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Effects of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Beverages on Cardiometabolic Risk Factors, Body Composition, and Sweet Taste Preference: A Randomized Controlled Trial.
Ebbeling, CB, Feldman, HA, Steltz, SK, Quinn, NL, Robinson, LM, Ludwig, DS
Journal of the American Heart Association. 2020;(15):e015668
Abstract
Background A 2018 American Heart Association science advisory indicated that, pending further research, artificially sweetened beverages (ASBs) may be an appropriate initial replacement for sugar-sweetened beverages (SSBs) during transition to unsweetened beverages (USBs). Methods and Results We randomly assigned 203 adults (121 males, 82 females; 91.6% retention), who habitually consumed SSBs, to 3 groups and delivered free SSBs, ASBs, or USBs to their homes for 12 months. Outcomes included serum triglyceride to high-density lipoprotein cholesterol ratio (primary), body weight, and sweet taste preference (experimental assessment, 0%-18% sucrose solutions). Change in serum triglyceride to high-density lipoprotein cholesterol ratio was not different between groups. Although overall change in weight also was not different between groups, we found effect modification (P=0.006) by central adiposity. Among participants in the highest tertile of baseline trunk fat but not other tertiles, weight gain was greater (P=0.002) for the SSB (4.4±1.0 kg, estimate±SE) compared with ASB (0.5±0.9 kg) or USB (-0.2±0.9 kg) group. Both sweetness threshold (-1.0±0.2% m/v; P=0.005) and favorite concentration (-2.3±0.4% m/v; P<0.0001) decreased in the USB group; neither changed in the SSB group. In the ASB group, sweetness threshold did not change, and favorite concentration decreased (-1.1±0.5% m/v; P=0.02). Pairwise comparison between the ASB and USB groups indicated a difference in sweetness threshold (P=0.015). Conclusions Replacing SSBs with noncaloric beverages for 12 months did not affect serum triglyceride to high-density lipoprotein cholesterol ratio. Among individuals with central adiposity, replacing SSBs with either ASBs or USBs lowered body weight. However, USBs may have the most favorable effect on sweet taste preference. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT01295671.
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Effects of Consuming Sugar-Sweetened Beverages for 2 Weeks on 24-h Circulating Leptin Profiles, Ad Libitum Food Intake and Body Weight in Young Adults.
Sigala, DM, Widaman, AM, Hieronimus, B, Nunez, MV, Lee, V, Benyam, Y, Bremer, AA, Medici, V, Havel, PJ, Stanhope, KL, et al
Nutrients. 2020;(12)
Abstract
Sugar-sweetened beverage (sugar-SB) consumption is associated with body weight gain. We investigated whether the changes of (Δ) circulating leptin contribute to weight gain and ad libitum food intake in young adults consuming sugar-SB for two weeks. In a parallel, double-blinded, intervention study, participants (n = 131; BMI 18-35 kg/m2; 18-40 years) consumed three beverages/day containing aspartame or 25% energy requirement as glucose, fructose, high fructose corn syrup (HFCS) or sucrose (n = 23-28/group). Body weight, ad libitum food intake and 24-h leptin area under the curve (AUC) were assessed at Week 0 and at the end of Week 2. The Δbody weight was not different among groups (p = 0.092), but the increases in subjects consuming HFCS- (p = 0.0008) and glucose-SB (p = 0.018) were significant compared with Week 0. Subjects consuming sucrose- (+14%, p < 0.0015), fructose- (+9%, p = 0.015) and HFCS-SB (+8%, p = 0.017) increased energy intake during the ad libitum food intake trial compared with subjects consuming aspartame-SB (-4%, p = 0.0037, effect of SB). Fructose-SB decreased (-14 ng/mL × 24 h, p = 0.0006) and sucrose-SB increased (+25 ng/mL × 24 h, p = 0.025 vs. Week 0; p = 0.0008 vs. fructose-SB) 24-h leptin AUC. The Δad libitum food intake and Δbody weight were not influenced by circulating leptin in young adults consuming sugar-SB for 2 weeks. Studies are needed to determine the mechanisms mediating increased energy intake in subjects consuming sugar-SB.
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Chronic sucralose consumption induces elevation of serum insulin in young healthy adults: a randomized, double blind, controlled trial.
Bueno-Hernández, N, Esquivel-Velázquez, M, Alcántara-Suárez, R, Gómez-Arauz, AY, Espinosa-Flores, AJ, de León-Barrera, KL, Mendoza-Martínez, VM, Sánchez Medina, GA, León-Hernández, M, Ruiz-Barranco, A, et al
Nutrition journal. 2020;(1):32
Abstract
BACKGROUND Non-nutritive sweeteners (NNS) are widely consumed by humans due to their apparent innocuity, especially sucralose. However, several studies link sucralose consumption to weight gain and metabolic derangements, although data are still contradictory. OBJECTIVE To determine the effect of acute and chronic consumption of sucralose on insulin and glucose profiles in young healthy adults. MATERIAL AND METHODS This was a randomized, parallel, double-blind, placebo-controlled trial conducted in healthy young adults from 18 to 35 years old, without insulin resistance. A hundred thirty seven participants were randomized into three groups: a) volunteers receiving 48 mg sucralose, b) volunteers receiving 96 mg sucralose, and c) controls receiving water as placebo. All participants underwent a 3-h oral glucose tolerance test (OGTT) preceded by consuming sucralose or placebo 15 min before glucose load, at two time points: week zero (Wk0) and week ten (Wk10). Serum insulin and glucose were measured every 15 min during both OGTTs. RESULTS Compared to Wk0, consumption of sucralose for 10 weeks provoked 1) increased insulin concentrations at 0 min (7.5 ± 3.4 vs 8.8 ± 4.1 μIU/mL; p = 0.01), 30 min (91.3 ± 56.2 vs 110.1 ± 49.4 μIU/mL; p = 0.05), 105 min (47.7 ± 24.4 vs 64.3 ± 48.2 μIU/mL; p = 0.04) and 120 min (44.8 ± 22.1 vs 63.1 ± 47.8 μIU/mL; p = 0.01) in the 48 mg sucralose group; 2) increased blood glucose at - 15 min (87.9 ± 4.6 vs 91.4 ± 5.4 mg/dL; p = 0.003), 0 min (88.7 ± 4 vs 91.3 ± 6 mg/dL; p = 0.04) and 120 min (95.2 ± 23.7 vs 106.9 ± 19.5 mg/dL; p = 0.009) in the 48 mg sucralose group; 3) increased area under the curve (AUC) of insulin in both 48 and 96 mg sucralose groups (9262 vs 11,398; p = 0.02 and 6962 vs 8394; p = 0.12, respectively); and 4) reduced Matsuda index in the 48 mg sucralose group (6.04 ± 3.19 vs 4.86 ± 2.13; p = 0.01). CONCLUSIONS These data show that chronic consumption of sucralose can affect insulin and glucose responses in non-insulin resistant healthy young adults with normal body mass index (between 18.5 and 24.9 kg/m2), however, the effects are not consistent with dose; further research is required. CLINICAL TRIAL REGISTRY NCT03703141.
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Signs of Warning: Do Health Warning Messages on Sweets Affect the Neural Prefrontal Cortex Activity?
Mehlhose, C, Risius, A
Nutrients. 2020;(12)
Abstract
In the global attempt to combat rising obesity rates, the introduction of health warning messages on food products is discussed as one possible approach. However, the perception of graphical health warning messages in the food context and the possible impact that they may have, in particular at the neuronal level, have hardly been studied. Therefore, the aim of this explorative study was to examine consumers' reactions (measured as neuronal activity and subjective reporting) of two different types of graphical health warning messages on sweets compared to sweets without warning messages. One type used the red road traffic stop sign as graphical information ("Stop"), while the other one used shocking pictures ("Shock"), an approach similar to the images on cigarette packages. The neural response of 78 participants was examined with the neuroimaging technique functional near-infrared spectroscopy (fNIRS). Different hemodynamic responses in the orbitofrontal cortex (OFC), the frontopolar cortex (FOC), and the dorsolateral prefrontal cortex (dlPFC) were observed, regions which are associated with reward evaluation, social behavior consequences, and self-control. Further, the health warning messages were actively and emotionally remembered by the participants. These findings point to an interesting health information strategy, which should be explored and discussed further.
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Effects of Stevia Extract on Postprandial Glucose Response, Satiety and Energy Intake: A Three-Arm Crossover Trial.
Farhat, G, Berset, V, Moore, L
Nutrients. 2019;(12)
Abstract
UNLABELLED Non-nutritive sweeteners (NNS) are suggested to lower energy intake in the diet, but they have been paradoxically involved in the epidemic of obesity and Type 2 diabetes. Stevia is the least studied sweetener. This study aims to investigate the effect of stevia on postprandial glucose levels, appetite and food intake. METHODS 30 participants (20 females/10 males; 26.1 (10.56) years; body mass index (BMI) 23.44 (3.42) Kg/m2) took part in a three-arm crossover trial where they received preloads of water, sugar (60 g) and stevia (1 g) on three different days, followed by an ad libitum pizza lunch. Breakfast was standardised. A one-day diet diary was collected on each test day. Visual analogue scales (VAS) were used to assess subjective feelings of appetite. Blood glucose samples were collected at 30-min intervals until 120 min post lunch. RESULTS Energy intake did not significantly differ between preloads for ad libitum meals (p = 0.78) and overall day (p = 0.33). VAS scores for hunger and desire to eat (DTE) were lower following stevia preload compared to water (p < 0.05). After adjusting for the sugar preload and calorie content, postprandial glucose levels did not significantly differ between interventions. CONCLUSION Stevia lowers appetite sensation and does not further increase food intake and postprandial glucose levels. It could be a useful strategy in obesity and diabetes prevention and management.
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Fructose Consumption Contributes to Hyperinsulinemia in Adolescents With Obesity Through a GLP-1-Mediated Mechanism.
Galderisi, A, Giannini, C, Van Name, M, Caprio, S
The Journal of clinical endocrinology and metabolism. 2019;(8):3481-3490
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CONTEXT The consumption of high-fructose beverages is associated with a higher risk for obesity and diabetes. Fructose can stimulate glucagon-like peptide 1 (GLP-1) secretion in lean adults, in the absence of any anorexic effect. OBJECTIVE We hypothesized that the ingestion of glucose and fructose may differentially stimulate GLP-1 and insulin response in lean adolescents and adolescents with obesity. DESIGN We studied 14 lean adolescents [four females; 15.9 ± 1.6 years of age; body mass index (BMI), 21.8 ± 2.2 kg/m2] and 23 adolescents with obesity (five females; 15.1 ± 1.6 years of age; BMI, 34.5 ± 4.6 kg/m2). Participants underwent a baseline oral glucose tolerance test to determine their glucose tolerance and estimate insulin sensitivity and β-cell function [oral disposition index (oDIcpep)]. Eligible subjects received, in a double-blind, crossover design, 75 g of glucose or fructose. Plasma was obtained every 10 minutes for 60 minutes for the measures of glucose, insulin, and GLP-1 (radioimmunoassay) and glucose-dependent insulinotropic polypeptide (GIP; ELISA). Incremental glucose and hormone levels were compared between lean individuals and those with obesity by a linear mixed model. The relationship between GLP-1 increment and oDIcpep was evaluated by regression analysis. RESULTS Following the fructose challenge, plasma glucose excursions were similar in both groups, yet the adolescents with obesity exhibited a greater insulin (P < 0.001) and GLP-1 (P < 0.001) increase than did their lean peers. Changes in GIP were similar in both groups. After glucose ingestion, the GLP-1 response (P < 0.001) was higher in the lean group. The GLP-1 increment during 60 minutes from fructose drink was correlated with a lower oDIcpep (r2 = 0.22, P = 0.009). CONCLUSION Fructose, but not glucose, ingestion elicits a higher GLP-1 and insulin response in adolescents with obesity than in lean adolescents. Fructose consumption may contribute to the hyperinsulinemic phenotype of adolescent obesity through a GLP-1-mediated mechanism.
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Effects of Consuming a Low Dose of Alcohol with Mixers Containing Carbohydrate or Artificial Sweetener on Simulated Driving Performance.
Brickley, B, Desbrow, B, McCartney, D, Irwin, C
Nutrients. 2018;(4)
Abstract
The Australian National Drug and Alcohol Research Centre (NDARC) devised gender-based drinking recommendations to ensure blood or equivalized breath alcohol concentrations (BrAC) remain <0.050%. However, these may be inappropriate for individuals consuming alcohol without carbohydrate (CHO), which results in higher BrACs. This study investigated the effects of ingesting alcohol with and without CHO on BrACs and simulated driving performance. Thirty-two participants (16 males; age: 23 ± 6 years) completed two randomized single-blinded trials. Participants performed a baseline drive (Drive 1), then an experimental drive (Drive 2), following alcohol consumption (males: 20 g; females: 10 g). Alcoholic beverages contained either 25 g sucrose or aspartame (AS). Driving performance was assessed using lateral control (standard deviation of lane position [SDLP] and number of lane departures) and risk-taking (number of overtaking maneuvers and maximum overtaking speed). BrAC and subjective ratings (e.g., intoxication) were also assessed. BrAC was significantly lower as Drive 2 commenced with CHO compared to AS (0.022 ± 0.008% vs. 0.030 ± 0.011%). Two males provided BrACs >0.050% with AS. Neither beverage influenced changes to simulated driving performance. Ingesting alcohol in quantities advised by the NDARC results in no detectable simulated driving impairment. However, the likelihood of exceeding the legal drink-driving BrAC is increased when alcohol is consumed with artificially-sweetened mixers.
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Effects of caloric and noncaloric sweeteners on antroduodenal motility, gastrointestinal hormone secretion and appetite-related sensations in healthy subjects.
Meyer-Gerspach, AC, Biesiekierski, JR, Deloose, E, Clevers, E, Rotondo, A, Rehfeld, JF, Depoortere, I, Van Oudenhove, L, Tack, J
The American journal of clinical nutrition. 2018;(5):707-716
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BACKGROUND Activation of gastrointestinal (GI) sweet taste receptors by caloric sweeteners triggers secretion of anorexigenic and inhibition of orexigenic GI hormones to regulate food intake. The effect of noncaloric sweeteners on these mechanisms is controversial. We have recently shown that motilin-induced gastric phase III contractions signal hunger feelings, thereby identifying GI motility, and its regulatory hormone motilin, as novel players in food intake regulation. OBJECTIVE The objective of the present study was to determine the effect of caloric and noncaloric sweeteners on GI motility, GI hormone secretion, and hunger in humans. DESIGN The study was a randomized, double-blind, crossover trial. Twelve healthy volunteers underwent 4 gastroduodenal manometry recordings in which the occurrence of phase III contractions was followed by the intragastric (i.g.) administration of 250 mL tap water or equisweet caloric (1) 50 g glucose and 2) 25 g fructose) and noncaloric sweeteners [220 mg acesulfame-K (ace-K)] dissolved in 250 mL tap water. Measurement continued until ≥1 subsequent phase III. Blood samples were collected for the measurement of GI hormones. Visual analog scales were used to rate hunger and satiety feelings. Response curves were analyzed using (generalized) linear mixed models. RESULTS We found: 1) an inhibitory effect of the 2 caloric sweeteners on antral motility (P < 0.01), but no effect after ace-K, 2) an inhibitory effect of the 2 caloric sweeteners on motilin secretion (P < 0.01), but no effect after ace-K, 3) an early increase in cholecystokinin (CCK) secretion after the 2 caloric sweeteners (P < 0.01), but no effect after ace-K, and 4) an initial stronger decrease in hunger feelings and stronger increase in satiety after ace-K (P < 0.05), followed by a steeper return of hunger and decrease of satiety after ace-K (P < 0.05). CONCLUSIONS Our results demonstrate, for the first time to our knowledge, that the caloric sweeteners glucose and fructose, but not the noncaloric sweetener ace-K, inhibit motilin secretion and antral motility while increasing CCK secretion. This trial was registered at clinicaltrials.gov as NCT02891525.
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A 12-week randomized clinical trial investigating the potential for sucralose to affect glucose homeostasis.
Grotz, VL, Pi-Sunyer, X, Porte, D, Roberts, A, Richard Trout, J
Regulatory toxicology and pharmacology : RTP. 2017;:22-33
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The discovery of gut sweet taste receptors has led to speculations that non-nutritive sweeteners, including sucralose, may affect glucose control. A double-blind, parallel, randomized clinical trial, reported here and previously submitted to regulatory agencies, helps to clarify the role of sucralose in this regard. This was primarily an out-patient study, with 4-week screening, 12-week test, and 4-week follow-up phases. Normoglycemic male volunteers (47) consumed ∼333.3 mg encapsulated sucralose or placebo 3x/day at mealtimes. HbA1c, fasting glucose, insulin, and C-peptide were measured weekly. OGTTs were conducted in-clinic overnight, following overnight fasting twice during screening phase, twice during test phase, and once at follow-up. Throughout the study, glucose, insulin, C-peptide and HbA1c levels were within normal range. No statistically significant differences between sucralose and placebo groups in change from baseline for fasting glucose, insulin, C-peptide and HbA1c, no clinically meaningful differences in time to peak levels or return towards basal levels in OGTTs, and no treatment group differences in mean glucose, insulin, or C-peptide AUC change from baseline were observed. The results of other relevant clinical trials and studies of gastrointestinal sweet taste receptors are compared to these findings. The collective evidence supports that sucralose has no effect on glycemic control.
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Children's sugar-sweetened beverages consumption: associations with family and home-related factors, differences within ethnic groups explored.
van de Gaar, VM, van Grieken, A, Jansen, W, Raat, H
BMC public health. 2017;(1):195
Abstract
BACKGROUND The consumption of sugar-sweetened beverages (SSB) may contribute to the development of overweight among children. The present study aimed to evaluate associations between family and home-related factors and children's SSB consumption. We explored associations within ethnic background of the child. METHODS Cross-sectional data from the population-based 'Water Campaign' study were used. Parents (n = 644) of primary school children (6-13 years) completed a questionnaire on socio-demographic characteristics, family and home-related factors and child's SSB intake. The family and home-related factors under study were: cognitive variables (e.g. parental attitude, subjective norm), environmental variables (e.g. availability of SSB, parenting practices), and habitual variables (e.g. habit strength, taste preference). Regression analyses were used to evaluate the associations between family and home-related factors and child's SSB intake (p < 0.05). RESULTS Mean age of the children was 9.4 years (SD: 1.8) and 54.1% were girls. The child's average SSB intake was 0.9 litres (SD: 0.6) per day. Child's age, parents' subjective norm, parenting practices, and parental modelling were positively associated with the child's SSB intake. The availability of SSB at home and school and parental attitude were negatively associated with the child's SSB intake. The associations under study differed according to the child's ethnic background, with the explained variance of the full models ranging from 8.7% for children from Moroccan or Turkish ethnic background to 44.4% for children with Dutch ethnic background. CONCLUSIONS Our results provide support for interventions targeting children's SSB intake focussing on the identified family and home-related factors, with active participation of parents. Also, the relationships between these factors and the child's SSB intake differed for children with distinct ethnic backgrounds. Therefore, we would recommend to tailor interventions taking into account the ethnic background of the family. TRIAL REGISTRATION Number NTR3400 ; date April 4th 2012; retrospectively registered.