French Recommendations for Sugar Intake in Adults: A Novel Approach Chosen by ANSES

Dietary lipids shape cytokine and leptin profiles in obesity-metabolic syndrome implications: A cross-sectional study

BACKGROUND

Obesity, characterized by chronic energy imbalance and excessive adiposity, is a key component of metabolic syndrome and is associated with low-grade inflammation and altered adipokine secretion. This study aimed to evaluate the association between dietary fat consumption and its influence on interleukin (IL) and leptin levels in participants with obesity.

METHODS

Using the Asian obesity classification criteria, a cross-sectional study was conducted on 384 adults (18-59 years). Anthropometric measurements by bioelectrical impedance analyzer (BIA), blood biochemistry by colorimetric assay, inflammatory markers and hormones by ELISA test, and dietary intake were assessed by Semi-FFQ.

RESULTS

Obesity prevalence was 26.1% and 73.90% in males and females, respectively. Participants with obesity exhibited significantly higher inflammatory and hormonal marker levels. Positive correlations were observed between blood lipid, glucose, and tumor necrosis factor-α, IL-6, and leptin levels. Energy, carbohydrate, and sugar intake were positively correlated with leptin levels. High saturated fat intake was associated with increased IL-6 levels (odds ratio = 2.03, 95% confidence interval [CI] = 1.00-4.11, p < 0.047), whereas high total fat intake elevated leptin levels by 2.14-fold (95% CI = 1.12-4.10, p < 0.021) in participants with obesity.

CONCLUSIONS

This study demonstrates significant associations between dietary fat composition, inflammatory markers, and leptin levels in individuals with obesity. These findings suggest that modulating dietary fat intake can be a potential strategy for mitigating obesity-related inflammation and leptin resistance, highlighting the need for targeted nutritional interventions in obesity and metabolic syndrome management.

Current perspectives on global sugar consumption: definitions, recommendations, population intakes, challenges and future direction

Currently, there is considerable emphasis on the relationship between dietary sugar consumption and various health outcomes, with some countries and regions implementing national sugar reduction campaigns. This has resulted in significant efforts to quantify dietary sugar intakes, to agree on terms to describe dietary sugars and to establish associated recommendations. However, this information is infrequently collated on a global basis and in a regularised manner. The present review provides context regarding sugar definitions and recommendations. It provides a global review of the available data regarding dietary sugar intake, considering forms such as total, free and added sugars. A comprehensive breakdown of intakes is provided by age group, country and sugar form. This analysis shows that free sugar intakes as a percentage of total energy (%E) are the highest for children and adolescents (12-14%E) and the lowest for older adults (8%E). This trend across lifecycle stages has also been observed for added sugars. The available data also suggest that, while some reductions in sugar intake are observed in a few individual studies, overall intakes of free/added sugars remain above recommendations. However, any wider conclusions are hampered by a lack of detailed high-quality data on sugar intake, especially in developing countries. Furthermore, there is a need for harmonisation of terms describing sugars (ideally driven by public health objectives) and for collaborative efforts to ensure that the most up-to-date food composition data are used to underpin recommendations and any estimates of intake or modelling scenarios.

Sugars and Gastrointestinal Health

Sugar overconsumption is linked to a rise in the incidence of noncommunicable diseases such as diabetes, cardiovascular diseases, and cancer. This increased incidence is becoming a real public health problem that is more severe than infectious diseases, contributing to 35 million deaths annually. Excessive intake of free sugars can cause many of the same health problems as excessive alcohol consumption. Many recent international recommendations have expressed concerns about sugar consumption in Westernized societies, as current consumption levels represent quantities with no precedent during hominin evolution. In both adults and children, the World Health Organization strongly recommends reducing free sugar intake to <10% of total energy intake and suggests a further reduction to below 5%. Most studies have focused on the deleterious effects of Western dietary patterns on global health and the intestine. Whereas excessive dietary fat consumption is well studied, the specific impact of sugar is poorly described, while refined sugars represent up to 40% of caloric intake within industrialized countries. However, high sugar intake is associated with multiple tissue and organ dysfunctions. Both hyperglycemia and excessive sugar intake disrupt the intestinal barrier, thus increasing gut permeability and causing profound gut microbiota dysbiosis, which results in a disturbance in mucosal immunity that enhances infection susceptibility. This review aims to highlight the roles of different types of dietary carbohydrates and the consequences of their excessive intake for intestinal homeostasis.

Metal Contamination of Oman Sea Seaweed and Its Associated Public Health Risks

Oman Sea region is a major gateway for international and local shipping. Metal pollution of aquatic environment is primarily caused by such shipping and industrial activities. Agricultural runoffs are also of concern. Seaweed contamination with heavy metals in this area is therefore a distinct possibility. We examined seaweed of Oman Sea for heavy metal content and potential risk of its consumption to the public. During winter of 2019, water, sediment, and seaweed were collected along twelve stations on the coast of Oman Sea. Triplicates of each sample were analyzed for metal content by atomic absorption spectroscopy. Biomarkers of metals in seaweed (metallothionein and phytochelatin) were also analyzed. A significant positive correlation exists among levels of Zn, Ni, Pb, Cr, Cu, and Fe in water, sediment, and seaweed (P < 0.05). Cadmium correlations were weak. The highest levels of metallothionein and phytochelatin were found in brown and red seaweed (118.6 µg/g wet weight, 16.4 amol/cell; 111.4 µg/g ww, 12.1 amol/cell), respectively. For nickel and lead, human consumption of red, brown, and green seaweed was associated with "some health hazard," with a target hazard quotient of > 1. We conclude that concerns over heavy metal contamination of some parts of Oman Sea are valid, and we invite policy makers to implement measures for protection of public and environment from metal toxic effects in the region.

Influence of pro-obesogenic dietary habits on stress-induced cognitive alterations in healthy adult volunteers

Stress is a fundamental biological response that can be associated with alterations in cognitive processes. Unhealthy dietary habits are proposed to modulate this effect, notably through their pro-inflammatory potential. This cross-sectional study aimed to evaluate the influence of an obesogenic dietary pattern with inflammatory potential on stress-induced cognitive alterations in healthy volunteers. Fifty healthy adult participants were stratified into two diet groups: obesogenic vs. non-obesogenic, based on their self-reported consumption of fat, sugar, and salt, assessed by the French National Program for Nutrition and Health questionnaire and a food frequency questionnaire. Serum high-sensitive C-reactive protein (hsCRP) was measured as a marker of systemic inflammation using ELISA. Verbal memory and sustained attention were evaluated through the Verbal Recognition Memory (VRM) test and the Rapid Visual Information Processing (RVP) test respectively, from the Cambridge Neuropsychological Test Automated Battery. Assessments were performed before and after exposure to the psychological stressor Trier Social Stress Test (TSST). Stress response was evaluated by subjective stress perception, salivary cortisol, blood pressure, and heart rate. Twenty-two participants (44%) presented an obesogenic diet. Systemic inflammation was significantly higher in the obesogenic diet group (p=0.005). The TSST induced a significant stress response, regardless of dietary habits (Time effect p < 0.001). In the whole sample, exposure to TSST was associated with cognitive changes in the form of impaired performance on the VRM test and overall improved RVP scores. However, the obesogenic diet group exhibited an increased total number of false alarms (Time x Diet: p=0.014) on the RVP test after TSST exposure as well as a greater impairment in immediate verbal recognition on the VRM test (Time x Diet: p=0.002). This effect was not associated with the inflammatory component of the obesogenic diet. These results suggest that an obesogenic diet may sensitize healthy individuals to the detrimental effects of acute stress on cognitive performance.

Does weight change modify the association between the consumption of sugar-sweetened beverages and 100% fruit juice and the risk of metabolic syndrome?

BACKGROUND & AIMS

This study aimed to determine the prospective relationship between the consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice and metabolic syndrome (MetS) and to investigate whether weight change can modify this association in a representative sample of the population of Tehran, Iran.

METHODS

In this 8.9-year follow-up study, the consumption of SSBs and 100% fruit juice by 1915 individuals, who participated in Tehran Lipid and Glucose Study (TLGS), was examined using a validated food frequency questionnaire. The MetS was defined according to the Joint Interim Statement. Participants were categorized as those who lost weight (≥-2%), those with weight stability (-1.9%-1.9%), and those who gained weight (≥2%). The Cox regression model was used to determine the relationship between the consumption of SSBs and 100% fruit juice and the risk of MetS and weight gain ≥2%. Also, the modifying effect of weight change including weight loss, weight stability and weight gain on the relationship between SSBs and 100% fruit juice consumption and the incidence of MetS was assessed.

RESULTS

There was no significant association between the consumption of SSBs and the risk of MetS in the crude model; however, after adjustments for confounders, a significant positive association was found between the consumption of SSBs and the risk of MetS (HR: 1.33; 95% CI: 1.07-1.66). Also, no significant association was observed between the consumption of 100% fruit juice and the risk of MetS in the crude model. However, after adjustments for the potential confounders, 100% fruit juice was inversely associated with the MetS risk (HR: 0.78; 95% CI: 0.63-0.95). The consumption of SSBs and 100% fruit juice was positively associated with weight gain (≥2% during the follow-up). Nevertheless, after adjustments for lifestyle and dietary factors, there was no significant association between the consumption of SSBs and weight gain. On the other hand, the consumption of 100% fruit juice was positively associated with the increased risk of weight gain (HR: 1.41; 95% CI: 1.20-1.65). Among participants with weight loss, the first, second and third tertiles of 100% fruit juice reduced the risk of MetS by 29% (HR: 0.71; 95% CI: 0.51-0.99), 47% (HR: 0.53; 95% CI: 0.37-0.75) and 35% (HR: 0.65; 95% CI: 0.46-0.92), respectively.

CONCLUSION

Although 100% fruit juice reduced the risk of MetS, its consumption must be limited due to its positive effect on weight gain. On the other hand, the consumption of 100% fruit juice reduced the risk of MetS, depending on the individual's weight change. Also, high consumption of SSBs was associated with the incidence of MetS.

Associations of Intake of Free and Naturally Occurring Sugars from Solid Foods and Drinks with Cardiometabolic Risk Factors in a Quebec Adult Population: The PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) Study

BACKGROUND

Associations between sugar consumption and cardiometabolic health, taking into account the physical form of sugar-containing foods (liquid vs. solid) and the type of sugars consumed [free sugars (FSs) vs. naturally occurring sugars (NOSs)], remain to be thoroughly documented.

OBJECTIVE

The objective was to examine whether FS and NOS intakes from drinks and solid foods are associated with cardiometabolic risk factors in a sample of French-speaking adults from the province of Quebec, Canada.

METHODS

Data were collected as part of the cross-sectional PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) study (n = 1019, 18-65 y old; 50% women). FS and NOS intakes were assessed by three 24-h dietary recalls using a self-administered, web-based application. Diet quality was assessed using the Alternative Healthy Eating Index-2010. Participants underwent on-site clinical assessment of cardiometabolic risk factors, including blood pressure, waist circumference, BMI, and fasting blood sampling (glucose, insulin, C-reactive protein, blood lipids). Multivariable linear regression models were performed to examine the associations between sugar intake and cardiometabolic risk factors with sociodemographic characteristics, lifestyle variables, and diet quality entered as covariates.

RESULTS

In fully adjusted models, FS intake from drinks was associated with fasting insulin (1.06%; 95% CI: 0.30%, 1.84%; P = 0.006) and with insulin resistance as estimated using the HOMA model (1.01%; 95% CI: 0.19%, 1.84%; P = 0.02). All metabolic variables that were significantly associated with NOS intake from solid foods in minimally adjusted models were no longer significant after entering sociodemographic and lifestyle variables (e.g., educational and income levels, smoking, physical activity, daily energy intake) and diet quality in the models.

CONCLUSIONS

Our data from an adult sample showed that unfavorable and favorable associations with cardiometabolic risk factors observed, respectively, for FS intake from drinks and NOS intake from foods are mostly explained by sociodemographic and lifestyle variables, as well as by diet quality.

Metabolism of sugars: A window to the regulation of glucose and lipid homeostasis by splanchnic organs

BACKGROUND &AIMS

Dietary sugars are absorbed in the hepatic portal circulation as glucose, fructose, or galactose. The gut and liver are required to process fructose and galactose into glucose, lactate, and fatty acids. A high sugar intake may favor the development of cardio-metabolic diseases by inducing Insulin resistance and increased concentrations of triglyceride-rich lipoproteins.

METHODS

A narrative review of the literature regarding the metabolic effects of fructose-containing sugars.

RESULTS

Sugars' metabolic effects differ from those of starch mainly due to the fructose component of sucrose. Fructose is metabolized in a set of fructolytic cells, which comprise small bowel enterocytes, hepatocytes, and kidney proximal tubule cells. Compared to glucose, fructose is readily metabolized in an insulin-independent way, even in subjects with diabetes mellitus, and produces minor increases in glycemia. It can be efficiently used for energy production, including during exercise. Unlike commonly thought, fructose when ingested in small amounts is mainly metabolized to glucose and organic acids in the gut, and this organ may thus shield the liver from potentially deleterious effects.

CONCLUSIONS

The metabolic functions of splanchnic organs must be performed with homeostatic constraints to avoid exaggerated blood glucose and lipid concentrations, and thus to prevent cellular damages leading to non-communicable diseases. Excess fructose intake can impair insulin-induced suppression of glucose production, stimulate de novo lipogenesis, and increase intrahepatic and blood triglyceride concentrations. With chronically high fructose intake, enterocyte can switch to lipid synthesis and accumulation of triglyceride, possibly causing an enterocyte dysfunction.

Synergistic effects of fructose and glucose on lipoprotein risk factors for cardiovascular disease in young adults

BACKGROUND

Fructose consumption increases risk factors for cardiometabolic disease. It is assumed that the effects of free sugars on risk factors are less potent because they contain less fructose. We compared the effects of consuming fructose, glucose or their combination, high fructose corn syrup (HFCS), on cardiometabolic risk factors.

METHODS

Adults (18-40 years; BMI 18-35 kg/m²) participated in a parallel, double-blinded dietary intervention during which beverages sweetened with aspartame, glucose (25% of energy requirements (ereq)), fructose or HFCS (25% and 17.5% ereq) were consumed for two weeks. Groups were matched for sex, baseline BMI and plasma lipid/lipoprotein concentrations. 24-h serial blood samples were collected at baseline and at the end of intervention. Primary outcomes were 24-h triglyceride AUC, LDL-cholesterol (C), and apolipoprotein (apo)B. Interactions between fructose and glucose were assessed post hoc.

FINDINGS

145 subjects (26.0 ± 5.8 years; body mass index 25.0 ± 3.7 kg/m²) completed the study. As expected, the increase of 24-h triglycerides compared with aspartame was highest during fructose consumption (25%: 6.66 mmol/Lx24h 95% CI [1.90 to 11.63], P = 0.0013 versus aspartame), intermediate during HFCS consumption (25%: 4.68 mmol/Lx24h 95% CI [-0.18 to 9.55], P = 0.066 versus aspartame) and lowest during glucose consumption. In contrast, the increase of LDL-C was highest during HFCS consumption (25%: 0.46 mmol/L 95% CI [0.16 to 0.77], P = 0.0002 versus aspartame) and intermediate during fructose consumption (25%: 0.33 mmol/L 95% CI [0.03 to 0.63], P = 0.023 versus aspartame), as was the increase of apoB (HFCS-25%: 0.108 g/L 95%CI [0.032 to 0.184], P = 0.001; fructose 25%: 0.072 g/L 95%CI [-0.004 to 0.148], P = 0.074 versus aspartame). The post hoc analyses showed significant interactive effects of fructose*glucose on LDL-C and apoB (both P < 0.01), but not on 24-h triglyceride (P = 0.340).

CONCLUSION

A significant interaction between fructose and glucose contributed to increases of lipoprotein risk factors when the two monosaccharides were co-ingested as HFCS. Thus, the effects of HFCS on lipoprotein risks factors are not solely mediated by the fructose content and it cannot be assumed that glucose is a benign component of HFCS. Our findings suggest that HFCS may be as harmful as isocaloric amounts of pure fructose and provide further support for the urgency to implement strategies to limit free sugar consumption.

Canadian Adults with Moderate Intakes of Total Sugars have Greater Intakes of Fibre and Key Micronutrients: Results from the Canadian Community Health Survey 2015 Public Use Microdata File

Background: Global dietary guidelines recommend reducing free sugars intake, which may affect choices of sugars-containing foods, including important sources of key micronutrients. The purpose of the study was to compare the intakes of nutrients stratified by intakes of sugars in Canadian adults. Methods: The first-day 24-h dietary recalls from adults (n = 11,817) in the 2015 Canadian Community Health Survey-Nutrition were used to compare macronutrients, micronutrients and food categories across quintiles of total sugars [by %energy (%E)], adjusted for misreporting status and covariates. Results: Canadian adults consumed on average 86.9 g/day (18.8 %E) from total sugars and 47.5 g/day (9.9 %E) from free sugars. Mean intakes for the 1st (Q1), 3rd (Q3) and 5th (Q5) quintiles of total sugars were 7.9%E, 18.3%E and 33.3%E, respectively. Q3 had higher fibre, calcium, vitamin D, vitamin A, vitamin C and potassium intakes than Q1 (p < 0.001), reflecting higher fruit, milk and yogurt (p < 0.001) consumption. Compared to Q5, Q3 had higher intakes of folate, vitamin B12, iron and zinc. Conclusion: This study provides the first detailed analyses of Canadian adults' macro- and micro-nutrient intakes stratified by different intakes of total sugars. Moderate intakes of total sugars may result in greater intakes of fibre and micronutrients. Overall nutrient intake should be considered when making food choices.

Dietary Fructose and the Metabolic Syndrome

Consumption of fructose, the sweetest of all naturally occurring carbohydrates, has increased dramatically in the last 40 years and is today commonly used commercially in soft drinks, juice, and baked goods. These products comprise a large proportion of the modern diet, in particular in children, adolescents, and young adults. A large body of evidence associate consumption of fructose and other sugar-sweetened beverages with insulin resistance, intrahepatic lipid accumulation, and hypertriglyceridemia. In the long term, these risk factors may contribute to the development of type 2 diabetes and cardiovascular diseases. Fructose is absorbed in the small intestine and metabolized in the liver where it stimulates fructolysis, glycolysis, lipogenesis, and glucose production. This may result in hypertriglyceridemia and fatty liver. Therefore, understanding the mechanisms underlying intestinal and hepatic fructose metabolism is important. Here we review recent evidence linking excessive fructose consumption to health risk markers and development of components of the Metabolic Syndrome.

Biomarker approaches to assessing intakes and health impacts of sweeteners: challenges and opportunities

The term 'sweeteners' encompasses both nutritive and non-nutritive sweeteners, which when added to food/beverages, can enhance the flavour and other functional properties of food/beverage products. This review considers how dietary biomarker approaches may enhance current understanding of nutritive sweetener (namely free sugars) and non-nutritive or low-energy sweetener (LES) intakes and how these may impact health. Recent public health strategies to reduce free sugar consumption will help contribute to challenging sugar intake targets. Robust evaluation is needed to determine the effectiveness of these approaches to reducing free sugar consumption. LES provides a sweet taste without the addition of appreciable energy and can help maintain the palatability of reformulated products. All LES undergo rigorous safety evaluations prior to approval for use. Whilst intervention data suggest LES can be beneficial for health (relating to weight status and glycaemic control), debate persists on their use and findings from population-based research are mixed, in part because of potential contributing factors such as reverse causality. Additionally, assessments often consider only certain sources of LES (e.g. LES-beverages) and/or LES as a homogeneous group despite differing biological fates, thus not adequately capturing intakes of individual LES or allowing for reliable estimation of overall intakes. Urinary biomarker approaches developed/investigated for sweetener consumption have the potential to overcome existing limitations of dietary data by providing more objective intake data, thereby enhancing population-based research. In conclusion, such biomarker approaches to the concomitant study of free sugars and LES intakes are timely and represent interesting developments in an area of significant public health interest.