Sweetened Beverage Intake and Incident Chronic Kidney Disease in the UK Biobank Study

The Exposome and the Kidney: A Silent Dialogue Shaping Chronic Kidney Disease

Genetic predisposition accounts for less than 20% of the global disease burden, highlighting the substantial role of environmental factors in health outcomes. In chronic kidney disease (CKD), a growing global prevalence, understanding the interplay between genes and the environment is crucial. Emerging research in the exposome and genome underscores how environmental exposures interact with genetic variants to influence the development and progression of CKD. The term "exposome" encompasses a variety of factors, including personal behaviors like smoking, a sedentary lifestyle, and making specific dietary choices (such as consuming ultra-processed foods, sugar, or fat). It also includes broader determinants such as pesticides, air, water, and soil pollution, nanoplastics, global warming, stressful life events, and socioeconomic status. Research on the exposome significantly increases our understanding of toxicological processes and individual variations in susceptibility to environmental stressors. This narrative review aims to explore the exposome associated with CKD, highlight key environmental exposures in its development, and discuss potential preventive and therapeutic strategies informed by these exposure-related factors.

Associations between sweetened beverage consumption, degenerative valvular heart disease, and related events: a prospective study from UK Biobank

AIMS

There are no effective medications to prevent the onset of degenerative valvular heart disease (VHD). Sweetened beverage consumption may contribute to the development of VHD by affecting metabolic disorders, systemic inflammation, and calcification processes. This study aimed to prospectively assess the association between sweetened beverage consumption and the risk of degenerative VHD.

METHODS AND RESULTS

This prospective study included 167,801 participants from the UK Biobank who completed at least one dietary questionnaire. During a median follow-up of 14.53 years, 1,464 cases of aortic valve stenosis (AS) events, 584 cases of aortic valve regurgitation (AR) events, and 1,744 cases of mitral valve regurgitation (MR) events were recorded. Compared with non-consumers, participants consuming more than one drink per day of artificially sweetened beverages (ASBs) had a higher risk of AS (HR: 1.36, 95% CI: 1.10-1.68), AR (HR: 1.42, 95% CI: 1.02-2.00), MR (HR: 1.35, 95% CI: 1.10-1.64). Similarly, the consumption of more than one drink of sugar-sweetened beverages (SSBs) was associated with an increased incidence of MR (HR: 1.47, 95% CI: 1.22-1.77). In contrast, no significant association was observed between the consumption of natural juices (NJs) and VHD risk. Results for VHD-related interventions, deaths, or cardiovascular events were largely consistent. Substituting SSBs or ASBs per day with NJs was associated with a reduced risk of MR (HR: 0.83, 95% CI: 0.72-0.94) events or AS (HR: 0.81, 95% CI: 0.69-0.94) events, respectively.

CONCLUSIONS

Lower consumption of SSBs or ASBs may reduce the risk of degenerative VHD and VHD-related events.

Rediscovering Sweetness: The Evolution and Impact of Non-Nutritive and Natural Sweeteners

PURPOSE OF THE REVIEW

The escalating incidence of obesity and metabolic syndromes has catalyzed a critical evaluation of dietary sugars, leading to an increased interest in non-nutritive and natural sweeteners as viable alternatives. This manuscript reviews the historical developments, safety profiles, and health-related consequences of these sweeteners, tracing the evolution from early discoveries such as saccharin and cyclamate to contemporary compounds like aspartame, sucralose, and plant-derived sweeteners.

RECENT FINDINGS

We explore the physiological mechanisms underpinning sweet taste perception, including the roles of T1R and T2R receptors, and the neurochemical pathways involving dopamine in mediating the rewarding effects of sugar consumption. The review underscores the adverse health impacts associated with excessive intake of added sugars, which correlate positively with conditions such as obesity, type 2 diabetes, and cardiovascular diseases. Attention is given to the contrasting profiles of non-nutritive sweeteners and natural sweetener alternatives, with an emphasis on emerging concerns regarding the safety and long-term ramifications of synthetic sweeteners. The regulatory context surrounding the approval and utilization of sweeteners varies significantly across different jurisdictions, warranting careful consideration. As consumer inclination shifts towards healthier dietary choices, a nuanced understanding of the implications of sweetener selection on public health is imperative.

Consumption of Unsweetened Coffee or Tea May Reduce the Cancer Incidence and Mortality: A Prospective Cohort Study

BACKGROUND

Current evidence on the relationship between beverage intake and cancer risk remains inconclusive.

OBJECTIVES

This study aimed to examine the association between the intake of 11 beverages and cancer incidence and mortality, with a particular focus on coffee and tea, categorized by their sugar content.

METHODS

This large prospective cohort study included 189,020 participants from the United Kingdom Biobank. Multivariate Cox proportional hazard models were used to assess the association between beverage intake and the incidence and mortality of overall cancer and cancers of various systems. Additionally, the study investigated the effects of substituting 1 beverage for another and explored potential mediators underlying the relationship between beverage intake and cancer outcomes.

RESULTS

Over a median follow-up period of 8.8 y, consuming >2 cups of unsweetened coffee per day was associated with reduced overall cancer incidence and mortality. Compared with no intake of unsweetened coffee, the hazard ratios (HRs) were 0.95 [95% confidence interval (CI): 0.92, 0.98] for overall cancer incidence and 0.89 (95% CI: 0.83, 0.96) for overall cancer mortality. Similarly, consuming >2 cups of unsweetened tea per day was associated with reduced overall cancer incidence (HR: 0.94, 95% CI: 0.92, 0.97) and mortality (HR: 0.84, 95% CI: 0.79, 0.91) compared with no unsweetened tea intake. Substituting unsweetened coffee or tea for other beverages was associated with a 1%-5% reduction in overall cancer incidence and mortality. The association between unsweetened tea and reduced cancer risk may be partially mediated by inflammatory markers. Notably, the sugar content of coffee and tea had the most pronounced effect on risk of respiratory system cancers.

CONCLUSIONS

Beverage selection significantly impacts cancer incidence and mortality. For cancer prevention, unsweetened tea or coffee may be the optimal choice.

Deciphering the multifaceted effects of artificial sweeteners on body health and metabolic functions: a comprehensive review and future perspectives

As the rates of chronic diseases such as obesity and diabetes rise worldwide, there is a growing demand for low-calorie or no-calorie sweeteners to reduce sugar intake without sacrificing the sweetness of foods and beverages. Artificial sweeteners have become indispensable as substitutes for sugar due to their high sweetening power and low impact on blood sugar levels and are used in a variety of low-calorie foods and beverages. Although artificial sweeteners offer an alternative for reducing sugar intake while maintaining sweetness, research into their long-term health effects, particularly at high doses, is ongoing, further scientific research and regulatory review are needed to clarify these potential health risks. This article reviews the latest research on the health effects of artificial sweeteners, based on recent studies, introduces the classification, performance, and safety standards for artificial sweeteners, analyses their potential harms to the nervous, immune, and circulatory systems, reproductive system, as well as their effects on gut microbiota, liver function, cancer, diabetes, and obesity. In addition, consumer perceptions of artificial sweeteners and future research directions are discussed, providing insights into current research controversies and knowledge gaps, as well as the health research and market application of artificial sweeteners.

Association of dietary manganese intake with new-onset chronic kidney disease in participants with diabetes

BACKGROUND

We explored the association of dietary manganese (Mn) with new-onset chronic kidney disease (CKD) in participants with diabetes on different glycemia control status and potential mechanisms.

METHODS

The study included 7248 adults with diabetes from the UK Biobank who had complete dietary data and were free of CKD at baseline. Dietary information was collected by the online 24-h diet recall questionnaires. The primary outcome was new-onset CKD.

RESULTS

565 (7.8 %) participants developed new-onset CKD during a median follow-up of 11.96 years. Overall, there was a significantly inverse relationship of dietary Mn intake with new-onset CKD in individuals with diabetes at glycated hemoglobin (HbA1c) ≥6.5 % (per SD increment, HR [95%CI]: 0.79 [0.68-0.91]), but not in people with diabetes at HbA1c <6.5 % (per SD increment, HR [95%CI]: 1.07 [0.90-1.29]; P for interaction = 0.004). In individuals with diabetes at HbA1c ≥6.5 %, body mass index and waist circumference significantly mediated the association between dietary Mn intake and new-onset CKD, with mediated proportions of 17.5 % and 17.4 %, respectively.

CONCLUSIONS

Higher dietary Mn intake was significantly associated with a lower new-onset CKD risk in participants with diabetes at poor glycemic control status. The inverse association was mainly mediated by obesity. If further confirmed, our findings underscore the importance of maintaining adequate dietary Mn intake for the primary prevention of new-onset CKD in patients with diabetes, especially those with poor glycemic control.