Natural Alternative Sweeteners and Diabetes Management

PURPOSE OF REVIEW

The goal of this review is to discuss the data on natural alternative sweeteners and their effects on glucose homeostasis and other metabolic parameters within the past five years. We sought to answer whether common natural alternative sweeteners have a positive or negative effect on glucose control in both human and animal models, and whether the data supports their widespread use as a tool to help reduce the prevalence of diabetes and associated comorbid conditions.

RECENT FINDINGS

Recent studies suggest that natural alternative sweeteners may reduce hyperglycemia, improve lipid metabolism, and have antioxidant effects particularly in those that have baseline diabetes. Diabetes and metabolic syndrome have become a global healthcare crisis and the sugar overconsumption plays a major role. The use of artificial sweeteners has become more prevalent to improve insulin resistance in those with diabetes, obesity, and metabolic syndrome, although the evidence does not support this result. There are however some promising data to suggest that natural alternative sweeteners may be a better alternative to sugar and artificial sweeteners.

Cognitive Performance Following Ingestion of Glucose-Fructose Sweeteners That Impart Different Postprandial Glycaemic Responses: A Randomised Control Trial

We aimed to investigate the isolated effect of glycaemia on cognitive test performance by using beverages sweetened with two different glucose–fructose disaccharides, sucrose and isomaltulose. In a randomised crossover design, 70 healthy adults received a low-glycaemic-index (GI) isomaltulose and sucralose beverage (GI 32) and a high-GI sucrose beverage (GI 65) on two occasions that were separated by two weeks. Following beverage ingestion, declarative memory and immediate word recall were examined at 30, 80 and 130 min. At 140 min, executive function was tested. To confirm that the glycaemic response of the test beverages matched published GI estimates, a subsample (n = 12) of the cognitive testing population (n = 70) underwent glycaemic response testing on different test days. A significantly lower value of mean (95% CI) blood glucose concentration incremental area under the curve (iAUC) was found for isomaltulose, in comparison to the blood glucose concentration iAUC value for sucrose, the difference corresponding to −44 mmol/L∙min (−70, −18), p = 0.003. The mean (95% CI) difference in numbers of correct answers or words recalled between beverages at 30, 80 and 130 min were 0.1 (−0.2, 0.5), −0.3 (−0.8, 0.2) and 0.0 (−0.5, 0.5) for declarative memory, and −0.5 (−1.4, 0.3), 0.4 (−0.4, 1.3) and −0.4 (−1.1, 0.4) for immediate free word recall. At 140 min, the mean difference in the trail-making test between beverages was −0.3 sec (−6.9, 6.3). None of these differences were statistically or clinically significant. In summary, cognitive performance was unaffected by different glycaemic responses to beverages during the postprandial period of 140 min.

Electronic device use and beverage related sugar and caffeine intake in US adolescents

Background

Despite recent declines in consumption of sugary beverages, energy drinks (ED) and sodas continue to contribute a substantial amount of sugar and caffeine to the diet of youth. Consumption of these beverages has been linked with electronic device use, however in-depth associations between sugar and caffeine intake from energy drinks and sodas with various electronic devices are not clear.

Objective

Describe the relationship of soda and energy drink consumption and associated added sugar and caffeine intake with electronic device use among adolescents.

Methods

Secondary data from the 2013–2016 cycles of Monitoring the Future Survey, a national, repeated, cross-sectional study, were analyzed. Information on energy drink and soda consumption by students in grades 8 and 10 (n = 32,418) from 252–263 schools randomly sampled from all US states was used.

Results

Soda and energy drink consumption decreased each year from 2013–2016 while daily use of electronic devices remained stable. An additional hour/day of TV was linked to a 6.92g (6.31,7.48; p<0.001) increase in sugar intake and a 32% (OR = 1.32; 1.29,1.35; p < .001) higher risk of exceeding World Health Organization (WHO) recommended sugar intakes. Further, each hour/day of TV was linked to a 28% increased risk of exceeding caffeine recommendations (OR = 1.25–1.31; p<0.001). Each hour per day talking on a cellphone was associated with an increased risk of exceeding WHO sugar and caffeine intakes by 14% (OR = 1.11–1.16; p<0.001) and 18% (OR = 1.15–1.21; p<0.001) respectively. Video game use was only weakly linked to caffeine intake. Computer use for school was associated with lower likelihood of exceeding sugar intake cut-offs.

Conclusion

While a trend towards reduced energy drink and soda intake from 2013–2016 was evident, greater electronic device use, especially TV time, was linked to higher intake of beverage-derived added sugar and caffeine amongst adolescents. Addressing these behaviours through counselling or health promotion could potentially help to reduce excess sugar and caffeine intake from sodas and energy drinks among this population.

Modulations of microbehaviour by associative memory strength in Drosophila larvae

Finding food is a vital skill and a constant task for any animal, and associative learning of food-predicting cues gives an advantage in this daily struggle. The strength of the associations between cues and food depends on a number of parameters, such as the salience of the cue, the strength of the food reward and the number of joint cue-food experiences. We investigate what impact the strength of an associative odour-sugar memory has on the microbehaviour of Drosophila melanogaster larvae. We find that larvae form stronger memories with increasing concentrations of sugar or odour, and that these stronger memories manifest themselves in stronger modulations of two aspects of larval microbehaviour, the rate and the direction of lateral reorientation manoeuvres (so-called head casts). These two modulations of larval behaviour are found to be correlated to each other in every experiment performed, which is in line with a model that assumes that both modulations are controlled by a common motor output. Given that the Drosophila larva is a genetically tractable model organism that is well suited to the study of simple circuits at the single-cell level, these analyses can guide future research into the neuronal circuits underlying the translation of associative memories of different strength into behaviour, and may help to understand how these processes are organised in more complex systems.

Association of artificially sweetened and sugar-sweetened soft drinks with β-cell function, insulin sensitivity, and type 2 diabetes: the Maastricht Study

Purpose

Artificially sweetened and sugar-sweetened beverage consumptions have both been reported to be associated with type 2 diabetes mellitus (T2D) risk. The aim of the current study was to investigate the potential underlying associations with dynamic pancreatic β-cell function (BCF) and insulin sensitivity.

Methods

We evaluated cross-sectional associations in 2240 individuals (mean ± SD age 59.6 ± 8.18, 49.4% male, 21.9% T2D) participating in a diabetes-enriched population-based cohort. Artificially sweetened and sugar-sweetened soft drinks and juice consumption were assessed by a food-frequency questionnaire. Glucose metabolism status, insulin sensitivity, and BCF were measured by a seven-point oral glucose tolerance test. Regression analyses were performed to assess associations of artificially and sugar-sweetened beverage consumption with measures of glucose homeostasis. Associations were adjusted for potential confounders, and additionally with and without total energy intake and BMI, as these variables could be mediators.

Results

Moderate consumption of artificially sweetened soft drink was associated with lower β-cell glucose sensitivity [standardized beta (95% CI), − 0.06 (− 0.11, − 0.02)], total insulin secretion [β − 0.06 (− 0.10, − 0.02)], and with lower β-cell rate sensitivity [odds ratio (95% CI), 1.29 (1.03, 1.62)] compared to abstainers. Daily artificially sweetened soft drink consumption was associated with lower β-cell glucose sensitivity [β − 0.05 (− 0.09, 0.00)], and total insulin secretion [β − 0.05 − 0.09, − 0.01)] compared to abstainers.

Conclusions

Moderate and daily consumption of artificially sweetened soft drinks was associated with lower BCF, but not with insulin sensitivity. No evidence was found for associations of sugar-sweetened soft drink and juice consumption with BCF or insulin sensitivity in this middle-aged population. Prospective studies are warranted to further investigate the associations of artificially and sugar-sweetened beverage consumption with non-fasting insulin sensitivity and multiple BCF aspects.

Electronic supplementary material

The online version of this article (10.1007/s00394-019-02026-0) contains supplementary material, which is available to authorized users.

Impaired Fat Oxidation During Exercise in Long-Chain Acyl-CoA Dehydrogenase Deficiency Patients and Effect of IV-Glucose

CONTEXT

Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency (LCHADD) affects oxidation of long-chain fatty acids (FAO) and is associated with risk of metabolic crises and episodic rhabdomyolysis.

CASE DESCRIPTION

We present the cases of two patients with LCHADD. Patient 1 (male, 26 years old) was severely affected by muscle weakness and neuropathy. He was diagnosed at age 20 years and was nonadherent to standard dietary management. MRI revealed significant fat replacement of muscle in both calves. Patient 2 (female, 15 years old) was diagnosed at age 1 year. She had no muscle weakness and was compliant with the recommended diet. Compared with healthy persons, both patients had reduced FAO and palmitate oxidation, measured with indirect calorimetry and stable isotope technique during a submaximal cycle ergometer test. Patient 2 had some residual capacity to increase FAO and a compensatory higher carbohydrate oxidation, which ensured a near-normal exercise capacity. Patient 1 was unable to increase FAO and could only complete 23 minutes of exercise, vs 60 minutes by patient 2 and healthy persons. In both, 10% IV infusion of glucose (IV-glucose) during exercise increased carbohydrate oxidation slightly, but endurance was not improved, which likely relates to the fixed weakness in patient 1 and because the residual FAO was suppressed by the glucose infusion in both.

CONCLUSION

The two patients illustrate that FAO is impaired and carbohydrate oxidation is elevated during exercise in patients affected by LCHADD, compared with healthy persons, but IV-glucose has no beneficial effect on exercise tolerance in LCHADD.

Presence and consumption of sugars and low and no-calorie sweeteners in the Spanish diet: an updated overview

INTRODUCTION

Introduction: the term "sugars" describes a specific group of carbohydrates and one of the most controversial components of our diet, as public health authorities worldwide acknowledge that there is an excessive intake. Reformulation practices with low and no-calorie sweeteners (LNCS) are being carried out worldwide. However, a lack of information about the present market status and evolution is highly recognized. Materials and methods: review of the most recent studies. Results: there is a lack of comprehensive Food Composition Tables (FCT) and Databases (DB) including sugar contents and many countries have developed their own for the estimation of sugar intakes or with the aim of monitoring changes in processed food composition. Moreover, surveys assessing carbohydrate and sugar consumption and their dietary sources are scarce and sometimes not comparable due to the different methodologies, FCT and DB used, and non-harmonised use of terms and nomenclature, especially for the estimation of added sugars. Results from studies show that total and added sugar intakes around the world are quite comparable in terms of percentage of total energy from diet and major dietary sources. WHO's recommendations are being exceeded, especially amongst the younger population groups. Conclusions: future research on sweeteners, both caloric and low or non-caloric, should comprise the development of comprehensible, harmonized and updated databases of added sugar and LNCS, the evaluation of the frequent consumption of LNCS from foods and beverages and its potential association with an improved food model/pattern and lifestyles. Finally, intervention studies with LNCS are urgently needed.

Obesity, Xenobiotic Intake and Antimicrobial-Resistance Genes in the Human Gastrointestinal Tract: A Comparative Study of Eutrophic, Overweight and Obese Individuals

Although lifestyle and physiology in obese individuals are accepted to lead to changes in the intestinal microbiota, uncertainty remains about microbiota dysbiosis, and xenobiotics intake, as a source of selective pressure, independent of antimicrobial chemotherapy. The aim of this study was to compare the occurrence of antimicrobial resistance genetic markers (ARG) in faecal specimens of eutrophic, overweight and obese individuals, and their correlation with xenobiotic intake and gut bacteria density. Methods: This was a cross-sectional case-controlled study including 72 adult participants with no record of intestinal or systemic diseases, or recent use of antimicrobials, grouped as eutrophic, overweight, or obese. Anthropometric profile, eating habits and oral xenobiotics intake were recorded. Faecal metagenomic DNA was used to screen for ARG by PCR, and to measure bacterial groups by fluorescence in situ hybridization (FISH). Student’s t and Wilcoxon tests were used to compare means and differences in ARG detection (95% confidence intervals). Correlation analyses (odds ratio) and relationships between bacteria density and ARG were determined. Results: Increase in abdominal circumference, waist circumference, hip, waist-hip ratio, BMI, carbohydrate, fibres, and total calorie intakes were different from eutrophic to obese participants. Habitual use of antihypertensive and anti-inflammatory drugs, antacids, and artificial sweeteners were associated mainly with obesity and overweight. Nutritional supplements were associated to the eutrophic group. ARG screening showed differences being more frequent among obese, and positive for 27 genetic markers related to β-lactams, tetracyclines, the macrolide lincosamide and streptogramin group, quinolones, sulfonamides, aminoglycosides, and efflux pump. Positive correlation between ARG and BMI, caloric intake, and intake of xenobiotics, was observed for obese individuals. Relationships among ARG detection and bacteria densities were also different. Conclusions: This study reinforces the hypothesis that obese individuals may harbour an altered gut microbiota, if compared to eutrophic. The overweight individuals display a transitional gut microbiota which seems to be between eutrophic and obese. Furthermore, the increased xenobiotic intake associated to obesity may play an important role in the antimicrobial resistance phenomenon.

Contemporary Trends and Habits in the Consumption of Sugar and Sweeteners-A Questionnaire Survey among Poles

The purpose of the paper was a cross sectional study to evaluate the use of sugars and selected sweeteners by Polish consumers in their diet. The survey was conducted using the direct interview method on the group of 2000 adults declaring the consumption of sugar or sweeteners. The ANOVA test and multi-dimensional cluster analysis was used to the data interpretation (p < 0.05). It was stated that the consumption of sugar among consumers remained at a high level. Respondents declared taking up the activities towards reducing sugar intake in their diet mostly due to health-related reasons. It was emphasized in particular by women taking part in the survey. The most frequent way to limit the amount of sugar in the diet consisted in choosing sweeteners, mainly stevia and xylitol. However, the knowledge concerning steviol glycosides among the consumers was not extensive. Results are the source of up-to-date information concerning the consumption of sugar and sweeteners. Consumers to whom nutrition campaigns on the necessity to limit the content of sugar in the diet are worth addressing were identified. A hypothesis, that consumers are currently more aware of the negative influence of increased sugar consumption on their health and they aim at limiting the content of added sugar in their diet, was confirmed.

Sugar-Sweetened Beverage Consumption and Associated Factors in School-Going Adolescents of New Caledonia

This cross-sectional study assessed sugar-sweetened beverage (SSB) consumption and its associations with the sociodemographic and physical characteristics, behavior and knowledge of New Caledonian adolescents. The survey data of 447 adolescents from ages 11 to 16 years were collected in five secondary public schools of New Caledonia between July 2015 and April 2016. These data included measured height and weight, SSB consumption, sociodemographic characteristics, body weight perception, physical activity, and knowledge (sugar quantity/SSB unit; energy expenditure required to eliminate a unit) and opinions about the SSB‒weight gain relationship. Ninety percent of these adolescents declared regularly drinking SSBs. Quantities were associated with living environment (1.94 L·week⁻¹ in urban environment vs. 4.49 L·week⁻¹ in rural environment, p = 0.001), ethnic community (4.77 L·week⁻¹ in Melanesians vs. 2.46 L·week⁻¹ in Caucasians, p < 0.001) and knowledge about energy expenditure (6.22 L·week⁻¹ in unknowledgeable adolescents vs. 4.26 L·week⁻¹ in adolescents who underestimated, 3.73 L·week⁻¹ in adolescents who overestimated, and 3.64 L·week⁻¹ in adolescents who correctly responded on the energy expenditure required to eliminate an SSB unit, p = 0.033). To conclude, community-based health promotion strategies should (1) focus on the physical effort needed to negate SSB consumption rather than the nutritional energy from SSB units and (2) highlight how to achieve sustainable lifestyles and provide tools for greater understanding and positive action.

Sucrose ingestion induces glutamate AMPA receptor phosphorylation in dorsal hippocampal neurons: Increased sucrose experience prevents this effect

Evidence suggests that meal-related memory influences later eating behavior. Memory can serve as a powerful mechanism for controlling eating behavior because it provides a record of recent intake that likely outlasts most physiological signals generated by ingestion. Dorsal (dHC) and ventral hippocampal (vHC) neurons are critical for memory, and we demonstrated previously that they limit energy intake during the postprandial period. If dHC or vHC neurons control intake through a process that requires memory, then ingestion should increase events necessary for synaptic plasticity in dHC and vHC during the postprandial period. To test this, we determined whether ingesting a sucrose solution induced posttranslational events critical for hippocampal synaptic plasticity: phosphorylation of AMPAR GluA1 subunits at 1) serine 831 (pSer831) and 2) serine 845 (pSer845). We also examined whether increasing the amount of previous experience with the sucrose solution, which would be expected to decrease the mnemonic demand involved in an ingestion bout, would also attenuate sucrose-induced phosphorylation. Quantitative immunoblotting of dHC and vHC membrane fractions demonstrated that sucrose ingestion increased postprandial pSer831 in dHC but not vHC. Increased previous sucrose experience prevented sucrose-induced dHC pSer831. Sucrose ingestion did not affect pSer845 in either dHC or vHC. Thus, the present findings show that ingestion activates a postranslational event necessary for synaptic plasticity in an experience-dependent manner, which is consistent with the hypothesis that dHC neurons form a memory of a meal during the postprandial period.

Reduction in purchases of energy-dense nutrient-poor foods in Mexico associated with the introduction of a tax in 2014

In 2014, an 8% tax on energy-dense nutrient-poor foods was implemented in Mexico with the aim of reducing its consumption. This paper estimated changes in household purchases of taxed food. We used the latest five waves of the nationally representative Mexican Income and Expenditure Survey (2008, 2010, 2012, 2014 and 2016). The analytic sample comprises 154,777 households. We estimated changes in purchases based on a before and after comparison. Results show a reduction in purchases of taxed food of -5.4 g/week per capita, equivalent to a relative reduction of -5.3% in the 2014 and 2016 waves compared to the 2008, 2010 and 2012 rounds. The largest relative reductions were in urban areas (-6.9%), among households with children (-7.0%), households where the head had an intermediate educational level (-9.9%) and the southern region (-14.8%). We did not find a significant reduction in rural areas. While there is a large heterogeneity, the fiscal instrument has been effective in reducing taxed food purchases and has generated substantial revenue that could be used to finance policies for the prevention and treatment of obesity.

Medium-chain triglyceride reinforce the hepatic damage caused by fructose intake in mice

We aimed to investigate the effects of medium-chain triglyceride oil on the high fructose diet-provoked hepatic abnormalities in mice. We used C57bl/6 mice of 3-months-old divided into four groups for 12 weeks: control (C), control with MCT (C-MCT), fructose (F), and fructose with MCT (F-MCT). We investigated food and water intake, body mass, blood pressure, glucose tolerance, plasma and liver biochemistry, hepatic protein and gene expression. There were no changes in body mass, food intake and glucose tolerance among the groups. The F group presented increased water intake and blood pressure associated with hepatic steatosis and elevated de novo lipogenesis, beta-oxidation, mitochondrial biogenesis and inflammation in the liver. Surprisingly, the C-MCT group also showed hepatic steatosis and inflammation in the liver, and the F-MCT group had no exacerbations of fructose-induced abnormalities, showing marked hepatic steatosis, lipogenesis de novo and hepatic inflammation. The MCT oil groups also presented increased beta-oxidation and mitochondrial biogenesis. In conclusion, MCT oil showed detrimental hepatic effects and should be used with caution, especially in the presence of hepatic alterations.

Gastrointestinal Tolerance of D-Allulose in Healthy and Young Adults. A Non-Randomized Controlled Trial

D-allulose has recently received attention as a sugar substitute. However, there are currently no reports regarding its association with gastrointestinal (GI) tolerance. Thus, we performed a GI tolerance test for D-allulose in order to establish its daily acceptable intake level. When the dose of D-allulose was gradually increased in steps of 0.1 g/kg·Body Weight (BW) to identify the maximum single dose for occasional ingestion, no cases of severe diarrhea or GI symptoms were noted until a dose of 0.4 g/kg·BW was reached. Severe symptoms of diarrhea were noted at a dose of 0.5 g/kg·BW. Similarly, the GI tolerance test did not show any incidences of severe diarrhea or GI symptoms until a dose of 0.5 g/kg·BW was reached. A correlation analysis of the GI tolerance test for D-allulose and sugar revealed significantly higher frequencies of symptoms of diarrhea (p = 0.004), abdominal distention (p = 0.039), and abdominal pain (p = 0.031) after D-allulose intake. Increasing the total daily D-allulose intake gradually to 1.0 g/kg·BW for regular ingestion resulted in incidences of severe nausea, abdominal pain, headache, anorexia, and diarrheal symptoms. Based on these results, we suggest a maximum single dose and maximum total daily intake of D-Allulose of 0.4 g/kg·BW and 0.9 g/kg·BW, respectively.

Exposure to liquid sweetness in early childhood: artificially-sweetened and sugar-sweetened beverage consumption at 4-5 years and risk of overweight and obesity at 7-8 years

BACKGROUND

A significant gap exists in longitudinal evidence on early exposure to artificially sweetened beverages (ASBs) and weight outcomes for paediatric populations.

OBJECTIVE

The objective of this study is to examine the relationship between ASB/sugar-sweetened beverage (SSB) consumption at 4-5 years and risk of overweight and obesity at 7-8 years.

METHODS

Data from a nationally representative cohort (n = 2986) in Scotland were analysed using logistic regression to evaluate the association between exposure to ASBs/SSBs at 4-5 years and risk of overweight and obesity at 7-8 years.

RESULTS

There were positive unadjusted associations between ASB consumption and risk of obesity, and following adjustment for confounders, ASB associations attenuated, and only the middle consumption category (1 to 6 times per week) remained significant (odds ratio 1.57, 95% confidence interval {CI} 1.05-2.36). For SSB consumption, there were no significant unadjusted associations, and following adjustment for confounders, only the middle consumption category was significant (odds ratio 1.65, 95% CI 1.12-2.44). There were no significant associations for risk of overweight.

CONCLUSIONS

Longitudinal analysis from 4-5 to 7-8 years demonstrated some evidence of associations between ASBs/SSB consumption and risk of obesity. However, non-linear patterns and wide CIs suggest cautious interpretation and need for future studies with long-term follow-up.

Astrogliosis and decreased neural viability as consequences of early consumption of aspartame and acesulfame potassium in male Wistar rats

Artificial sweeteners are mainly used as substitutes for sucrose derivates. In this study, we analyzed if the chronic consumption of aspartame or acesulfame potassium at an early age, produces histological alterations, astrogliosis and decreased neuronal viability, in hippocampus, prefrontal cortex, amygdala and hypothalamus of male Wistar rats. A histological analysis was performed on male Wistar rats that consumed aspartame or acesulfame potassium during 90 days, initiating the consumption of sweeteners immediately after weaning. The evaluation of neuronal morphology in different areas of the brain was performed with hematoxylin - eosin staining. To measure astrogliosis and neuronal viability, we used the immunohistochemical technique, with the glial fibrillary acidic protein immunomodulators (GFAP) and with neuronal-specific enolase (NSE). The consumption of aspartame or acesulfame potassium promoted morphological changes of neurons including increased pyknotic nuclei and vacuolization in all the brain areas studied. In hippocampus, prefrontal cortex, amygdala and hypothalamus, astrogliosis and reduction of neural viability were observed in sweeteners consumers in comparison with the control group. Chronic consumption of ASP and ACK from early stages of development and during long periods, may promote neural modifications, astrogliosis and decrease neuronal viability in prefrontal cortex, amygdala, hippocampus, and hypothalamus.

A Comparison of Psychophysical Dose-Response Behaviour across 16 Sweeteners

Reduction or replacement of sucrose while maintaining sweetness in foods is challenging, but today there are many sweeteners with diverse physical and caloric compositions to choose from. The choice of sweetener can be adapted to match reformulation goals whether these are to reduce calories, lower the glycaemic response, provide bulk or meet criteria as a natural ingredient. The current study sought to describe and compare the sweetness intensity dose-response, sweetness growth rate, sweetness potency, and potential for calorie reduction across 16 different sweeteners including sucrose. Sweetness growth rate was defined as the rate of change in sweetness intensity per unit of sweetener concentration. Sweetness potency was defined as the ratio of the concentration of a sweetener to that of sucrose at equivalent sweetness intensity, whereas the potential for calorie reduction is the caloric value of a sweetener compared to sucrose at matched sweetness intensities. Sweeteners were drawn from a range of nutritive saccharide (sucrose, dextrose, fructose, allulose (d-psicose), palatinose (isomaltulose), and a sucrose⁻allulose mixture), nutritive polyol (maltitol, erythritol, mannitol, xylitol, sorbitol), non-nutritive synthetic (aspartame, acesulfame-K, sucralose) and non-nutritive natural sweeteners stevia (rebaudioside A), luo han guo (mogroside V). Sweetness intensities of the 16 sweeteners were compared with a sensory panel of 40 participants (n = 40; 28 females). Participants were asked to rate perceived sweetness intensity for each sweetener series across a range of concentrations using psychophysical ratings taken on a general labelled magnitude scale (gLMS). All sweeteners exhibited sigmoidal dose-response behaviours and matched the 'moderate' sweetness intensity of sucrose (10% w/v). Fructose, xylitol and sucralose had peak sweetness intensities greater than sucrose at the upper concentrations tested, while acesulfame-K and stevia (rebA) were markedly lower. Independent of sweetener concentration, the nutritive sweeteners had similar sweetness growth rates to sucrose and were greater than the non-nutritive sweeteners. Non-nutritive sweeteners on the other hand had higher potencies relative to sucrose, which decreases when matching at higher sweetness intensities. With the exception of dextrose and palatinose, all sweeteners matched the sweetness intensity of sucrose across the measured range (3.8⁻25% w/v sucrose) with fewer calories. Overall, the sucrose⁻allulose mixture, maltitol and xylitol sweeteners were most similar to sucrose in terms of dose-response behaviour, growth rate and potency, and showed the most potential for sugar replacement within the range of sweetness intensities tested.

A mHealth randomized controlled trial to reduce sugar-sweetened beverage intake in preschool-aged children

BACKGROUND

Sugar-sweetened beverages and maternal weight are strong drivers of child obesity, but few studies have targeted these risk factors as an obesity prevention strategy in children.

OBJECTIVE

The objective of this study was to test the efficacy of a smartphone-delivered intervention to reduce parent-provided sugar-sweetened beverage and juice (SSB/juice) consumption among children ages 3-5 and maternal weight.

METHODS

Mothers with overweight or obesity, who had a child ages 3-5 that consumed at least 12 fl. oz./day of SSB/juice (N = 51 dyads) were randomized to the Smart Moms group that received one group session, lessons on a mobile website, and text messages, or to a waitlist control group. Mothers self-monitored their children's beverages in addition to their own beverages, high-calorie foods, and weight. Assessments at baseline, 3, and 6 months included dietary recalls to measure SSB/juice intake and objectively measured maternal weight.

RESULTS

Using linear mixed models controlling for baseline values, child age and race, there was a greater reduction in child SSB/juice in Smart Moms compared with control at 6 months (-9.7 oz./day vs. 1.7 oz./day, p < .01). Mothers in Smart Moms lost 2.4 kg at 6 months compared with a 0.9-kg gain in the control group (p < .01).

CONCLUSIONS

An intervention delivered using mHealth technologies can target mothers to change child dietary behaviours and improve maternal weight, which suggests a novel approach to family-based obesity prevention.

The Comparative Effect on Satiety and Subsequent Energy Intake of Ingesting Sucrose or Isomaltulose Sweetened Trifle: A Randomized Crossover Trial

The effect that blood glucose concentration has on feelings of satiety is unclear. Our aims were to assess satiety and subsequent energy intake following the ingestion of trifle sweetened with sucrose or isomaltulose whilst measuring plasma glucose concentration to confirm glycemic differences between trifles. Seventy-seven healthy adults participated in a double-blind crossover trial where trifle sweetened with sucrose or isomaltulose was consumed on separate days with a two-week washout. Blood was sampled at the baseline, 1 and 2 h postprandially, and satiety assessed using visual analogue scales (VAS). Weighed diet records were taken on test days. A statistically significant difference in blood glucose concentration between trifles was found at 60 min following consumption, with the isomaltulose trifle having a 0.69 mmol/L (95% confidence interval: −1.07, −0.31) lower concentration when compared with the sucrose trifle. Mean satiety response by area-under-the-curve (AUC) was not significantly different between trifles. Mean (SD) appetite scores for the sucrose and isomaltulose trifles were 4493 (2393) and 4527 (2590) mm·min, respectively, with a between trifle difference of −9 (95% CI: −589, 572) mm·min. Mean (SD) energy intake for the remainder of the day following trifle consumption was 3894 kJ (1950 kJ) and 3530 kJ (1926 kJ) after the sucrose and isomaltulose trifles, respectively, and was not significantly different (p = 0.133). The differing glycemic response to trifle was not related to satiety or to subsequent energy intake.

Sugar consumption and caries occurrence among Pakistani school children

OBJECTIVE

To estimate the frequency and pattern of sugar intake among Pakistani school going children and its association with early carious lesion and caries history.

METHODS

The cross-sectional study was conducted from January to May 2016 in seven schools of Bhakkar district in the Punjab province of Pakistan, and comprised of school children aged 11-12 years. Diet diaries were used to assess the frequency of sugar intake while caries was assessed using the Modified International Caries Detection and Assessment System. Bivariate analysis was used to assess the association of sugar consumption and early carious lesion with selected sociodemographic variables, and regression analysis was performed to evaluate the factor that matters most in caries occurrence.

RESULTS

Of the 226 subjects, 115(51%) had early carious lesion. Mean frequency of sugar intake was 5.2±3.2 times per day. Children who consumed sugar between main meals (p=0.01) and within two hours before bedtime (p=0.04) had significantly higher history of having caries. Cariogenic intake before bedtime was significantly associated with overall caries risk (p=0.02).

CONCLUSIONS

The frequency of sugar intake among the subjects was slightly higher than the recommended level. .

The Impact of Adding Sugars to Milk and Fruit on Adiposity and Diet Quality in Children: A Cross-Sectional and Longitudinal Analysis of the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS) Study

Sugar, particularly as free sugars or sugar-sweetened beverages, significantly contributes to total energy intake, and, possibly, to increased body weight. Excessive consumption may be considered as a proxy of poor diet quality. However, no previous studies evaluated the association between the habit of adding sugars to "healthy" foods, such as plain milk and fresh fruit, and indicators of adiposity and/or dietary quality in children. To answer to these research questions, we Panalysed the European cohort of children participating in the IDEFICS study. Anthropometric variables, frequency of consumption of sugars added to milk and fruit (SAMF), and scores of adherence to healthy dietary pattern (HDAS) were assessed at baseline in 9829 children stratified according to age and sex. From this cohort, 6929 children were investigated again after two years follow-up. At baseline, a direct association between SAMF categories and adiposity indexes was observed only in children aged 6⁻<10 years, while the lower frequency of SAMF consumption was significantly associated with a higher HDAS. At the two year follow-up, children with higher baseline SAMF consumption showed significantly higher increases in all the anthropometric variables measured, with the exception of girls 6⁻<10 years old. The inverse association between SAMF categories and HDAS was still present at the two years follow-up in all age and sex groups. Our results suggest that the habit to adding sugars to foods that are commonly perceived as healthy may impact the adherence to healthy dietary guidelines and increase in adiposity risk as well.

Added Sugars and Low- and No-Calorie Sweeteners in a Representative Sample of Food Products Consumed by the Spanish ANIBES Study Population

Low- and no-calorie sweeteners (LNCS), intensely sweet compounds that virtually contain no calories, are used to replace added sugars in food and drinks. Knowledge about different LNCS data in Spanish foods and added sugar sources in Spain is limited, therefore our aim was to identify and compare their presence across main food groups consumed. Food and beverage products (n = 434) were obtained from the ANIBES Study (anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles), a cross-sectional study of a representative sample of the Spanish population (9⁻75 years old; n = 2009) carried out in 2013. Food records were obtained from a three-day dietary record using a tablet device. Label data from 1,164 products of different brands were collected and reviewed for content of added sugars and LNCS. LNCS were present in diet soft drinks (100%), "other sweets" (89%), soya drinks (45%), and yogurt and fermented milks (18%). Added sugars were present mainly in sugar soft drinks (100%), energy drinks (96%), sports drinks (96%), bakery and pastry (100%), chocolates (100%), ice cream (100%), breakfast cereals/bars (96%) and jams (89%). Main LNCS were acesulfame K, aspartame, cyclamate and sucralose. Sucrose, dextrose, glucose-fructose syrup, caramel and honey were the main added sugars. Our results show the diversity of foods groups including these ingredients. These data are not compiled in food composition databases, which should be periodically updated to include LNCS and added sugars to facilitate their assessment and monitoring in nutritional surveys.

Flavor Alterations Associated with Miracle Fruit and Gymnema sylvestre

Taste and flavor (retronasal olfaction) interact in the brain. The rules of that interaction are not well understood. This study uses 2 taste modifiers that alter sweet to examine the effects on flavors. Subjects used the Global Sensory Intensity Scale to assess the aroma, sweetness, sourness, and flavor of 10 foods. As previous work had shown, miracle fruit added sweetness to acids, which secondarily reduced sourness (mixture suppression) and Gymnema sylvestre reduced sweetness in sweet foods as well as the sweetness induced by miracle fruit. In this study, multiple regression showed that both sweet and sour contribute to flavor. Gymnema sylvestre reduced the perceived sweet of predominantly sweet foods (chocolate and maple syrup) as expected; reducing the sweet, reduced the flavor. The effects of miracle fruit were complicated by its dual action: intensification of sweet and reduction of sour. Predominantly sour foods (vinegar, lemon, mustard, pickle) were sweetened by miracle fruit but any flavor enhancement associated with the added sweet appears to have been countered by the flavor reduction associated with reduced sourness. Moderately sour foods that are also sweet (tomatoes, strawberries) were sweetened by miracle fruit and thus flavor was enhanced; flavor loss through sour reduction was apparently not sufficient to counter the flavor enhancement due to increased sweet so the net result was that tomato and strawberry flavors were enhanced. The flavors of control foods (not predominantly sweet or sour [sausage, peanuts]) showed only small changes.

Associations of artificially sweetened beverage intake with disease recurrence and mortality in stage III colon cancer: Results from CALGB 89803 (Alliance)

Purpose

Observational studies have demonstrated increased colon cancer recurrence and mortality in states of excess energy balance, as denoted by factors including sedentary lifestyle, diabetes, increased dietary glycemic load, and increased intake of sugar-sweetened beverages. Nonetheless, the relation between artificially sweetened beverages, a popular alternative for sugar-sweetened beverages, and colon cancer recurrence and survival is unknown.

Methods

We analyzed data from 1,018 patients with stage III colon cancer who prospectively reported dietary intake during and after chemotherapy while enrolled in a National Cancer Institute-sponsored trial of adjuvant chemotherapy. Using Cox proportional hazards regressions, we assessed associations of artificially sweetened beverage intake with cancer recurrence and mortality.

Results

Patients consuming one or more 12-ounce servings of artificially sweetened beverages per day experienced an adjusted hazard ratio for cancer recurrence or mortality of 0.54 (95% confidence interval, 0.36 to 0.80) when compared to those who largely abstained (P_trend = .004). Similarly, increasing artificially sweetened beverage intake was also associated with a significant improvement in both recurrence-free survival (P_trend = .005) and overall survival (P_trend = .02). Substitution models demonstrated that replacing a 12-ounce serving of a sugar-sweetened beverage with an isovolumetric serving of an artificially sweetened beverage per day was associated with a 23% lower risk of cancer recurrence and mortality (relative risk, 0.77; 95% confidence interval, 0.63 to 0.95; P = .02).

Conclusion

Higher artificially sweetened beverage consumption may be associated with significantly reduced cancer recurrence and death in patients with stage III colon cancer. This association may be mediated by substitution for sugar-sweetened alternatives. Further studies are needed to confirm these findings.

Prophylactic Dextrose Gel Does Not Prevent Neonatal Hypoglycemia: A Quasi-Experimental Pilot Study

OBJECTIVE

To test the hypothesis that prophylactic dextrose gel administered to newborn infants at risk for hypoglycemia will increase the initial blood glucose concentration after the first feeding and decrease neonatal intensive care unit (NICU) admissions for treatment of asymptomatic neonatal hypoglycemia compared with feedings alone.

STUDY DESIGN

This quasi-experimental study allocated asymptomatic at-risk newborn infants (late preterm, birth weight <2500 or >4000 g, and infants of mothers with diabetes) to receive prophylactic dextrose gel (Insta-Glucose; Valeant Pharmaceuticals North America LLC, Bridgewater, New Jersey); other at-risk infants formed the control group. After the initial feeding, the prophylactic group received dextrose gel (0.5 mL/kg) rubbed into the buccal mucosa. The blood glucose concentration was checked 30 minutes later. Initial glucose concentrations and rate of NICU admissions were compared between the prophylactic group and controls using bivariate analyses. A multivariable linear regression compared first glucose concentrations between groups, adjusting for at-risk categories and age at first glucose concentration.

RESULTS

There were 236 subjects (72 prophylactic, 164 controls). The first glucose concentration was not different between the prophylactic and control groups in bivariate analysis (52.1 ± 17.1 vs 50.5 ± 15.3 mg/dL, P = .69) and after adjusting for covariates (P  = .18). Rates of NICU admission for treatment of transient neonatal hypoglycemia were 9.7% and 14.6%, respectively (P = .40).

CONCLUSIONS

Prophylactic dextrose gel did not reduce transient neonatal hypoglycemia or NICU admissions for hypoglycemia. The carbohydrate concentration of Insta-Glucose (77%) may have caused a hyperinsulinemic response, or alternatively, exogenous enteral dextrose influences glucose homeostasis minimally during the first few hours when counter-regulatory mechanisms are especially active.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02523222.