Use of sugars and sweeteners in children's diets. Recommendations of the Nutrition Committee of the Spanish Association of Paediatrics

Soft drinks and sweeteners intake: Possible contribution to the development of metabolic syndrome and cardiovascular diseases. Beneficial or detrimental action of alternative sweeteners?

The rapid increase in obesity, metabolic syndrome, and cardiovascular diseases (CVDs) has been related to the rise in sugar-added foods and sweetened beverages consumption. An interesting approach has been to replace sugar with alternative sweeteners (AS), due to their impact on public health. Preclinical and clinical studies, which analyze the safety of AS intake, are still limited. Major pathogenic mechanisms of these substances include ROS and AGEs formation. Indeed, endothelial dysfunction involving in the pathogenesis of micro- and macro-vascular diseases is mitochondrial dysfunction dependent. Hyperglycemia and endoplasmic reticulum stress together produce ROS, contributing to the development and progression of cardiovascular complications during type 2 diabetes (T2D), thus causing oxidative changes and direct damage of lipids, proteins, and DNA. Epidemiological studies in healthy subjects have suggested that the consumption of artificial AS can promote CV complications, such as glucose intolerance and predisposition to the onset of T2D, whereas natural AS could reduce hyperglycemia, improve lipid metabolism and have antioxidant effects. Long-term prospective clinical randomized studies are needed to evaluate precisely whether exposure to alternative sugars can have clinical implications on natural history and clinical outcomes, especially in children or during the gestational period through breast milk.

Sweetening Agents and Sweeteners in Dietary Supplements for Children-Analysis of the Polish Market

Sweetening agents (SA) and sweeteners are major additives used in the production of dietary supplements (DS), they fulfill both technological and organoleptic functions. The aim of this study is to identify the types of SA and sweeteners found in DS intended for children and to determine the secondary role of them. The study was performed on data from the documentation of representative samples of DS (N = 315) available on the Polish market. The results show that 75.24% of the products contained at least one SA or sweetener. Sucrose is the SA most frequently used in DS production. The empirical findings show that the type of sweetening ingredient correlates closely with the formulation of products, which in turn has to be suited to consumption abilities of the target group as well as to the children's taste requirements. The crucial need for analysis of the composition of DS is emphasized in the light of high consumption rates of these products as well as limited regulations and policy.

Early nutrition and gut microbiome: interrelationship between bacterial metabolism, immune system, brain structure, and neurodevelopment

Disturbances of diet during pregnancy and early postnatal life may impact colonization of gut microbiota during early life, which could influence infant health, leading to potential long-lasting consequences later in life. This is a nonsystematic review that explores the recent scientific literature to provide a general perspective of this broad topic. Several studies have shown that gut microbiota composition is related to changes in metabolism, energy balance, and immune system disturbances through interaction between microbiota metabolites and host receptors by the gut-brain axis. Moreover, recent clinical studies suggest that an intestinal dysbiosis in gut microbiota may result in cognitive disorders and behavioral problems. Furthermore, recent research in the field of brain imaging focused on the study of the relationship between gut microbial ecology and large-scale brain networks, which will help to decipher the influence of the microbiome on brain function and potentially will serve to identify multiple mediators of the gut-brain axis. Thus, knowledge about optimal nutrition by modulating gut microbiota-brain axis activity will allow a better understanding of the molecular mechanisms involved in the crosstalk between gut microbiota and the developing brain during critical windows. In addition, this knowledge will open new avenues for developing novel microbiota-modulating based diet interventions during pregnancy and early life to prevent metabolic disorders, as well as neurodevelopmental deficits and brain functional disorders.

Non-nutritive sweeteners and type 2 diabetes: Should we ring the bell?

Non-nutritive sweeteners (NNS) were thought to be healthy sugar substitutes used instead of sugar for caloric and glycemic control but evidences blaming them for contributing to type 2 diabetes (T2D) are rising. We aim to investigate whether NNS consumption prevents or causes T2D. Articles of all designs conducted on humans were retrieved from three databases in addition to manually reviewed articles. The literature is highly heterogeneous, and conclusions vary with different studies' types and designs. While some studies highlighted the neutral effect of NNS on T2D or reported inconclusive evidences to make their conclusion, others either found NNS culprit for increasing the risk for T2D or reported their protective effect against it. Those results were changing after adjustment for confounders. Due to the inconsistency in the literature, well-designed studies that take into consideration all types of confounders are needed. RESEARCH IN CONTEXT: Evidence before this study: The epidemic of obesity is the result of many factors and causes several chronic diseases where its association with type 2 diabetes is well established. The first line of treatment for obesity is lifestyle changes including physical activity and dietary intervention where non-nutritive sweeteners have received a high attention; those were thought to be healthy sugar substitutes used instead of sugar for caloric and glycemic control but several evidences have blamed them for having a role in the development of type 2 diabetes. In our paper, we aim to investigate whether non-nutritive sweeteners consumption prevents or causes type 2 diabetes. To respond to this question, an extensive search of the literature was conducted between October and December 2018 using the key terms "non-nutritive sweeteners", "artificial sweeteners", "high-intensity sweeteners", "type 2 diabetes" and "prediabetes" on three databases including Pubmed, Science direct and Scopus. Additional search for relevant articles was carried out manually from the reference list of selected articles. Animal studies, studies involving sugar alcohols or those conducted on children, adolescents, pregnant women, or on participants with diabetes were excluded. Human studies conducted from January 2004 to October 2018 were included and divided into observational, interventional, and systematic review and meta-analysis for discussion and analysis Added value of this study: In the literature, the term high-intensity sweeteners has been used interchangeably with non-nutritive sweeteners, artificial sweeteners or low-calorie sweeteners but few articles, if any, clarified the difference between them. In our review, we gathered the different definitions and classifications and summarized them to help the reader understand the difference. Since artificial sweeteners are nowadays widely used and prescribed for caloric and glycemic control, and are unintentionally consumed because they enter in the manufacturing process of thousands of products and due to their potential side effects reported in several studies, we found it interesting to gather, summarize and discuss the available results assessing the role of non-nutritive sweeteners in the development of type 2 diabetes. Those results showed the heterogeneity of the literature and the difficulty in having a firm conclusion; this helps researchers to profit from our study and to conduct well-designed studies leading to firm conclusions and recommendations. Implications of all the available evidence: Despite the absence of strong conclusion that confirms the fact that non-nutritive sweeteners consumption increases the risk for diabetes, no firm conclusion rejects this statement. In result, the existing evidences in addition to our study should ring the bell for clinicians and practitioners who are prescribing those sugar-alternatives as "healthy substitute" to white sugar. Moreover, this encourages the manufacturers to search for a healthy natural alternative to artificial sweeteners to be used in the manufacturing process.

Noncaloric Sweeteners in Children: A Controversial Theme

Noncaloric sweeteners (NCS) are food additives used to provide sweetness without adding calories. Their consumption has become more widespread around the world in all age groups, including children. The aim of this study is to show the state of the art about the intake of noncaloric sweeteners in children, as well as their benefits and consumption risk. Scientific searchers were used (PUBMED, Scopus, and Scielo) to analyze articles that included keywords (noncaloric sweeteners/saccharin/cyclamate/acesulfame potassium/aspartame/sucralose/stevia/children) in English, Spanish, and Portuguese. Authors conclude that it is imperative that health professionals judiciously and individually evaluate the overall benefits and risks of NCS use in consumers before recommending their use. Different subgroups of the population incorporate products containing NCS in their diet with different objectives, which should be considered when recommending a diet plan for the consumer. In childhood, in earlier age groups, this type of additives should be used as a dietary alternative when other forms of prevention in obesity are not sufficient.