1
|
Gibbons C, Beaulieu K, Almiron-Roig E, Navas-Carretero S, Martínez JA, O'Hara B, O'Connor D, Nazare JA, Le Bail A, Rannou C, Hardman C, Wilton M, Kjølbæk L, Scott C, Moshoyiannis H, Raben A, Harrold JA, Halford JCG, Finlayson G. Acute and two-week effects of neotame, stevia rebaudioside M and sucrose-sweetened biscuits on postprandial appetite and endocrine response in adults with overweight/obesity-a randomised crossover trial from the SWEET consortium. EBioMedicine 2024; 102:105005. [PMID: 38553262 PMCID: PMC11026940 DOI: 10.1016/j.ebiom.2024.105005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Sweeteners and sweetness enhancers (S&SE) are used to replace energy yielding sugars and maintain sweet taste in a wide range of products, but controversy exists about their effects on appetite and endocrine responses in reduced or no added sugar solid foods. The aim of the current study was to evaluate the acute (1 day) and repeated (two-week daily) ingestive effects of 2 S&SE vs. sucrose formulations of biscuit with fruit filling on appetite and endocrine responses in adults with overweight and obesity. METHODS In a randomised crossover trial, 53 healthy adults (33 female, 20 male) with overweight/obesity in England and France consumed biscuits with fruit filling containing 1) sucrose, or reformulated with either 2) Stevia Rebaudioside M (StRebM) or 3) Neotame daily during three, two-week intervention periods with a two-week washout. The primary outcome was composite appetite score defined as [desire to eat + hunger + (100 - fullness) + prospective consumption]/4. FINDINGS Each formulation elicited a similar reduction in appetite sensations (3-h postprandial net iAUC). Postprandial insulin (2-h iAUC) was lower after Neotame (95% CI (0.093, 0.166); p < 0.001; d = -0.71) and StRebM (95% CI (0.133, 0.205); p < 0.001; d = -1.01) compared to sucrose, and glucose was lower after StRebM (95% CI (0.023, 0.171); p < 0.05; d = -0.39) but not after Neotame (95% CI (-0.007, 0.145); p = 0.074; d = -0.25) compared to sucrose. There were no differences between S&SE or sucrose formulations on ghrelin, glucagon-like peptide 1 or pancreatic polypeptide iAUCs. No clinically meaningful differences between acute vs. two-weeks of daily consumption were found. INTERPRETATION In conclusion, biscuits reformulated to replace sugar using StRebM or Neotame showed no differences in appetite or endocrine responses, acutely or after a two-week exposure, but can reduce postprandial insulin and glucose response in adults with overweight or obesity. FUNDING The present study was funded by the Horizon 2020 program: Sweeteners and sweetness enhancers: Impact on health, obesity, safety and sustainability (acronym: SWEET, grant no: 774293).
Collapse
Affiliation(s)
- Catherine Gibbons
- School of Psychology, Faculty of Medicine & Health, University of Leeds, UK.
| | - Kristine Beaulieu
- School of Psychology, Faculty of Medicine & Health, University of Leeds, UK
| | - Eva Almiron-Roig
- University of Navarra, Faculty of Pharmacy and Nutrition, Dept. of Food Science and Physiology, Center for Nutrition Research, Pamplona, Spain; Navarra Institute for Health Research (IdiSNa), Pamplona, Spain
| | - Santiago Navas-Carretero
- University of Navarra, Faculty of Pharmacy and Nutrition, Dept. of Food Science and Physiology, Center for Nutrition Research, Pamplona, Spain; Navarra Institute for Health Research (IdiSNa), Pamplona, Spain; Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - J Alfredo Martínez
- University of Navarra, Faculty of Pharmacy and Nutrition, Dept. of Food Science and Physiology, Center for Nutrition Research, Pamplona, Spain; Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Beverley O'Hara
- School of Psychology, Faculty of Medicine & Health, University of Leeds, UK
| | - Dominic O'Connor
- School of Psychology, Faculty of Medicine & Health, University of Leeds, UK
| | - Julie-Anne Nazare
- Human Nutrition Research Center Rhône-Alpes, Lyon 1 Claude Bernard University, France
| | | | | | - Charlotte Hardman
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Moon Wilton
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Louise Kjølbæk
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Corey Scott
- Core Research and Development, Cargill, Inc, USA
| | | | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark; Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Joanne A Harrold
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Jason C G Halford
- School of Psychology, Faculty of Medicine & Health, University of Leeds, UK
| | - Graham Finlayson
- School of Psychology, Faculty of Medicine & Health, University of Leeds, UK
| |
Collapse
|
2
|
Almiron-Roig E, Navas-Carretero S, Castelnuovo G, Kjølbæk L, Romo-Hualde A, Normand M, Maloney N, Hardman CA, Hodgkins CE, Moshoyiannis H, Finlayson G, Scott C, Raats MM, Harrold JA, Raben A, Halford JCG, Martínez JA. Impact of acute consumption of beverages containing plant-based or alternative sweetener blends on postprandial appetite, food intake, metabolism, and gastro-intestinal symptoms: Results of the SWEET beverages trial. Appetite 2023; 184:106515. [PMID: 36849009 DOI: 10.1016/j.appet.2023.106515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 02/27/2023]
Abstract
Project SWEET examined the barriers and facilitators to the use of non-nutritive sweeteners and sweetness enhancers (hereafter "S&SE") alongside potential risks/benefits for health and sustainability. The Beverages trial was a double-blind multi-centre, randomised crossover trial within SWEET evaluating the acute impact of three S&SE blends (plant-based and alternatives) vs. a sucrose control on glycaemic response, food intake, appetite sensations and safety after a carbohydrate-rich breakfast meal. The blends were: mogroside V and stevia RebM; stevia RebA and thaumatin; and sucralose and acesulfame-potassium (ace-K). At each 4 h visit, 60 healthy volunteers (53% male; all with overweight/obesity) consumed a 330 mL beverage with either an S&SE blend (0 kJ) or 8% sucrose (26 g, 442 kJ), shortly followed by a standardised breakfast (∼2600 or 1800 kJ with 77 or 51 g carbohydrates, depending on sex). All blends reduced the 2-h incremental area-under-the-curve (iAUC) for blood insulin (p < 0.001 in mixed-effects models), while the stevia RebA and sucralose blends reduced the glucose iAUC (p < 0.05) compared with sucrose. Post-prandial levels of triglycerides plus hepatic transaminases did not differ across conditions (p > 0.05 for all). Compared with sucrose, there was a 3% increase in LDL-cholesterol after stevia RebA-thaumatin (p < 0.001 in adjusted models); and a 2% decrease in HDL-cholesterol after sucralose-ace-K (p < 0.01). There was an impact of blend on fullness and desire to eat ratings (both p < 0.05) and sucralose-acesulfame K induced higher prospective intake vs sucrose (p < 0.001 in adjusted models), but changes were of a small magnitude and did not translate into energy intake differences over the next 24 h. Gastro-intestinal symptoms for all beverages were mostly mild. In general, responses to a carbohydrate-rich meal following consumption of S&SE blends with stevia or sucralose were similar to sucrose.
Collapse
Affiliation(s)
- Eva Almiron-Roig
- University of Navarra, Faculty of Pharmacy and Nutrition, Dept. of Food Science and Physiology, Pamplona, Spain; University of Navarra, Center for Nutrition Research, Pamplona, Spain; Navarra Institute for Health Research (IdiSNa), Pamplona, Spain.
| | - Santiago Navas-Carretero
- University of Navarra, Faculty of Pharmacy and Nutrition, Dept. of Food Science and Physiology, Pamplona, Spain; University of Navarra, Center for Nutrition Research, Pamplona, Spain; Navarra Institute for Health Research (IdiSNa), Pamplona, Spain; Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain.
| | | | - Louise Kjølbæk
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
| | - Ana Romo-Hualde
- University of Navarra, Faculty of Pharmacy and Nutrition, Dept. of Food Science and Physiology, Pamplona, Spain; University of Navarra, Center for Nutrition Research, Pamplona, Spain.
| | - Mie Normand
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
| | - Niamh Maloney
- Department of Psychology, University of Liverpool, Liverpool, UK.
| | | | - Charo E Hodgkins
- Food Consumer Behaviour and Health Research Centre, School of Psychology, University of Surrey, Guildford, UK.
| | | | | | - Corey Scott
- Cargill R&D Centre Europe, Vilvoorde, Belgium.
| | - Monique M Raats
- Food Consumer Behaviour and Health Research Centre, School of Psychology, University of Surrey, Guildford, UK.
| | - Joanne A Harrold
- Department of Psychology, University of Liverpool, Liverpool, UK.
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark; Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.
| | - Jason C G Halford
- Department of Psychology, University of Liverpool, Liverpool, UK; School of Psychology, University of Leeds, Leeds, UK.
| | - J Alfredo Martínez
- University of Navarra, Faculty of Pharmacy and Nutrition, Dept. of Food Science and Physiology, Pamplona, Spain.
| |
Collapse
|
3
|
Gibbons C, O'Hara B, O'Connor D, Hardman C, Wilton M, Harrold JA, Almiron-Roig E, Navas-Carretero S, Hodgkins CE, Nazare JA, Alligier M, Martínez JA, Scott C, Kjølbæk L, Normand M, Rannou C, Blaak EE, Feskens E, Moshoyiannis H, Raben A, Halford JCG, Beaulieu K, Finlayson G. Acute and repeated impact of sweeteners and sweetness enhancers in solid and semi-solid foods on appetite: protocol for a multicentre, cross-over, RCT in people with overweight/obesity - the SWEET Project. BMJ Open 2022; 12:e063903. [PMID: 36564114 PMCID: PMC9791453 DOI: 10.1136/bmjopen-2022-063903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Intake of free sugars in European countries is high and attempts to reduce sugar intake have been mostly ineffective. Non-nutritive sweeteners and sweetness enhancers (S&SEs) can maintain sweet taste in the absence of energy, but little is known about the impact of acute and repeated consumption of S&SE in foods on appetite. This study aims to evaluate the effect of acute and repeated consumption of two individual S&SEs and two S&SE blends in semisolid and solid foods on appetite and related behavioural, metabolic and health outcomes. METHODS AND ANALYSIS A work package of the SWEET Project; this study consists of five double-blind randomised cross-over trials which will be carried out at five sites across four European countries, aiming to have n=213. Five food matrices will be tested across three formulations (sucrose-sweetened control vs two reformulated products with S&SE blends and no added sugar). Participants (body mass index 25-35 kg/m2; aged 18-60 years) will consume each formulation for 14 days. The primary endpoint is composite appetite score (hunger, inverse of fullness, desire to eat and prospective food consumption) over a 3-hour postprandial incremental area under the curve during clinical investigation days on days 1 and 14. ETHICS AND DISSEMINATION The trial has been approved by national ethical committees and will be conducted in accordance with the Declaration of Helsinki. Results will be published in international peer-reviewed open-access scientific journals. Research data from the trial will be deposited in an open-access online research data archive. TRIAL REGISTRATION NUMBER NCT04633681.
Collapse
Affiliation(s)
| | | | | | - Charlotte Hardman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Moon Wilton
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Joanne A Harrold
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Eva Almiron-Roig
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Santiago Navas-Carretero
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Charo E Hodgkins
- Food, Consumer Behaviour and Health Research Centre, School of Psychology, University of Surrey, Guildford, UK
| | - Julie Anne Nazare
- Hospices Civils de Lyon, Rhône-Alpes Research Centre for Human Nutrition, Pierre-Benite, France
| | - Maud Alligier
- Hospices Civils de Lyon, Rhône-Alpes Research Centre for Human Nutrition, Pierre-Benite, France
- Hospices Civils de Lyon, French Obesity Research Centre of France, Pierre-Bénite, France
| | - Jose Alfredo Martínez
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- Precision Nutrition Program, IMDEA, Madrid, Spain
| | - Corey Scott
- Ingredients, Materials and Nutrition, Cargill, Minneapolis, Minnesota, USA
| | - Louise Kjølbæk
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mie Normand
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | - Ellen E Blaak
- School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Edith Feskens
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | | | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | | | | |
Collapse
|
4
|
Kjølbæk L, Manios Y, Blaak EE, Martínez JA, Feskens EJM, Finlayson G, Andersen SSH, Reppas K, Navas-Carretero S, Adam TC, Hodgkins CE, Del Álamo M, Lam T, Moshoyiannis H, Halford JCG, Harrold JA, Raben A. Protocol for a multicentre, parallel, randomised, controlled trial on the effect of sweeteners and sweetness enhancers on health, obesity and safety in overweight adults and children: the SWEET project. BMJ Open 2022; 12:e061075. [PMID: 36223962 PMCID: PMC9562305 DOI: 10.1136/bmjopen-2022-061075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim of this randomised controlled trial (RCT) is to investigate whether prolonged consumption of sweeteners and sweetness enhancers (S&SEs) within a healthy diet will improve weight loss maintenance and obesity-related risk factors and affect safety markers compared with sugar. METHODS AND ANALYSIS SWEET (S&SEs: prolonged effects on health, obesity and safety) is a 1-year multicentre RCT including at least 330 adults with overweight (18-65 years, body mass index (BMI) >25 kg/m2) and 40 children (6-12 years, BMI-for-age >85th percentile). In an initial 2-month period, adults will consume a low-energy diet with the aim to achieve ≥5% weight loss. Children are advised to consume a generally healthy diet to maintain body weight, thus reducing their BMI-for-age z-score. In the following 10 months, participants will be randomised to follow a healthy ad libitum diet with or without S&SE products. Clinical investigations are scheduled at baseline, after 2, 6 and 12 months. The primary outcomes are body weight for efficacy and gut microbiota composition (in relation to metabolic health) for safety, both in adults. Secondary outcomes include anthropometry, risk markers for type-2 diabetes and cardiovascular diseases, questionnaires including, for example, food preferences, craving and appetite and tests for allergenicity. ETHICS AND DISSEMINATION The trial protocol has been approved by the following national ethical committees; The research ethics committees of the capital region (Denmark), approval code: H-19040679, The medical ethics committee of the University Hospital Maastricht and Maastricht University (the Netherlands), approval code: NL70977.068.19/METC19-056s, Research Ethics Committee of the University of Navarra (Spain), approval code: 2019.146 mod1, Research Ethics Committee of Harokopio University (Greece), approval code: 1810/18-06-2019. The trial will be conducted in accordance with the Declaration of Helsinki. Results will be published in international peer-reviewed scientific journals regardless of whether the findings are positive, negative or inconclusive. TRIAL REGISTRATION NUMBER NCT04226911 (Clinicaltrials.gov).
Collapse
Affiliation(s)
- Louise Kjølbæk
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
- Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Ellen E Blaak
- Department of Human Biology, Maastricht University, Maastricht, Netherlands
| | - J Alfredo Martínez
- Center for Nutrition Research, University of Navarra, Pamplona, Navarra, Spain
- IMDEA Food Institute, Madrid, Spain
| | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | | | - Sabina S H Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Kyriakos Reppas
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Santiago Navas-Carretero
- Center for Nutrition Research, University of Navarra, Pamplona, Navarra, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Tanja C Adam
- Department of Nutrition & Movement Sciences, Maastricht University, Maastricht, Limburg, Netherlands
| | - Charo E Hodgkins
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Guildford, UK
| | - Marta Del Álamo
- European Clinical Research Infrastructure Network, Paris, France
| | - Tony Lam
- NetUnion sarl, Lausanne, Switzerland
| | | | - Jason C G Halford
- School of Psychology, University of Leeds, Leeds, UK
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Joanne A Harrold
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg C, Denmark
- Clinical Research, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark
| |
Collapse
|
5
|
Almiron-Roig E, Navas-Carretero S, Finlayson G, Hardman C, Rakvaag E, Lam T, Moshoyiannis H, Raats M, Alligier M, Nazare JA, Blaak E, Nychas G, Feskens E, Raben A, Harrold J, Halford J, Martinez J. Impact of acute & repeated exposure to sweeteners & sweetness enhancers on food behaviour, physiology, health: study protocol for SWEET WP2. Appetite 2021. [DOI: 10.1016/j.appet.2020.104895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
6
|
Mittag TW, Xu X, Moshoyiannis H, Kornfeld P, Genkins G. Analysis of false negative results in the immunoassay for anti-acetylcholine receptor antibodies in myasthenia gravis. Clin Immunol Immunopathol 1984; 31:191-201. [PMID: 6713740 DOI: 10.1016/0090-1229(84)90239-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Possible causes for the failure of immunoassays to detect anti-acetylcholine receptor activity in serum from confirmed myasthenia gravis (MG) patients were investigated. A more sensitive assay, using Protein A to trap immune complexes (ARIA), was applied to 65 MG sera which were negative in the usual assay and to 42 normal human sera. Normal and negative MG sera had antibody (Ab) activity in the same range (50-70 pM). Titers present in 70% of normal sera appeared to be specific antireceptor antibodies as defined by tests for antigen specificity. Thus, higher sensitivity assays did not improve discrimination of MG from normals. In a second group of 108 MG sera studied, 48 were negative by the usual assay criteria in a rat acetylcholine receptor immunoassay. Further detailed analysis of this negative group showed that 3/48 had IgG3 antibody not detectable in the test, 14/48 had Ab's recognizing human receptor determinants exclusively, 29/48 had toxin blocking Ab's not determined by immunoassays, and 6/48 were negative in all tests. The results indicate that the exclusive occurrence of toxin-blocking antibodies in MG subjects is a major factor contributing to false negatives in the ARIA test. Estimates of the amount of Ab's with this functionality indicated that they are present in very much smaller amounts than other classes of anti-receptor Ab's. Degree of blocking activity in patient serum showed a fair correlation with severity of disease. Thus, blocking antibodies appear capable of causing all degrees of disease severity in the absence of other types of antireceptor Ab's. The development of a sensitive and quantitative in vitro assay for blocking antibodies combined with the usual immunoassay would be a major improvement for a MG diagnostic test, with greater than 94% positivity predicted.
Collapse
|