Daily Early-Life Exposures to Diet Soda and Aspartame Are Associated with Autism in Males: A Case-Control Study

Since its introduction, aspartame-the leading sweetener in U.S. diet sodas (DS)-has been reported to cause neurological problems in some users. In prospective studies, the offspring of mothers who consumed diet sodas/beverages (DSB) daily during pregnancy experienced increased health problems. We hypothesized that gestational/early-life exposure to ≥1 DS/day (DSearly) or equivalent aspartame (ASPearly: ≥177 mg/day) increases autism risk. The case-control Autism Tooth Fairy Study obtained retrospective dietary recalls for DSB and aspartame consumption during pregnancy/breastfeeding from the mothers of 235 offspring with autism spectrum disorder (ASD: cases) and 121 neurotypically developing offspring (controls). The exposure odds ratios (ORs) for DSearly and ASPearly were computed for autism, ASD, and the non-regressive conditions of each. Among males, the DSearly odds were tripled for autism (OR = 3.1; 95% CI: 1.02, 9.7) and non-regressive autism (OR = 3.5; 95% CI: 1.1, 11.1); the ASPearly odds were even higher: OR = 3.4 (95% CI: 1.1, 10.4) and 3.7 (95% CI: 1.2, 11.8), respectively (p < 0.05 for each). The ORs for non-regressive ASD in males were almost tripled but were not statistically significant: DSearly OR = 2.7 (95% CI: 0.9, 8.4); ASPearly OR = 2.9 (95% CI: 0.9, 8.8). No statistically significant associations were found in females. Our findings contribute to the growing literature raising concerns about potential offspring harm from maternal DSB/aspartame intake in pregnancy.

Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES)

Recent studies using data from the National Health and Nutrition Examination Survey (NHANES) have used inconsistent approaches to identify and categorize beverages, especially those containing low-calorie sweeteners (LCS), also referred to as low-calorie sweetened beverages (LCSBs). Herein, we investigate the approaches used to identify and categorize LCSBs in recent analyses of NHANES data. We reviewed published studies examining LCS consumption in relation to dietary and health outcomes and extracted the methods used to categorize LCS as reported by the authors of each study. We then examined the extent to which these approaches reliably identified LCSBs using the Internet Archive Wayback Machine to examine beverage ingredients lists across three NHANES cycles (2011–2016). None of the four general strategies used appeared to include all LCSBs while also excluding all beverages that did not contain LCS. In some cases, the type of sweetener in the beverage consumed could not be clearly determined; we found 9, 16, and 18 of such “mixed” beverage identifiers in the periods 2011–2012, 2013–2014, and 2015–2016, respectively. Then, to illustrate how heterogeneity in beverage categorization may impact the outcomes of published analyses, we compared results of a previously published analysis with outcomes when “mixed” beverages were grouped either all as LCSBs or all as sugary beverages. Our results suggest that caution is warranted in design and interpretation of studies using NHANES data to examine dietary and health correlates of sweetened beverage intake.

Perspective: Chaos in a Bottle-A Critical Evaluation of Beverage Categorization in Nutrition Research

Beverage consumption is an important contributor to total daily calorie intake among children and adolescents. While associations between excess calories from beverages and development of obesity are well established, a standardized approach for beverage categorization does not exist. As a result, there is marked heterogeneity in assessment and categorization of beverage intake across studies. The purpose of this article is to critically review beverage categorization in recent (published since 2010) observational studies that evaluated beverage intake in relation to weight/adiposity in US youth, and to put forth an initial proposal for a standardized beverage classification system. Standardized beverage classification is critical to ensure transparency in nutrition science research and facilitate comparison of findings across studies. A systematic literature search identified 37 eligible studies, across which beverage categorization varied considerably. The most heterogeneity was observed for categorization of "sugar-sweetened beverages" and the greatest consistency was observed for categorization of 100% juices. This review provides an evidence-based starting point for urgently needed, collaborative work to determine priorities for beverage categorization and leverage existing standards of identity in order to create and disseminate a standardized beverage classification system. A standardized approach will inform meaningful assessment of beverage consumption in research studies and facilitate impactful translation of research findings into public health nutrition policy.

Consumption of low-calorie sweetened beverages is associated with higher total energy and sugar intake among children, NHANES 2011-2016

OBJECTIVE

To examine associations between consumption of low-calorie sweetened beverages (LCSBs), sugar, and total energy intake in children in the United States.

METHODS

We used 24-hour dietary recalls from 7026 children enrolled in the National Health and Nutrition Examination Survey (NHANES) 2011 to 2016 to assess energy and macronutrient intake among LCSB (≥4 oz LCSB, <4 oz SB), SB (≥4 oz SB, <4 oz LCSB), and LCSB + SB consumers (≥4 oz each) compared with water consumers (≥4 oz water, <4 oz LCSB and SBs). Sample weights and complex survey procedures were used for all analyses.

RESULTS

Adjusting for body mass index (BMI) percentile, LCSB, SB, and LCSB + SB consumption was associated with 196, 312, and 450 more total calories and 15, 39, and 46 more grams of added sugar, which amounts to 60, 156, 184 more calories from added sugar, compared with water consumers (P < .05 for all pairwise comparisons). No differences in energy intake were observed between LCSB and SB consumers. [Correction added on 28 May 2019, after first online publication: In the preceding sentence, quantities of added sugar reported are in grams. The corresponding calories have also been specified in this version.] CONCLUSIONS: These findings challenge the utility of LCSB for weight management in children and adolescents.

Low-calorie sweetener use, weight, and metabolic health among children: A mini-review

A reduction in the consumption of added sugars and sugar-sweetened beverages (SSBs) is a key focus of public health recommendations for a healthy diet among children. One approach to lower added sugar intake is to instead use low-calorie sweeteners (LCSs), which contain no or few calories. Consumption of LCSs is increasing worldwide, with the most marked rise observed among children and adolescents. However, the extent to which LCS consumption is helpful or harmful for weight management is controversial, particularly when LCS consumption begins in childhood. Herein, we summarize the limited existing literature examining effects of paediatric LCS consumption on appetite, energy intake, and body weight. While positive associations between LCS consumption and weight gain are reported in observational analyses, the majority of intervention studies, some of which blinded children to the contents of the drinks, report benefits of LCSs for reducing excessive child weight gain. Several potential mechanisms have been proposed to explain LCS effects on body weight, including LCS-induced promotion of appetite and energy intake. Yet studies assessing effects of beverages with LCSs (LCSBs) compared with SSBs on child appetite report mixed findings. Some demonstrate that children completely compensate for the diluted energy content of LCSBs by eating more solid food calories at subsequent meals compared with children administered SSBs, while others report a reduction in total energy intake with LCSB ingestion. Given the limited studies and resulting uncertainty as to whether LCSs benefit or worsen weight and metabolic health in children is integral that effects of LCS use during childhood continue to be investigated in future prospective studies.

Nonnutritive Sweeteners in Weight Management and Chronic Disease: A Review

OBJECTIVE

The objective of this review was to critically review findings from recent studies evaluating the effects of nonnutritive sweeteners (NNSs) on metabolism, weight, and obesity-related chronic diseases. Biologic mechanisms that may explain NNS effects will also be addressed.

METHODS

A comprehensive review of the relevant scientific literature was conducted.

RESULTS

Most cross-sectional and prospective cohort studies report positive associations between NNS consumption, body weight, and health conditions, including type 2 diabetes, cardiovascular disease, and nonalcoholic fatty liver disease. Although findings in cellular and rodent models suggest that NNSs have harmful effects on metabolic health, most randomized controlled trials in humans demonstrate marginal benefits of NNS use on body weight, with little data available on other metabolic outcomes.

CONCLUSIONS

NNS consumption is associated with higher body weight and metabolic disease in observational studies. In contrast, randomized controlled trials demonstrate that NNSs may support weight loss, particularly when used alongside behavioral weight loss support. Additional long-term, well-controlled intervention studies in humans are needed to determine the effects of NNSs on weight, adiposity, and chronic disease under free-living conditions.

Sweetened beverage intake in association to energy and sugar consumption and cardiometabolic markers in children

BACKGROUND

Artificially sweetened beverages (ASBs) are promoted as healthy alternatives to sugar-sweetened beverages (SSBs) in order to reduce sugar intake, but their effects on weight control and glycaemia have been debated. This study examines associations of SSBs and ASBs with energy and sugar intake and cardiometabolic measures.

METHODS

One thousand six hundred eighty-seven children aged 4-18 participated in the National Diet and Nutrition Survey Rolling Programme (2008/9-2011/12) in the UK. Linear regression was used to examine associations between SSBs and ASBs and energy and sugar, overall and from solid foods and beverages, and body mass index, waist-to-hip ratio and blood analytes. Fixed effects linear regression examined within-person associations with energy and sugar.

RESULTS

Compared with non-consumption, SSB consumption was associated with higher sugar intake overall (6.1%; 4.2, 8.1) and ASB consumption with higher sugar intake from solid foods (1.7%; 0.5, 2.9) but not overall, mainly among boys. On SSB consumption days, energy and sugar intakes were higher (216 kcal; 163, 269 and 7.0%; 6.2, 7.8), and on ASB consumption days, sugar intake was lower (-1.0%; -1.8, -0.1) compared with those on non-consumption days. SSB and ASB intakes were associated with higher levels of blood glucose (SSB: 0.30 mmol L^-1 ; 0.11, 0.49 and ASB: 0.24 mmol L^-1 ; 0.06, 0.43) and SSB intake with higher triglycerides (0.29 mmol L^-1 ; 0.13, 0.46). No associations were found with other outcomes.

CONCLUSION

Sugar-sweetened beverage intake was associated with higher sugar intake and both SSBs and ASBs with a less healthy cardiometabolic profile. These findings add to evidence that health policy should discourage all sweetened beverage consumption.

Beneficial effects of replacing diet beverages with water on type 2 diabetic obese women following a hypo-energetic diet: A randomized, 24-week clinical trial

AIMS

To compare the effect of replacing diet beverages (DBs) with water or continuing to drink DBs in patients with type 2 diabetes during a 24-week weight loss program. The primary endpoint was the effect of intervention on weight over a 24-week period. The main secondary endpoints included anthropometric measurement and glucose and fat metabolism during the 24-week period.

METHODS

A total of 81 overweight and obese women with type 2 diabetes, who usually consumed DBs in their diet, were asked to either substitute water for DBs or continue drinking DBs five times per week after lunch for 24 weeks (DBs group) during a weight loss program.

RESULTS

Compared with the DBs group, the water group had a greater decrease in weight (water, -6.40 ± 2.42 kg; DBs, -5.25 ± 1.60 kg; P = .006), in BMI (water, -2.49 ± 0.92 kg/m² ; DBs, -2.06 ± 0.62 kg/m² ; P = .006), in FPG (water, -1.63 ± 0.54 mmol/L; DBs, -1.29 ± 0.48 mmol/L, P = .005), in fasting insulin (water, -5.71 ± 2.30 m lU/mL; DBs, -4.16 ± 1.74 m lU/mL, P = .011), in HOMA IR (water, -3.20 ± 1.17; DBs, -2.48 ± 0.99, P = 003) and in 2 hour postprandial glucose (water, -1.67 ± 0.62 mmol/L; DBs, -1.35 ± 0.39 mmol/L; P = 0.027) over the 24-week period. However, there was no significant time × group interaction for waist circumference, lipid profiles and HbA1c within both groups over the 24-week period.

CONCLUSION

Replacement of DBs with water after the main meal in obese adult women with type 2 diabetes may lead to more weight reduction during a weight loss program.

Effects on weight loss in adults of replacing diet beverages with water during a hypoenergetic diet: a randomized, 24-wk clinical trial

BACKGROUND

Obese people believe that drinking diet beverages (DBs) may be a simple strategy to achieve weight loss. However, nutritionists advise drinking water when attempting to lose weight. It is unclear how important drinking water instead of DBs is during a weight-loss program.

OBJECTIVE

In this study, we compared the effect on weight loss of either replacing DBs with water or continuing to consume DBs in adults during a 24-wk weight-loss program.

DESIGN

Overweight and obese women [n = 89; body mass index (BMI; in kg/m(2)): 27-40; age: 18-50 y] who usually consumed DBs in their diet were asked to either substitute water for DBs (water group) or continue drinking DBs 5 times/wk after their lunch for 24 wk (DB group) while on a weight-loss program.

RESULTS

Sixty-two participants (71%) completed the trial (32 in the DB group, 30 in the water group). Baseline variables were not statistically significantly different between groups. A statistically significant reduction in anthropometric measurements and statistically significant improvements in cardiometabolic risk characteristics were observed over 24 wk in both groups. Compared with the DB group, the water group had a greater decrease in weight (mean ± SD: water: -8.8 ± 1.9 kg; DBs: -7.6 ± 2.1 kg; P = 0.015, time × group), fasting insulin (mean ± SD: water: -2.84 ± 0.77 mU/L; DBs: -1.78 ± 1.25 mU/L, P < 0.001), homeostasis model assessment of insulin resistance (mean ± SD: water: -0.097 ± 0.049; DBs: -0.057 ± 0.042, P < 0.001), and 2-h postprandial glucose (mean ± SD: water: -1.02 ± 0.25 mmol/L; DBs: -0.72 ± 0.27 mmol/L; P < 0.001) over the 24 wk. However, there was no significant time × group interaction for waist circumference, fasting plasma glucose, and lipid profiles within both groups over 24 wk.

CONCLUSIONS

Replacement of DBs with water after the main meal may lead to greater weight reduction during a weight-loss program. It may also offer clinical benefits to improve insulin resistance. This trial was registered at www.irct.ir/ as IRCT201402177754N5.