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Fueling the Obesity Epidemic? Artificially Sweetened Beverage Use and Long-term Weight Gain
Abstract
We have examined the relationship between artificially sweetened beverage (ASB) consumption and long-term weight gain in the San Antonio Heart Study. From 1979 to 1988, height, weight, and ASB consumption were measured among 5,158 adult residents of San Antonio, Texas. Seven to eight years later, 3,682 participants (74% of survivors) were re-examined. Outcome measures were incidence of overweight/obesity (OW/OB(inc)) and obesity (OB(inc)) (BMI > or = 25 and > or = 30 kg/m(2), respectively), and BMI change by follow-up (DeltaBMI, kg/m(2)). A significant positive dose-response relationship emerged between baseline ASB consumption and all outcome measures, adjusted for baseline BMI and demographic/behavioral characteristics. Consuming >21 ASBs/week (vs. none) was associated with almost-doubled risk of OW/OB (odds ratio (OR) = 1.93, P = 0.007) among 1,250 baseline normal-weight (NW) individuals, and doubled risk of obesity (OR = 2.03, P = 0.0005) among 2,571 individuals with baseline BMIs <30 kg/m(2). Compared with nonusers (+1.01 kg/m(2)), DeltaBMIs were significantly higher for ASB quartiles 2-4: +1.46 (P = 0.003), +1.50 (P = 0.002), and +1.78 kg/m(2) (P < 0.0001), respectively. Overall, adjusted DeltaBMIs were 47% greater among artificial sweetener (AS) users than nonusers (+1.48 kg/m(2) vs. +1.01 kg/m(2), respectively, P < 0.0001). In separate analyses--stratified by gender; ethnicity; baseline weight category, dieting, or diabetes status; or exercise-change category--DeltaBMIs were consistently greater among AS users. These differences, though not significant among exercise increasers, or those with baseline diabetes or BMI >30 kg/m(2) (P = 0.069), were significant in all 13 remaining strata. These findings raise the question whether AS use might be fueling--rather than fighting--our escalating obesity epidemic.
... The association between LCS use and higher body weight, normally seen in crosssectional studies, has at times been taken to suggest that LCS use may lead to obesity, type 2 diabetes, and the metabolic syndrome [7][8][9][10]. Among proposed metabolic mechanisms were heightened response to sweet taste [11], impaired satiety and metabolic ...
... Among women aged >19 years, energy intakes of LCS consumers were also lower compared to LCS non consumers. For the 1999-2018 data, energy intakes for women aged >19 years were 1762 (12) for LCS consumers and 1817 (8) for nonconsumers. Importantly, LCS consumers had significantly lower intakes of added sugars than did nonconsumers. ...
... In past studies, we used retroactive 10-y weight history-another component of NHANES-to show that previously expressed desire to lose/control body weight was linked to higher LCS use [16]. That study counters the still-repeated arguments that LCS leads to weight gain and is a causal factor in the development of obesity [8,11,12]; assertions that were not confirmed in recent systematic reviews [34,35] It is important to note here that obesity is a recognized risk factor for many cancers that may be unrelated to LCS use. ...
Low-calorie sweeteners (LCS) serve to replace added sugars in beverages and foods. The present goal was to explore any potential links between LCS use and cancer risk using the nationally representative National Health and Nutrition Examination Surveys 1988–2018 linked to 2019 Public-Use Linked Mortality Files. Analyses were based on dietary intakes from 1988–1994 NHANES (n = 15,948) and 1999–2018 NHANES (n = 48,754) linked to mortality data. The 1988–1994 NHANES separated aspartame from saccharin consumption; later data did not. LCS consumers were more likely to be older, female, non-Hispanic White, and with higher education and incomes compared to nonconsumers. LCS consumers were less likely to smoke and had higher HEI-2015 scores indicating higher-quality diets. In the cross-sectional NHANES data, LCS use was associated with higher BMI and higher prevalence of obesity and diabetes. There was no indication that aspartame, saccharin, or all LCS had any impact on overall cancer mortality. By using nonconsumers as the reference group, the hazard ratio (95th confidence interval, CI) group trend for tertiles of LCS use for 1988–1994 for aspartame was 1.00 (0.89–1.12), for saccharin 0.96 (0.79–1.10), and for 1988–2018 for all LCS was 0.92 (0.88–1.101). The null group trend effects were seen for analyses stratified by age/gender. The present analyses confirm past US-based reports that LCS use was associated with higher socioeconomic status, lower prevalence of smoking, and generally higher-quality diets. No association with cancer mortality was observed.
... Interestingly, epidemiological data suggests otherwise. In the famous San Antonio Heart Study [33], 5158 subjects aged from 25-64 years in a prospective cohort were observed for a period of 7-8 years, and of these, 3682 completed the study. It was observed that the participants using artificial sweeteners had a significantly higher BMI across all categories (including gender, ethnicity, baseline weight, diabetes-exercise change). ...
... It was observed that the participants using artificial sweeteners had a significantly higher BMI across all categories (including gender, ethnicity, baseline weight, diabetes-exercise change). It was speculated that the use of artificial sweeteners may be fuelling the obesity epidemic, rather than decreasing it [33]. A similar increase in BMI with the use of artificial sweeteners has been observed on separate studies of women (n = 78,694), children (n = 11,654), and adolescent girls (n = 2371) over an eight-to-ten-year period [6]. ...
... Aspartate, a component of aspartame, is toxic to hypothalamic neurons, and may cause leptin resistance at high levels, leading to obesity [33]. In addition, most artificial sweeteners have restrictions on the amount and duration for which they can be used, due to various adverse effects. ...
Traditional medicine systems around the globe, like Unani, Ayurveda and traditional Chinese medicine, include a number of sugar-based formulations, which contain a large amount of saccharide-containing sweetener, such as honey, sucrose or jaggery. With pervasive lifestyle disorders throughout the world, there have been discussions to consider alternative sweetening agents. Here, from the perspective of Unani medicine, we discuss how the saccharide-based sweeteners may be an essential component of these traditional preparations, like electuaries, which may be deprived of their bioactivities without these saccharides. With contemporary researches, it is known that apart from their own therapeutic effects, saccharides also form deep eutectic solvents which help in enhancing the bioactivity of other ingredients present in crude drugs. In addition, they provide energy for fermentation which is essential for biotransformation of compounds. Interestingly, the sugars also increase the shelf-life of these compound drugs and act as natural preservatives. On the basis of this review, we strongly believe that saccharide-based sweeteners are an essential component of traditional medicines and not merely an excipient.
... (8,9) However, some long-term studies showed a positive doseresponse association between artificial sweetened beverages consumption with weight gain, incidence of type 2 diabetes, and incidence of CVDs. (10,11) These findings were proposed to relate to disturbances in the association between sweetness and energy intake. Normally, the sweet taste is thought to predict the caloric content of food. ...
... (8,9) However, their use coincides with the increase in the obesity and diabetes epidemics, and long-term studies associated them with weight gain and designated them as a factor fueling obesity. (11,12,(16)(17)(18)(19) Indeed, prolonged consumption of foods or fluids containing acesulfame-K or saccharin, in comparison to glucose, has led to an increase in food intake, body weight, and body fat accumulation in rats. (20,21) Our previous work further supported this notion, as both body weight Accepted manuscript and fat gains were found to be higher in rats consuming acesulfame-K as compared to sucrosesweetened water. ...
... (24) Our findings are in accordance with the numerous studies associating the long-term consumption of NCS with weight gain, further confirming the poor Accepted manuscript impact of NCS on body composition and metabolism. (11,12,(18)(19)(20)(21) Indeed, NCS were proposed to disrupt the caloric signal associated with sweetness, and thus its failure to provide calories may consequently enhance energy deposition through the triggering of the starvation mode, which is known to reduce energy expenditure and increase in energy efficiency. (12) NCS are actually recognized by the sweet taste receptors that are expressed throughout the body, they however do not seem to be associated with potent satiety signals. ...
The ingestion of non-caloric sweeteners from food and/or drink was intended to reduce caloric intake without compromising palatability. However, the inconclusive relation between non-caloric sweeteners and body weight may partially relate to their form of ingestion (solid or liquid). Thus, two paralleled experiments (Aspartame and Sucralose) were conducted. In each, Sprague Dawley rats (7-week-old male) were randomly divided into 4 groups. In experiment 1, aspartame (0.05%) was added to the diet (AD) or drinking water (AW) or both diet and water (ADW), and a control group (C) was given a non-sweetened diet with plain water. In experiment 2, sucralose (0.016%) was similarly provided in the diet (SD) or drinking water (SW) or both diet and water (SDW), with a control group (C). All rats had free access to food and water for 7 weeks. Energy intake, body weight, and body composition were monitored and blood metabolites were determined. Results showed that aspartame ingestion significantly increased body weight and fat mass mainly due to an increase in energy efficiency. The effect was related to the amount rather than the form of ingestion. Additionally, aspartame ingestion was associated with glucose intolerance. Sucralose ingestion had a similar impact to that of aspartame though to a lesser extent. In conclusion, 7-week ingestion of aspartame and sucralose had adverse effects on body measures that were not related to the form of ingestion.
... Although data in rodents and cellular assays suggest that low-calorie sweeteners cause weight gain through a loss of association between taste receptor activation, nutrient assimilation, and appetite (Renwick & Molinary, 2010), studies in humans fail to reproduce some of the adverse effects observed in animal studies. Several prospective cohort studies have not found a correlation between lowcalorie sweeteners and an increase in body weight (Miller & Perez, 2014, Rogers et al., 2016, whereas others have noted the opposite trend (Fowler et al. 2008, Lutsey, Steffen, & Stevens, 2008, Nettleton et al., 2009). Through a systematic search of the literature, Miller and Perez found 15 randomized controlled trials (RCTs) and nine prospective cohort studies that assess the impact of low-or no-calorie sweeteners on bodyweight, BMI, and waist circumference and found no association. ...
... In contrast, Fowler et al. (2008) found a positive dose-response relationship between longterm weight gain and artificially sweetened (AS) beverage consumption in an assessment of more than 3,000 participants. Participants were divided as either "no AS use" or "any AS use" based on self-reported artificial sweetener intake in soda, coffee, tea, sugar-sweetened drink, alco-holic beverages, and/or milk, with higher AS consumption in individuals who were dieting (Fowler et al., 2008). Another study also found an association between consumption of diet soda and risk of metabolic syndrome (Nettleton et al., 2009). ...
The global rise in obesity, type II diabetes, and other metabolic disorders in recent years has been attributed in part to the overconsumption of added sugars. Sugar reduction strategies often rely on synthetic and naturally occurring sweetening compounds to achieve their goals, with popular synthetic sweeteners including saccharin, cyclamate, acesulfame potassium, aspartame, sucralose, neotame, alitame, and advantame. Natural sweeteners can be further partitioned into nutritive, including polyols, rare sugars, honey, maple syrup, and agave, and nonnutritive, which include steviol glycosides and rebaudiosides, luo han guo (monk fruit), and thaumatin. We choose the foods we consume largely on their sensory properties, an area in which these sugar substitutes often fall short. Here, we discuss the most popular synthetic and natural sweeteners, with the goal of providing an understanding of differences in the sensory profiles of these sweeteners versus sucrose, that they are designed to replace, essential for the effectiveness of sugar reduction strategies. In addition, we break down the influence of these sweeteners on metabolism, and present results from a large survey of consumers' opinions on these sweeteners. Consumer interest in clean label foods has driven a move toward natural sweeteners; however, neither natural nor synthetic sweeteners are metabolically inert. Identifying sugar replacements that not only closely imitate the sensory profile of sucrose but also exert advantageous effects on body weight and metabolism is critical in successfully the ultimate goals of reducing added sugar in the average consumer's diet. With so many options for sucrose replacement available, consumer opinion and cost, which vary widely with suagr replacements, will also play a vital role in which sweeteners are successful in widespread adoption.
... There is some controversy around non-nutritive sweeteners and health outcomes, particularly with the more novel sweeteners such as sucralose and stevia. There are observational research findings showing associations between consumption and changes to the gut microbiome (43), weight gain (46), and an increased risk of type-two diabetes (47). In this study, there was found to be minimal difference between the inclusion of sweeteners and the accuracy of calculated energy content as per the NIP and it was observed that sweeteners were contained in most sports foods and in some cases multiple in one product. ...
Objective
To determine store availability, total number of products, and types of Formulated Supplementary Sports Foods in Australia, along with their stated nutrition content, sweeteners added, total number, and type of claims displayed on the packaging.
Design
A cross-sectional, visual product audit of mainstream retailers.
Setting
Supermarkets, pharmacies, health food stores, and gym/fitness centres.
Results
A total of 558 products were captured in the audit, 275 of which displayed the correct mandatory packaging attributes. Three categories of products were identified, based on the dominant nutrient. Only 184 products appeared to display the correct energy value based on the listed macronutrient content (protein, fat, carbohydrate, dietary fibre). The stated nutrient content was highly variable across all product subcategories. Nineteen different sweeteners were identified, with most foods containing only one (38.2%) or two (34.9%) types. The predominant sweetener was stevia glycosides. Packages displayed multiple claims, with a maximum of 67 and minimum of 2 claims. Nutrition content claims were most frequently displayed (on 98.5% of products). Claims included regulated, minimally regulated and marketing statements.
Conclusion
Sports food consumers should be provided with accurate and detailed on pack nutrition information, to ensure informed choices are made. However, this audit showed multiple products which did not conform to current standards, appeared to provide inaccurate nutrition information, contained multiple sweeteners, and displayed an overwhelming number of on-pack claims. The increase in sales, availability, and products available in mainstream retail environments, could be impacting both intended consumers (athletes), and general non-athlete population. The results indicate underperformance in manufacturing practices which preference marketing over quality and stronger regulatory approaches are needed to protect consumer health and safety, and to prevent misleading consumers.
... Second, it is an inherent problem of dietary studies that awareness of being on a dietary study, per se, may impact the outcome, and that choosing an adequate placebo is difficult. A placebo group receiving artificially sweetened beverages was not used in the study, as such non-caloric sweeteners potentially affect human metabolism (e.g., appetite control, weight and microbiome composition) [44,45]. For future studies, a water control might by an option to at least control for the volume provided. ...
Human fibroblast growth factor 21 (FGF21) is a multifaceted metabolic regulator considered to control sugar intake and to exert beneficial effects on glucose and lipid metabolism. Elevated serum FGF21 levels are associated with metabolic syndrome, suggesting a state of FGF21 resistance. Further, given the evidence of a hepatic ChREBP and FGF21 signaling axis, it can be assumed that SSBs containing fructose would possibly increase FGF21 concentrations. We investigated the effects of sugar-sweetened beverage (SSB) consumption on fasting FGF21 levels in healthy, lean men, discriminating the effects of glucose, fructose, and their disaccharide sucrose by secondary data analysis from a randomized controlled trial. Seven weeks of daily SSB consumption resulted in increased fasting FGF21 in healthy, lean men, irrespective of the sugar type. Medians of ΔFGF21 between post-SSB intervention values (week 7) and no-intervention period values (IQR) in pg/mL were: glucose 17.4 (0.4–45.8), fructose 22.9 (−8.6–35.1), and sucrose 13.7 (2.2–46.1). In contrast, this change in FGF21 concentration was only 6.3 (−20.1–26.9) pg/mL in the control group. The lack of a fructose-specific effect on FGF21 concentrations is contrary to our assumption. It is concluded that SSB intake may impact FGF21 concentrations and could contribute to the increased FGF21 concentrations observed in subjects suffering from metabolic syndrome that is possibly associated with decreased FGF21 responsiveness.
... However, the safety of these sweeteners has been contradictory issue and there is some concern about their health effects (Cao et al., 2020). Several previous studies reported that artificial sweetener consumption can be related to psychotic conditions (Lindseth et al., 2014), oxidative stress (Ashok et al., 2017), type 2 diabetes mellitus (De Koning et al., 2011), weight gain (Fowler et al., 2008), obesity (Fowler, 2016), metabolic syndrome (Lutsey et al., 2008), coronary heart disease (Fung et al., 2009) and even cancer (Soffritti et al., 2006). It has been determined that the frequent use of these additives is also a risk factor for higher-grade tumors (Sturgeon et al., 1994). ...
Acesulfame potassium (ACE-K) is an artificial sweetener widely used in many foods. This investigation assessed the cytotoxic effect of ACE-K using MTT assay in human hepatocellular carcinoma (HepG2) cell line and the genotoxic effect using chromosomal aberrations (CAs), micronucleus (MN), and comet assays in human lymphocytes. 7.5-240 μg/mL concentrations of ACE-K were applied to cells. ACE-K notably decreased the cell viability on HepG2 cells, especially at 120 and 240 μg/mL at 24 and 48 h. It also significantly reduced the mitotic index (MI) at 60, 120, and 240 μg/mL at both treatments (24 and 48 h) in human lymphocytes. The frequency of the CAs significantly increased at 60, 120, and 240 μg/mL for 48 h treatment compared to control. However, no difference was observed in the frequency of MN and nuclear division index (NDI) at all the treatments. ACE-K also induced comet tail length, tail intensity, and moment at 15 μg/mL in isolated human lymphocytes. Therefore, ACE-K showed a cytotoxic effect in HepG2 cells as well as human lymphocytes at higher concentrations. It also exhibits a mild genotoxic effect by increasing the frequency of CAs at long-term treatment and DNA damaging effect only at 15 μg/mL.
... The idea behind artificial sweeteners was originally to replace the sugar so that using these products would reduce caloric intake, result in weight loss and reduce diabetes mellitus' incidence [16]. However, existing research has shown that instead of reducing the risk of certain chronic diseases such as obesity, insulin resistance, or coronary artery disease, the use of artificial sweeteners even increases the likelihood of these diseases [47][48][49]. The results of our research demonstrated that artificial sweeteners' intake seemed not to increase the risk of overall cancer incidence and mortality. ...
Cancer has become a major challenge in the global disease burden. Artificial sweeteners are a class of chemical compounds that are used as food and beverage addition agent to replace sugar. However, the health effects of consuming artificial sweeteners are still unclear. This meta-analysis was performed to evaluate the role of artificial sweeteners on cancer. The databases PubMed, Cochrane Library, MEDLINE, Web of Science and EMBASE were searched up until July 2022. A Newcastle–Ottawa scale (NOS) was used to estimate the study quality. A total of 25 observational studies were included with a total of 3,739,775 subjects. The intake of artificial sweeteners had no apparent association with overall cancer incidence and mortality. However, in Europe, artificial sweeteners’ intake could increase the risk of cancer incidence (HR/RR = 1.07, 95% CI = [1.02, 1.12], I2 = 25.8%, P = 0.223), which appears to be related to a shift in nutritional behaviors in the countries. Significant results were also observed in subgroups with aspartame and a mixed intake of artificial sweeteners. Moreover, higher risk was observed for artificial sweeteners intake in all-cause mortality (HR/RR =1.13, 95% CI = [1.03, 1.25], I2 = 79.7%, p < 0.001) and a J-shaped association between them was found. More data from well-conducted studies and clinical trials are required.
... The effects of NNS consumption in relation to body weight management have been largely divided over the main findings and randomized controlled trials in humans are limited (50). Several observational studies have reported weight gain (17,51,52), conflicting reports of weight loss (34, 53, 54), or negligible effects on weight (50,55,56). A key drawback to many of these studies is determining directionality of the interactions as well as accurate estimates of NNS intake, as these observational studies do not demonstrate causality (44,57). ...
Non-nutritive sweeteners (NNS) are broadly incorporated into foods, especially those representing a growing share of the beverage market. NNS are viewed as a noncaloric and desirable alternative to sugar-based sweeteners and are thought to contribute to reducing overall caloric intake. While these compounds have been studied extensively and have long been considered inert, new research has presented a different view and raises new questions about the effects of NNS on human physiology. Namely, the influence on glucose responses, the gastrointestinal epithelium, and the gut microbiome. As the gut microbiome is now recognized as a major mediator of human health and perturbations to this community are generally associated with negative health trajectories or overt disease, interactions between NNS and the gut microbiome are of increasing interest to clinicians and researchers. Several NNS compounds are now hypothesized to affect human physiology by modulating the gut microbiome, though the mechanism for this action remains unclear. The purpose of this review is to discuss the history and current knowledge of NNS, their reported utility and effects on host physiology and the gut microbiome, and describes a model for investigating the underlying mechanism behind reported effects of NNS on the gut microbiome.
... Despite the expected benefits of NNS consumption, evidence from some animal studies suggests NNSs may be associated with adverse metabolic effects, including obesity and disruption of glycaemic homeostasis [11][12][13]. In contrast, works of others have concluded NNSs show limited or no metabolic effects in mice and rats [14][15][16]. ...
Reducing consumption of sugar-sweetened beverages (SSBs) has been encouraged due to its strong association with obesity. In parallel, consumption of “diet” or non-nutritive sweetened (NNS) beverages has significantly increased. This has led to burgeoning numbers of animal studies investigating metabolic consequences of NNS beverage consumption. However, most animal study designs do not reflect the way humans consume NNS drinks, thus reducing translational capacity. The present experiment aimed to find an ecologically valid model of NNS consumption and evidence of metabolic recovery following a switch from sucrose to NNS in female and male Sprague Dawley rats. The main behavioural outcome was consumption of commercially available NNS beverages during preference and acceptance testing, with changes to consumption following chronic sucrose consumption as a secondary outcome. The main metabolic outcome was retroperitoneal fat pad mass at culling, with body weight gain and fasting blood glucose levels (FBGLs) as secondary outcomes. In a two-phase experiment, behavioural tests were performed before and after 4 weeks of ad libitum access to 10% w/v sucrose. During Phase 2, the rats were given ad libitum access to assigned commercial NNS drinks for a further 4 weeks, with controls provided access to water only. FBGLs were measured at the end of Phases 1 and 2. Female and male rats accepted commercially available NNS beverages, although the volumes consumed varied considerably. Following the switch from sucrose to NNS (containing no sucrose), no group difference was observed in retroperitoneal fat mass, body weight change or FBGLs, suggesting both sexes exhibited limited metabolic recovery. These findings demonstrate that an ecologically valid model for NNS consumption can be developed for some commercially available NNS beverages to further enhance translational capacity.
... Despite the proposed health benefits of sugar substitute sweeteners, many studies have found associations between their consumption and the development of diseases and metabolic syndrome (7)(8)(9), some of which were initially intended to be prevented by the use of sugar substitute sweeteners. Sweeteners have been found by metagenomics to induce changes in the gut microbiome composition in animals and humans (10)(11)(12). ...
The human gut microbiome is closely related to human health. Sugar substitute sweeteners as commonly used food additives are increasingly consumed and have potential impacts on microbiome functionality.
... A total of 32 RCTs (22,23, and 13 prospective cohort studies (55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69) reporting on measures of adiposity were included in meta-analyses. Results for measures of adiposity are summarized in Table 2. ...
Non-sugar sweeteners have been developed as an alternative to sugars and are widely used both as an ingredient in pre-packaged foods and beverages and added to food and beverages directly by the consumer. Individual non-sugar sweeteners undergo toxicological assessment by the by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) and other authoritative bodies to establish safe levels of intake (i.e. acceptable daily intake or ADI). While results of randomized controlled trials have generally suggested non-sugar sweeteners may have little impact on glucose metabolism and result in lower body weight when coupled with energy restriction in the short-term, there is no clear consensus on whether non-sugar sweeteners are effective for long-term weight loss or maintenance, or if they are linked to other long-term health effects at intakes within the ADI. This systematic review brings together the most current scientific evidence on health effects of non-sugar sweetener use. https://www.who.int/publications/i/item/9789240046429
... Clinical trials have demonstrated a reduction in BMI (16)(17)(18) and fasting blood glucose (19,20) . However, observational studies have reported associations between NNS consumption and weight gain (21)(22)(23)(24) , changes to the gut microbiome (25) and typetwo diabetes (26,27) . ...
Objective
This study aimed to critically analyse Australia’s current and proposed policy actions to reduce added sugar consumption. Over-consumption of added sugar is a significant public health nutrition issue. The competing interests, values and beliefs among stakeholders means they have disparate views regarding which policy actions are preferable to reduce added sugar consumption.
Design
Semi-structured interviews using purposive, snowball sampling and policy mapping. Policy actions were classified by two frameworks: NOURISHING (e.g. behaviour change communication, food environment and food system) and the Orders of Change (e.g. first order: technical adjustments, second order: reforming the system, third order: transforming the system).
Setting
Australia
Participants
Twenty-two stakeholders from the food industry, food regulation, government, public health groups and academia.
Results
All proposed and existing policy actions targeted the food environment/behaviour change, most were assessed as first order changes, and reductionist (nutrient specific) in nature. Influences on policy actions included industry power, stakeholder fragmentation, government ideology/political will, and public pressure. Few stakeholders considered potential risks of policy actions, particularly of non-nutritive sweetener substitution or opportunity costs for other policy.
Conclusions
Most of Australia’s policy actions to reduce added sugar consumption are reductionist. Preferencing nutrient-specific, first order policy actions could reflect the influence of vested interests, a historically dominant reductionist orientation to nutrition science and policy, and the perceived difficulty of pursuing second or third order changes. Pursuing only first-order policy actions could lead to ‘regrettable’ substitutions and creates an opportunity cost for more comprehensive policy aimed at adjusting the broader food system.
... A systematic review and meta-analysis evaluating the effects of LCSs in both adults and children concluded that there is no convincing evidence to date to recommend the use of LCSs and that harmful effects could not be excluded [98,99]. In a study conducted on 3682 adults, long-term consumption of LCSs was associated with increased body weight [100]. It seems that habitual LCS consumers uncouple sweet taste from energy intake and, as a consequence, increase food intake to reach "energy compensation" [92]. ...
Type 2 diabetes mellitus has a high prevalence worldwide, with a rapidly increasing incidence even in youth. Nutrition, dietary macronutrient composition, and in particular dietary carbohydrates play a major role in the development of type 2 diabetes. The aim of this narrative review is to discuss the current evidence on the role of dietary carbohydrates in the prevention and management of type 2 diabetes. The digestibility or availability of carbohydrates and their glycemic index (and glycemic load) markedly influence the glycemic response. High consumption of dietary fiber is beneficial for management of type 2 diabetes, whereas high consumption of both glycemic starch and sugars may have a harmful effect on glucose metabolism, thereby increasing the risk of developing type 2 diabetes in the presence of genetic predisposition or making its glycemic control more difficult to achieve in people with established T2D. Therefore, the same dietary macronutrient may have harmful or beneficial effects on type 2 diabetes mainly depending on the subtypes consumed. Some other factors are involved in glucose metabolism, such as meal composition, gut microbiota and genetics. For this reason, the glycemic response after carbohydrate consumption is not easy to predict in the single individual. Nutrition suggested to subjects with known type 2 diabetes should be always person-centered, considering the individual features of each subject.
... The adverse effects of ASBs consumption on health outcomes are still unclear. It was noteworthy that ASBs intake was found to be not accompanied by typical and expected post-ingestive consequences, such as the release of insulin after meals, and therefore, this might degrade the capacity of sweet tastes to evoke these responses, resulting in higher blood glucose levels and more consequences, such as obesity, metabolic syndromes, and diabetes [23,76,77]. Furthermore, according to previous findings from animal studies, altered gut microbiota was found in mice by using artificial sweetener intervention, which was associated with the increased insulin resistance, and a similar phenomenon was also observed in humans [78]. ...
Although studies have examined the association between habitual consumption of sugar- (SSBs) and artificially sweetened beverages (ASBs) and health outcomes, the results are inconclusive. Here, we conducted a dose-response meta-analysis of prospective cohort studies in order to summarize the relationship between SSBs and ASBs consumption and risk of type 2 diabetes (T2D), cardiovascular diseases (CVDs), and all-cause mortality. All relevant articles were systematically searched in PubMed, Embase, and Ovid databases until 20 June 2020. Thirty-four studies met the inclusion criteria and were eligible for analysis. Summary relative risks (RRs) and 95% confidence intervals (95% CI) were estimated using random effects or fixed-effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships. With each additional SSB and ASB serving per day, the risk increased by 27% (RR: 1.27, 95%CI: 1.15–1.41, I2 = 80.8%) and 13% (95%CI: 1.03–1.25, I2 = 78.7%) for T2D, 9% (RR: 1.09, 95%CI: 1.07–1.12, I2 = 42.7%) and 8% (RR: 1.08, 95%CI: 1.04–1.11, I2 = 45.5%) for CVDs, and 10% (RR: 1.10, 95%CI: 0.97–1.26, I2 = 86.3%) and 7% (RR: 1.07, 95%CI: 0.91–1.25, I2 = 76.9%) for all-cause mortality. Linear relationships were found for SSBs with T2D and CVDs. Non-linear relationships were found for ASBs with T2D, CVDs, and all-cause mortality and for SSBs with all-cause mortality. The findings from the current meta-analysis indicate that increased consumption of SSBs and ASBs is associated with the risk of T2D, CVDs, and all-cause mortality.
... In the United States, European Union and China, the maximum residue level (MRL) of sodium saccharin was also set in different kind of foods (U.S. Food and Drug Administration, 2018; Nation Health Commission of the People's Republic of China, 2014; The European Parliament and the Council of the European Union, 2006). What's more, the frequent consumers of these sugar substitutes might be at increased risk of excessive weight gain (Fowler et al., 2008), metabolic syndrome (Duffey, Steffen, Van Horn, Jacobs, & Popkin, 2012), type 2 diabetes (Guy et al., 2013), and cardiovascular disease (Swithers, 2013). But the illegal and excessive use of sodium saccharin in foods was still reported from time to time. ...
Sodium saccharin is a common artificial sweetener. However, due to its possible carcinogenic effects and causing metabolic disorders, many countries have strictly regulated its use in food. In the study, we prepared a specific monoclonal antibody (mAb 2H11) using the new hapten (6-carboxylsaccharin) and developed a direct competitive enzyme-linked immunosorbent assay (dcELISA) for the screening of sodium saccharin residue in food. The half-maximum inhibition concentration (IC50) and working range (IC20–IC80, the concentrations causing 20% and 80% inhibition by sodium saccharin) were 32.5 and 6.47 to 164 ng/mL, which was 6.5 times more sensitive than the previously reported immunoassay. The average recoveries of sodium saccharin in spiked food samples detected by dcELISA ranged from 82.1% to 117%. Among 70 food samples bought in the physical stores and online, sodium saccharin residues were only detected in four samples purchased online (one canned pineapple, two winter jujube, and one kimchi). The content measured by dcELISA agreed well with those determined by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). The developed dcELISA was proved to be a sensitive and accurate method for determining sodium saccharin in food.
Practical Application
Quantitation of sodium saccharin residue in food is very necessary and important for consumers and regulatory agencies.
... It is suggested that AS induces taste receptor activation in the intestine and adaptively regulates the expression of glucose transporters (SGLT-1/GLUT2), which are closely related to the glucose homeostasis [3]. Therefore, many researchers insist that AS ingestion stimulates hunger and consequently increases food intake via activating sweet taste receptors in the small intestine [4,5]. The paradoxical association between the consumption of AS and weight gain mainly focuses on the feed intake, glucose absorption, and gut flora. ...
The effects of saccharin, as a type of sweetener additive, on the metabolism and development of mammals are still controversial. Our previous research revealed that saccharin sodium (SS) promoted the feed intake and growth of guinea pigs. In this experiment, we used the guinea pig model to study the physiological effect of SS in the microbiota–gut–hypothalamus axis. Adding 1.5 mM SS to drinking water increased the serum level of glucose, followed by the improvement in the morphology and barrier function of the ileal villus, such as SS supplementation which increased the villus height and villus height/crypt depth ratio. Saccharin sodium (SS) treatment activated the sweet receptor signaling in the ileum and altered GHRP hormone secretion. In the hypothalamus of SS and control (CN) group, RNA-seq identified 1370 differently expressed genes (796 upregulated, 574 downregulated), enriching into the taste signaling transduction, and neuroactive ligand–receptor interaction. LEfSe analysis suggested that Lactobacillaceae-Lactobacillus was the microbe with significantly increased abundance of ileum microorganisms in the SS-treated group, while Brevinema-Andersonii and Erysipelotrichaceae-Ilebacterium were the microbes with significantly increased abundance of the control. Furthermore, SS treatment significantly enhanced the functions of chemoheterotrophy and fermentation of ileal microflora compared to the CN group. Accordingly, SS treatment increased levels of lactic acid and short-chain fatty acids (acetic acid, propionic acid and N-valeric acid) in the ileal digesta. In summary, drinking water with 1.5 mM SS activated sweet receptor signaling in the gut and altered GHRP hormone secretion, followed by the taste signaling transduction in the hypothalamus.
... Another interesting issue for artificial sweeteners is the exposure time. In humans adverse effects of artificial sweeteners indeed can be found after chronic exposure [70][71][72] which lead us to perform follow-up sub-chronic exposure tests. Although our data suggest that no significant difference was observed, it will be worth to note that the potential chronic toxicity of artificial sweetener exposure cannot be ignored as some research suggest that artificial sweetener could accumulate inside the body. ...
Artificial sweeteners are widely used food ingredients in beverages and drinks to lower calorie intake which in turn helps prevent lifestyle diseases such as obesity. However, as their popularity has increased, the release of artificial sweetener to the aquatic environment has also increased at a tremendous rate. Thus, our study aims to systematically explore the potential cardiovascular physiology alterations caused by eight commercial artificial sweeteners, including acesulfame-K, alitame, aspartame, sodium cyclamate, dulcin, neotame, saccharine and sucralose, at the highest environmentally relevant concentration on cardiovascular performance using zebrafish (Danio rerio) as a model system. Embryonic zebrafish were exposed to the eight artificial sweeteners at 100 ppb and their cardiovascular performance (heart rate, ejection fraction, fractional shortening, stroke volume, cardiac output, heartbeat variability, and blood flow velocity) was measured and compared. Overall, our finding supports the safety of artificial sweetener exposure. However, several finding like a significant increase in the heart rate and heart rate variability after incubation in several artificial sweeteners are noteworthy. Biomarker testing also revealed that saccharine significantly increase the dopamine level in zebrafish larvae, which is might be the reason for the cardiac physiology changes observed after saccharine exposure.
... In contrast to SSBs, which represent the largest source of added sugar in the American diet (1), ASBs contain few to no calories, which makes them a likely attractive substitute for SSBs. However, observational studies and intervention trials have shown inconclusive results regarding their health effects (63,64). In the present study, null results were observed for ASB intake and the overall breast cancer risk, consistent with results from the NutriNet-Santé cohort study (23). ...
Background
Whether consumption of sugar-sweetened beverages (SSBs) or artificially sweetened beverages (ASBs) is associated with the risk of breast cancer is of public health interest.
Objectives
We sought to evaluate associations between consumption of SSBs and ASBs and risks of total and subtype-specific breast cancer.
Methods
We followed 82,713 women from the Nurses’ Health Study (1980 to 2016) and 93,085 women from the Nurses’ Health Study II (1991 to 2017). Cumulatively averaged intakes of SSBs and ASBs from FFQs were tested for associations with incident breast cancer cases and subtypes using Cox regression models. We also evaluated the associations stratified by menopausal status, physical activity, BMI, and alcohol intake.
Results
We documented 11,379 breast cancer cases during 4,655,153 person-years of follow-up. Consumption of SSBs or ASBs was not associated with total breast cancer risk: pooled HRs comparing extreme categories (≥1/day compared with <1/month) were 1.03 (95% CI, 0.95–1.12) and 0.96 (95% CI, 0.91–1.02), respectively. We observed a suggestive interaction by BMI using pooled data (P-interaction = 0.08), where a modestly higher risk of breast cancer with each serving per day increment of SSBs was found in lean women (HR, 1.06; 95% CI, 1.01–1.11) but not among overweight or obese women (HR, 1.00; 95% CI, 0.95–1.06). Moreover, in the pooled, fully adjusted analysis, compared to infrequent consumers (<1/month), those who consumed ≥1 serving of ASBs per day had a lower risk of luminal A breast tumors (HR, 0.90; 95% CI, 0.80–1.01; P-trend = 0.02).
Conclusions
Although no significant associations were observed overall, consumption of SSBs was associated with a slightly higher risk of breast cancer among lean women. This finding could have occurred by chance and needs confirmation. Our findings also suggest no substantial increase in the risk of breast cancer with consumption of ASBs.
... Controversia sobre el consumo de edulcorantes: posibles riesgos para la salud El uso de edulcorantes tiene un gran impacto a nivel metabólico, ya que son añadidos como aditivos a comidas y bebidas, y esto puede favorecer principalmente a las características nutricionales, el consumo de energía y el peso corporal. Sin embargo, aún no se tiene información científica certera la cual apoye su uso, ya que hay estudios epidemiológicos en los cuales la sustitución de las bebidas endulzadas calóricas por las no calóricas se relaciona con una mayor incidencia de obesidad, ya que si hay un sobreconsumo de estas bebidas en presentaciones como refrescos dietéticos, café y té hay un doble de riesgo de padecer obesidad en comparaciones que las personas que no consumen estas bebidas [1]. En un estudio con roedores se encontró que la ingesta de alimentos y bebidas con edulcorantes acalóricos, se asoció con el incremento del apetito de los animales y esto provocaba una mayor ingesta de alimentos, aumento de peso corporal y acumulación de la grasa corporal [2]. ...
https://contactos.izt.uam.mx/index.php/contactos/article/view/71
... It is also possible that following weight gain, children consume diet soft drinks in an attempt to reduce their calorie intake (44). However, prospective studies have shown that these associations remain significant after controlling for BMI at baseline or when studying normal-weight adults separately (26). Repeatedly consuming sweet-tasting foods with no energy content may lead to the failure to anticipate calories from sugar when they are consumed, disrupting the signals that lead to satiety (66). ...
Purpose:
To examine (1) associations between body fat percent (BF) and lifestyle behaviors in children aged 9-11 years and (2) the consistency of these associations over a 10-year period.
Methods:
In this repeat, cross-sectional study, 15,977 children aged 9-11 years completed an anthropometric assessment and the SportsLinx Lifestyle survey between 2004 and 2013. Body fat was estimated according to the sum of the triceps and subscapular skinfold measurements. Multilevel models were utilized to examine associations between BF and responses to the lifestyle survey while controlling for known covariates.
Results:
Lifestyle behaviors explained 8.6% of the total variance in body fat. Specifically, negative associations were found between BF and active transport to school (β = −0.99 [0.19], P < .001), full-fat milk (−0.07 [0.15], P < .001), and sweetened beverage consumption (−0.40 [0.15], P = .007). Relative to the reference group of ≤8:00 PM, later bedtime was positively associated with BF: 8:00 to 8:59 PM (β = 1.60 [0.26], P < .001); 9:00 to 10:00 PM (β = 1.04 [0.24], P < .001); ≥10:00 PM (β = 1.18 [0.30], P < .001). Two-way interactions revealed opposing associations between BF and the consumption of low-calorie beverages for boys (β = 0.95 [0.25], P < .001) and girls (β = −0.85 [0.37], P = .021). There was no significant change in these associations over a 10-year period.
Conclusions:
In this population-level study covering a decade of data collection, lifestyle behaviors were associated with BF. Policies and interventions targeting population-level behavior change, such as active transport to school, sleep time, and consumption of full-fat milk, may offer an opportunity for improvements in BF.
... Additionally, weight gain and elevated glycaemic index might be associated with promotion of inflammation, which could lead to the development of cancer. Fowler et al. (45) in a cohort study on 'obesity epidemic' observed subgroup meta-analysis by type of study design; (c) subgroup meta-analysis by type of GI cancer. OR, OR; RR, relative risk; CI, CI; AC, adenocarcinoma; SCC, squamous cell carcinoma; AEG, adenocarcinomas of oesophagogastric junction, and HCC, hepatocellular carcinoma. ...
Objective
There remain inconclusive findings from previous observational epidemiological studies on whether consumption of artificially-sweetened soft drinks (ASSDs) increases the risk of gastrointestinal (GI) cancer. We investigated the associations between the consumption of ASSDs and the risk of GI cancer using a meta-analysis.
Design
Systematic review and meta-analysis.
Setting
PubMed and EMBASE were searched using keywords until May 2020 to identify observational epidemiological studies on the association between the consumption of ASSDs and the risk of GI cancer.
Subjects
Twenty-one case-control studies and 17 cohort studies with 12,397 cancer cases and 2,474,452 controls.
Results
In the random-effects meta-analysis of all the studies, consumption of ASSDs was not significantly associated with the risk of overall GI cancer (odds ratio (OR)/relative risk (RR), 1.02; 95% CI, 0.92-1.14). There was no significant association between the consumption of ASSDs and the risk of overall GI cancer in the subgroup meta-analyses by study design (case-control studies: OR, 0.95; 95% CI, 0.82-1.11; cohort studies: RR, 1.14; 95% CI, 0.97-1.33). In the subgroup meta-analysis by type of cancer, consumption of ASSDs was significantly associated with the increased risk of liver cancer (OR/RR, 1.28; 95% CI,1.03-1.58).
Conclusions
The current meta-analysis of observational epidemiological studies suggests that overall, there is no significant association between the consumption of ASSDs and the risk of GI cancer.
... Clinical trials have demonstrated a reduction in body mass index [23][24][25] and fasting blood glucose [26,27]. However, observational studies have reported associations between NNS consumption and weight gain [28][29][30][31], changes to the gut microbiome [32] and type-two diabetes [33,34]. Relationships from observational studies are correlational and may be biased, as participants with existing morbidities may be more likely to consume NNS than those without [9]. ...
Dietary risk factors, including excess added sugar intake, are leading contributors to Australia’s burden of disease. An objective of the Australian Health Star Rating (HSR) system is to encourage the reformulation of packaged foods. Manufacturers may improve a product’s HSR by replacing added sugar with non-nutritive sweeteners (NNS). Concerns have been raised regarding the potential substitution effects of ultra-processed foods containing NNS for whole foods, and the long-term impact this may have on population health. The aim of this study was to determine whether the implementation of the HSR system has impacted the use of added sugars and NNS in the food supply. Four product categories were used: products with no added sweetener, products containing added sugar only, products containing NNS only, and products containing a combination of added sugar and NNS. Of 6477 newly released products analyzed displaying a HSR in Australia between 2014–2020, 63% contained added sugars. The proportion of new products sweetened with added sugars increased over time, while NNS use did not, despite a higher average and median HSR for products sweetened with NNS. These findings suggest that at the current time, the HSR system may not discourage the use of added sugars in new products or incentivize the reformulation of added sugar with NNS. As the health risks of NNS are questioned, increased reformulation of products with NNS to reduce the presence of added sugar in the food supply may not address broader health concerns. Instead, supporting the promotion of whole foods and drinks should be prioritized, as well as policy actions that reduce the proliferation and availability of UPFs.
... Some epidemiological data suggest the opposite. National Health and Nutrition Examination Survey (NHANES) Study and San Antonio Heart Study showed higher weight gain and BMI in people consuming sweeteners Colditz et al. 1990;Fowler et al. 2008;Stellman and Garfinkel 1986). Also, the European E3N study (Fagherazzi et al. 2013), Health Professionals Follow-up Study (HPFS) (de Koning et al. 2011), the European Prospective Investigation into Cancer and Nutrition (EPIC) Study (Romaguera et al. 2013) linked the consumption of artificial sweeteners to an increased risk of developing type 2 diabetes. ...
Diabetes mellitus is the most common metabolic disorder contributing to significant morbidity and mortality in humans. Different preventive and therapeutic agents, as well as various pharmacological strategies or non-pharmacological tools, improve the glycemic profile of diabetic patients. Isomaltulose, D-tagatose, and trehalose are naturally occurring, low glycemic sugars that are not synthesized by humans but widely used in food industries. Various studies have shown that these carbohydrates can regulate glucose metabolism and provide support in maintaining glucose homeostasis in patients with diabetes, but also can improve insulin response, subsequently leading to better control of hyperglycemia. In this review, we discussed the anti-hypergly-cemic effects of isomaltulose, D-tagatose, and trehalose, comparing their properties with other known sweeteners, and highlighting their importance for the development of the pharmaceutical and food industries.
... As non-caloric sweeteners potentially affect human metabolism (e.g. appetite control, weight, microbiome composition), the present study did not use a placebo in the control group [24,25]. The study (NCT01733563) was approved by the ethical committee (Canton Zurich, Switzerland). ...
Background & aims:
Excessive fructose intake associates with increased de novo lipogenesis, blood triglycerides, and hepatic insulin resistance. Whether fructose-specific effects on lipid metabolism in healthy men exist independently from overfeeding needs clarification.
Methods:
94 subjects were studied in this double-blind, randomized trial. They were assigned to daily consumption of sugar-sweetened beverages (SSB) containing moderate amounts of fructose, sucrose (fructose-glucose disaccharide) or glucose (80g/day) in addition to their usual diet or SSB abstinence (control group) for seven weeks. De novo fatty acid (FA) and triglyceride (TAG) synthesis, lipolysis and plasma free FA (FFA) oxidation were assessed by tracer methodology.
Results:
Daily intake of beverages sweetened with free fructose and fructose combined with glucose (sucrose) increased basal fractional secretion rates (FSR) of newly synthesized FA by the liver 2-fold compared to control (median FSR %/day: sucrose 20.8 (p=0.0015); fructose 19.7 (p=0.013); control 9.1). Conversely, the same amounts of glucose did not change FSR (median of FSR %/day 11.0 (ns)). Fructose intake did not change basal secretion of newly synthesized VLDL-TAG. It did neither alter rates of peripheral lipolysis nor total FA and plasma FFA oxidation. Total energy intake was similar across groups with SSB intake and controls.
Conclusions:
Regular consumption of both fructose and sucrose sweetened beverages in moderate doses associated with stable caloric intake increases hepatic FA synthesis even in a basal state, whereas this effect is not observed after consumption of glucose. These findings support the hypothesis of an adaptative response of the liver to regular fructose exposure, i. e. habitual SSB consumption. The study has a trial registration number of NCT01733563 (www.clinicaltrials.gov).
... A "sugar tax" has 70 been implemented by public bodies to food products rich in added sugars in some 71 countries as UK and states of US, and recently in Spain (Pell et al., 2020; Puig-Codina, 72 Imamura et al., 2015) or obesity (S. P. Fowler et al., 2008) weight gain (S. P. G. 101 Fowler, 2016). ...
Background: Low-caloric sweeteners represent a good alternative to the extra boost of energy of sugar-sweetened beverages. However, their long-term effects have barely been assessed. In the present study, the influence of low-caloric sweeteners added to a maqui/Citrus beverage on the glycemic profile has been evaluated. Methods: A parallel, randomized and triple blind clinical study was performed in overweight subjects (n=138), who consumed 330 mL/day of a beverage added with Stevia, Sucralose or Sucrose, for 60 days. Results: BMI did not change significantly with any treatment. Fasting glucose increased after the short-term consumption of Sucrose added beverage (26 %), as well as with the addition of the low-caloric sweeteners, but in a lesser extent: 11 % for Stevia and 20 % for Sucralose. Insulin concentrations did not change significantly with any drink, which resulted in a significant increase in HOMA-IR with Sucralose (p = 0.002) and Sucrose (p=0.001). Conclusions: The results obtained link the consumption of sucrose sweetened beverages with a disbalance in glycaemic response, and a better response with Stevia addition, although it also produces certain negative effects on glycemic control. The evidence available to date is not conclusive enough to advise the wide use of LCS.
ClinicalTrials.gov NCT 04016337.
... It is questionable whether non-nutritious and sugar-free beverages other than water are healthier than sugary ones. Although the results of a recent meta-analysis showed that artificial sweeteners might be beneficial for short-term weight loss, this benefit was not substantiated by the long-term prospective cohort studies [31,32]. Children demonstrate enhanced preferences for sweet tastes from very early in life, and prolonged exposure to hyper-sweetened foods and beverages can set the stage for the persistence of heightened sweet preferences [33]. ...
Background
: The prevalence of convenience and beverage stores in Taiwan provides an environment for children to access different beverages. To our knowledge, the relationship between beverage consumption types and anthropometrics in children hasn't been reported in Taiwan.
Methods
: A cross-sectional study was conducted in the third graders to examine the association between the consumption frequency of beverage type and anthropometrics. Parents of 515 children completed a questionnaire with written instructions, which was designed to collect demographics, frequency of consumed beverage types, and anthropometrics. This study is novel because beverage types were categorized based on sugar and protein contents, namely nutritious (N), sugar (S), nutritious and sugar (NS), and non-nutritious and sugar-free (NS-free). The differences in height and body weight between intake frequencies within each beverage type were determined using analysis of variance (ANOVA) test or nonparametric statistics, dependent on the confirmation of normal data distribution.
Results
: Height and weight of children consuming the most N beverages fell in the highest respective percentile compared to those who did not consume them (P = 0.001 and 0.035, respectively). Consumption of NS and S beverages were not associated with height, body weight, and BMI. Children who consumed more NS-free beverages were significantly heavier (p = 0.016) and had a larger BMI (p = 0.001).
Conclusion
: This is the first study conducted on third-grade children in Taiwan showing the beverage consumption type was associated with anthropometrics. In conclusion, nutritious beverages appear to be a better choice for growth in children. Nevertheless, additional related studies, including an overall assessment of children's calorie and nutrient intakes and related dietary behaviors, are warranted to provide more helpful information for policymakers.
... As such, beliefs about hedonic enjoyment and health appear to influence consumer decisions about consumption or avoidance of LCSBs. These contrasting beliefs, and the more negative views among non-consumers, are not surprising, given that several studies have raised public awareness of potential adverse health effects of LCSBs, (36,(46)(47)(48) which likely discourages their consumption among some consumers. The importance of overcoming such misinformation and scepticism about LCS will be discussed in further detail later in the paper. ...
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.
... Potential safety concerns have been raised regarding the possible relationship between the consumption of non-caloric high-intensity sweeteners and the development of adverse effects, including carcinogenicity [95]. Moreover, several studies have found a correlation between artificial sweetener use and weight gain [96], and risk of type 2 diabetes [97]. Furthermore, sweetness decoupled from caloric content offers partial, but incomplete activation of the food reward pathways, which may further fuel food seeking behavior, encouraging sweet cravings and sugar dependence from other foods [98]. ...
Non-communicable diseases (NCDs) are the first causes of death worldwide. Reduction in the dietary intake of salt and sugars is important lifestyle advice that is useful for NCD prevention. However, the simple recommendations of reducing salt and sugars by healthcare professionals are often ineffective; innovative strategies are therefore necessary. This review aimed at describing the current knowledge about the strategies to reduce dietary salt and sugar intake, including both strategies for the food industry to reduce the salt or sugar of its products and recommendations for health professionals in a clinical context, such as the replacement with substitutes in foods, the gradual reduction to allow a progressive consumer adaptation towards less intense taste, and the different spatial distribution of tastants within the food matrix with taste intensity enhancement. In addition, the cross-modal interaction between two or more different sensory modalities as an innovative strategy for enhancing sweetness and saltiness perception was described. Finally, the dietary tips for salt and sugar reduction were summarized in order to create a comprehensive guide of dietary advices for healthcare professionals for optimizing the management of patients at increased cardiometabolic risk.
... Despite the fact that many national authorities have recognized artificial sweeteners as safe and well-tolerated, a lot of controversies about the effects of sweeteners on human health still exist. Whereas, some longitudinal cohort studies show an association between artificial sweeteners consumption and reduced risk of T2DM, overweight and obesity, other observational studies have yielded opposite findings (25)(26)(27)(28). Furthermore, longitudinal cohort studies found a positive association between the consumption of artificial sweeteners and the risk of hypertension, stroke, and cardiovascular events (29). ...
A poor diet is one of the leading causes for non-communicable diseases. Due to the increasing prevalence of overweight and obesity, there is a strong focus on dietary overconsumption and energy restriction. Many strategies focus on improving energy balance to achieve successful weight loss. One of the strategies to lower energy intake is refraining from sugars and replacing them with artificial sweeteners, which maintain the palatability without ingesting calories. Nevertheless, the safety and health benefits of artificial sweeteners consumption remain a topic of debate within the scientific community and society at large. Notably, artificial sweeteners are metabolized differently from each other due to their different properties. Therefore, the difference in metabolic fate of artificial sweeteners may underlie conflicting findings that have been reported related to their effects on body weight control, glucose homeostasis, and underlying biological mechanisms. Thus, extrapolation of the metabolic effects of a single artificial sweetener to all artificial sweeteners is not appropriate. Although many rodent studies have assessed the metabolic effects of artificial sweeteners, long-term studies in humans are scarce. The majority of clinical studies performed thus far report no significant effects or beneficial effects of artificial sweeteners on body weight and glycemic control, but it should be emphasized that the study duration of most studies was limited. Clearly, further well-controlled, long-term human studies investigating the effects of different artificial sweeteners and their impact on gut microbiota, body weight regulation and glucose homeostasis, as well as the underlying mechanisms, are warranted.
... 96 It is important to understand the impact of regular consumption of NCS on body weight as recent evidence has identified their use to be motivated by weight management goals, 97 with a large proportion of habitual consumers being those with overweight or obesity, or individuals that regularly exercise and diet. 98 There are some additional trials revealing reductions in body weight following NCS consumption compared to increases in body weight following consumption of nutritive sweeteners ( primarily sucrose). 55,83 For example, at the end of a 4-week intervention comparing diets supplemented with commercially available beverages (250 ml 4× daily), sweetened with either sucrose or aspartame, there was an increase in body weight in the sucrose condition. ...
Numerous strategies have been investigated to overcome the excessive weight gain that accompanies a chronic positive energy balance. Most approaches focus on a reduction of energy intake and the improvement of lifestyle habits. The use of high intensity artificial sweeteners, also known as non-caloric sweeteners (NCS), as sugar substitutes in foods and beverages, is rapidly developing. NCS are commonly defined as molecules with a sweetness profile of 30 times higher or more that of sucrose, scarcely contributing to the individual's net energy intake as they are hardly metabolized. The purpose of this review is first, to assess the impact of NCS on eating behaviour, including subjective appetite, food intake, food reward and sensory stimulation; and secondly, to assess the metabolic impact of NCS on body weight regulation, glucose homeostasis and gut health. The evidence reviewed suggests that while some sweeteners have the potential to increase subjective appetite, these effects do not translate in changes in food intake. This is supported by a large body of empirical evidence advocating that the use of NCS facilitates weight management when used alongside other weight management strategies. On the other hand, although NCS are very unlikely to impair insulin metabolism and glycaemic control, some studies suggest that NCS could have putatively undesirable effects, through various indirect mechanisms, on body weight, glycemia, adipogenesis and the gut microbiota; however there is insufficient evidence to determine the degree of such effects. Overall, the available data suggests that NCS can be used to facilitate a reduction in dietary energy content without significant negative effects on food intake behaviour or body metabolism, which would support their potential role in the prevention of obesity as a complementary strategy to other weight management approaches. More research is needed to determine the impact of NCS on metabolic health, in particular gut microbiota.
... The generality of findings, from rats in their highly controlled settings to humans in their complicated environments, should be considered carefully. However, results obtained from animal experiments designed to reveal the causal relationship are consistent with human epidemiological studies that showed a correlation between heightened consumption of artificial sweeteners and heightened prevalence of overweight and obesity [35][36][37][38]. Conversely, recent reviews suggest that randomized controlled trials in humans generally demonstrate the benefits of artificial sweetener use on body weight, particularly when used alongside behavioral weight loss support [39][40][41]. ...
Repeated experience with artificial sweeteners increases food consumption and body weight gain in rats. Saccharin consumption may reduce the conditioned satiety response to sweet-tasting food. Rats were trained to press a lever to obtain sucrose for five days. A compound cue (tone + light) was presented with every sucrose delivery. On the following day, each lever press produced only the compound cue (cue-reactivity test). Subjects were then provided with yogurt for three weeks in their home cages. The rats were divided into two groups. Rats in the saccharin group received yogurt sweetened with saccharin on some days and unsweetened yogurt on others. For the plain group, only unsweetened plain yogurt was provided. Subsequently, the cue-reactivity test was conducted again. On the following day, the rats underwent a consumption test in which each lever press was reinforced with sucrose. Chow consumption and body weight gain were larger in the saccharin group than in the plain group. Lever responses increased from the first to the second cue-reactivity tests (incubation of craving) in both groups. During the consumption test, lever responses were higher in the saccharin group than in the plain group, suggesting that the conditioned satiety response was impaired in the saccharin group.
Diabetes is a metabolic disorder caused due to the destruction of insulin-producing β-cells. Most diabetic patients consume aspartame as an artificial sweetener to feel the sugar taste. The present study explores the effect of aspartame consumption on cognitive behavior, biochemical changes, and histopathological alterations in selected brain regions of streptozotocin-induced diabetic Wistar rats. The animals were divided into four groups based on the treatment they received, and each group consisted of six rats. The groups include control (C), diabetes (D), aspartame (ASP), and diabetes in combination with aspartame (D + ASP). The morphometric studies, including the general appearance of animals, and food & water intake, were observed daily; additionally, body weight and blood sugar levels were also noted weekly. Besides, behavioral studies were performed at the end day of the experiment. After completing a thirty-days experimental period, the rats were sacrificed by cervical dislocation, and different parts of the brain regions were isolated for biochemical and histopathological studies. Our results demonstrated that aspartame administered to diabetic rats had significantly elevated blood glucose levels, food and water intake, and neurodegenerative changes in different brain regions compared to control. At the same time, the bodyweights, cognitive and gross behavioral activities, and the levels of acetylcholine, acetylcholinesterase, and total ATPases in various brain regions were significantly reduced. Our results conclude that aspartame administration to diabetic rats has shown adverse effects linked to cognitive dysfunction.
We aimed to understand the process of setting or varying food standards related to non-nutritive sweeteners (NNS) in Australia and New Zealand. Overconsumption of added sugars is a risk factor for non-communicable diseases. Limiting added sugar consumption is recommended by the World Health Organization. NNS are sweet substances with little to no energy that can be used to maintain the sweetness of packaged food when added sugar is reduced. The health and dietary pattern impacts of NNS are contested. Understanding how and why applications for NNS are submitted, assessed and approved within food regulatory systems is important to contextualize the increasing availability of NNS in the food supply. We completed an interpretive content analysis of applications to change the Food Standards Australia and New Zealand (FSANZ) Code, risk assessments and stakeholder submissions. Literature used in risk assessments were drawn from a mixture of documents supplied by industry and peer-reviewed studies. Risk assessments were primarily focussed on toxicological outcomes, while broader public health outcomes were not explicitly considered. Consumption data available to FSANZ were collected several years prior to dietary exposure assessments, and thus may not accurately represent current intakes. The study findings raise questions about whether the scope of what constitutes a ‘risk’ to public health in the setting of food standards needs to extend beyond immediate toxicological and food safety concerns, to include longer-term dietary balance considerations.
Azo is one of the most effective functional groups used to synthesis commonly colors and plays an important role in several applications of industrial dyes. More specifically, saccharin has been extensively used in the field of human food. In this paper, saccharin has been successfully implemented as a primary material for the preparation of new AZO dyes, which illustrates the novelty of this research. The chromophore system mainly consists of a group (-N = N-) associated with one or more different aromatic. The invented dyes are identified by spectroscopic that measured the stability of these dyes and evaluated the color of the polystyrene and nylon.6 on the fibers. The influence of the substitution groups on the stability of the color of newly prepared dyes is also investigated.
Artificial sweeteners have become increasingly popular worldwide owing to their lower calorie content in addition to the claims of health benefits such as weight control, blood glucose level regulation in diabetics, and protection against dental caries. Nevertheless, there is still controversy regarding their safety, especially when administered over the long term, taking into account that most of the safety studies are based on animal models and only a few human studies. This review focuses on low-calorie protein/peptide sweeteners. These include artificial sweeteners, i.e. aspartame, advantame, neotame, and alitame which are synthetic, versus those of natural origin such as thaumatin, monellin, brazzein, pentadin, mabinlin, curculin, and egg white lysozyme. We conducted a systematic literature survey to ensure the accuracy of the data regarding the chemical properties, synthesis, and industrial applications. The health benefits and safety of these sweeteners in humans are presented for the first time in context to their metabolic profiles and gut interaction.
Background and aims
White sugar has been blamed to cause health consequences including diabetes and obesity. With the increased need to decrease sugar intake, attention was shifted towards sugar alternatives also known as low-calorie sweeteners. Low-calorie sweeteners are ubiquitous within food products, but their consumption among Lebanese adults isn’t well elucidated. Our study aims to investigate the trends and amounts of low-calorie sweeteners’ consumption in addition to their main sources among a sample of Lebanese adults.
Methods
A cross-sectional study was conducted over 384 adult Lebanese individuals from both genders residing in Beirut and Mount-Lebanon from February to August 2020. After excluding eight individuals, 376 completed the survey. To assess the trends, frequency and quantity of low-calorie sweeteners’ consumption, a questionnaire was filled by trained and licensed dietitians in addition to a previously validated food frequency questionnaire adapted to the most widely known products in the Lebanese market. Food products were divided into categories, amount of sweeteners in each item was obtained from the label, and analysis was performed according to the type of sweetener they are made of. Frequencies were converted into numbers of servings per day and multiplied by the standard portion size. Daily individual consumption of each sweetener apart was obtained by multiplying the amount of sweetener in each item consumed by total daily consumption. The amount in mg/kg was obtained by dividing total consumption of each sweetener apart by the mean weight of our population. The Statistical Package for Social Sciences (SPSS) was used for data entry and analysis.
Results
Results showed that 94.4% were consuming an artificially-sweetened item at least once in the last six months. While weight loss and healthy lifestyle constituted the main reasons for past and current consumption respectively, safety and unpleasant taste affected consumption trends. Pills and powders’ consumption was significantly associated with gender (p=0.032) and dieting (p=0.000) but not with age (p=0.831), educational level (p=0.294), living district (p=0.421) or income (p=0.828) where women and dieters used significantly more pills and powders than their counterparts. “Food and beverages” consumption was independent of all factors except age (p=0.001); it peaked at 26-40 and declined thereafter. Consumption of low-calorie sweeteners came mainly from beverages and was as follows while remaining within the acceptable daily intake limits: aspartame: 98.9mg/d (1.38mg/kg/d); sucralose: 22.19mg/d (0.31mg/kg/d); acesulfame-K: 39.12mg/d (0.55mg/kg/d); stevia 3.28mg/d (0.05mg/kg/d). Food and beverages were consumed more than pills and powders due to unintentional consumption.
Conclusion
Despite that safety and unpleasant taste affected consumption of low-calorie sweetened products, intake of such products was found to be highly prevalent in the studied population. While remaining within the acceptable daily intake limits, consumption of food and beverages exceeded that of pills and powders due to unintentional consumption making awareness a necessity to help consumers make an informed decision. Moreover, a nation-level study is needed to generalize the results.
Human food is composed of loads of chemicals derived naturally as well as unintentionally through environmental sources. Food additives added purposefully, play an important role in the palatability of foods. Most additives are synthetic whose essentiality in food processing is well-known however their health risks are not overlooked. The palatability of food should not only stimulate our eating desire alone but, also assure sufficient quality and safety. Application of food additives varies from region to region due to cultural or ethnic differences and the local food availability. There are about more than ten thousand chemicals allowed in food whereas due to weak enforcement, it becomes onerous for regulatory bodies identifying chemicals that are inadequately or not tested at all for safety. The hiking population and urbanization in many industrialized and developing countries resulted in life-style changes including culinary and eating choices. Particularly, the modern way of this globalised life demands ready-to-cook or ready-made foods, snacks, sweets, soft drinks, desserts, confectionery and so on. These sorts of food would be most uninteresting unless processed with additives. This puts food industries under demand to robustly supply foods that are either partially, fully or ultra-processed using plenty of additives. Recent research warns consuming food additives may result in serious health risks, not only for children but also for adults. Growing body of studies on food additives in various experimental animals, cell cultures, and human population suggest elevation of number of obesity and diabetes risk factors i.e. adiposity, dyslipidemia, weight gain, hyperglycaemia, insulin resistance, glucose intolerance, energy imbalance, hormonal intervention etc. Hence, it is important to identify and explore food obesogens or obesogenic food additives posing potential impact. Based on the recent toxicological findings, the review aspires to establish the association between exposure of food obesogen and metabolic disruption which may help filling knowledge gaps and distributing more knowledge, awareness and effective measures to implement treatment and preventive strategies for metabolic syndrome.
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.
Objective
With many characterizingobesity as a national priority, the U.S. Government is considering a 1, 2, or 3 cents-per-ounce (cpo) federal sin tax on soda products. Because prior research finds that consumers substitute equally, if not more, dangerous nicotine products with a tobacco sin tax and common alcohol-like household goods with alcohol prohibition, this research sets out to determine whether the imposition of a soda sin tax produces similar first-party externalities.
Method
Adaptive conjoint analysis is utilized among respondents across several regions of the United States, including actual soda consumers.
Results
This study finds that given a soda sin tax, soda consumers do not substitute healthier beverages, that is, beverages with relatively fewer calories and grams of sugar and sodium, such as water, pure fruit juice, or unsweetened tea. Instead, soda consumers switch to other sugary beverages not considered in most legislation, such as sweetened coffees, teas, or sports drinks, or continue consuming soda at tax rates of 2 and 3 cpo after the shock of a 1 cent tax wears off.
Conclusion
Unlike prior research examining decreased soda consumption across a general marketplace, this research offers insight into potential externalities among the key transacting actors in such an exchange: soda consumers.
Dietary habits and dietary composition have an important impact on human health. Research into the health impact of food has so far focused mainly on the salt, fat and sugar content and the lack of fiber. However, it has recently been suggested that the degree of processing of food could be an overarching factor. In addition, the gut microbiota is also strongly suggested as an important link between diet and obesity and associated diseases. A Western diet, which includes a lot of processed food, including food additives, could cause an imbalance in the gut system by affecting the gut bacteria and their metabolism. This article discusses some recently investigated properties of processed foods with regard to their influence on risk factors for metabolic disorders. We discuss the lack of micronutrients and the high energy density, as well as different types of food additives and the effect of thermal treatment of food ingredients. The literature shows that all these characteristics of processed food can be related to Western diseases and that they can have a negative impact on the gut microbiota of humans. We conclude that the evidence for gut microbiota to form the link between processed food consumption and the development of Western diseases is gaining weight. Further research should reveal whether the effect on the gut microbiota is a direct or an indirect effect. These findings are important tools in the fight against metabolic disorders and associated diseases.
Background and Aims
The artificial sweetener acesulfame potassium (ACK) is officially approved as safe for intake and has been used in processed foods. However, ACKs have been reported to induce metabolic syndrome, along with alteration of the gut microbiota in mice. In recent years, studies have suggested that this artificial sweetener promotes myeloperoxidase reactivity in Crohn's disease-like ileitis. We aimed to investigate the effect of ACK on the intestinal mucosa and gut microbiota of normal mice.
Methods
ACK was administered to C57BL/6J mice (8 weeks old) via free drinking. Intestinal damage was evaluated histologically and messenger RNA (mRNA) levels of TNF-α, IFN-γ, IL1-β, MAdCAM-1, GLP1R, and GLP2R were determined with quantitative reverse transcription polymerase chain reaction (qRT-PCR). Immunohistochemistry was performed to examine the expression of MAdCAM-1 in the small intestine. The composition of gut microbiota was assessed using high-throughput sequencing. We performed intravital microscopic observation to examine if ACK altered lymphocyte migration to the intestinal microvessels.
Results
ACK increased the expression of proinflammatory cytokines, decreased the expression of GLP-1R and GLP2-R, and induced small intestinal injury with an increase in intestinal permeability, and. ACK treatment induced microbial changes, but the transfer of feces alone from ACK mice did not reproduce intestinal damage in recipient mice. ACK treatment significantly increased the migration of lymphocytes to intestinal microvessels.
Conclusion
ACK induces dysbiosis and intestinal injury with enhanced lymphocyte migration to intestinal mucosa. Massive use of non-caloric artificial sweeteners may not be as safe as we think.
The salient rise of chronic disease from the mid-twentieth century threatens to overwhelm public health systems in an increasing number of countries and is now considered an epidemic. Dry eye disease is an underappreciated disorder that bears all the hallmarks of chronic disease. Preventative health care seeks improved and sustainable patient engagement in the self-management of health to limit the progress and extent of chronic disease. Anthropogenic environments engendering lifestyles and behaviours that can be detrimental to human health, can be considered as direct or indirect threats to successful preventative health strategies. Chronic disease can be viewed as the result of physiological responses of the human body to the modern environment. The quest for an increasingly convenient, global, and disease-free lifestyle is ironically threatening to undo the gains in health and quality of life made over the last one hundred years. Considering dry eye disease as an anthropogenic chronic disease, contributions of diet (food and beverages consumed) and nutrition (extending to relationships with self, community, and nature) to development of dry eye disease are explored in this review. Evidence of environmental and behavioural instigators of chronic disease with an emphasis on production, disbursement, and preservation of food, is presented. Furthermore, evidence of traditional food practices that offer resistance to the development of chronic systemic inflammatory disorders are reviewed as an exemplar of potential strategies that can be put into practice by individuals and communities to reinstate a balanced life, community and planet.
As ultraprocessed foods (i.e., foods composed of mostly cheap industrial sources of dietary energy and nutrients plus additives) have become more abundant in our food supply, rates of obesity and diet-related disease have increased simultaneously. Food addiction has emerged as a phenotype of significant empirical interest within the past decade, conceptualized most commonly as a substance-based addiction to ultraprocessed foods. We detail ( a) how approaches used to understand substance-use disorders may be applicable for operationalizing food addiction, ( b) evidence for the reinforcing potential of ingredients in ultraprocessed foods that may drive compulsive consumptions, ( c) the utility of conceptualizing food addiction as a substance-use disorder versus a behavioral addiction, and ( d) clinical and policy implications that may follow if ultraprocessed foods exhibit an addictive potential. Broadly, the existing literature suggests biological and behavioral parallels between food addiction and substance addictions, with ultraprocessed foods high in both added fat and refined carbohydrates being most implicated in addictive-like eating. Future research priorities are also discussed, including the need for longitudinal studies and the potential negative impact of addictive ultraprocessed foods on children.
Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Sucrose drink induced obesity and metabolic syndrome in human and animal models. However, age-specific metabolic effects of sucrose beverages are not clear yet. The purpose of this study was then to investigate changes in plasma biochemical parameters, oxidative stress markers, as well as lipid and redox contents and lipolytic activities in insulin target organs (liver, adipose tissue) in sucrose drinking rats at 10% and 30% during one month (day 30) and three months (day 90). Our results emphasized that sucrose drink induced obesity, adipose tissue accumulation with hyperinsulinemia, hyperglycemia, hyperlipidemia, liver steatosis, alterations in lipases activities and oxidative stress. These metabolic alterations were worsened by the amount of sucrose in the drink (30% versus 10%). The changes were apparent in young rats at day 30 and persisted until adulthood at day 90. Adult rats presented more sucrose-induced-metabolic abnormalities. In conclusion, sucrose drink induced an early increase in metabolic syndrome components. These data indicate the need of corrective nutritional intervention for young people and also for adults.
Objective
Reviews on the relationship of low-energy sweeteners (LES) with body weight (BW) have reached widely differing conclusions. To assess possible citation bias, citation analysis was used to quantify the relevant characteristics of cited articles, and explore citation patterns in relation to review conclusions.
Design
A systematic search identified reviews published from January 2010 to March 2020. Different characteristics (for example, type of review or research, journal impact factor, conclusions) were extracted from the reviews and cited articles. Logistic regression was used to estimate likelihood of articles with particular characteristics being cited in reviews. A qualitative network analysis linked reviews sub-grouped by conclusions with the types of articles they cited.
Main outcome measures
(OR; 95% CI) for likelihood that articles with particular characteristics were cited as evidence in reviews.
Results
From 33 reviews identified, 183 different articles were cited (including other reviews). Narrative reviews were 62% less likely to be cited than systematic reviews with meta-analysis (OR 0.38; 0.16 to 0.86; p=0.03). Likelihood of being cited was higher for evidence on children than adults (OR 2.27; 1.59 to 3.25; p<0.0001), and with increased journal impact factor (OR 1.15; 1.00 to 1.31; p=0.04). No other factors were statistically significant in the main analysis, and few factors were significant in subgroup analyses. Network analysis showed that reviews concluding a beneficial relationship of LES with BW cited mainly randomised controlled trials, whereas reviews concluding an adverse relationship cited mainly observational studies.
Conclusions
Overall reference to the available evidence across reviews appears largely arbitrary, making citation bias likely. Differences in the conclusions of individual reviews map onto different types of evidence cited. Overall, inconsistent and selective use of the available evidence may account for the diversity of conclusions in reviews on LES and BW.
Trial registration number
Prior to data analysis, the protocol was registered with the Open Science Framework ( https://osf.io/9ghws ).
Introduction:
Humans are known to adapt to external temperature variations by altering energy intake, expenditure, and body fat storage for insulation [ 1 , 2 ]. However, it is not clear whether the temperature of ingested water would induce such effects. Similarly, the involvement of the temperature of the ingested beverage has not been addressed in terms of body weight changes [ 3 ].
Objectives:
This study was to investigate the effect of the ingestion of plain or sweetened water with varied temperatures on growth measures of rats.
Methods:
Approval was obtained from the Institutional Animal Care and Use Committee of the American University of Beirut. After a 1-week adaptation period, 5- to 6-week-old male Sprague-Dawley rats were randomly divided into their respective experimental groups, housed individually (22 ± 1°C, reverse light cycle 12:12 h dark/light, light off at 10:00 a.m.) with free access to food and beverage for 8 weeks. Experiment 1 (Plain Water): Two groups of rats (n = 9) consumed room-temperature [∼22°C] (NW) or cold [∼5°C] (CW) water. Experiment 2 (Sweetened Water): Four groups of rats were offered sweetened water for 12 h, followed by plain water; (1) 10% sucrose + cold temperature (CS, n = 7), (2) 10% sucrose + room temperature (NS, n = 8), (3) 0.05% acesulfame K + cold temperature (CA, n = 7), and 4) 0.05% acesulfame K + room temperature (NA, n = 8). Food and beverage intake, body weight, and body composition were monitored using NMR minispec (LF110 Body Composition Analyzer, Bruker, USA) and energy expenditure was calculated based on the equation developed by Ravussin et al. [ 4 ]. Significance was set at a p value <0.05.
Results:
Experiment 1: Body weight changes were similar between groups (Fig. 1 -Exp 1a). In the CW group, lean body mass (%) was significantly higher, while body fat (%) was lower than the NW (Fig. 1 -Exp 1b, c). These changes may relate to the calculated total energy expenditure [NW: 66.73 ± 4.49 kcal/day and CW: 73.75 ± 3.92 kcal/day) (p value = 0.003) since energy intake (NW: 89.97 ± 7.63 kcal/day vs. CW: 93.29 ± 6.26 kcal/day, p value = 0.329) was similar between groups. Experiment 2: Body weight of the CA group was higher than that of the other groups (Fig. 1 -Exp 2a). Lean body mass (%) of the sucrose-sweetened water groups (Fig. 1 -Exp 2b, c) was significantly higher, while body fat (%) was lower than that of the non-caloric sweetened water groups; these were not affected by the temperature of the beverage. Those variations are mostly explained by the differences in energy expenditure (p value temperature × sweetener = 0.015), as energy intake was not significantly different between groups.
Conclusion:
Cold plain water decreased body fat and increased lean body mass with no effect on total body weight. Sucrose-sweetened water had a better impact on body composition irrespective of the temperature of the beverage. The beneficial effects are mainly due to increased energy expenditure rather than variations in energy intake. Thus, the energy cost of warming the water seems to have been derived from an increase in fat oxidation.
Summary Strategies to reverse the upward trend in obesity rates need to focus on both reducing energy intake and increasing energy expenditure. The provision of low- or reduced-energy-dense foods is one way of helping people to reduce their energy intake and so enable weight maintenance or weight loss to occur. The use of intense sweeteners as a substitute for sucrose potentially offers one way of helping people to reduce the energy density of their diet without any loss of palatability.
This report reviews the evidence for the effect of aspartame on weight loss, weight maintenance and energy intakes in adults and addresses the question of how much energy is compensated for and whether the use of aspartame-sweetened foods and drinks is an effective way to lose weight.
All studies which examined the effect of substituting sugar with either aspartame alone or aspartame in combination with other intense sweeteners on energy intake or bodyweight were identified. Studies which were not randomised controlled trials in healthy adults and which did not measure energy intakes for at least 24 h (for those with energy intakes as an outcome measure) were excluded from the analysis. A minimum of 24-h energy intake data was set as the cut-off to ensure that the full extent of any compensatory effects was seen. A total of 16 studies were included in the analysis. Of these 16 studies, 15 had energy intake as an outcome measure. The studies which used soft drinks as the vehicle for aspartame used between 500 and about 2000 ml which is equivalent to about two to six cans or bottles of soft drinks every day.
A significant reduction in energy intakes was seen with aspartame compared with all types of control except when aspartame was compared with non-sucrose controls such as water. The most relevant comparisons are the parallel design studies which compare the effects of aspartame with sucrose. These had an overall effect size of 0.4 standardised difference (SD). This corresponds to a mean reduction of about 10% of energy intake. At an average energy intake of 9.3 MJ/day (average of adult men and women aged 19–50 years) this is a deficit of 0.93 MJ/day (222 kcal/day or 1560 kcal/week), which would be predicted (using an energy value for obese tissue of 7500 kcal/kg) to result in a weight loss of around 0.2 kg/week with a confidence interval 50% either side of this estimate.
Information on the extent of compensation was available for 12 of the 15 studies. The weighted average of these figures was 32%. Compensation is likely to vary with a number of factors such as the size of the caloric deficit, the type of food or drink manipulated, and timescale. An estimate of the amount of compensation with soft drinks was calculated from the four studies which used soft drinks only as the vehicle. A weighted average of these figures was 15.5%.
A significant reduction in weight was seen. The combined effect figure of 0.2 SD is a conservative figure as it excludes comparisons where the controls gained weight because of their high-sucrose diet and the long-term follow-up data in which the aspartame groups regained less weight than the control group. An effect of 0.2 SD corresponds to about a 3% reduction in bodyweight (2.3 kg for an adult weighing 75 kg). Given the weighted average study length was 12 weeks, this gives an estimated rate of weight loss of around 0.2 kg/week for a 75-kg adult.
The meta-analyses demonstrate that using foods and drinks sweetened with aspartame instead of sucrose results in a significant reduction in both energy intakes and bodyweight. Meta-analyses both of energy intake and of weight loss produced an estimated rate of weight loss of about 0.2 kg/week. This close agreement between the figure calculated from reductions in energy intake and actual measures of weight loss gives confidence that this is a true effect. The two meta-analyses used different sets of studies with widely differing designs and controls. Although this makes comparisons between them difficult, it suggests that the final figure of around 0.2 kg/week is robust and is applicable to the variety of ways aspartame-containing foods are used by consumers.
This review has shown that using foods and drinks sweetened with aspartame instead of those sweetened with sucrose is an effective way to maintain and lose weight without reducing the palatability of the diet. The decrease in energy intakes and the rate of weight loss that can reasonably be achieved is low but meaningful and, on a population basis, more than sufficient to counteract the current average rate of weight gain of around 0.007 kg/week. On an individual basis, it provides a useful adjunct to other weight loss regimes.
Some compensation for the substituted energy does occur but this is only about one-third of the energy replaced and is probably less when using soft drinks sweetened with aspartame. Nevertheless, these compensation values are derived from short-term studies. More data are needed over the longer term to determine whether a tolerance to the effects is acquired.
To achieve the average rate of weight loss seen in these studies of 0.2 kg/week will require around a 220-kcal (0.93 MJ) deficit per day based on an energy value for obese tissue of 7500 kcal/kg. Assuming the higher rate of compensation (32%), this would require the substitution of around 330 kcal/day (1.4 MJ/day) from sucrose with aspartame (which is equivalent to around 88 g of sucrose). Using the lower estimated rate of compensation for soft drinks alone (15.5%) would require the substitution of about 260 kcal/day (1.1 MJ/day) from sucrose with aspartame. This is equivalent to 70 g of sucrose or about two cans of soft drinks every day.
The presence and physiologic importance of cephalic phase insulin release in humans remains controversial. The aim of these studies was to determine whether cephalic phase insulin release could be demonstrated in normal weight subjects and whether it would be associated with changes in blood glucose, free fatty acid, and pancreatic polypeptide levels. The studies were followed by a hyperglycemic clamp to determine whether cephalic responses would alter overall glucose disposal or glucose-stimulated insulin secretion. In all, 17 subjects were studied on two occasions with and without (control study) presentation of food stimuli. Tease-feeding alone (n = 6), or the administration of a sweet taste alone (aspartame, n = 5) failed to stimulate cephalic responses. However, the presentation of the combined stimuli (tease meals plus sweet taste, n = 7) resulted in a significant fall (P less than .005) in blood glucose levels and a variable rise in serum insulin (% insulin rise 38 +/- 15%, P less than .05) and C-peptide levels (7 +/- 6%, NS) within five minutes of the food presentation when compared with control studies, with no change seen in free fatty acid or pancreatic polypeptide levels. The blood glucose fall correlated strongly (r = .90, P less than .01) with a score of the subjective response to the food and taste.(ABSTRACT TRUNCATED AT 250 WORDS)
In this era of increasing obesity and increasing threats of legislation and regulation of food marketing practices, regulatory agencies have pointedly asked how "low-fat" nutrition claims may influence food consumption. The authors develop and test a framework that contends that low-fat nutrition labels increase food intake by (1) increasing perceptions of the appropriate serving size and (2) decreasing consumption guilt. Three studies show that low-fat labels lead all consumers--particularly those who are overweight--to overeat snack foods. Furthermore, salient objective serving-size information (e.g., "Contains 2 Servings") reduces overeating among guilt-prone, normal-weight consumers but not among overweight consumers. With consumer welfare and corporate profitability in mind, the authors suggest win-win packaging and labeling insights for public policy officials and food marketers. [ABSTRACT FROM AUTHOR]
The possible role played by artificial sweeteners in the long-term maintenance of body weight is considered. Although artificial sweeteners can play a role in a short-term energy-controlled diet, the evidence that they are helpful over a longer period is limited. In those in the recommended weight range there is evidence of compensation; that is, the consumption of low-energy foods is followed by an increased energy intake to make up the lost energy. Energy compensation is more likely in those not displaying dietary restraint. The desire to remove sugar from the diet reflects an assumption that its intake is associated with obesity. However, the consumption of energy-dense food, that almost entirely reflects a high fat and low water content, is the best predictor of obesity. Diets offering a high proportion of energy in the form of carbohydrate tend to contain low levels of fat. There are several reports that the use of artificial sweeteners leads to an increased consumption of fat. The weak ability of fat to satisfy hunger makes it easy to overeat fatty foods; in contrast, carbohydrates promote a feeling of 'fullness'. Various short-term studies have found that carbohydrate consumed as a liquid, rather than a solid, is more likely to result in weight gain.
The sweet taste of aspartame, saccharin, and acesulfame-K has been reported to increase ratings of hunger and, after saccharin consumption, to increase food intake. However, most investigators have found that aspartame consumption is associated with decreased or unchanged ratings of hunger. Even if aspartame consumption increases ratings of hunger in some situations, it apparently has little impact on the controls of food intake and body weight. Aspartame has not been found to increase food intake; indeed, both short-term and long-term studies have shown that consumption of aspartame-sweetened foods or drinks is associated with either no change or a reduction in food intake. Preliminary clinical trials suggest that aspartame may be useful aid in a complete diet-and-exercise program or in weight maintenance. Intense sweeteners have never been found to cause weight gain in humans.
Patterns of weight change for 31,940 non-smoking women aged 30-55 y in 1976 were examined for 8 y of follow-up. Each woman reported her weight every 2 y on questionnaires, and diet was assessed in 1980 with a semiquantitative food frequency questionnaire. Self-reported weight was highly correlated over time, decreasing from r = 0.95 over 2 y to r = 0.89 over 8 y. Weight gain was inversely related to age (r = -0.06). Weight change in a given 2-y interval was inversely related to change in weight over the subsequent 2 y (r = -0.30). Age, relative weight, and prior weight change were stronger predictors of recent weight change than were intake patterns of specific nutrients. Recent prior weight change was the strongest predictor of subsequent weight change. In a population of free-living women, prior weight loss and younger age are far stronger predictors of subsequent weight gain than are the qualitative aspects of diet.
The macronutrient composition of the diet can influence hunger, satiety, food intake, body weight, and body composition. Fat, not carbohydrate, is the macronutrient associated with overeating and obesity. Fat is overeaten because it is highly palatable and because it provides a high level of energy in a given volume of food. However, when given in equal volumes, carbohydrate (sugar) and fat have similar effects on hunger, satiety, and subsequent food intake when infused intragastrically or ingested in foods by normal-weight, unrestrained young men. In obese and restrained subjects, preloads of high-carbohydrate yogurts suppress subsequent food intake more than do high-fat yogurts, indicating a relative insensitivity to the satiety value of fat. Both the amount of fat in the diet and total energy intake should be managed in weight-loss regimens. Low-fat foods and fat substitutes can help to reduce fat intake. Although more data are required, currently the best dietary advice for weight maintenance and for controlling hunger is to consume a low-fat, high-carbohydrate diet with a high fiber content.
To compare the effects of aspartame-sweetened and sucrose-sweetened soft drinks on food intake and appetite ratings of female restrained eaters.
Fourteen female students, shown to have eating restraint.
Subjects were given four drinks (330 ml) of aspartame-sweetened lemonade, sucrose-sweetened lemonade and carbonated mineral water on three separate days. Seven of the subjects were informed of the drink type they were consuming on each occasion.
Appetite ratings were recorded and energy and macronutrient intakes were measured during the study day and day after leaving the department.
During the first study day energy intake was lower whilst drinking the sucrose-sweetened lemonade compared with the aspartame-sweetened lemonade, although neither differed significantly from energy intakes during the day the drank water. When the calories from the sucrose-sweetened lemonade were included (1381 kJ, 330 Kcal) energy intake did not differ between treatments. The following day energy intake was significantly higher after the aspartame-sweetened lemonade compared with both sucrose-sweetened lemonade and the water due to an increase in the amount of carbohydrate consumed and resulted in a higher total energy intake over the two days studied. Knowledge of the drink types had no effect on energy intake or macronutrient intake. Appetite ratings did not differ between drinks and were not affected by knowledge of the drink types.
These results suggest that in females with eating restraint, substituting sucrose-sweetened drinks for diet drinks does not reduce total energy intake and may even result in a higher intake during the subsequent day.
Dietary factors, independent of total energy, may be important in promoting obesity. We examined prospectively the relationship between baseline diet composition and weight gain among adult men and women from southeastern New England.
The prospective association of nutrient consumption and weight change was examined in a randomly selected cohort examined four years apart.
Adults aged 18 through 64 years from two communities in Southeastern New England were randomly selected for the study after being interviewed in their homes. The present investigation is based on a subgroup of 465 individuals who completed a food-frequency questionnaire in 1986 or 1987 and were reinterviewed four years later.
Multiple regression analyses were used to determine the association of weight change with different nutrients and food groups after adjusting for age, smoking status, baseline body mass index, physical activity level, and total energy.
Total energy was positively associated with weight gain and age was inversely associated with weight gain. None of the nutrients or food groups were significantly related to weight gain.
These findings indicate that weight gain increased with increasing baseline total energy intake, particularly in the young. Future research is required to determine ways of decreasing energy intake in younger individuals.
In adult mammals, the adipocyte-derived hormone leptin acts on the brain to reduce food intake by regulating the activity
of neurons in the arcuate nucleus of the hypothalamus (ARH). Here, we report that neural projection pathways from the ARH
are permanently disrupted in leptin-deficient (Lepob/Lepob) mice and leptin treatment in adulthood does not reverse these neuroanatomical defects. However, treatment of Lepob/Lepob neonates with exogenous leptin rescues the development of ARH projections, and leptin promotes neurite outgrowth from ARH
neurons in vitro. These results suggest that leptin plays a neurotrophic role during the development of the hypothalamus and
that this activity is restricted to a neonatal critical period that precedes leptin's acute regulation of food intake in adults.
Existing data was reexamined to determine changes in beverage consumption and associations between beverages consumed and BMI Z-score in children (n = 164) across two years.
Beverages (milk, 100% juice, diet soda or sugar sweetened) and total caloric intake were calculated from a 24-hour diet recall. Height and weight were measured to calculate BMI. Subjects were categorized by BMI Z-score as normal weight, overweight, gained weight and lost weight. Data was collected at baseline and year 2.
Significant decreases in milk and increases in diet soda were found over two years in all subjects and normal weight, whereas overweight had a significant increase in diet soda consumption and a decrease in milk consumption that did not reach significance. Change in milk consumption was inversely correlated with sugar-sweetened beverage consumption. Increases in diet soda consumption were significantly greater for overweight and subjects who gained weight as compared to normal weight subjects. Baseline BMI Z-score and year 2 diet soda consumption predicted 83.1% of the variance in year 2 BMI Z-score.
Shifts in beverage consumption were found in this convenient sample across two years. Diet soda consumption was the only type of beverage associated with year 2 BMI Z-score, and consumption was greater in overweight subjects and subjects who gained weight as compared to normal weight subjects at two years. Additional longitudinal data examining associations between beverage consumption and BMI is needed in children and adolescents, as consumption of regular and diet soda has become more of a social norm.
The aim of this study was to investigate the association of dietary macronutrient composition and energy density with the change in body weight and waist circumference and diabetes incidence in the Finnish Diabetes Prevention Study.
Overweight, middle-aged men (n=172) and women (n=350) with impaired glucose tolerance were randomised to receive either 'standard care' (control) or intensive dietary and exercise counselling. Baseline and annual examinations included assessment of dietary intake with 3-day food records and diabetes status by repeated 75-g OGTTs. For these analyses the treatment groups were combined and only subjects with follow-up data (n=500) were included.
Individuals with low fat (<median) and high fibre (>median) intakes lost more weight compared with those consuming a high-fat (>median), low-fibre (<median) diet (3.1 vs 0.7 kg after 3 years). In separate models, hazard ratios for diabetes incidence during a mean follow-up of 4.1 years were (highest compared with lowest quartile) 0.38 (95% CI 0.19-0.77) for fibre intake, 2.14 (95% CI 1.16-3.92) for fat intake, and 1.73 (95% CI 0.89-3.38) for saturated-fat intake, after adjustment for sex, intervention assignment, weight and weight change, physical activity, baseline 2-h plasma glucose and intake of the nutrient being investigated. Compared with the low-fat/high-fibre category, hazard ratios were 1.98 (95% CI 0.98-4.02), 2.68 (95% CI 1.40-5.10), and 1.89 (95% CI 1.09-3.30) for low-fat/low-fibre, high-fat/high-fibre, and high-fat/low-fibre, respectively.
Dietary fat and fibre intake are significant predictors of sustained weight reduction and progression to type 2 diabetes in high-risk subjects, even after adjustment for other risk factors.
Consumption of sugar-sweetened beverages (SSBs), particularly carbonated soft drinks, may be a key contributor to the epidemic of overweight and obesity, by virtue of these beverages’ high added sugar content, low satiety, and incomplete compensation for total energy. Whether an association exists between SSB intake and weight gain is unclear. We searched English-language MEDLINE publications from 1966 through May 2005 for cross-sectional, prospective cohort, and experimental studies of the relation between SSBs and the risk of weight gain (ie, overweight, obesity, or both). Thirty publications (15 cross-sectional, 10 prospective, and 5 experimental) were selected on the basis of relevance and quality of design and methods. Findings from large cross-sectional studies, in conjunction with those from well-powered prospective cohort studies with long periods of follow-up, show a positive association between greater intakes of SSBs and weight gain and obesity in both children and adults. Findings from short-term feeding trials in adults also support an induction of positive energy balance and weight gain by intake of sugar-sweetened sodas, but these trials are few. A school-based intervention found significantly less soft-drink consumption and prevalence of obese and overweight children in the intervention group than in control subjects after 12 mo, and a recent 25-week randomized controlled trial in adolescents found further evidence linking SSB intake to body weight. The weight of epidemiologic and experimental evidence indicates that a greater consumption of SSBs is associated with weight gain and obesity. Although more research is needed, sufficient evidence exists for public health strategies to discourage consumption of sugary drinks as part of a healthy lifestyle.
In short-term tests, rats given saccharin solution to drink eat 10–15% more food than when given only water. This is due to the combination of a cephalic-phase neural reflex that influences liver metabolism, a favorable osmotic environment and learning. It is hypothesized that sweet taste increases food intake by producing biochemical changes in the liver that increase fuel storage and consequently decrease fuel oxidation.
... 8. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar - sweetened drinks and childhood obesity : a prospective, observational analysis. Lancet. 2001;357:505-508.pmid:11229668. ...
The response to the covert removal of around 500 kcal/d from the food of 10 healthy free-living male volunteers was measured over 10 days. A similar amount of energy was added to the food of four subjects. Normal food and drink was available ad libitum, and adjustments in food energy were made by the interchange of sugar and artificial sweeteners. Compensation for the theoretical energy deficit or surplus was incomplete, averaging around 50%. This, however, was very variable, some subjects achieving more than 90% recovery, whereas others failed completely to adjust energy intake within this timespan. It is concluded that the regulation of energy balance in the lean is a long-term phenomenon, conditioned by large day-to-day fluctuations in energy intake. The removal of sugar from the food raised the energy density of the diet. The substitution of artificial sweeteners for sugar caused an increase of 11% in total fat intake. The restoration of sugar had an opposite effect. This inverse relationship between dietary sugar and fat poses problems for those seeking to lose weight, and for the lean attempting to follow current guidelines for a ‘healthier’ diet without incurring weight loss.
This study was carried out to disclose effects generated by the uncoupling of the sensory and energetic components of sweet solutions. A comparison was made between equi-sweet preloads of three intense sweeteners (saccharin, aspartame and acesulfame-K), a bulk sweetener (glucose) and a nonsweet water control. Measures were made of subjective ratings of motivation to eat, food preferences and energy intake in a test meal. The glucose load produced a consistent pattern of changes on all measures. The intense sweeteners tended to facilitate motivational ratings and food preference checklist responses, but marginally lowered intake in the test meal. The facilitative action is probably due to the stimulation of sensory receptors for sweetness by the high-intensity agents, while the effects on intake are most likely due to a ceiling effect imposed by methodological limitations of this particular design. The results of this study must be interpreted with reference to the prevailing experimental conditions, but they suggest that intense sweeteners can produce significant changes in appetite. Of the intense sweeteners, aspartame gave rise to the most pronounced effects.
A comparison was made of the effects on hunger and food intake of consuming preloads varying in sweetness and energy content. The preloads were a plain (unsweetened) yogurt, and the same yogurt sweetened to equal intensity with saccharin or glucose, or supplemented with starch. This balanced design made it possible to assess the consequences of adding sweetness to food as well as the consequences of substituting a nonnutritive sweetener for a caloric sweetener. Subjects (N=24, repeated measures design) ate the preload at midday and returned one hour later for a sandwich lunch. Food intake in this meal was measured directly, and intake during the remaining part of the day was monitored using home recording in diaries. Hunger was assessed using subjective ratings of motivation to eat. Food intake at lunchtime was significantly greater following the saccharin compared with the plain preload, and parallel effects were revealed by the motivational ratings. Saccharin also stimulated further increases in intake after lunch. Food intake was lowest following the high-energy preloads, with the starch supplemented yogurt producing somewhat the largest suppression of intake. The results confirm and extend previous findings showing that intense sweeteners do not possess the same satiating capacity as glucose and sucrose. The stimulation of appetite by saccharin may be due to its sweet taste and also to effects on postingestive mechanisms.
To determine the effects of calories and sweetness perception on intake, fasted normal weight subjects drank a preload sweetened with sucrose (1.1 g/kg) or L-asparthyl-L-phenylalanyl-methyl ester (Aspartame, 0.011 g/kg), or with no added sweetener. Sweetness perception of the load was reduced in half of the subjects by oral application of Gymnema sylvestre extracts. One hour after the preload, a meal of snack foods was presented and amounts of nutrients eaten were calculated. Subjects whose perception of sweetness had been decreased for the preload ate less total and sweet calories than did those with normal perception. Calories did not affect intake. The effect of calories and perception of the load was also assessed on variables presumed to correlate with satiety. Sucrose pleasantness ratings were not related to calories, perception or intake. Subjects' estimates of the amount of milkshake that they would drink if given the opportunity to do so and hunger ratings were related to overall intake and carbohydrate intake, respectively. The findings indicate that hedonistic aspects of taste are of greater importance than calories in determining short term intake.
This paper addresses the expected impact of use of macronutrient substitutes by individuals without strong motivation to control macronutrient or energy intake when such modified foods serve as replacements of foods normally ingested rather than as "add-ons". A basic premise of the paper is that individuals are likely to replace a substantial part of the energy equivalent of the original substitution. It further assumes that the macronutrient composition of the additional foods consumed will reflect normal food selection behaviours. The paper derives a description of the expected selection behaviour from examination of the within subject variance in energy and macronutrient intake of 29 subjects followed for 365 consecutive days (the Beltsville One Year Dietary Intake Study). Patterns observed in these subjects were validated through examination of associations between macronutrient intake and energy intake in 600 women, each of whom contributed 6 days of dietary data (USDA CSFII-85). As presently proposed the model suggests that the use of non-caloric fat replacements, by subjects without strong motivation to control fat or energy intake, can be expected to result in a net decrease (less than original substitution) in fat intake and net increases in carbohydrate and protein intakes. Conversely, use of carbohydrate replacements in core foods can be expected to result in net increases in fat and protein intakes and a partial decrease in carbohydrate intake. The magnitude of these net changes is seen to be a function of the extent of replacement of energy.
Nonnutritive sweeteners and fat substitutes have achieved rapid consumer acceptance. This is largely due to the perception held by the public that these products are helpful in weight control and diet improvement. The cognitive component in human eating behavior makes it difficult to generalize from animal research. The effectiveness of these products in weight control has yet to be demonstrated conclusively in human research. Currently these products appear to add palatibility to reduced-calorie diets and may be helpful to weight-loss efforts as part of an overall balanced, nutritious diet and healthy life-style that includes exercise.
Ingestion of aspartame-sweetened beverages has been reported to increase subjective measures of appetite. This study examined the effects of familiar carbonated soft drinks sweetened with aspartame on subjective hunger, energy intake and macronutrient selection at a lunch-time meal. Subjects were 20 normal weight young adult males, classified as either restrained or nonrestrained eaters. Four treatments of carbonated beverages included 280 ml of mineral water, one can of a soft drink (280 ml) consumed in either 2 or 10 minutes, or two cans of a soft drink (560 ml) consumed in 10 minutes, administered at 11:00 a.m. Subjective hunger and food appeal were measured from 9:30 a.m. to 12:30 p.m., and food intake data were obtained from a buffet lunch given at 12:00 noon. There were no treatment effects on energy intake, macronutrient selection or food choice at the lunch-time meal, or food appeal, though restrained eaters consumed more than nonrestrained eaters in all four treatment conditions. Consumption of two soft drinks (560 ml, 320 mg aspartame) significantly reduced subjective hunger from 11:05 a.m. to 11:30 a.m. compared to one soft drink (280 ml, 160 mg aspartame) or 280 ml of mineral water. Thus ingestion of soft drinks containing aspartame did not increase short-term subjective hunger or food intake.
We evaluated whether "sweetness" increases hunger. Groups of 10 male and 10 female subjects chewed a gum base containing one of four concentrations of aspartame (0.05%, 0.3%, 0.5%, or 1.0%) for 15 min. Relative to groups given nothing or unsweetened gum base to chew, groups given the sweetened gum bases increased hunger ratings, but not in a manner monotonically related to aspartame concentration. The most effective aspartame concentration to increase hunger was 0.3% for females and 0.5% for males. The highest aspartame concentrations had a time-dependent, biphasic effect on appetite, producing a transient decrease followed by a sustained increase in hunger ratings. Thus, the concentration of the sweetener, the sex of the subject and the time after chewing, were all important determinants of whether "sweetness" increased hunger.
Physiological and behavioral responses to high intensity sweeteners have been poorly characterized, leading to questions regarding their utility in weight management regimens. To address this issue, studies must independently control attributes such as the taste properties, chemical composition and energy contribution of a given sweetener, as well as subject expectations of its effects. In the present study, 24 adults of normal weight consumed breakfasts including unsweetened or sweetened (sucrose or aspartame) cereal for 5 days, during which hunger and energy intake were monitored. The cereals were rated as equally sweet and pleasant and were equicaloric. Half of the subjects were aware of the cereal composition. Neither sweet taste nor aspartame alone significantly affected reported hunger, daily energy intake or subsequent selection of foods with varying taste qualities. Energy intake tended to be more strongly influenced by perceptions of the energy value of the experimental breakfast. Thus, this study failed to find an appetite stimulating effect of either sweetness or sweetener (aspartame or sucrose).
To examine the orosensory and postingestive effects of saccharin solution on food intake and food preference, freely feeding rats were given flavored food to eat and a solution to drink for 2 h on eight to ten occasions. Relative to trials with a different flavored food and only water to drink, food intake was increased by drinking 0.2% saccharin or 0.45% NaCl, unaffected by drinking 1% almond extract, and decreased by drinking 10% glucose. Food preference, which was assessed in a choice test with simultaneous access to the two flavored foods, was increased by drinking 0.2% saccharin or 10% glucose and unaffected by drinking 1% almond extract or 0.45% NaCl. These results are consistent with the possibility that a combination of the oral and hydrational properties of saccharin solution increase food intake. Saccharin's sweet taste may be responsible for its effects on food preference.
The effect of the artificial sweetener Acesulfame K on insulin release in vitro was investigated. Pancreatic islets were obtained from Male Wistar rats. Acesulfame K produced a significant increase in insulin release from incubated islets. This effect was dose- and glucose-dependent. When islets were incubated with different amounts of Acesulfame K (2.5, 7.5 and 15 mM) and 15 mM glucose in the media for one hour, insulin concentrations were 140.2 +/- 21.1, 246.7 +/- 32.4 and 313.9 +/- 37.7 microU/ml, respectively. When 15 mM Acesulfame K was added to a media containing 0, 2.5, 5, 10 and 15 mM glucose, insulin release from incubated islets after 60 min were 25.6 +/- 6.4, 65.4 +/- 12.1, 109.0 +/- 10.0, 229.6 +/- 28.0 and 313.9 +/- 37.7 microU/ml. Incubating islets in the media containing arginine or acetylcholine increased insulin release significantly. However, when Acesulfame K was added to the media containing either arginine or acetylcholine, no further potentiating effect could be detected. The effect of Acesulfame K on insulin secretion was decreased by noradrenaline. However, the addition of naloxone, atropine and propranolol had no significant effect. Somatostatin inhibited insulin release from isolated pancreatic islets, but did not antagonize the action of Acesulfame K. When 2.5 mM Acesulfame K was added to a medium containing somatostatin, the inhibitory effect of somatostatin was totally neutralized. In a perifusion system, Acesulfame K stimulated both phases of insulin secretion. In conclusion, Acesulfame K acts directly on the pancreatic islets and potentiates glucose-induced insulin release.
In short-term tests, rats given saccharin solution to drink eat 10-15% more food than when given only water. This is due to the combination of a cephalic-phase neural reflex that influences liver metabolism, a favorable osmotic environment and learning. It is hypothesized that sweet taste increases food intake by producing biochemical changes in the liver that increase fuel storage and consequently decrease fuel oxidation.
Extreme obesity and leanness are risk factors for many types of cancer. An earlier American Cancer Society study (1959-1972) found a nearly twofold increased risk for death from all causes in men and women who weighed 40% or more above average for their age and height, and found elevated cancer rates as well. A new (1982), ongoing ACS prospective study of 1.2 million men and women continues to find increased death rates from all causes and from cancer in the very heavy and the very lean. Artificial sweetener (AS) use is an important correlate of relative weight in this population. The relationship between weight change during the year preceding enrollment and AS usage was studied in a highly homogeneous subgroup of 78694 women ages 50-69 years. The percentage of users increased with body mass index (BMI) and was inversely related to age. Users were significantly more likely than non-users to gain weight, regardless of initial BMI. Among those who gained weight, the average number of lbs gained by AS users was higher (by 0.5-1.5 lb) than the amount gained by non-users. Within the entire cohort, AS users of both sexes ate chicken, fish and vegetables significantly more often than did non-users and consumed beef, butter, white bread, potatoes, ice cream and chocolate significantly less often, suggesting that our weight change results are not explicable by differences in food consumption patterns.
Hypocaloric diets cause a fall in resting metabolic rate that interferes with weight loss. To evaluate the mechanisms underlying this phenomenon, resting metabolic rate was measured sequentially in six healthy obese women on a weight maintenance diet (more than 2,300 kilocalories), after 15 days of an 800 kilocalories carbohydrate-free diet, and after isocaloric sucrose replacement for an additional 15 days. The carbohydrate-free diet produced a 21 percent decline in resting metabolic rate (p less than 0.005) as well as a decrease in circulating triiodothyronine (41 percent, p less than 0.02) and insulin (38 percent, p less than 0.005) concentrations. Plasma norepinephrine levels also tended to decline (10 percent, 0.05 greater than p less than 0.1). However, when sucrose was substituted, resting metabolic rate rose toward baseline values even though total caloric intake was unchanged and weight loss continued. The sucrose-induced rise in resting metabolic rate was accompanied by a rise in serum triiodothyronine values, but not plasma insulin or norepinephrine concentrations. Throughout, changes in resting metabolic rate correlated with changes in serum triiodothyronine levels (r = 0.701, p less than 0.01). In four obese women, a hypocaloric sucrose diet was given at the outset for 15 days. The fall in both resting metabolic rate and triiodothyronine concentration was markedly reduced as compared with values during the carbohydrate-free diet. It is concluded that carbohydrate restriction plays an important role in mediating the fall in resting metabolic rate during hypocaloric feeding. This effect may, at least in part, be related to changes in circulating triiodothyronine levels. Incorporation of carbohydrate in diet regimens may, therefore, minimize the thermic adaptation to weight loss.
Summary Monosodium L-glutamate (MSG), a neuroexcitatory amino acid is known to destroy hypothalamic (arcuate nucleus) neurons and give rise to subsequent obesity, skeletal stunting and reduced mass of pituitaries, ovaries and testes when administered subcutaneously to infant rodents. Here it is demonstrated that the same hypothalamic lesion and syndrome of neuroendocrine manifestations occurs following treatment of infant mice with either of two other neuroexcitatory amino acids (L-cysteic or L-aspartic acids) which destroy arcuate neurons but not from a structurally related amino acid (DL-a-aminoadipic acid) which lacks neuroexcitatory properties and spares arcuate neurons.
STRIKING degenerative changes in the infant mouse retina after
subcutaneous treatment with monosodium glutamate (MSG) were reported by
Lucas and Newhouse in 19571. Other studies2-6
established that the process of retinal degeneration induced by MSG
treatment is a remarkably acute and irreversible form of neuronal
pathology. Recently it was found that a similar process of acute
neuronal necrosis occurs in several regions of the infant mouse brain
after subcutaneous treatment with MSG, and that animals treated with
high doses in infancy tend to manifest obesity and neuroendocrine
disturbances as adults7,8. The arcuate nucleus of the
hypothalamus is an area particularly vulnerable to glutamate induced
damage in infant animals of several species (mice and rats7,
rabbits and chicks and the rhesus monkey9). In mice, which
have been studied more extensively for MSG induced disturbances than
other species, the infant animal suffered hypothalamic damage from a
relatively low subcutaneous dose (0.5 g/kg of body weight)7.