Nutritive/non-nutritive sweeteners and high fat diet contribute to dysregulation of sweet taste receptors and metabolic derangements in oral, intestinal and central nervous tissues

OBJECTIVES

Overconsumption of non-nutritive sweeteners is associated with obesity, whereas the underlying mechanisms remain controversial. This study aimed to investigate the effects of long-term consumption of nutritive or non-nutritive sweeteners with or without high fat diet on sweet taste receptor expression in nutrient-sensing tissues and energy regulation dependent on sweet-sensing.

METHODS

50 Male Sprague-Dawley rats (140-160 g) were assigned to 10 groups (n = 5/group). All received fructose at 2.5% or 10%, sucralose at 0.01% or 0.015% or water with a normal chow diet or high fat diet for 12 weeks. Food and drink intake were monitored daily. Oral glucose tolerance test and intraperitoneal glucose tolerance test were performed at week 10 and 11 respectively. Serum was obtained for measurement of biochemical parameters. Tongue, duodenum, jejunum, ileum, colon and hypothalamus were rapidly removed to assess gene expression.

RESULTS

Long-term consumption of sweeteners impaired glucose tolerance, increased calorie intake and body weight. A significant upregulation of sweet taste receptor expression was observed in all the four intestinal segments in groups fed 0.01% sucralose or 0.015% sucralose, most strikingly in the ileum, accompanied by elevated serum glucagon-like peptide-1 levels and up-regulated expression of sodium-dependent glucose cotransporter 1 and glucose transporter 2. A significant down-regulation in the tongue and hypothalamus was observed in groups fed 10% fructose or 0.015% sucralose, with alterations in hypothalamic appetite signals. The presence of high fat diet differentially modulates sweet taste perception in nutrient-sensing tissues.

CONCLUSIONS

Long-term consumption of whether nutritive sweeteners or non-nutritive sweeteners combined with high fat diet contribute to dysregulation of sweet taste receptor expression in oral, intestinal and central nervous tissues.

Is the Consumption of Added Sugar from Common Beverages Associated with the Presence of Attention Deficit Hyperactivity Disorder Symptoms in Thai Medical Students?

Attention deficit hyperactivity disorder (ADHD) significantly affects the well-being of medical students in various aspects. Sugar-sweetened beverages (SSBs) pose a potential risk of ADHD. Our study aimed to determine the prevalence of ADHD symptoms and the association between consumption of added sugar in common beverages and ADHD symptoms in Thai medical students. An online cross-sectional survey was conducted among medical students at Chiang Mai University from May 2022 to April 2023. The consumption of added sugar from common beverages in Thailand was assessed using the Thai Adolescence Sugar Sweetened Beverage Intake (THASSI) questionnaire. An Adult ADHD Self-Report Scale (ASRS) score ≥ 3 identified the presence of ADHD symptoms. Multivariable logistic regression was used for the analysis. Of 441 participants, 29.9% had ADHD symptoms. Daily consumption of added sugar from beverages higher than 25 g/day showed an increased risk of ADHD symptoms (adjusted odds ratio (OR) 1.80, 95%CI 1.15 to 2.84, p = 0.011). The same trend was observed when using the sex-specific cutoff points (adjusted OR 1.73, 95%CI 1.10 to 2.73, p = 0.018). Higher consumption of added sugar from beverages may increase the risk of ADHD symptoms in Thai medical students. This finding supports the implementation of health policies that promote healthy consumption behaviors among medical students.

Food and beverage consumption and food addiction among women in the Nurses' Health Studies

BACKGROUND AND AIMS

Previous studies have not addressed a fundamental component of a food addiction disorder: the compulsive relationship between eating and potentially positively reinforcing foods. We aimed to evaluate the association between food consumption and food addiction.

METHODS

We conducted cross-sectional analyses merging data from the Nurses' Health Study (n = 58,625) and Nurses' Health Study II (n = 65,063), two prospective cohort studies of female nurses in the United States. Diet was assessed in 2006-2007 using a food frequency questionnaire, and food addiction was assessed in 2008-2009 using the Modified Yale Food Addiction Scale.

RESULTS

The prevalence of food addiction was 5.4%. The odds of food addiction were strongest among nurses consuming 5+ servings/week (compared with <1 serving/month) of hamburgers (multivariable odds ratio (MVOR) 4.08; 95% CI, 2.66-6.25), French fries (MVOR, 2.37; 95% CI, 1.59-3.51) and pizza (MVOR, 2.49; 95% CI, 1.67-3.69). Consumption of red/processed meat, low/no fat snacks/desserts, and low calorie beverages was positively associated with food addiction, while consumption of refined grains, sugar-sweetened beverages and fruits, vegetables, and legumes was inversely associated with food addiction.

CONCLUSIONS

This epidemiologic study was the largest to examine food consumption and food addiction. Food addiction was positively associated with consumption of many hypothesized positively reinforcing foods that include a combination of carbohydrates and fats such as snacks, "fast foods," and candy bars. However, it was inversely or not associated with certain sweet foods, refined grains, and sugar-sweetened beverages, which is consistent with literature suggesting that carbohydrates (without other ingredients) are less associated with food addiction. Longitudinal analyses will help untangle the temporal order between food consumption and food addiction, as some relationships in our analyses were difficult to interpret due to the cross-sectional design.

Sugar-sweetened carbonated beverage consumption and coronary artery calcification in asymptomatic men and women

BACKGROUND

Sugar-sweetened carbonated beverage consumption has been linked to obesity, metabolic syndrome, type 2 diabetes, and clinically manifest coronary heart disease, but its association with subclinical coronary heart disease remains unclear. We investigated the relationship between sugar-sweetened carbonated beverage consumption and coronary artery calcium (CAC) in a large study of asymptomatic men and women.

METHODS

This was a cross-sectional study of 22,210 adult men and women who underwent a comprehensive health screening examination between 2011 and 2013 (median age 40 years). Sugar-sweetened carbonated beverage consumption was assessed using a validated food frequency questionnaire, and CAC was measured by cardiac computed tomography. Multivariable-adjusted CAC score ratios and 95% CIs were estimated from robust Tobit regression models for the natural logarithm (CAC score +1).

RESULTS

The prevalence of detectable CAC (CAC score >0) was 11.7% (n = 2,604). After adjustment for age; sex; center; year of screening examination; education level; physical activity; smoking; alcohol intake; family history of cardiovascular disease; history of hypertension; history of hypercholesterolemia; and intake of total energy, fruits, vegetables, and red and processed meats, only the highest category of sugar-sweetened carbonated beverage consumption was associated with an increased CAC score compared with the lowest consumption category. The multivariable-adjusted CAC ratio comparing participants who consumed ≥5 sugar-sweetened carbonated beverages per week with nondrinkers was 1.70 (95% CI, 1.03-2.81). This association did not differ by clinical subgroup, including participants at low cardiovascular risk.

CONCLUSION

Our findings suggest that high levels of sugar-sweetened carbonated beverage consumption are associated with a higher prevalence and degree of CAC in asymptomatic adults without a history of cardiovascular disease, cancer, or diabetes.

Differences in energy balance-related behaviours in European preschool children: the ToyBox-study

BACKGROUND

The aim of the current study was to compare levels of energy balance-related behaviours (physical activity, sedentary behaviour, and dietary behaviours (more specifically water consumption, sugar-sweetened beverage consumption and unhealthy snacking)) in four- to six-year-old preschoolers from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, and Spain) within the ToyBox cross-sectional study.

METHODS

A sample of 4,045 preschoolers (4.77 ± 0.43 years; 52.2% boys) had valid physical activity data (steps per day), parents of 8,117 preschoolers (4.78 ± 0.46 years; 53.0% boys) completed a parental questionnaire with questions on sedentary behaviours (television viewing, computer use, and quiet play), and parents of 7,244 preschoolers (4.77 ± 0.44 years; 52.0% boys) completed a food frequency questionnaire with questions on water consumption, sugar-sweetened beverage consumption and unhealthy snacking.

RESULTS

The highest levels of physical activity were found in Spain (12,669 steps/day on weekdays), while the lowest levels were found in Bulgaria and Greece (9,777 and 9,656 steps/day on weekdays, respectively). German preschoolers spent the least amount of time in television viewing (43.3 min/day on weekdays), while Greek preschoolers spent the most time in television viewing (88.5 min/day on weekdays). A considerable amount of time was spent in quiet play in all countries, with the highest levels in Poland (104.9 min/day on weekdays), and the lowest levels in Spain (60.4 min/day on weekdays). Belgian, German, and Polish preschoolers had the lowest intakes of water and the highest intakes of sugar-sweetened beverages. The intake of snacks was the highest in Belgian preschoolers (73.1 g/day) and the lowest in Greek preschoolers (53.3 g/day).

CONCLUSIONS

Across six European countries, differences in preschoolers' energy balance-related behaviours were found. Future interventions should target European preschoolers' energy balance-related behaviours simultaneously, but should apply country-specific adaptations.

Nonnutritive sweeteners are not supernormal stimuli

BACKGROUND

It is often claimed that nonnutritive sweeteners (NNS) are 'sweeter than sugar', with the implicit implication that high-potency sweeteners are supernormal stimuli that encourage exaggerated responses. This study aimed to investigate the perceived sweetness intensity of a variety of nutritive sweeteners (sucrose, maple syrup and agave nectar) and NNS (acesulfame-K (AceK), rebaudioside A (RebA), aspartame and sucralose) in a large cohort of untrained participants using contemporary psychophysical methods.

METHODS

Participants (n=401 total) rated the intensity of sweet, bitter and metallic sensations for nutritive sweeteners and NNS in water using the general labeled magnitude scale.

RESULTS

Sigmoidal dose-response functions were observed for all stimuli except AceK. That is, sucrose follows a sigmoidal function if the data are not artifactually linearized via prior training. More critically, there is no evidence that NNS have a maximal sweetness (intensity) greater than sucrose; indeed, the maximal sweetness for AceK, RebA and sucralose were significantly lower than that for concentrated sucrose. For these sweeteners, mixture suppression due to endogenous dose-dependent bitter or metallic sensations appears to limit maximal perceived sweetness.

CONCLUSIONS

In terms of perceived sweetness, NNS cannot be considered supernormal stimuli. These data do not support the view that NNS hijack or overstimulate sweet receptors to produce elevated sweet sensations.

Blending better beverage options: a nutrition education and experiential workshop for youths

OBJECTIVE

To reduce intake of sugar-sweetened beverages (SSBs) in youths as a means to reduce obesity risk.

METHODS

Youths 5-14 years old attending a summer program were given a two-hour workshop addressing the sugar content in SSBs, the health risks from drinking SSBs, and hands-on preparation as well as tastings of low-sugar beverage alternatives. Data on usual intake of SSBs was obtained at baseline, and pre- and postprogram surveys were conducted to gauge change in knowledge and/or attitudes regarding SSBs.

RESULTS

There were 128 participants (63% male) in the program. SSBs were commonly consumed with over 80% reporting regular consumption (mean daily intake 17.9 ounces). Significant increase in knowledge regarding the sugar content of commonly consumed SSBs was achieved; however change in attitudes was not significant. The large majority of youths reported enjoying the workshop and intention to reduce intake of SSBs following program participation.

CONCLUSION

SSBs are commonly consumed by youths. Knowledge regarding the sugar content of SSBs is easier to impart to youths than influencing attitudes held about these beverages. Long-term interventions that reach out to parents and address the widespread availability of SSBs are needed to influence resistant attitudes and beverage choosing behaviors in youths.

Parents' obesity-related behavior and confidence to support behavioral change in their obese child: data from the STAR study

OBJECTIVE

Successful childhood obesity interventions frequently focus on behavioral modification and involve parents or family members. Parental confidence in supporting behavior change may be an element of successful family-based prevention efforts. We aimed to determine whether parents' own obesity-related behaviors were related to their confidence in supporting their child's achievement of obesity-related behavioral goals.

METHODS

Cross-sectional analyses of data collected at baseline of a randomized control trial testing a treatment intervention for obese children (n = 787) in primary care settings (n = 14). Five obesity-related behaviors (physical activity, screen time, sugar-sweetened beverage, sleep duration, fast food) were self-reported by parents for themselves and their child. Behaviors were dichotomized on the basis of achievement of behavioral goals. Five confidence questions asked how confident the parent was in helping their child achieve each goal. Logistic regression modeling high confidence was conducted with goal achievement and demographics as independent variables.

RESULTS

Parents achieving physical activity or sleep duration goals were significantly more likely to be highly confident in supporting their child's achievement of those goals (physical activity, odds ratio 1.76; 95% confidence interval 1.19-2.60; sleep, odds ratio 1.74; 95% confidence interval 1.09-2.79) independent of sociodemographic variables and child's current behavior. Parental achievements of TV watching and fast food goals were also associated with confidence, but significance was attenuated after child's behavior was included in models.

CONCLUSIONS

Parents' own obesity-related behaviors are factors that may affect their confidence to support their child's behavior change. Providers seeking to prevent childhood obesity should address parent/family behaviors as part of their obesity prevention strategies.

Talking health, a pragmatic randomized-controlled health literacy trial targeting sugar-sweetened beverage consumption among adults: rationale, design & methods

High consumption of sugar-sweetened beverages (SSB) contributes to a wide range of poor health outcomes. Further, few US adults drink less than the recommended ≤8 oz per day; and individuals with low socioeconomic, low health literacy status, and in rural areas are even less likely to meet recommendations. Unfortunately, few SSB behavioral interventions exist targeting adults, and none focus on low health literacy in rural areas. Talking Health, a type 1 effectiveness-implementation hybrid trial targeting adults in rural southwest Virginia, was developed using the RE-AIM planning and evaluation framework (reach, effectiveness, adoption, implementation, maintenance). The primary aim of this pragmatic randomized-controlled trial was to determine the effectiveness of a scalable 6-month intervention aimed at decreasing SSB consumption (SIPsmartER) when compared to a matched contact physical activity promotion control group (MoveMore). SIPsmartER was developed based upon the Theory of Planned Behavior and uses health literacy strategies to improve comprehension of the intervention content among participants. MoveMore is based on a research-tested intervention that was adapted to address all theory of planned behavior constructs and health literacy principles. Secondary aims include additional health outcomes (e.g., physical activity, weight) and reach, adoption, implementation, and maintenance indicators. This paper highlights the opportunities and considerations for developing health behavior trials that aim to determine intervention effectiveness, provide all study participants an opportunity to benefit from research participation, and collect key information on reach and the potential for organizational adoption, implementation, and maintenance with the longer-term goal of speeding translation into practice settings.