Fructose acute effects on glucose, insulin, and triglyceride after a solid meal compared with sucralose and sucrose in a randomized crossover study

Effects of Daily Ingestion of Two SunGold Kiwifruit for 6 Weeks on Metabolic and Inflammatory Biomarkers: A Randomized, Cross-Over, Exploratory Intervention Study

Kiwifruit contain many components, some considered beneficial, such as vitamins, phytochemicals and dietary fibre, and others potentially harmful, such as fructose and glucose in fruit sugars. In a 6-week, randomised, crossover study aimed at exploring the net effects of daily consumption of kiwifruit, 23 healthy participants consumed two Actinidia chinensis var. chinensis 'Zesy002' (marketed as Zespri™ SunGold™ Kiwifruit) per day as part of their customary diet (intervention) or without kiwifruit (control) as their customary diet for 6 weeks in a cross-over study. Anthropometric data, venous blood, and urine samples were collected at the start and end of the 6-week intervention and control periods for the measurement of physical changes, plasma glucose, insulin, glycated haemoglobin, short-chain fatty acids, blood lipids, uric acid, inflammatory biomarkers, and urinary ascorbic acid. Variables were measured between the start and finish of interventions, and between intervention and control periods. Food diaries were completed on the 3 days before blood sampling to estimate dietary ascorbic acid and dietary fibre intakes. Despite urinary vitamin C and food diaries indicating compliance, and good precision in measurements, there were no appreciable changes in biomarkers during the study, either within or between intervention and control periods, that would indicate a change in health status. Thus, the sizes of any effects of kiwifruit ingestion were too small to become significant under the test conditions used, indicating a high probability that daily ingestion of two SunGold kiwifruit is safe with respect to metabolic health.

Comparison of aspartame- and sugar-sweetened soft drinks on postprandial metabolism

Aim: We compared the impact of artificially- and sugar-sweetened beverages co-ingested with a mixed meal on postprandial fat and carbohydrate oxidation, blood glucose, and plasma insulin and triglyceride concentrations. Methods: Eight college-aged, healthy males completed three randomly assigned trials, which consisted of a mixed macronutrient meal test with 20oz of Diet-Coke (AS), Coca-Cola (NS), or water (CON). One week separated each trial and each participant served as his own control. Resting energy expenditure (REE) via indirect calorimetry, blood pressure, and blood samples were obtained immediately before, 5, 10, 30, 60, 120, and 180 min after meal and beverage ingestion. A two-way (treatment × time) repeated-measures ANOVA was conducted to assess REE, fat and carbohydrate oxidation rates, blood glucose, and plasma insulin and triglyceride concentrations. Results: There was a significant main effect of treatment on total fat oxidation (P = 0.006), fat oxidation was significantly higher after AS (P = 0.006) and CON (P = 0.001) compared to following NS. There was a significant main effect of treatment on total carbohydrate oxidation (P = 0.005), carbohydrate oxidation was significantly lower after AS (P = 0.014) and CON (P = 0.001) compared to following NS. Plasma insulin concentration AUC was significantly lower after AS (P = 0.019) and trended lower in CON (P = 0.054) compared to following NS. Conclusion: Ingestion of a mixed meal with an artificially-sweetened beverage does not impact postprandial metabolism, whereas a sugar-sweetened beverage suppresses fat oxidation and increases carbohydrate oxidation compared to artificially-sweetened beverage and water.

Nonalcoholic fatty liver disease and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides clinicians an overview of nonalcoholic fatty liver disease (NAFLD), potential progression to nonalcoholic steatohepatitis (NASH), and their application to obesity.

Methods

The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

Topics of this CPS include the prevalence of NAFLD and NASH, the prevalence of NAFLD and NASH among patients with obesity, as well as NAFLD and NASH definitions, diagnosis, imaging, pathophysiology, differential diagnosis, role of high fructose corn syrup and other simple sugars, and treatment (e.g., nutrition, physical activity, medications).

Conclusions

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding NAFLD and obesity is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Patients with obesity are at increased risk for NAFLD and NASH. Patients may benefit when clinicians who manage obesity understand the etiology, diagnosis, and optimal treatment of NAFLD with a goal to prevent NASH.

Effect of a moderate dose of fructose in solid foods on TAG, glucose and uric acid before and after a 1-month moderate sugar-feeding period

There are few data on the effects on TAG, glucose and uric acid of chronic consumption of a moderate dose of fructose in solid foods. Twenty-eight participants with prediabetes and/or obesity and overweight commenced the study (BMI 32·3 kg/m2, age 44·7 years, fasting glucose 5·3 (sd 0·89) mmol/l and 2-h glucose 6·6 (sd 1·8) mmol/l). Twenty-four men and women who completed the study consumed, in random order, two acute test meals of muffins sweetened with either fructose or sucrose. This was followed by 4-week chronic consumption of 42 g/d of either fructose or sucrose in low-fat muffins after which the two meal tests were repeated. The sugar type in the chronic feeding period was also randomised. Fasting TAG increased after chronic consumption of fructose by 0·31 (sd 0·37) mmol/l compared with sucrose in those participants with impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) (P = 0·004). Total cholesterol (0·33 mmol/l), LDL-cholesterol (0·24 mmol/l) and HDL-cholesterol (0·08 mmol/l) increased significantly over the 1- month feeding period with no differences between muffin types. Fasting glucose was not different after 1 month of muffin consumption. Uric acid response was not different between the two sugar types either baseline or 1 month, and there were no differences between baseline and 1 month. The increase in fasting TAG in participants with IFG/IGT suggests the need for caution in people at increased risk of type 2 diabetes.

Evaluation of sucrose-enriched diet consumption in the development of risk factors associated to type 2 diabetes, atherosclerosis and non-alcoholic fatty liver disease in a murine model

Overconsumption of sucrose, the main contributor of the total added sugar intake in the world, has been associated with negative metabolic effects related to non-communicable diseases. However, this relationship continues to be a controversial topic and further studies are needed. The aim of this study was to evaluate the sucrose-enriched diet consumption in the development of risk factors associated with type 2 diabetes, atherosclerosis and non-alcoholic fatty liver disease in a murine model. Sucrose-enriched diet-fed rats showed a decrease in food, lipids and protein intake as well as in serum total cholesterol levels, an increase in carbohydrates intake, glucose, insulin, triglycerides, VLDL-c and HDL-c levels and a greater degree of insulin resistance, steatosis and non-alcoholic steatohepatitis. Our results show that sucrose-enriched diet consumption during 25 weeks contribute to the development of risk factors associated with type 2 diabetes, atherosclerosis and non-alcoholic fatty liver disease in male Wistar rats.

A fructose-based meal challenge to assess metabotypes and their metabolic risk profile: A randomized, crossover, controlled trial

OBJECTIVES

The first aim of this study was to determine the metabolic type of individuals based on the postprandial metabolic response after the ingestion of a meal challenge that was high protein and either high glucose (high GI) or fructose (low GI). The second aim was to compare the baseline characteristics between the different metabolic types (metabotypes). The third aim was to assess whether the inclusion of fructose or glucose in a high-protein breakfast modulated the glucose, insulin, and TG response over a 4-h period.

METHODS

The study included 46 Asian women with a body mass index between 17 and 28 kg/m² in a randomized crossover design. Metabolic typing was based on the assessment of the postprandial glycemic, insulin and triacylglycerol (TG) response after the ingestion of two high-protein meal challenges either high in fructose or glucose. Baseline characteristics were compared between the different metabolic types. Baseline and 4-h postprandial blood samples were collected and glucose, insulin, and TG levels were analyzed. Cluster analysis was used to phenotype the participants in distinct groups. Baseline characteristics including anthropometry, glycemic, and lipid profiles and resting metabolic rate were compared among the metabolic types.

RESULTS

Cluster analysis revealed that women could be grouped into three metabolic types based on postprandial glucose, insulin, and TG response after the fructose meal challenge: cluster 1 with an average glucose + high TG response (highTG; n = 12), cluster 2 with a high glucose + average TG response (highGLU; n = 8), and cluster 3 with an average glucose + average TG response (Avg; n = 26). Post hoc analysis revealed significantly greater waist-to-hip ratio and a worse lipid profile for the highTG cluster and a higher fasting blood glucose, body mass index, fat percentage, and hip circumference in the highGLU cluster.

CONCLUSIONS

Three metabolic types with a distinct metabolic response could be distinguished after a high fructose meal. The results suggest a different risk profile and may indicate why some people develop diabetes in an obesogenic environment. Improved metabolic-type assessments will enable us to develop and optimize nutritional and medical interventions for individuals with differing diabetes risk.

Non-nutritive Sweeteners and Glycaemic Control

PURPOSE OF REVIEW

The consumption of foods and beverages containing non-nutritive sweeteners (NNS) has increased worldwide over the last three decades. Consumers' choice of NNS rather than sugar or other nutritive sweeteners may be attributable to their potential to reduce weight gain.

RECENT FINDINGS

It is not clear what the effects of NNS consumption are on glycaemic control and the incidence of type 2 diabetes. This review aims to examine this question in epidemiological, human intervention and animal studies. It is not clear that NNS consumption has an effect on the incidence of type 2 diabetes or on glycaemic control even though there is some evidence for the modification of the microbiome and for interaction with sweet taste receptors in the oral cavity and the intestines' modification of secretion of glucagon-like peptide-1 (GLP-1), peptide YY (PYY), ghrelin and glucose-dependent insulinotropic polypeptide (GIP), which may affect glycaemia following consumption of NNS. In conclusion, long-term studies of NNS consumption are required to draw a firm conclusion about the role of NNS consumption on glycaemic control.

The Metabolic Concept of Meal Sequence vs. Satiety: Glycemic and Oxidative Responses with Reference to Inflammation Risk, Protective Principles and Mediterranean Diet

With increasing exposure to eating opportunities and postprandial conditions becoming dominant states, acute effects of meals are garnering interest. In this narrative review, meal components, combinations and course sequence were questioned vis-à-vis resultant postprandial responses, including satiety, glycemic, oxidative and inflammatory risks/outcomes vs. protective principles, with reference to the Mediterranean diet. Representative scientific literature was reviewed and explained, and corresponding recommendations discussed and illustrated. Starting meals with foods, courses and/or preloads high in innate/added/incorporated water and/or fibre, followed by protein-based courses, delaying carbohydrates and fatty foods and minimizing highly-processed/sweetened hedonic foods, would increase satiety-per-calorie vs. obesogenic passive overconsumption. Similarly, starting with high-water/fibre dishes, followed by high-protein foods, oils/fats, and delayed/reduced slowly-digested whole/complex carbohydrate sources, optionally closing with simpler carbohydrates/sugars, would reduce glycaemic response. Likewise, starting with foods high in innate/added/incorporated water/fibre/antioxidants, high monounsaturated fatty acid foods/oils, light proteins and whole/complex carbohydrate foods, with foods/oils low in n-6 polyunsaturated fatty acids (PUFA) and n-6:n-3 PUFA ratios, and minimal-to-no red meat and highly/ultra-processed foods/lipids, would reduce oxidative/inflammatory response. Pyramids illustrating representative meal sequences, from most-to-least protective foods, visually communicate similarities between axes, suggesting potential unification for optimal meal sequence, consistent with anti-inflammatory nutrition and Mediterranean diet/meal principles, warranting application and outcome evaluation.

Acute Effects of Nutritive and Non-Nutritive Sweeteners on Postprandial Blood Pressure

Postprandial hypotension (PPH) is under-recognised, but common, particularly in the elderly, and is of clear clinical importance due to both the independent association between PPH and an increase in mortality and lack of effective management for this condition. Following health concerns surrounding excessive consumption of sugar, there has been a trend in the use of low- or non-nutritive sweeteners as an alternative. Due to the lack of literature in this area, we conducted a systematic search to identify studies relevant to the effects of different types of sweeteners on postprandial blood pressure (BP). The BP response to ingestion of sweeteners is generally unaffected in healthy young subjects, however in elderly subjects, glucose induces the greatest decrease in postprandial BP, while the response to sucrose is less pronounced. The limited studies investigating other nutritive and non-nutritive sweeteners have demonstrated minimal or no effect on postprandial BP. Dietary modification by replacing high nutritive sweeteners (glucose, fructose, and sucrose) with low nutritive (d-xylose, xylitol, erythritol, maltose, maltodextrin, and tagatose) and non-nutritive sweeteners may be a simple and effective management strategy for PPH.

Determination of glycemic index of enteral formulas used in clinical practice

Glycemic Index (GI) is a measure of carbohydrate quality and is recognised as a valid and reproducible method of classifying carbohydrate foods according to its effects on postprandial glycaemia. In this randomised crossover trial (RBR-7rjx3k) we determined the GI of nine enteral formulas, following the Food and Agriculture Organisation/World Health Organisation method. Forty healthy participants were included in the study (85% female mean age 27.1 ± 6.7 years). GI of the enteral formulas ranged from 40.5 to 85.2; four formulas had high GI (Nutrienteral 1.5^®, Novasource GI Control^®, Diamax^®, Isosource Soya^®), two intermediate GI (Fresubin 1.2 HP Fibre^®, Nutrison Energy Multifiber 1.5^®) and three low GI (Trophic 1.5^®, Glucerna^®, Novasource GC HP^®). The GI coefficient of variation ranged from 22.9% to 83.6%. The effect of the enteral formulas with low GI in glycemic control of patients with enteral nutrition prescription needs to be test in future studies.

High fructose consumption with a high-protein meal is associated with decreased glycemia and increased thermogenesis but reduced fat oxidation: A randomized controlled trial

OBJECTIVES

Fructose is often recommended due to its ability to lower glycemic response and its increased thermogenic effect. Additionally, proteins can reduce the glycemic response of carbohydrate-rich foods and have a high diet-induced thermogenesis (DIT). The aim of this study was to investigate whether the inclusion of fructose in a high-protein meal would demonstrate metabolic advantages.

METHODS

Nineteen Asian women (body mass index 17-28 kg/m²) consumed a low-glycemic index (GI; fructose) or high GI (glucose), high-protein breakfast followed by a standardized lunch in a randomized crossover design. Simultaneously, 8-h continuous glucose monitoring provided incremental area under the curve (iAUC) and 4-h indirect calorimetry provided DIT and respiratory quotient (RQ).

RESULTS

The low GI diet resulted in a lower glucose iAUC (135 ± 25 versus 212 ± 23 mmol/L, P < 0.05) following breakfast, but no second-meal effect after the standardized lunch (217 ± 37 versus 228 ± 27 mmol/L, P < 0.05) compared with the high GI diet. Furthermore, 4-h DIT was greater (40.6 ± 2.3 versus 34.9 ± 1.8 kcal, P < 0.05) and RQ was increased after the fructose high-protein breakfast (0.047 ± 0.009 versus 0.028 ± 0.009, P < 0.05) compared with the glucose meal.

CONCLUSIONS

Fructose is an effective sweetener in reducing glycemia and increasing DIT in the presence of a high-protein diet. However, the reduced fat oxidation after high fructose consumption might present a risk for increased lipogenesis.

Maternal dietary free or bound fructose diversely influence developmental programming of lipogenesis

Background

Maternal dietary choices throughout preconception, pregnancy, and lactation irreversibly affect the development of fetal tissues and organs, known as fetal programming. Recommendations tend to emphasize reducing added sugars. However, the impact of maternal dietary free or bound fructose in added sugars on developmental programming of lipogenesis is unknown.

Methods

Virgin Sprague-Dawley rats were randomly divided into five groups. Rats were given feed and plain water (control) or water containing maltodextrin (vehicle), fructose, high-fructose corn syrup (HFCS) containing 55% fructose, sucrose (20% w/v) for 12 weeks before mating and throughout the pregnancy and lactation periods. Body weight, water, and feed intake were measured throughout the study. At the end of the lactation period, blood was drawn to determine the fasting levels of glucose, insulin, triglycerides, and non-esterified fatty acids (NEFA) in blood. Triglycerides and acetyl Co-A Carboxylase-1 (ACC1) levels in livers were analyzed, and insulin resistance was calculated.

Results

The energy intake of dams in the HFCS group was higher than in the fructose group, while weight gain was less in the HFCS group than in the fructose group. HFCS resulted in greater insulin resistance in dams, whereas free fructose had a robust effect on the fetal programming of insulin resistance. Free fructose and HFCS in the maternal diet increased blood and liver triglycerides and NEFA content in pups. Furthermore, fructose and HFCS exposure increased phosphorylated ACC1 as compared to maltodextrin and control, indicating greater fatty acid synthesis in pups and dams.

Conclusion

Different types of added sugar in the maternal diet have different metabolic effects on the developmental programming of lipogenesis. Consequently, high fructose intake via processed foods may increase the risk for chronic diseases, and free fructose might contribute to developmental programming of chronic diseases more than bound fructose.

Do non-nutritive sweeteners influence acute glucose homeostasis in humans? A systematic review

The human body associates sensory cues with metabolic consequences. Exposure to sweet-tasting sugars - even in the absence of ingestion - triggers physiological responses that are associated with carbohydrate digestion, absorption and metabolism. These responses include the release of insulin and incretin hormones, which work to reduce blood glucose. For this reason, non-nutritive sweeteners (NNS) have been posited to trigger similar physiological responses and reduce postprandial blood glucose concentrations. The first part of this review presents a brief overview of sweet taste receptor activation in the oral cavity and gastrointestinal tract and the ensuing physiological responses related to glucose homeostasis. The second part of this review contains a systematic literature review that tested the hypothesis that NNS use improves glucose regulation postprandially. Studies were grouped based on sweet taste receptor stimulation paradigms, including pre-ingestive stimulation, ingestion of NNS alone, co-ingestion of NNS with foods, and using NNS as preloads to influence subsequent blood glucose excursions. In summary, the review found that NNS triggered physiological responses, albeit inconsistently, yet failed to significantly lower blood glucose levels in almost all studies.

Sweeteners and sweetness enhancers

PURPOSE OF REVIEW

The current review summarizes and discusses current knowledge on sweeteners and sweetness enhancers.

RECENT FINDINGS

The perception of sweet taste is mediated by the type 1 taste receptor 2 (T1R2)/type 1 taste receptor 3 (T1R3) receptor, which is expressed in the oral cavity, where it provides input on the caloric and macronutrient contents of ingested food. This receptor recognizes all the compounds (natural or artificial) perceived as sweet by people. Sweeteners are highly chemically diverse including natural sugars, sugar alcohols, natural and synthetic sweeteners, and sweet-tasting proteins. This single receptor is also the target for developing novel sweet enhancers. Importantly, the expression of a functional T1R2/T1R3 receptor is described in numerous extraoral tissues. In this review, the physiological impact of sweeteners is discussed.

SUMMARY

Sweeteners and sweetness enhancers are perceived through the T1R2/T1R3 taste receptor present both in mouth and numerous extraoral tissues. The accumulated knowledge on sugar substitutes raises the issue of potential health effects.