, King's College London, London, United Kingdom
| | - Yi Chen
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, School of Life Courses, King's College London, London, United Kingdom
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9
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Suez J, Cohen Y, Valdés-Mas R, Mor U, Dori-Bachash M, Federici S, Zmora N, Leshem A, Heinemann M, Linevsky R, Zur M, Ben-Zeev Brik R, Bukimer A, Eliyahu-Miller S, Metz A, Fischbein R, Sharov O, Malitsky S, Itkin M, Stettner N, Harmelin A, Shapiro H, Stein-Thoeringer CK, Segal E, Elinav E. Personalized microbiome-driven effects of non-nutritive sweeteners on human glucose tolerance. Cell 2022; 185:3307-3328.e19. [PMID: 35987213 DOI: 10.1016/j.cell.2022.07.016] [Citation(s) in RCA: 126] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/26/2022] [Accepted: 07/18/2022] [Indexed: 02/06/2023]
Abstract
Non-nutritive sweeteners (NNS) are commonly integrated into human diet and presumed to be inert; however, animal studies suggest that they may impact the microbiome and downstream glycemic responses. We causally assessed NNS impacts in humans and their microbiomes in a randomized-controlled trial encompassing 120 healthy adults, administered saccharin, sucralose, aspartame, and stevia sachets for 2 weeks in doses lower than the acceptable daily intake, compared with controls receiving sachet-contained vehicle glucose or no supplement. As groups, each administered NNS distinctly altered stool and oral microbiome and plasma metabolome, whereas saccharin and sucralose significantly impaired glycemic responses. Importantly, gnotobiotic mice conventionalized with microbiomes from multiple top and bottom responders of each of the four NNS-supplemented groups featured glycemic responses largely reflecting those noted in respective human donors, which were preempted by distinct microbial signals, as exemplified by sucralose. Collectively, human NNS consumption may induce person-specific, microbiome-dependent glycemic alterations, necessitating future assessment of clinical implications.
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Affiliation(s)
- Jotham Suez
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel.
| | - Yotam Cohen
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Rafael Valdés-Mas
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Uria Mor
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Mally Dori-Bachash
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Sara Federici
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Niv Zmora
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel; Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; Internal Medicine Department, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Avner Leshem
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel; Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Melina Heinemann
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Raquel Linevsky
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Maya Zur
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Rotem Ben-Zeev Brik
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Aurelie Bukimer
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Shimrit Eliyahu-Miller
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Alona Metz
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Ruthy Fischbein
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Olga Sharov
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Sergey Malitsky
- Department of Biological Services, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Maxim Itkin
- Department of Biological Services, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Noa Stettner
- Department of Veterinary Resources, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Alon Harmelin
- Department of Veterinary Resources, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Hagit Shapiro
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Christoph K Stein-Thoeringer
- Microbiome & Cancer Division, DKFZ, Heidelberg, Germany; National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot 7610001, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot 7610001, Israel.
| | - Eran Elinav
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel; Microbiome & Cancer Division, DKFZ, Heidelberg, Germany.
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10
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An updated multifaceted overview of sweet proteins and dipeptides as sugar substitutes; the chemistry, health benefits, gut interactions, and safety. Food Res Int 2022; 162:111853. [DOI: 10.1016/j.foodres.2022.111853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 08/13/2022] [Accepted: 08/21/2022] [Indexed: 11/24/2022]
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Bayındır Gümüş A, Keser A, Tunçer E, Altuntaş Yıldız T, Kepenekci Bayram İ. Effect of saccharin, a non-nutritive sweeteners, on insulin and blood glucose levels in healthy young men: A crossover trial. Diabetes Metab Syndr 2022; 16:102500. [PMID: 35598544 DOI: 10.1016/j.dsx.2022.102500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Artificial sweeteners used instead of sugar were considered as the best alternatives that have no endocrine effects. However, it has recently been suggested that artificial sweeteners may cause impaired metabolic parameters. The hypothesis of the study was there is an association between acute saccharin consumption and both glycemia and insulin response in young healthy adult men. METHODS 9 healthy adult males were included in this study. This study randomly provided participants with preloads as (a)300 ml of water, or 300 ml of water sweetened with (b)75 g of sucrose, (c)240 mg of saccharine (adjusted to the sweetness of 75 g of sucrose) 1 h before a standard breakfast. RESULTS Compared to mean blood glucose and serum insulin after test drinks consumption, there was only one difference between sucrose and saccharin trials in the 15th minute (117.0 ± 18.70, 95.4 ± 5.64 mg/dl respectively, p < 0.05). At the 60th minute, insulin secretion (0.80 ± 0.27 pg/dl) after the sucrose trial was found significantly higher than the saccharin trial (0.53 ± 0.09 pg/dl) and water (0.49 ± 0.06 pg/dl) (p < 0.05). Although at all intervals (except 90th minute), the mean insulin is higher after the saccharin trial compared to the water trial, these were non-statistically significant differences (p > 0.05). CONCLUSIONS Consequently, it was determined that saccharin had no glycemic effect. However, for the effect on serum insulin to be clarified, the long-term effects should be investigated.
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Affiliation(s)
- Aylin Bayındır Gümüş
- Kırıkkale University Faculty of Health Sciences Department of Nutrition and Dietetics, Health Location Fabrikalar Street No 12 City Center, Kırıkkale, Turkey.
| | - Alev Keser
- Ankara University Faculty of Health Sciences Department of Nutrition and Dietetics, Ankara, Turkey.
| | - Esra Tunçer
- Ankara University Faculty of Health Sciences Department of Nutrition and Dietetics, Ankara, Turkey.
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12
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Kraemer MVDS, Fernandes AC, Chaddad MCC, Uggioni PL, Rodrigues VM, Bernardo GL, Proença RPDC. Food additives in childhood: a review on consumption and health consequences. Rev Saude Publica 2022; 56:32. [PMID: 35544885 PMCID: PMC9060765 DOI: 10.11606/s1518-8787.2022056004060] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To discuss the context of scientific publications on the consumption of food additives by children and the possible health consequences in this age group. METHODS A literature review, with a search carried out between April 2020 and April 2021 in the Web of Science, Scopus, PubMed and Google Scholar databases, as well as in websites of Brazilian and foreign official bodies. Official documents and studies published since 2000 were selected. Keywords related to food additives, children, food consumption, and health were used for the search. RESULTS Food additives are substances intentionally added to foods for technological purposes. Processed foods are the main sources of additives in food and their consumption occurs since childhood. It is observed, however, that there are limitations inherent to the scientific method regarding the analysis of consumption and toxicity of food additives in humans, causing scarcity of data in the scientific literature. Additionally, existing data suggest that the additives have a higher toxic potential in children, considering that the body weight in this age group is lower than in adults. This context emphasizes the need to observe the precautionary principle, according to which risks of harm must be prevented. CONCLUSIONS This is a scenario in which the literature points to a risk to people's health and, in particular, to children, about whom the duty of protection must be even greater, with absolute priority. Thus, the relevance of an expanded technical-scientific debate regarding the establishment of specific and stricter parameters for children is considered, regarding the consumption and toxicity of additives, as well as the different sources of exposure to these substances.
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Affiliation(s)
- Mariana Vieira dos Santos Kraemer
- Universidade Federal de Santa CatarinaNúcleo de Pesquisa de Nutrição em Produção de RefeiçõesPrograma de Pós-Graduação em NutriçãoFlorianópolisSCBrasilUniversidade Federal de Santa Catarina. Núcleo de Pesquisa de Nutrição em Produção de Refeições. Programa de Pós-Graduação em Nutrição. Florianópolis, SC, Brasil
| | - Ana Carolina Fernandes
- Universidade Federal de Santa CatarinaNúcleo de Pesquisa de Nutrição em Produção de RefeiçõesPrograma de Pós-Graduação em NutriçãoFlorianópolisSCBrasilUniversidade Federal de Santa Catarina. Núcleo de Pesquisa de Nutrição em Produção de Refeições. Programa de Pós-Graduação em Nutrição. Florianópolis, SC, Brasil
| | - Maria Cecília Cury Chaddad
- Pontifícia Universidade CatólicaFaculdade de DireitoSão PauloSPBrasilPontifícia Universidade Católica. Faculdade de Direito. São Paulo, SP, Brasil
- Movimento Põe no RótuloSão PauloSPBrasilMovimento Põe no Rótulo. São Paulo, SP, Brasil
| | - Paula Lazzarin Uggioni
- Universidade Federal de Santa CatarinaNúcleo de Pesquisa de Nutrição em Produção de RefeiçõesPrograma de Pós-Graduação em NutriçãoFlorianópolisSCBrasilUniversidade Federal de Santa Catarina. Núcleo de Pesquisa de Nutrição em Produção de Refeições. Programa de Pós-Graduação em Nutrição. Florianópolis, SC, Brasil
| | - Vanessa Mello Rodrigues
- Universidade Federal de Santa CatarinaNúcleo de Pesquisa de Nutrição em Produção de RefeiçõesPrograma de Pós-Graduação em NutriçãoFlorianópolisSCBrasilUniversidade Federal de Santa Catarina. Núcleo de Pesquisa de Nutrição em Produção de Refeições. Programa de Pós-Graduação em Nutrição. Florianópolis, SC, Brasil
| | - Greyce Luci Bernardo
- Universidade Federal de Santa CatarinaNúcleo de Pesquisa de Nutrição em Produção de RefeiçõesPrograma de Pós-Graduação em NutriçãoFlorianópolisSCBrasilUniversidade Federal de Santa Catarina. Núcleo de Pesquisa de Nutrição em Produção de Refeições. Programa de Pós-Graduação em Nutrição. Florianópolis, SC, Brasil
| | - Rossana Pacheco da Costa Proença
- Universidade Federal de Santa CatarinaNúcleo de Pesquisa de Nutrição em Produção de RefeiçõesPrograma de Pós-Graduação em NutriçãoFlorianópolisSCBrasilUniversidade Federal de Santa Catarina. Núcleo de Pesquisa de Nutrição em Produção de Refeições. Programa de Pós-Graduação em Nutrição. Florianópolis, SC, Brasil
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Aggarwal M, Freeman AM, Ros E, Allen K, Sikand G, Aspry K, Kris-Etherton P, Devries S, Reddy K, Singh T, Litwin SE, O'Keefe J, Miller M, Andrus B, Blankstein R, Batiste C, Belardo D, Wenger C, Batts T, Barnard ND, White BA, Ornish D, Williams KA, Ostfeld RJ. Trending Nutrition Controversies #3: Top Controversies in 2021. Am J Med 2022; 135:146-156. [PMID: 34509452 DOI: 10.1016/j.amjmed.2021.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/27/2022]
Abstract
Each year, patients are bombarded with diverging and even contradictory reports concerning the impact of certain additives, foods, and nutrients on cardiovascular health and its risk factors. Accordingly, this third review of nutrition controversies examines the impact of artificial sweeteners, cacao, soy, plant-based meats, nitrates, and meats from grass compared to grain-fed animals on cardiovascular and other health outcomes with the goal of optimizing clinician-led diet counseling.
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Affiliation(s)
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo
| | - Emilio Ros
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic, Barcelona and Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Geeta Sikand
- Heart Disease Prevention Program, University of California Irvine, Irvine
| | - Karen Aspry
- Division of Cardiology, Lifespan Cardiovascular Institute, and Brown University, Providence, RI
| | | | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Ill; Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Koushik Reddy
- Division of Cardiology, James A Haley VA Medical Center, University of South Florida, Tampa
| | - Tamanna Singh
- Division of Cardiovascular Medicine, Heart, Vascular, Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sheldon E Litwin
- Division of Cardiology, University of South Carolina, Charleston; Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC
| | - James O'Keefe
- Saint Luke's Mid America Heart Institute, Kansas City, Mo
| | - Michael Miller
- Division of Cardiology, University of Maryland School of Medicine, Baltimore
| | - Bruce Andrus
- Division of Cardiology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Ron Blankstein
- Division of Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Columbus Batiste
- Division of Cardiology, Kaiser Permanente Riverside Medical Center, Riverside, Calif
| | | | | | - Travis Batts
- Division of Cardiology, Department of Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, Tex
| | - Neal D Barnard
- Adjunct Faculty, George Washington University School of Medicine, Washington, DC; Physici Committee for Responsible Medicine, Washington, DC
| | - Beth A White
- Division of Cardiology, Marshall Health/Joan C. Edward School of Medicine, Huntington, WV
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, Calif; Deparment of Medicine, University of California, San Francisco, San Francisco
| | - Kim A Williams
- Division of Cardiology, Rush University Medical Center, Chicago, Ill
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Manavalan D, Shubrook C, Young CF. Consumption of Non-nutritive Sweeteners and Risk for Type 2 Diabetes: What Do We Know, and Not? Curr Diab Rep 2021; 21:53. [PMID: 34902074 DOI: 10.1007/s11892-021-01422-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW The article explores the relationship between non-nutritive sweetener consumption and the risk of developing type 2 diabetes through reviewing meta-analyses and systematic reviews, as well as clinical trials and observational studies. RECENT FINDINGS The data overall has yet to show a strong and clear link between consumption of non-nutritive sweeteners and the development of type 2 diabetes. However, several observational studies have shown a positive relationship between these two variables, with a stronger association found among women. Regarding non-nutritive sweeteners that are currently commercially available, there is not one specific non-nutritive sweetener that appears to be more strongly associated with the development of type 2 diabetes than other non-nutritive sweeteners. There is still much to be learned regarding non-nutritive sweeteners and their potential link to metabolic disorders. Further research is needed to identify the long-term impacts of non-nutritive sweetener consumption and identify the nuances in terms of risk of developing type 2 diabetes concerning specific non-nutritive sweeteners.
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Affiliation(s)
- Diya Manavalan
- Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Casey Shubrook
- Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Clipper F Young
- Primary Care Department, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA.
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Rubin D, Bosy-Westphal A, Kabisch S, Kronsbein P, Simon MC, Tombek A, Weber K, Skurk T. Empfehlungen zur Ernährung von Personen mit Typ-1-Diabetes mellitus. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1515-8766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Diana Rubin
- Vivantes Klinikum Spandau, Berlin
- Vivantes Humboldt Klinikum, Berlin
| | - Anja Bosy-Westphal
- Institut für Humanernährung, Agrar- und Ernährungswissenschaftliche Fakultät, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Stefan Kabisch
- Deutsches Zentrum für Diabetesforschung (DZD), München
- Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Technische Universität München, Freising
| | - Peter Kronsbein
- Fachbereich Oecotrophologie, Hochschule Niederrhein, Campus Mönchengladbach
| | - Marie-Christine Simon
- Institut für Ernährungs- und Lebensmittelwissenschaften, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn
| | | | - Katharina Weber
- Institut für Epidemiologie, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Thomas Skurk
- ZIEL – Institute for Food & Health, Technische Universität München, München
- Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Technische Universität München, Freising
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Jamshidi-Naeini Y, Moyo G, Napier C, Oldewage-Theron W. Food and beverages undermining elderly health: three food-based dietary guidelines to avoid or delay chronic diseases of lifestyle among the elderly in South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.1947039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Gugulethu Moyo
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Carin Napier
- Department of Food & Nutrition Consumer Sciences, Durban University of Technology, Durban, South Africa
- Centre for Longitudinal Research, The University of Auckland, Auckland, New Zealand
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
- Department of Sustainable Food Systems and Development, Free State University, Bloemfontein, South Africa
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17
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Andrade L, Lee KM, Sylvetsky AC, Kirkpatrick SI. Low-calorie sweeteners and human health: a rapid review of systematic reviews. Nutr Rev 2021; 79:1145-1164. [PMID: 33236063 DOI: 10.1093/nutrit/nuaa123] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Low-calorie sweeteners are increasingly prevalent in the food supply and their consumption has increased in recent decades. Although low-calorie sweeteners approved for use are considered safe from a toxicological perspective, their short- and long-term impacts on chronic disease risk remain uncertain. The aim of this review was to summarize the evidence from systematic reviews on low-calorie sweetener use and chronic conditions and risk factors in children and adults. METHODS MEDLINE and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews of randomized and nonrandomized studies that considered low-calorie sweeteners in relation to type 2 diabetes, cardiovascular disease, cancer, anthropometric measures, hypertension, hyperglycemia, hyperlipidemia, insulin resistance, and dental caries. Data were extracted from 9 reviews deemed of moderate or high quality on the basis of AMSTAR-2. RESULTS Narrative synthesis suggested inconsistent evidence on low-calorie sweetener use in relation to chronic conditions and associated risk factors, with nonrandomized studies suggesting positive associations and randomized studies suggesting negative or no associations. CONCLUSION Continued research on the long-term health impacts of low-calorie sweeteners across all life stages is warranted.
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Affiliation(s)
- Lesley Andrade
- the School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kirsten M Lee
- the School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Allison C Sylvetsky
- the Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Sharon I Kirkpatrick
- the School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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18
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Nadolsky KZ. COUNTERPOINT: Artificial Sweeteners for Obesity-Better than Sugary Alternatives; Potentially a Solution. Endocr Pract 2021; 27:1056-1061. [PMID: 34481971 DOI: 10.1016/j.eprac.2021.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Nonnutritive (NNSs) are used in place of sugars to reduce caloric and glycemic intake while providing desired sweetness, commonly replacing sugar-sweetened beverages (SSBs) with "diet" (zero-calorie) alternatives. Concern has developed due to observational data associating NNSs with obesity and adiposity-based chronic disease. This counterpoint argues that, in general, NNSs used in place of added or excess sugars in the diet are likely beneficial. METHODS A literature review was conducted on interventional trials investigating NNSs and obesity or type 2 diabetes mellitus. Key words used in the search included artificial sweeteners, nonnutritive sweeteners, saccharin, sucralose, aspartame, stevia/steviol, acesulfame potassium, meal replacements, type 2 diabetes mellitus, obesity, and weight. RESULTS Interventional data and indirect interventional data consistently showed beneficial effects on weight and cardiometabolic health, including glycemia, when SSBs or other energy-dense foods were replaced by artificially sweetened beverages or artificially sweetened meal replacements. CONCLUSION Although NNSs correlate with obesity and adiposity-based chronic disease, those data are fraught with confounding and error. Plausibility has been suggested on the basis of preclinical research on neuroendocrine control of appetite, satiety, and cravings plus the gut microbiome. However, interventional data reveal that replacing caloric/glycemic energy intake via NNSs creates an energy deficit resulting in weight loss and improvement in disease-especially dysglycemic disease. Intensive dietary intervention using artificially sweetened meal replacements shows a marked clinical benefit without detriment from their NNSs. Furthermore, beverages sweetened with NNSs rather than SSBs have been noted to be a critical component for those succeeding in maintaining weight loss. Although individual responses to the effects of NNSs are always warranted just like in any clinical situation, patients should not be advised to avoid NNSs in the context of dietary intervention to improve quality and energy deficit.
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Affiliation(s)
- Karl Z Nadolsky
- College of Human Medicine, Michigan State University, Grand Rapids, Michigan; Department of Endocrinology & Diabetes, Spectrum Health West Michigan, Grand Rapids, Michigan.
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19
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Czarnecka K, Pilarz A, Rogut A, Maj P, Szymańska J, Olejnik Ł, Szymański P. Aspartame-True or False? Narrative Review of Safety Analysis of General Use in Products. Nutrients 2021; 13:1957. [PMID: 34200310 PMCID: PMC8227014 DOI: 10.3390/nu13061957] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
Aspartame is a sweetener introduced to replace the commonly used sucrose. It was discovered by James M. Schlatter in 1965. Being 180-200 times sweeter than sucrose, its intake was expected to reduce obesity rates in developing countries and help those struggling with diabetes. It is mainly used as a sweetener for soft drinks, confectionery, and medicines. Despite its widespread use, its safety remains controversial. This narrative review investigates the existing literature on the use of aspartame and its possible effects on the human body to refine current knowledge. Taking to account that aspartame is a widely used artificial sweetener, it seems appropriate to continue research on safety. Studies mentioned in this article have produced very interesting results overall, the current review highlights the social problem of providing visible and detailed information about the presence of aspartame in products. The studies involving the impact of aspartame on obesity, diabetes mellitus, children and fetus, autism, neurodegeneration, phenylketonuria, allergies and skin problems, its cancer properties and its genotoxicity were analyzed. Further research should be conducted to ensure clear information about the impact of aspartame on health.
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Affiliation(s)
- Kamila Czarnecka
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, Muszyńskiego 1, 90-151 Lodz, Poland; (A.P.); (A.R.); (P.M.); (J.S.); (Ł.O.)
- Department of Radiobiology and Radiation Protection, Military Institute of Hygiene and Epidemiology, 4 Kozielska St., 01-163 Warsaw, Poland
| | - Aleksandra Pilarz
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, Muszyńskiego 1, 90-151 Lodz, Poland; (A.P.); (A.R.); (P.M.); (J.S.); (Ł.O.)
| | - Aleksandra Rogut
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, Muszyńskiego 1, 90-151 Lodz, Poland; (A.P.); (A.R.); (P.M.); (J.S.); (Ł.O.)
| | - Patryk Maj
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, Muszyńskiego 1, 90-151 Lodz, Poland; (A.P.); (A.R.); (P.M.); (J.S.); (Ł.O.)
| | - Joanna Szymańska
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, Muszyńskiego 1, 90-151 Lodz, Poland; (A.P.); (A.R.); (P.M.); (J.S.); (Ł.O.)
| | - Łukasz Olejnik
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, Muszyńskiego 1, 90-151 Lodz, Poland; (A.P.); (A.R.); (P.M.); (J.S.); (Ł.O.)
| | - Paweł Szymański
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, Muszyńskiego 1, 90-151 Lodz, Poland; (A.P.); (A.R.); (P.M.); (J.S.); (Ł.O.)
- Department of Radiobiology and Radiation Protection, Military Institute of Hygiene and Epidemiology, 4 Kozielska St., 01-163 Warsaw, Poland
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20
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Villaño D, Masoodi H, Marhuenda J, García-Viguera C, Zafrilla P. Stevia, sucralose and sucrose added to a maqui-Citrus beverage and their effects on glycemic response in overweight subjects: A randomized clinical trial. Lebensm Wiss Technol 2021. [DOI: 10.1016/j.lwt.2021.111173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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21
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Dietrich AM, Pang Z, Zheng H, Ma X. Mini review: Will artificial sweeteners discharged to the aqueous environment unintentionally “sweeten” the taste of tap water? CHEMICAL ENGINEERING JOURNAL ADVANCES 2021. [DOI: 10.1016/j.ceja.2021.100100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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22
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Ahmad SY, Friel JK, Mackay DS. Effect of sucralose and aspartame on glucose metabolism and gut hormones. Nutr Rev 2021; 78:725-746. [PMID: 32065635 DOI: 10.1093/nutrit/nuz099] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Non-nutritive sweeteners are thought to be useful replacements for caloric sweeteners in sweet food and beverages, since the reduction in energy and carbohydrate intake may lead to health benefits stemming from weight management and glycemic control. However, the potential effects of non-nutritive sweeteners on glucose metabolism and gut hormones have not been determined definitively. Here, the available evidence of the effects of aspartame and sucralose consumption on glucose metabolism and gut hormones is reviewed. A majority of studies have found that consumption of aspartame or sucralose has no effect on concentrations of blood glucose, insulin, or gut hormones; however, 2 trials have shown that aspartame consumption affects glucose, insulin, and glucagon-like peptide 1 concentrations, while only a few trials have shown that sucralose consumption affects glucose, insulin, and glucagon-like peptide 1 concentrations. One study found higher glucose concentrations after sucralose consumption, while 3 studies found lower concentrations and 33 studies found no change in glucose concentrations. Moreover, only 4 studies reported increased concentrations of glucagon-like peptide 1. Three studies reported decreased insulin sensitivity following sucralose consumption, while 1 trial reported an increase in insulin sensitivity. In summary, the evidence from the clinical trials conducted to date is contradictory because of the different protocols used.
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Affiliation(s)
- Samar Y Ahmad
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James K Friel
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dylan S Mackay
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Schiano C, Grimaldi V, Scognamiglio M, Costa D, Soricelli A, Nicoletti GF, Napoli C. Soft drinks and sweeteners intake: Possible contribution to the development of metabolic syndrome and cardiovascular diseases. Beneficial or detrimental action of alternative sweeteners? Food Res Int 2021; 142:110220. [PMID: 33773688 DOI: 10.1016/j.foodres.2021.110220] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 01/04/2023]
Abstract
The rapid increase in obesity, metabolic syndrome, and cardiovascular diseases (CVDs) has been related to the rise in sugar-added foods and sweetened beverages consumption. An interesting approach has been to replace sugar with alternative sweeteners (AS), due to their impact on public health. Preclinical and clinical studies, which analyze the safety of AS intake, are still limited. Major pathogenic mechanisms of these substances include ROS and AGEs formation. Indeed, endothelial dysfunction involving in the pathogenesis of micro- and macro-vascular diseases is mitochondrial dysfunction dependent. Hyperglycemia and endoplasmic reticulum stress together produce ROS, contributing to the development and progression of cardiovascular complications during type 2 diabetes (T2D), thus causing oxidative changes and direct damage of lipids, proteins, and DNA. Epidemiological studies in healthy subjects have suggested that the consumption of artificial AS can promote CV complications, such as glucose intolerance and predisposition to the onset of T2D, whereas natural AS could reduce hyperglycemia, improve lipid metabolism and have antioxidant effects. Long-term prospective clinical randomized studies are needed to evaluate precisely whether exposure to alternative sugars can have clinical implications on natural history and clinical outcomes, especially in children or during the gestational period through breast milk.
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Affiliation(s)
- Concetta Schiano
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "L. Vanvitelli", Naples, Italy.
| | | | - Michele Scognamiglio
- Clinical Department of Internal Medicine and Specialistic Units, Division of Clinical Immunology and Immunohematology, Transfusion Medicine, and Transplant Immunology [SIMT], Regional Reference Laboratory of Transplant Immunology [LIT], Azienda Universitaria Policlinico (AOU), Naples, Italy
| | - Dario Costa
- Clinical Department of Internal Medicine and Specialistic Units, Division of Clinical Immunology and Immunohematology, Transfusion Medicine, and Transplant Immunology [SIMT], Regional Reference Laboratory of Transplant Immunology [LIT], Azienda Universitaria Policlinico (AOU), Naples, Italy
| | - Andrea Soricelli
- IRCCS SDN, Naples, Italy; Department of Exercise and Wellness Sciences, University of Naples Parthenope, Naples, Italy
| | - Giovanni Francesco Nicoletti
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Plastic Surgery Unit, University of Campania "L. Vanvitelli", Naples, Italy
| | - Claudio Napoli
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "L. Vanvitelli", Naples, Italy; IRCCS SDN, Naples, Italy; Clinical Department of Internal Medicine and Specialistic Units, Division of Clinical Immunology and Immunohematology, Transfusion Medicine, and Transplant Immunology [SIMT], Regional Reference Laboratory of Transplant Immunology [LIT], Azienda Universitaria Policlinico (AOU), Naples, Italy
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Risdon S, Battault S, Romo-Romo A, Roustit M, Briand L, Meyer G, Almeda-Valdes P, Walther G. Sucralose and Cardiometabolic Health: Current Understanding from Receptors to Clinical Investigations. Adv Nutr 2021; 12:1500-1513. [PMID: 33578411 PMCID: PMC8321845 DOI: 10.1093/advances/nmaa185] [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] [Received: 08/27/2020] [Revised: 10/26/2020] [Accepted: 12/31/2020] [Indexed: 12/15/2022] Open
Abstract
The excess consumption of added sugar is consistently found to be associated with weight gain, and a higher risk of type 2 diabetes mellitus, coronary heart disease, and stroke. In an effort to reduce the risk of cardiometabolic disease, sugar is frequently replaced by low- and null-calorie sweeteners (LCSs). Alarmingly, though, emerging evidence indicates that the consumption of LCSs is associated with an increase in cardiovascular mortality risk that is amplified in those who are overweight or obese. Sucralose, a null-caloric high-intensity sweetener, is the most commonly used LCS worldwide, which is regularly consumed by healthy individuals and patients with metabolic disease. To explore a potential causal role for sucralose in increased cardiovascular risk, this present review summarizes the preclinical and clinical data from current research detailing the effects of sucralose on systems controlling food intake, glucose homeostasis, and gut microbiota.
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Affiliation(s)
| | | | - Alonso Romo-Romo
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Matthieu Roustit
- Université Grenoble Alpes, Inserm U1042, Grenoble, France,Grenoble Alpes University Hospital, Clinical Pharmacology, Inserm CIC1406, Grenoble, France
| | - Loic Briand
- AgroSup Dijon, INRAE, Université de Bourgogne Franche-Comté, CNRS, Centre des Sciences du Goût et de l'Alimentation, Dijon, France
| | | | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
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Knowledge and Perceptions of Non-Nutritive Sweeteners Within the UK Adult Population. Nutrients 2021; 13:nu13020444. [PMID: 33572877 PMCID: PMC7911612 DOI: 10.3390/nu13020444] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 12/15/2022] Open
Abstract
Non-nutritive sweeteners (NNS) are popular sugar substitutes that can help in weight and diabetes management, but concerns regarding their use have been raised by the public. This study aimed to investigate knowledge, benefits and safety perceptions of NNS in a sample of UK adults. The impact of knowledge dissemination on the change in perceptions was also examined. An online survey was distributed through social media platforms and UK Universities and was completed by 1589 participants aged 18 years and above. Results showed a high-risk perception of NNS and a lack of knowledge in regulations in nearly half the population sample. The artificial attributes of NNS further limited their acceptance. Risk perception has been significantly linked to a lower consumption of sweeteners (p < 0.001) and was affected by gender, occupation, education levels, age and body weight status. Information dissemination significantly reduced risk perception and increased awareness of the benefits of NNS. Results suggest that developing effective communication strategies to educate consumers, potentially through trusted health government agencies and professional bodies, can help them to make informed choices. Education of health professionals could also be valuable in reassuring the public of the benefits of NNS.
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Gallagher AM, Ashwell M, Halford JCG, Hardman CA, Maloney NG, Raben A. Low-calorie sweeteners in the human diet: scientific evidence, recommendations, challenges and future needs. A symposium report from the FENS 2019 conference. J Nutr Sci 2021; 10:e7. [PMID: 33889390 PMCID: PMC8057368 DOI: 10.1017/jns.2020.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
Overconsumption of free sugars, particularly from sugar-sweetened beverages (SSB), has potential negative health impacts. Implementation of a range of public health strategies is needed to reduce intakes of free sugars, including reducing portion sizes, promoting healthier dietary choices and reformulating foods and beverages. Although low-calorie sweeteners (LCS) are a useful tool for reducing energy intake and control glucose response when consuming sweet foods and drinks, several opinions persist about the adverse health effects of LCS, many of which are based on poor, little or no scientific evidence. This symposium report summarises key messages of the presentations and related discussions delivered at a scientific symposium at the 13th European Nutrition Conference (FENS 2019). These presentations considered the scientific evidence and current recommendations about the use and potential benefits of LCS for human health, with a particular focus on current evidence in relation to body weight and glycaemic control. Many of the studies to date on LCS have focused on low-calorie sweetened beverages (LCSB); however, the psychological and behavioural factors influencing consumer beliefs and consumption of LCSB need to be further explored. Current recommendations for LCS use are described, including the conclusions from a recent expert consensus report identifying the challenges that remain with LCS research. Finally, existing knowledge gaps and future actions are described, as well as two large ongoing research projects: SWITCH and SWEET.
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Affiliation(s)
- Alison M. Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, Ulster University, ColeraineBT52 1SA, Northern Ireland, UK
| | | | | | | | - Niamh G. Maloney
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, FrederiksbergDK-1958, Denmark
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Abstract
Introduction Non-nutritive sweeteners (NNS) are food additives that have been used as a possible tool to reduce energy and sugar intake. There is a scientific debate around the real benefits of their use. NNS are substances widely evaluated in the scientific literature. Their safety is reviewed by international regulatory health agencies. Health professionals and consumers often lack education and objective information about food additives based on the best scientific evidence. NNS have been used as a substitute for sucrose, especially by people with diabetes mellitus and obesity. However, concerns related to their possible association with preterm birth have been raised, and also with their use during pregnancy and lactation because of the possibility of metabolic or other consequences in both the mother and offspring. This analysis of the evidence in gynecology and obstetrics presents a review of the most commonly asked questions regarding this matter by health professionals and their patients. This document evaluates a diversity of scientific publications under the sieve of evidence-based medicine and the regulatory framework for food additives to elucidate whether the use of NNS in women in these critical stages of pregnancy and breastfeeding represents a potential risk.
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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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Rubin D, Bosy-Westphal A, Kabisch S, Kronsbein P, Simon MC, Tombek A, Weber KS, Skurk T. Nutritional Recommendations for People with Type 1 Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2020; 129:S27-S43. [PMID: 33374025 DOI: 10.1055/a-1284-6036] [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: 10/22/2022]
Affiliation(s)
- Diana Rubin
- Vivantes Hospital Spandau, Berlin, Germany.,Vivantes Humboldt Hospital, Berlin, Germany
| | - Anja Bosy-Westphal
- Institute of Human Nutrition, Faculty of Agriculture and Nutritional Sciences, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Stefan Kabisch
- German Institute of Human Nutrition Potsdam-Rehbrücke, Potsdam, Germany
| | - Peter Kronsbein
- Faculty of Nutrition and Food Sciences, Niederrhein University of Applied Sciences, Campus Mönchengladbach, Germany
| | - Marie-Christine Simon
- Institute of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | | | - Katharina S Weber
- Institute for Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Thomas Skurk
- ZIEL - Institute for Food & Health, Technical University Munich, Munich, Germany
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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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Rubin D, Bosy-Westphal A, Kabisch S, Kronsbein P, Simon MC, Tombek A, Weber K, Skurk T. Empfehlungen zur Ernährung von Personen mit Typ-1-Diabetes mellitus. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1245-5623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Diana Rubin
- Vivantes Klinikum Spandau, Berlin
- Vivantes Humboldt Klinikum, Berlin
| | - Anja Bosy-Westphal
- Institut für Humanernährung, Agrar- und Ernährungswissenschaftliche Fakultät, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Stefan Kabisch
- Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke, Potsdam
| | - Peter Kronsbein
- Fachbereich Oecotrophologie, Hochschule Niederrhein, Campus Mönchengladbach
| | - Marie-Christine Simon
- Institut für Ernährungs- und Lebensmittelwissenschaften, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn
| | | | - Katharina Weber
- Institut für Epidemiologie, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Thomas Skurk
- ZIEL – Institute for Food & Health, Technische Universität München, München
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Effects of the Daily Consumption of Stevia on Glucose Homeostasis, Body Weight, and Energy Intake: A Randomised Open-Label 12-Week Trial in Healthy Adults. Nutrients 2020; 12:nu12103049. [PMID: 33036155 PMCID: PMC7600789 DOI: 10.3390/nu12103049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 12/11/2022] Open
Abstract
Stevia is a non-nutritive sweetener, providing sweet taste with no calories. This randomised, controlled, open-label 2-parallel arm trial examined the effects of daily stevia consumption on glycaemia in healthy adults. Secondary endpoints included body weight (BW) and energy intake (EI). Healthy participants (n = 28; aged 25 ± 5y, body mass index 21.2 ± 1.7 kg/m2) were randomised into either the stevia group (n = 14)—required to consume a stevia extract daily—or to the control group (n = 14). At weeks 0 and 12, the glucose and insulin responses to an oral glucose tolerance test were measured; BW and EI were assessed at weeks 0, 6, and 12. There was no significant difference in the glucose or insulin responses. There was a significant main effect of group on BW change (F(1,26) = 5.56, p = 0.026), as the stevia group maintained their weight as opposed to the control group (mean weight change at week 12: −0.22 kg, 95%CI [−0.96, 0.51] stevia group, +0.89 kg, 95%CI [0.16, 1.63] control group). The energy intake was significantly decreased between week 0 and 12 in the stevia group (p = 0.003), however no change was found in the control group (p = 0.973). Although not placebo-controlled, these results suggest that daily stevia consumption does not affect glycaemia in healthy individuals, but could aid in weight maintenance and the moderation of EI.
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Greyling A, Appleton KM, Raben A, Mela DJ. Acute glycemic and insulinemic effects of low-energy sweeteners: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2020; 112:1002-1014. [PMID: 32672338 DOI: 10.1093/ajcn/nqaa167] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It has been suggested that low-energy sweeteners (LES) may be associated with an increased risk of metabolic diseases, possibly due to stimulation of glucose-responsive mechanisms. OBJECTIVE We conducted a systematic review and meta-analysis of human intervention studies examining the acute effect of LES intake on postprandial glucose (PPG) and postprandial insulin (PPI) responses, in order to comprehensively and objectively quantify these relations. METHODS We systematically searched the Medline, OVID FSTA, and SCOPUS databases until January 2020. Randomized controlled trials comparing acute postprandial effects on PPG and/or PPI after exposure to LES, either alone, with a meal, or with other nutrient-containing preloads to the same intervention without LES were eligible for inclusion. PPG and PPI responses were calculated as mean incremental area under the curve divided by time. Meta-analyses were performed using random effects models with inverse variance weighing. RESULTS Twenty-six papers (34 PPG trials and 29 PPI trials) were included. There were no reports of statistically significant differences in the effects of LES on PPG and PPI responses compared with control interventions. Pooled effects of LES intake on the mean change difference in PPG and PPI were -0.02 mmol/L (95% CI: -0.09, 0.05) and -2.39 pmol/L (95% CI: -11.83, 7.05), respectively. The results did not appreciably differ by the type or dose of LES consumed, cointervention type, or fasting glucose and insulin levels. Among patients with type 2 diabetes, the mean change difference indicated a smaller PPG response after exposure to LES compared with the control (-0.3 mmol/L; 95% CI: -0.53, -0.07). CONCLUSIONS Ingestion of LES, administered alone or in combination with a nutrient-containing preload, has no acute effects on the mean change in postprandial glycemic or insulinemic responses compared with a control intervention. Apart from a small beneficial effect on PPG (-0.3 mmol/L) in studies enrolling patients with type 2 diabetes, the effects did not differ by type or dose of LES, or fasting glucose or insulin levels. This review and meta-analysis was registered at PROSPERO as CRD42018099608.
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Affiliation(s)
- Arno Greyling
- Unilever Foods Innovation Centre, Wageningen, The Netherlands
| | | | - Anne Raben
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Denmark
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Yeung AWK, Wong NSM. How Does Our Brain Process Sugars and Non-Nutritive Sweeteners Differently: A Systematic Review on Functional Magnetic Resonance Imaging Studies. Nutrients 2020; 12:nu12103010. [PMID: 33007961 PMCID: PMC7600285 DOI: 10.3390/nu12103010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
This systematic review aimed to reveal the differential brain processing of sugars and sweeteners in humans. Functional magnetic resonance imaging studies published up to 2019 were retrieved from two databases and were included into the review if they evaluated the effects of both sugars and sweeteners on the subjects’ brain responses, during tasting and right after ingestion. Twenty studies fulfilled the inclusion criteria. The number of participants per study ranged from 5 to 42, with a total number of study participants at 396. Seven studies recruited both males and females, 7 were all-female and 6 were all-male. There was no consistent pattern showing that sugar or sweeteners elicited larger brain responses. Commonly involved brain regions were insula/operculum, cingulate and striatum, brainstem, hypothalamus and the ventral tegmental area. Future studies, therefore, should recruit a larger sample size, adopt a standardized fasting duration (preferably 12 h overnight, which is the most common practice and brain responses are larger in the state of hunger), and reported results with familywise-error rate (FWE)-corrected statistics. Every study should report the differential brain activation between sugar and non-nutritive sweetener conditions regardless of the complexity of their experiment design. These measures would enable a meta-analysis, pooling data across studies in a meaningful manner.
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Affiliation(s)
- Andy Wai Kan Yeung
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
- Correspondence: ; Tel.: +852-28590403
| | - Natalie Sui Miu Wong
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China;
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Mbambo NP, Dlamini SN, Chukwuma CI, Islam MS. Comparative effects of commonly used commercially available non-nutritive sweeteners on diabetes-related parameters in non-diabetic rats. J Food Biochem 2020; 44:e13453. [PMID: 32869881 DOI: 10.1111/jfbc.13453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/01/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
Studies of non-nutritive sweeteners (NNS) in diabetes models have been limited to their pure forms or NNS-sweetened products. Hence, we conducted a comparative study on the effects of commercial table-top NNS on diabetes-related parameters in non-diabetic rats. Normal animals were fed for 5 weeks with aqueous solutions of aspartame-, sucralose-, stevia-, sodium cyclamate- and saccharin-based commercial NNS at concentrations equivalent to the sweetness of 10% sucrose solution and thereafter food intake, blood glucose, lipid profile, and biochemical parameters were measured. Aspartame adversely affected blood cholesterols, while cyclamate increased food intake and weight gain. Stevia reduced weight gain and exhibited insulinotropic effects. These data in normal rats hypothetically suggest that stevia-based NNS may help in glycemic control and body weight management, while cyclamate- and aspartame-based NNS may increase body weight and risk of cardiovascular diseases. Further clinical studies are, however, required to confirm the results of this study. PRACTICAL APPLICATIONS: The use of NNS is becoming more popular, especially for individuals with diabetes. However, while there are several commercial table-top NNS available in the market, little is known about how they affect most diabetes-related parameters of consumers, as most of the previous studies on NNS have been limited to their pure forms or NNS-sweetened products. Therefore, we comparatively studied the effects of some commercially available table-top forms of the different NNS (aspartame, sucralose, cyclamate, saccharin, and stevia) on diabetes-related parameters in normal rats. These findings in normal rats suggested that some commercially available NNSs like stevia-based NNS may be suitable for glycemic control and body weight management, while cyclamate- and aspartame-based NNS may increase body weight and risk of cardiovascular diseases. However, these finding in normal rats is subject to additional corroborative clinical studies.
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Affiliation(s)
- Nondumiso Prosperity Mbambo
- Department of Biochemistry, School of Life Sciences, University of KwaZulu-Natal (Westville Campus), Durban, South Africa
| | - Siphiwe Ndumiso Dlamini
- Department of Biochemistry, School of Life Sciences, University of KwaZulu-Natal (Westville Campus), Durban, South Africa
| | - Chika Ifeanyi Chukwuma
- Center on Quality of Health and Living (CQHL), Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, South Africa
| | - Md Shahidul Islam
- Department of Biochemistry, School of Life Sciences, University of KwaZulu-Natal (Westville Campus), Durban, South Africa
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Consumption of non-nutritive sweeteners during pregnancy. Am J Obstet Gynecol 2020; 223:211-218. [PMID: 32275895 DOI: 10.1016/j.ajog.2020.03.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/15/2023]
Abstract
In an effort to reduce sugar consumption to prevent diabetes mellitus and cardiovascular diseases, "sugar-free" or "no added sugar" products that substitute sugar with non-nutritive sweeteners (NNSs) (eg, Splenda, Sweet'N Low, and Stevia) have become increasingly popular. The use of these products during pregnancy has also increased, with approximately 30% of pregnant women reporting intentional NNS consumption. In clinical studies with nonpregnant participants and animal models, NNSs were shown to alter gut hormonal secretion, glucose absorption, appetite, kidney function, in vitro insulin secretion, adipogenesis, and microbiome dysbiosis of gut bacteria. In pregnant animal models, NNS consumption has been associated with altered sweet taste preference later in life and metabolic dysregulations in the offspring (eg, elevated body mass index, increased risk of obesity, microbiome dysbiosis, and abnormal liver function tests). Despite the accumulating evidence, no specific guidelines for NNS consumption are available for pregnant women. Furthermore, there are limited clinical studies on the effects of NNS consumption during pregnancy and postpartum and long-term outcomes in the offspring.
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Romo-Romo A, Aguilar-Salinas CA, López-Carrasco MG, Guillén-Pineda LE, Brito-Córdova GX, Gómez-Díaz RA, Gómez-Pérez FJ, Almeda-Valdes P. Sucralose Consumption over 2 Weeks in Healthy Subjects Does Not Modify Fasting Plasma Concentrations of Appetite-Regulating Hormones: A Randomized Clinical Trial. J Acad Nutr Diet 2020; 120:1295-1304. [PMID: 32711853 DOI: 10.1016/j.jand.2020.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The effect of nonnutritive sweeteners on appetite is controversial. Some studies have found changes in certain appetite control hormones with sucralose intake that may be through interaction with sweet taste receptors located in the intestine. OBJECTIVE The aim of this study was to evaluate whether sucralose consumption could produce changes in fasting plasma concentrations of appetite-regulating hormones, including glucagon-like peptide 1, ghrelin, peptide tyrosine tyrosine, and leptin, and secondarily in insulin resistance. DESIGN A 2-week parallel randomized clinical trial with an additional visit conducted 1 week after dosing termination. PARTICIPANTS/SETTING Sixty healthy, normal-weight individuals, without habitual consumption of nonnutritive sweeteners were recruited from July 2015 to March 2017 in Mexico City. INTERVENTION Daily sucralose consumption at 15% of the acceptable daily intake by using commercial sachets added to food. The control group followed the same protocol without an intervention. MAIN OUTCOMES MEASURED Fasting concentrations of appetite regulating hormones before and after the intervention. Fasting glucose and insulin concentrations were measured to assess insulin resistance as a secondary outcome. STATISTICAL ANALYSIS PERFORMED Basal and final concentrations were compared using Wilcoxon matched-pairs test and Mann-Whitney U test for analysis between groups. Repeated measures analysis of variance was used to evaluate changes in the homeostasis model assessment of insulin resistance. RESULTS Sucralose was not associated with changes in any of the hormones measured. One week postintervention, an incremental change (P=0.04) in the homeostasis model assessment of insulin resistance was found in the intervention group. CONCLUSIONS Sucralose intake is not associated with changes in fasting concentrations of glucagon-like peptide 1, ghrelin, peptide tyrosine tyrosine, or leptin. An increase in the homeostasis model assessment of insulin resistance observed only at 1 week postdosing is of unknown clinical significance, if any.
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Laviada-Molina H, Molina-Segui F, Pérez-Gaxiola G, Cuello-García C, Arjona-Villicaña R, Espinosa-Marrón A, Martinez-Portilla RJ. Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: Systematic review and meta-analysis. Obes Rev 2020; 21:e13020. [PMID: 32216045 DOI: 10.1111/obr.13020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
There is an ongoing debate about the possible influences of nonnutritive sweeteners (NNS) on body weight. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) with NNS to assess their impact on body weight. We systematically searched for RCTs at least 4 weeks in duration, evaluating the effect of NNS on body weight, both in subjects with healthy weight and in subjects with overweight/obesity at any age, and compared the effects of NNS vs caloric and noncaloric comparators. The primary outcome was the difference in body weight between NNS and comparators. Twenty studies were eligible (n = 2914). Participants consuming NNS showed significant weight/BMI differences favouring NNS compared with nonusers. Grouping by nature of comparator revealed that NNS vs placebo/no intervention and NNS vs water produced no effect. When comparing NNS vs sucrose, significant weight/BMI differences appeared favouring NNS. Consumption of NNS led to significantly negative weight/BMI differences in unrestricted energy diets, but not in weight-reduction diets. Participants with overweight/obesity and adults showed significant favourable weight/BMI differences with NNS. Data suggest that replacing sugar with NNS leads to weight reduction, particularly in participants with overweight/obesity under an unrestricted diet, information that could be utilized for evidence-based public policy decisions.
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Affiliation(s)
- Hugo Laviada-Molina
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Merida, Mérida, Mexico
| | - Fernanda Molina-Segui
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Merida, Mérida, Mexico
| | | | - Carlos Cuello-García
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ruy Arjona-Villicaña
- Endocrinology Service, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida, Mexico
| | - Alan Espinosa-Marrón
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Merida, Mérida, Mexico
| | - Raigam Jafet Martinez-Portilla
- Nuffield Department of Primary Health Sciences, Radcliffe Observatory Quarter, University of Oxford Centre for Evidence-Based Medicine, Oxford, UK
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Ashwell M, Gibson S, Bellisle F, Buttriss J, Drewnowski A, Fantino M, Gallagher AM, de Graaf K, Goscinny S, Hardman CA, Laviada-Molina H, López-García R, Magnuson B, Mellor D, Rogers PJ, Rowland I, Russell W, Sievenpiper JL, la Vecchia C. Expert consensus on low-calorie sweeteners: facts, research gaps and suggested actions. Nutr Res Rev 2020; 33:145-154. [PMID: 31928558 PMCID: PMC7282854 DOI: 10.1017/s0954422419000283] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 09/09/2019] [Accepted: 11/01/2019] [Indexed: 01/29/2023]
Abstract
A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy substitution). The available evidence suggests no grounds for concerns about adverse effects of LCS on sweet preference, appetite or glucose control; indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality and developing effective communication strategies to foster informed choice. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation.
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Affiliation(s)
| | | | | | | | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA
| | - Marc Fantino
- Fantino Consulting SAS, F-69230 Saint Genis Laval, France
| | - Alison M. Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, UK
| | - Kees de Graaf
- Division of Human Nutrition and Health, Wageningen, The Netherlands
| | - Séverine Goscinny
- Service Organic Contaminants and Additives (SCIENSANO), Brussels, Belgium
| | | | - Hugo Laviada-Molina
- Escuela de Ciencias de la Salud, Universidad Marista de Mérida, Merida, Mexico
| | | | - Berna Magnuson
- Health Science Consultants, Inc., Mississauga, Ontario, Canada
| | - Duane Mellor
- Aston Medical School, Aston University, Birmingham, UK
| | - Peter J. Rogers
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, UK
| | - Ian Rowland
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Wendy Russell
- University of Aberdeen Rowett Institute, Aberdeen, UK
| | - John L. Sievenpiper
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s, Toronto, Canada
| | - Carlo la Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Lohner S, Kuellenberg de Gaudry D, Toews I, Ferenci T, Meerpohl JJ. Non-nutritive sweeteners for diabetes mellitus. Cochrane Database Syst Rev 2020; 5:CD012885. [PMID: 32449201 PMCID: PMC7387865 DOI: 10.1002/14651858.cd012885.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Products sweetened with non-nutritive sweeteners (NNS) are widely available. Many people with type 1 or type 2 diabetes use NNS as a replacement for nutritive sweeteners to control their carbohydrate and energy intake. Health outcomes associated with NNS use in diabetes are unknown. OBJECTIVES To assess the effects of non-nutritive sweeteners in people with diabetes mellitus. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Scopus, the WHO ICTRP, and ClinicalTrials.gov. The date of the last search of all databases (except for Scopus) was May 2019. We last searched Scopus in January 2019. We did not apply any language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with a duration of four weeks or more comparing any type of NNS with usual diet, no intervention, placebo, water, a different NNS, or a nutritive sweetener in individuals with type 1 or type 2 diabetes. Trials with concomitant behaviour-changing interventions, such as diet, exercise, or both, were eligible for inclusion, given that the concomitant interventions were the same in the intervention and comparator groups. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, full texts, and records retrieved from trials registries, assessed the certainty of the evidence, and extracted data. We used a random-effects model to perform meta-analysis, and calculated effect estimates as risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, using 95% confidence intervals (CIs). We assessed risk of bias using the Cochrane 'Risk of bias' tool and the certainty of evidence using the GRADE approach. MAIN RESULTS We included nine RCTs that randomised a total of 979 people with type 1 or type 2 diabetes. The intervention duration ranged from 4 to 10 months. We judged none of these trials as at low risk of bias for all 'Risk of bias' domains; most of the included trials did not report the method of randomisation. Three trials compared the effects of a dietary supplement containing NNS with sugar: glycosylated haemoglobin A1c (HbA1c) was 0.4% higher in the NNS group (95% CI -0.5 to 1.2; P = 0.44; 3 trials; 72 participants; very low-certainty evidence). The MD in weight change was -0.1 kg (95% CI -2.7 to 2.6; P = 0.96; 3 trials; 72 participants; very low-certainty evidence). None of the trials with sugar as comparator reported on adverse events. Five trials compared NNS with placebo. The MD for HbA1c was 0%, 95% CI -0.1 to 0.1; P = 0.99; 4 trials; 360 participants; very low-certainty evidence. The 95% prediction interval ranged between -0.3% and 0.3%. The comparison of NNS versus placebo showed a MD in body weight of -0.2 kg, 95% CI -1 to 0.6; P = 0.64; 2 trials; 184 participants; very low-certainty evidence. Three trials reported the numbers of participants experiencing at least one non-serious adverse event: 36/113 participants (31.9%) in the NNS group versus 42/118 participants (35.6%) in the placebo group (RR 0.78, 95% CI 0.39 to 1.56; P = 0.48; 3 trials; 231 participants; very low-certainty evidence). One trial compared NNS with a nutritive low-calorie sweetener (tagatose). HbA1c was 0.3% higher in the NNS group (95% CI 0.1 to 0.4; P = 0.01; 1 trial; 354 participants; very low-certainty evidence). This trial did not report body weight data and adverse events. The included trials did not report data on health-related quality of life, diabetes complications, all-cause mortality, or socioeconomic effects. AUTHORS' CONCLUSIONS There is inconclusive evidence of very low certainty regarding the effects of NNS consumption compared with either sugar, placebo, or nutritive low-calorie sweetener consumption on clinically relevant benefit or harm for HbA1c, body weight, and adverse events in people with type 1 or type 2 diabetes. Data on health-related quality of life, diabetes complications, all-cause mortality, and socioeconomic effects are lacking.
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Affiliation(s)
- Szimonetta Lohner
- Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary
| | - Daniela Kuellenberg de Gaudry
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingrid Toews
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tamas Ferenci
- Physiological Controls Research Center, Obuda University, Budapest, Hungary
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane France, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes University, Paris, France
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Stamataki NS, Scott C, Elliott R, McKie S, Bosscher D, McLaughlin JT. Stevia Beverage Consumption prior to Lunch Reduces Appetite and Total Energy Intake without Affecting Glycemia or Attentional Bias to Food Cues: A Double-Blind Randomized Controlled Trial in Healthy Adults. J Nutr 2020; 150:1126-1134. [PMID: 32125421 DOI: 10.1093/jn/nxaa038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/21/2019] [Accepted: 02/04/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Stevia is a zero-calorie alternative to caloric sugars. Substituting caloric sweeteners with noncaloric sweeteners reduces available energy, but their effects on appetite, subsequent food intake, and neurocognitive responses are still unclear. OBJECTIVE The aim was to examine whether sweetness with or without calories influences food intake, appetite, blood glucose concentrations, and attentional bias (AB) to food cues. METHODS This was a randomized, controlled, double-blind crossover study. Healthy participants [n = 20; aged 27 ± 5 y, 55% female; BMI (kg/m2): 21.8 ± 1.5] completed 5 visits, consuming 5 study beverages: 330 mL water (control, no sweet taste, no calories) and either 330 mL water containing 40 g glucose or sucrose (sweet taste; calories, both 160 kcal), maltodextrin (no sweet taste; calories, 160 kcal), or 240 ppm stevia (sweet taste, no calories). Glucose and stevia beverages were matched for sweetness. Subjective appetite ratings and blood glucose were measured at baseline and at 15, 30, and 60 min postprandially. At 15 min participants performed a visual-dot probe task to assess AB to food cues; at 30 min, participants were offered an ad libitum lunch; food intake was measured. RESULTS Subjective appetite ratings showed that preload sweetness and calorie content both affected appetite. The total AUC for glycemia was significantly higher after the caloric beverages (mean ± SD: maltodextrin, 441 ± 57.6; glucose, 462 ± 68.1; sucrose, 425 ± 53.6 mmol × min × L-1 ) compared with both stevia (320 ± 34.2 mmol × min × L-1) and water (304 ± 32.0 mmol × min × L-1) (all P < 0.001). Total energy intake (beverage and meal) was significantly lower after the stevia beverage (727 ± 239 kcal) compared with water (832 ± 198 kcal, P = 0.013), with no significant difference between the water and caloric beverages (P = 1.00 for water vs. maltodextrin, glucose, and sucrose). However, food-related AB did not differ across conditions (P = 0.140). CONCLUSIONS This study found a beneficial and specific effect of a stevia beverage consumed prior to a meal on appetite and energy intake in healthy adults. This trial is registered at clinicaltrials.gov as NCT03711084.
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Affiliation(s)
- Nikoleta S Stamataki
- Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Corey Scott
- Cargill R&D Center North America, Minneapolis, MN, USA
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Shane McKie
- Faculty of Biology, Medicine and Health Platform Sciences, Enabling Technologies and Infrastructure, Faculty of Biology, Medicine and Health Research and Innovation, The University of Manchester, Manchester, United Kingdom
| | | | - John T McLaughlin
- Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Department of Gastroenterology, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
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Ajami M, Seyfi M, Abdollah Pouri Hosseini F, Naseri P, Velayati A, Mahmoudnia F, Zahedirad M, Hajifaraji M. Effects of stevia on glycemic and lipid profile of type 2 diabetic patients: A randomized controlled trial. AVICENNA JOURNAL OF PHYTOMEDICINE 2020; 10:118-127. [PMID: 32257884 PMCID: PMC7103435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Stevia (Stevia rebaudiana Bertoni) is a natural and healthy alternative sweetener to sugar and artificial sweeteners, which has become important for human diets and food manufactures. In this study, the effects of stevia or sucralose as tea sweeteners on glycemic and lipid profile of type 2 diabetic patients were investigated. MATERIALS AND METHODS A double-blind clinical trial was carried out in 34 type 2 diabetic patients. These patients were assigned into two groups of stevia (n=15) (received 1 cup of 2% stevia extract-sweet tea in three meals) and non-stevia (n=19) (received one tablet of sucralose sweetener) daily for eight weeks. Glycemic response and lipid profile of the participants were assessed. Furthermore, height, weight and body mass index (BMI) of the participants were measured as well as their dietary intakes at the baseline and at the end of the study. RESULTS Findings showed no significant differences in fasting blood sugar (FBS) levels between the base line and after two hours, in participants. Also, no significant differences in insulin, glycosylated hemoglobin (HbA1C) and lipid levels were found between the two groups. CONCLUSION Results of the current study showed that the highlighted doses of stevia in sweetened tea could be an alternative to sucralose in diabetic patients with no effects on blood glucose, HbA1C, insulin and lipid levels.
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Affiliation(s)
- Marjan Ajami
- Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Seyfi
- Nutritional Sciences, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abdollah Pouri Hosseini
- Nutritional Sciences, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Naseri
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences. Tehran. Iran
| | - Aynaz Velayati
- Nutritional Sciences, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Mahmoudnia
- Department of Biology, Faculty of Science, Farhangian University, Tehran, Iran
| | - Malihe Zahedirad
- Department of Nutrition, School of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Hajifaraji
- Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding Author: Tel: +98-21-22357486, Fax: +98-21-22097419,
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The effect of a new mixture of sugar and sugar-alcohols compared to sucrose and glucose on blood glucose increase and the possible adverse reactions: A phase I double-blind, three-way randomized cross-over clinical trial. ENDOCRINOL DIAB NUTR 2019; 66:647-653. [DOI: 10.1016/j.endinu.2018.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 11/23/2022]
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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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Ahmad SY, Friel JK, MacKay DS. The effect of the artificial sweeteners on glucose metabolism in healthy adults: a randomized, double-blinded, crossover clinical trial. Appl Physiol Nutr Metab 2019; 45:606-612. [PMID: 31697573 DOI: 10.1139/apnm-2019-0359] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This study aimed to determine the effect of pure forms of sucralose and aspartame, in doses reflective of common consumption, on glucose metabolism. Healthy participants consumed pure forms of a non-nutritive sweetener (NNS) that were mixed with water and standardized to doses of 14% (0.425 g) of the acceptable daily intake (ADI) for aspartame and 20% (0.136 g) of the ADI for sucralose every day for 2 weeks. Blood samples were collected and analyzed for glucose, insulin, active glucagon-like peptide-1 (GLP-1), and leptin. Seventeen participants (10 females and 7 males; age, 24 ± 6.8 years; body mass index, 22.9 ± 2.5 kg/m2) participated in the study. The total area under the curve values of glucose, insulin, active GLP-1 and leptin were similar for the aspartame and sucralose treatment groups compared with the baseline values in healthy participants. There was no change in insulin sensitivity after NNS treatment compared with the baseline values. These findings suggest that daily repeated consumption of pure sucralose or aspartame for 2 weeks had no effect on glucose metabolism among normoglycaemic adults. However, these results need to be tested in studies with longer durations. Novelty Daily consumption of pure aspartame or sucralose for 2 weeks had no effect on glucose metabolism. Daily consumption of pure aspartame or sucralose for 2 weeks had no effect on insulin sensitivity among healthy adults.
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Affiliation(s)
- Samar Y Ahmad
- Department of Food and Human Nutritional Sciences, Richardson Centre for Functional Foods and Nutraceuticals, Faculty of Agriculture and Food Sciences, University of Manitoba, Winnipeg, MB R3T 6C5, Canada
| | - James K Friel
- Department of Food and Human Nutritional Sciences, Richardson Centre for Functional Foods and Nutraceuticals, Faculty of Agriculture and Food Sciences, University of Manitoba, Winnipeg, MB R3T 6C5, Canada
| | - Dylan S MacKay
- Department of Food and Human Nutritional Sciences, Richardson Centre for Functional Foods and Nutraceuticals, Faculty of Agriculture and Food Sciences, University of Manitoba, Winnipeg, MB R3T 6C5, Canada.,Department of Community Health Sciences, University of Manitoba, Rady Faculty of Health Sciences, Winnipeg, MB R3T 6C5, Canada
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Sánchez-Delgado M, Estrada JA, Paredes-Cervantes V, Kaufer-Horwitz M, Contreras I. Changes in nutrient and calorie intake, adipose mass, triglycerides and TNF-α concentrations after non-caloric sweetener intake: A pilot study. INT J VITAM NUTR RES 2019; 91:87-98. [PMID: 31656130 DOI: 10.1024/0300-9831/a000611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Establishing the safety of non-caloric sweetener consumption in humans is a difficult task, since many contradictory results have been reported. The objective of this study was to compare the effect of frequent intake of sucrose, sucralose or steviol glycosides, on selected anthropometric, biochemical and immunological parameters in healthy, young adults. 38 individuals with normal body mass index were recruited and randomly divided into three experimental groups. After a washout week (where food with added sweeteners was restricted), each group was supplemented with sucrose (8 × 5 g packets/day), sucralose or steviol glycosides (4 × 1 g packets/day each) for 6 weeks. Selected variables were measured before and after treatment in each group and differences within and among groups were assessed. Our results showed that, compared to baseline, there was a modest but significant increase in weight (p = 0.0293) in the sucralose group, while the steviol glycosides group reduced their fat mass (p = 0.0390). No differences were observed in glycaemia; however, there was a significant increase in serum triglycerides (77.8-110.8 mg/dL) and cholesterol (162.0-172.3 mg/dL) in the sucrose group, whereas the steviol glycosides group presented lower triglycerides (104.7-92.8 mg/dL) and TNF-α concentrations (51.1-47.5 pg/mL). Comparison among groups showed differences in serum triglycerides (p = 0.0226), TNF-α (p = 0.0460) and IL-β (p = 0.0008). Our results suggest that, even in a short time span, frequent intake of steviol glycosides may have positive effects on metabolic parameters that may be relevant for human health.
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Affiliation(s)
- Marcela Sánchez-Delgado
- Laboratorio de Neuroquímica, Facultad de Medicina, Universidad Autónoma del Estado de México, México
| | - José Antonio Estrada
- Laboratorio de Neuroquímica, Facultad de Medicina, Universidad Autónoma del Estado de México, México
| | | | - Martha Kaufer-Horwitz
- Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
| | - Irazú Contreras
- Laboratorio de Neuroquímica, Facultad de Medicina, Universidad Autónoma del Estado de México, México
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Bueno-Hernández N, Vázquez-Frías R, Abreu y Abreu A, Almeda-Valdés P, Barajas-Nava L, Carmona-Sánchez R, Chávez-Sáenz J, Consuelo-Sánchez A, Espinosa-Flores A, Hernández-Rosiles V, Hernández-Vez G, Icaza-Chávez M, Noble-Lugo A, Romo-Romo A, Ruiz-Margaín A, Valdovinos-Díaz M, Zárate-Mondragón F. Review of the scientific evidence and technical opinion on noncaloric sweetener consumption in gastrointestinal diseases. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Bueno-Hernández N, Vázquez-Frías R, Abreu Y Abreu AT, Almeda-Valdés P, Barajas-Nava LA, Carmona-Sánchez RI, Chávez-Sáenz J, Consuelo-Sánchez A, Espinosa-Flores AJ, Hernández-Rosiles V, Hernández-Vez G, Icaza-Chávez ME, Noble-Lugo A, Romo-Romo A, Ruiz-Margaín A, Valdovinos-Díaz MA, Zárate-Mondragón FE. Review of the scientific evidence and technical opinion on noncaloric sweetener consumption in gastrointestinal diseases. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2019; 84:492-510. [PMID: 31564473 DOI: 10.1016/j.rgmx.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/03/2019] [Accepted: 08/20/2019] [Indexed: 01/16/2023]
Abstract
The present review of noncaloric sweeteners (NCSs) by the Asociación Mexicana de Gastroenterología was carried out to analyze and answer some of the most frequent questions and concerns about NCS consumption in patients with gastrointestinal disorders, through a thorough review of the medical literature. A group of gastroenterologists and experts on nutrition, toxicology, microbiology, and endocrinology reviewed and analyzed the published literature on the topic. The working group formulated conclusions, based on the scientific evidence published, to give an opinion with respect to NCS ingestion. Current evidence does not confirm the carcinogenic potential of NCSs. However, the studies analyzed showed that saccharin could have a proinflammatory effect and that polyols can cause gastrointestinal symptoms and manifestations, depending on the dose and type of compound. The ingestion of xylitol, erythritol, sucralose, aspartame, acesulfame K, and saccharin could increase the secretion of the gastrointestinal hormones that regulate intestinal motility, and stevia and its derivatives could have a favorable effect on the percentage of liver fat. Caution should be taken in recommending aspartame consumption in patients with chronic liver disease because it reduces the ratio of branched-chain amino acids to aromatic amino acids. In addition, NCS ingestion could modify the composition of the intestinal microbiota, having an effect on gastrointestinal symptoms and manifestations. It is important to continue conducting causality studies on humans to be able to establish recommendations on NSC consumption.
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Affiliation(s)
- N Bueno-Hernández
- Dirección de Investigación, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México.
| | - R Vázquez-Frías
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - A T Abreu Y Abreu
- Gastroenterología, Hospital Ángeles Pedregal, Ciudad de México, México
| | - P Almeda-Valdés
- Departamento de Endocrinología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - L A Barajas-Nava
- Unidad de Investigación de Medicina Basada en Evidencia, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | | | - J Chávez-Sáenz
- Consulta privada de Gastroenterología Pediátrica, Hospital Puerta de Hierro Andares, Zapopan, Jalisco, México
| | - A Consuelo-Sánchez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - A J Espinosa-Flores
- Dirección de Investigación, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - V Hernández-Rosiles
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - G Hernández-Vez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - M E Icaza-Chávez
- Consulta privada de Gastroenterología, Hospital Star Médica, Mérida, Yucatán, México
| | - A Noble-Lugo
- Departamento de Enseñanza e Investigación, Hospital Español de México, Ciudad de México, México
| | - A Romo-Romo
- Departamento de Endocrinología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - A Ruiz-Margaín
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - M A Valdovinos-Díaz
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - F E Zárate-Mondragón
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
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Ryuk JA, Kang S, Daily JW, Ko BS, Park S. Moderate intake of aspartame and sucralose with meals, but not fructose, does not exacerbate energy and glucose metabolism in estrogen-deficient rats. J Clin Biochem Nutr 2019; 65:223-231. [PMID: 31777424 PMCID: PMC6877401 DOI: 10.3164/jcbn.19-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
Both nutritive and non-nutritive sweeteners may influence energy and glucose metabolism differently. The hypothesis that sucrose, fructose, aspartame, and sucralose intake differently modulate energy and glucose metabolism was tested in an estrogen-deficient animal model. At 30 min after giving aspartame and sucralose (10 mg/kg body weight), an oral glucose tolerance test (OGTT) was conducted with glucose, sucrose, and fructose in ovariectomized (OVX) rats. After OGTT, they were continuously fed high fat diets including either 10% corn starch (Control), 10% sucrose (Sucrose), 10% fructose (Fructose), 0.05% aspartame + 9.95% starch (Aspartame) or 0.05% sucralose + 9.95% starch (Sucralose) for 8 week. During 30 min after acute administration of aspartame and sucralose, serum glucose concentrations increased despite slightly increased serum insulin levels before glucose infusion. However, glucose tolerance was not significantly different among the groups. In chronic study, serum glucose concentrations were lowest and insulin highest at the overnight-fasted state in Aspartame and Sucralose. Postprandial serum glucagon-like peptide-1 (GLP-1) and insulin levels were higher in Aspartame and Sucralose than Control. Hepatic insulin signaling (pAkt → pGSK-3β) and phosphoenolpyruvate carboxykinase (PEPCK) expression were lower in Sucralose and Aspartame than the Fructose. Serum acetate levels produced by gut microbiota were higher were lower in the fructose group than Aspartame and Sucralose groups. In conclusion, aspartame and sucralose with a meal might be preferable sweeteners to fructose and sucrose in estrogen deficient rats, and possibly post-menopausal women; however, this needs to be confirmed in human studies.
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Affiliation(s)
- Jin Ah Ryuk
- Korean Medicine Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea
| | - Suna Kang
- Department of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, ChungNam-Do, 336-795, South Korea
| | - James W Daily
- Department of R&D, Daily Manufacturing Inc., Rockwell, NC, USA
| | - Byoung-Seob Ko
- Korean Medicine Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea
| | - Sunmin Park
- Department of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University, 165 Sechul-Ri, BaeBang-Yup, Asan-Si, ChungNam-Do, 336-795, South Korea
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Abstract
Abstract. Prior research has suggested that circulating levels of glucose in the bloodstream help to determine success at self-control. However, this idea has been challenged on multiple grounds. The current research added new evidence to the debate by testing (1) the extent to which exercising self-control reduces blood glucose levels, (2) whether consuming glucose, rinsing the mouth with glucose, or consuming aspartame (a sugar substitute) increases blood glucose levels, and (3) the extent to which measured blood glucose levels relate to emotional responding, delay discounting, and cognitive control, respectively. We found no evidence that blood glucose levels influence or are influenced by self-control.
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Affiliation(s)
- Anna J. Finley
- Department of Psychology, Texas A&M University, College Station, TX, USA
| | - David Tang
- Department of Psychology, Texas A&M University, College Station, TX, USA
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