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A randomized controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesity.
Higgins, KA, Mattes, RD
The American journal of clinical nutrition. 2019;(5):1288-1301
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Abstract
BACKGROUND Low-calorie sweeteners (LCSs) provide sweetness with little or no energy. However, each LCS's unique chemical structure has potential to elicit different sensory, physiological, and behavioral responses that affect body weight. OBJECTIVE The purpose of this trial was to compare the effects of consumption of 4 LCSs and sucrose on body weight, ingestive behaviors, and glucose tolerance over a 12-wk intervention in adults (18-60 y old) with overweight or obesity (body mass index 25-40 kg/m2). METHODS In a parallel-arm design, 154 participants were randomly assigned to consume 1.25-1.75 L of beverage sweetened with sucrose (n = 39), aspartame (n = 30), saccharin (n = 29), sucralose (n = 28), or rebaudioside A (rebA) (n = 28) daily for 12 wk. The beverages contained 400-560 kcal/d (sucrose treatments) or <5 kcal/d (LCS treatments). Anthropometric indexes, energy intake, energy expenditure, appetite, and glucose tolerance were measured at baseline. Body weight was measured every 2 wk with energy intake, expenditure, and appetite assessed every 4 wk. Twenty-four-hour urine collections were completed every 4 wk to determine study compliance via para-aminobenzoic acid excretion. RESULTS Of the participants enrolled in the trial, 123 completed the 12-wk intervention. Sucrose and saccharin consumption led to increased body weight across the 12-wk intervention (Δweight = +1.85 ± 0.36 kg and +1.18 ± 0.36 kg, respectively; P ≤ 0.02) and did not differ from each other. There was no significant change in body weight with consumption of the other LCS treatments compared with baseline, but change in body weight for sucralose was negative and significantly lower compared with all other LCSs at week 12 (weight difference ≥ 1.37 ± 0.52 kg, P ≤ 0.008). Energy intake decreased with sucralose consumption (P = 0.02) and ingestive frequency was lower for sucralose than for saccharin (P = 0.045). Glucose tolerance was not significantly affected by any of the sweetener treatments. CONCLUSIONS Sucrose and saccharin consumption significantly increase body weight compared with aspartame, rebA, and sucralose, whereas weight change was directionally negative and lower for sucralose compared with saccharin, aspartame, and rebA consumption. LCSs should be categorized as distinct entities because of their differing effects on body weight. This trial was registered at clinicaltrials.gov as NCT02928653.
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Are Liquid Sugars Different from Solid Sugar in Their Ability to Cause Metabolic Syndrome?
Sundborn, G, Thornley, S, Merriman, TR, Lang, B, King, C, Lanaspa, MA, Johnson, RJ
Obesity (Silver Spring, Md.). 2019;(6):879-887
Abstract
OBJECTIVE Intake of sugary drinks, especially soft drinks, carries increased risk for obesity and diabetes. This article reviews whether sugary drinks carry different risks for metabolic syndrome compared with foods that contain natural or added sugars. METHODS A narrative review was performed to evaluate differences between liquid and solid sugars in their ability to induce metabolic syndrome and to discuss potential mechanisms to account for the differences. RESULTS Epidemiological studies support liquid added sugars, such as soft drinks, as carrying greater risk for development of metabolic syndrome compared with solid sugar. Some studies suggest that fruit juice may also confer relatively higher risk for weight gain and insulin resistance compared with natural fruits. Experimental evidence suggests this may be due to differences in how fructose is metabolized. Fructose induces metabolic disease by reducing the energy levels in liver cells, mediated by the concentration of fructose to which the cells are exposed. The concentration relates to the quantity and speed at which fructose is ingested, absorbed, and metabolized. CONCLUSIONS Although reduced intake of added sugars (sucrose and high-fructose corn syrup) remains a general recommendation, there is evidence that sugary soft drinks may provide greater health risks relative to sugar-containing foods.
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Indirect Chronic Effects of an Oleuropein-Rich Olive Leaf Extract on Sucrase-Isomaltase In Vitro and In Vivo.
Pyner, A, Chan, SY, Tumova, S, Kerimi, A, Williamson, G
Nutrients. 2019;(7)
Abstract
Consumption of dietary bioactives is an avenue to enhancing the effective healthiness of diets by attenuating the glycaemic response. The intestinal brush border enzyme sucrase-isomaltase (SI) is the sole enzyme hydrolysing consumed sucrose, and we previously showed the acute effects of olive leaf extract (OLE) on sucrase activity when given together with sugars both in vitro and in vivo. Here we tested whether OLE could affect sucrase expression when pre-incubated chronically, a "priming" effect not dependent on competitive interaction with SI, in both a cell model and a human intervention. Using differentiated Caco-2/TC7 cells, long-term pre-treatment with oleuropein-rich olive leaf extract (OLE) lowered SI mRNA, surface protein and activity, and attenuated subsequent sucrose hydrolysis. Based on these results, a randomised, double-blinded, placebo-controlled, crossover pilot study was conducted. OLE (50 mg oleuropein) was consumed in capsule form 3 times a day for 1 week by 11 healthy young women followed by an oral sucrose tolerance test in the absence of OLE. However this treatment, compared to placebo, did not induce a change in post-prandial blood glucose maximum concentration (Glcmax), time to reach Glcmax and incremental area under the curve. These results indicate that changes in SI mRNA, protein and activity in an intestinal cell model by OLE are not sufficient under these conditions to induce a functional effect in vivo in healthy volunteers.
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Investigating the Modifications of Sugar Perception and Consumption in Cancer Patients.
Depeint, F, Niamba, CN, Illner, AK, Buche-Foissy, C, Branchu, J, Younes, H, Loncke, C, Pouillart, PR
Nutrition and cancer. 2018;(7):1060-1068
Abstract
The idea that sugar feeds the tumor cells is relayed by some health professionals and media alike. Patients may be torn between what they read in the media and their food preferences during and after treatment. With this survey, we aim at understanding the perception and overall consumption patterns of sugar in cancer patients together with possible physiological and psychological triggers. We decided not to include quantitative nutritional measures of the sugar consumption. The survey was distributed in a hospital setting and through a cancer support online network. Results have shown that opinion on sugar was globally "average". However, there were differences depending on sex and age. Half of the patients declared having a decreased consumption of sugar and sweet products while 26% declared an increased consumption. When looking at psychological triggers to consumption, the weight of fatigue and worry increased after cancer diagnosis compared to before. Environmental triggers such as mixed messages from health professionals or the media need to be further investigated. In line with ESPEN guidelines, we advise to maintain moderate sugar intake as part of a healthy diet to prevent malnutrition as a first line of defense against cancer-associated morbidity and mortality.
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The effect of honey consumption compared with sucrose on lipid profile in young healthy subjects (randomized clinical trial).
Rasad, H, Entezari, MH, Ghadiri, E, Mahaki, B, Pahlavani, N
Clinical nutrition ESPEN. 2018;:8-12
Abstract
BACKGROUND AND AIMS Several studies have demonstrated that honey consumption has beneficial effects on cardiovascular disease indicators. The current study aimed to investigate the effect of honey consumption compared with sucrose on lipid profile among young healthy subjects. METHODS Sixty healthy subjects, aged 18-30 years, were randomly recruited into this double blind randomized trial and assigned into two groups: honey (received 70 g honey per day) and sucrose (received 70 g sucrose per day) groups. Total cholesterol, TG, LDL and HDL were measured in the control and intervention groups at the beginning and end of study. RESULTS In this trial, the baseline FBS, SBP and DBP were not different between honey and sucrose groups (P > 0.3). We found evidence indicating consumption of honey can decrease total cholesterol, TG and LDL and increase HDL in healthy young subjects, but intake of sucrose increase total cholesterol, TG and LDL and decreased HDL. In all of these analyses, confounding variable including age, physical activity and some nutrient intake were adjusted. CONCLUSIONS Honey consumption can improve the lipid profile such as; total cholesterol, TG and LDL and increase HDL, but consumption of sucrose increases total cholesterol, TG and LDL and decreases HDL. Further clinical trial studies are required to confirm our findings.
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The Effect of Graphic Warnings on Sugary-Drink Purchasing.
Donnelly, GE, Zatz, LY, Svirsky, D, John, LK
Psychological science. 2018;(8):1321-1333
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Abstract
Governments have proposed text warning labels to decrease consumption of sugary drinks-a contributor to chronic diseases such as diabetes. However, they may be less effective than more evocative, graphic warning labels. We field-tested the effectiveness of graphic warning labels (vs. text warning labels, calorie labels, and no labels), provided insight into psychological mechanisms driving effectiveness, and assessed consumer sentiment. Study 1 indicated that graphic warning labels reduced the share of sugary drinks purchased in a cafeteria from 21.4% at baseline to 18.2%-an effect driven by substitution of water for sugary drinks. Study 2 showed that graphic warning labels heighten negative affect and prompt consideration of health consequences. Study 3 indicated that public support for graphic warning labels can be increased by conveying effectiveness information. These findings could spur more effective labeling policies that facilitate healthier choices, do not decrease overall beverage purchases, and are publicly accepted.
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Effects of free sugars on blood pressure and lipids: a systematic review and meta-analysis of nutritional isoenergetic intervention trials.
Fattore, E, Botta, F, Agostoni, C, Bosetti, C
The American journal of clinical nutrition. 2017;(1):42-56
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Abstract
BACKGROUND Sugar has been suggested as a central risk factor in the development of noncommunicable diseases. OBJECTIVE We assessed the evidence of the effects of free sugars compared with complex carbohydrates on selected cardiovascular disease risk factors. DESIGN We conducted a systematic review and meta-analysis of intervention trials to compare diets that provide a given amount of energy from free sugars with a control diet that provides the same amount of energy from complex carbohydrates. The primary outcomes were: blood pressure, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triacylglycerols, apolipoproteins A-I and B, or very low-density lipoprotein cholesterol. Body weight was also recorded but was not a primary outcome of the studies. RESULTS In all, 28 studies involving 510 volunteers were included. When free sugars were substituted for complex carbohydrates, no significant increases were detected in systolic or diastolic blood pressure, and no heterogeneity was observed. There were significant increases in HDL cholesterol, LDL cholesterol, and triacylglycerols, although for LDL cholesterol and triacylglycerols there was significant heterogeneity between studies and evidence of publication bias. After adjustment for missing studies, these increases lost significance. Subgroup analyses showed that diets providing the largest total energy intake and energy exchange enhanced the effect of free sugars on total and LDL cholesterol and triacylglycerols. The increase of triacylglycerols was no longer significant when studies with the highest risk of bias were excluded or when only randomized trials were considered. Free sugars had no effect on body weight. CONCLUSIONS In short- or moderate-term isoenergetic intervention trials, the substitution of free sugars for complex carbohydrates had no effect on blood pressure or body weight and an unclear effect on blood lipid profile. Further independent trials are required to assess whether the reduction of free sugars improves cardiovascular disease risk factors. This review was registered at http://www.crd.york.ac.uk/prospero as CRD42016042930.
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Sugar-Sweetened Beverages and Weight Gain in Children and Adults: A Systematic Review from 2013 to 2015 and a Comparison with Previous Studies.
Luger, M, Lafontan, M, Bes-Rastrollo, M, Winzer, E, Yumuk, V, Farpour-Lambert, N
Obesity facts. 2017;(6):674-693
Abstract
OBJECTIVE Partly inconsistent findings from previous reviews have fueled discussions on the impact of sugar-sweetened beverages (SSBs) on obesity development. The aim was to systematically review the recent evidence in children and adults. METHODS Data were retrieved from the databases MEDLINE, EMBASE, and Cochrane library for the period January 2013 to October 2015. A systematic review of prospective cohort studies and randomized controlled trials (RCTs) relating SSBs to weight measures was conducted. RESULTS 30 publications met the inclusion criteria. Prospective cohort studies (96%; n = 26) showed a positive association between consumption of SSBs and weight/BMI in adults and children (n = 242,352), and only one cohort study in children showed no association. Findings from three RCTs in children demonstrated that SSB consumption had an effect on BMI/BMI z-score. The one RCT in adults showed no significant effect of the intervention. 63% of the studies were of good, 30% of medium quality, and none was funded by industry. CONCLUSION Recent evidence suggests that SSB consumption is positively associated with or has an effect on obesity indices in children and adults. By combining the already published evidence with the new one, we conclude that public health policies should aim to reduce the consumption of SSBs and encourage healthy alternatives such as water.
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Ethnic Variability in Glycemic Response to Sucrose and Isomaltulose.
Tan, WS, Tan, SY, Henry, CJ
Nutrients. 2017;(4)
Abstract
The aim of this study was to compare the glycemic response of Caucasians and Asians to two disaccharides of different glycemic index (GI), and to examine if ethnic groups that showed the largest glycemic response to sucrose would benefit the most when it is replaced with isomaltulose. Forty healthy participants (10 Chinese; 10 Malays; 10 Caucasians; and 10 Indians) consumed beverages containing 50 g of sucrose or isomaltulose on two separate occasions using a randomized crossover design. Capillary blood glucose was measured in a fasted state and at 15, 30, 45, 60, 90, and 120 min after beverage ingestion. Glycemic response to sucrose was significantly higher in Malays compared to Caucasians (p = 0.041), but did not differ between Caucasians vs. Chinese (p = 0.145) or vs. Indians (p = 0.661). When sucrose was replaced with isomaltulose, glycemic responses were significantly reduced in all ethnic groups, with the largest reduction in glycemic response being observed in Malays. Malays, who had the greatest glycemic response to sucrose, also showed the greatest improvement in glycemic response when sucrose was replaced with isomaltulose. This implies that Malays who are more susceptible to type 2 diabetes mellitus may benefit from strategies that replace high GI carbohydrate with lower GI alternatives to assist in glycemic control.
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Sugar Restriction Leads to Increased Ad Libitum Sugar Intake by Overweight Adolescents in an Experimental Test Meal Setting.
O'Reilly, GA, Black, DS, Huh, J, Davis, JN, Unger, J, Spruijt-Metz, D
Journal of the Academy of Nutrition and Dietetics. 2017;(7):1041-1048
Abstract
BACKGROUND The impact of sugar restriction on subsequent sugar intake by overweight adolescents is unknown. OBJECTIVE Our aim was to examine the effect of sugar restriction on subsequent ad libitum sugar intake by overweight adolescents and whether habitual sugar intake and impulsivity influence the effect of sugar restriction on subsequent sugar intake. DESIGN This was an in-laboratory crossover feeding trial with sugar-exposure and sugar-restriction conditions. PARTICIPANTS/SETTING Eighty-seven overweight Latino and African-American adolescents underwent both meal conditions in two separate 8-hour in-laboratory visits. INTERVENTION Participants had access to ad libitum snack trays for 3 hours after the condition-specific meals. MAIN OUTCOME MEASURES Ad libitum sugar intake during the snack period was measured at each visit. Habitual sugar intake and impulsivity were assessed at baseline. STATISTICAL ANALYSES PERFORMED Repeated measures analysis of covariance was used to examine the within-person effect of meal condition on ad libitum sugar intake. Mixed models were used to examine the moderating effects of habitual sugar intake and impulsivity on the meal condition-ad libitum sugar intake relationship. RESULTS Participants consumed more ad libitum sugar during the snack period in the sugar-restriction condition than in the sugar-exposure condition (sugar restriction=78.63±38.84 g, sugar exposure=70.86±37.73 g; F=9.64, P=0.002). There was no relationship between habitual sugar intake and how much ad libitum sugar participants consumed during either condition. Higher impulsivity was associated with greater ad libitum sugar intake during both conditions (sugar restriction: b=.029, standard error=.01, P<0.05; sugar exposure: b=.034, standard error=.01, P<0.05). CONCLUSIONS Findings suggest that overweight adolescents restricted from sugar intake consume greater amounts of sugar when they are later given access to high-sugar foods. Overweight adolescents with higher impulsivity appear to consume greater amounts of sugar regardless of previous levels of sugar consumption. Compensatory sugar intake and trait impulsivity may have implications for dietary interventions in this population.