A Systematic Review of Metabolomic Biomarkers for the Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages

Samuel Muli,Kolade Oluwagbemigun,Matthias Schmid,Jantje Goerdten,Ute Nöthlings,Anna Floegel

doi:10.3390/metabo11080546

Abstract

Intake of added sugars (AS) is challenging to assess compared with total dietary sugar because of the lack of reliable assessment methods. The reliance on self-reported dietary data in observational studies is often cited as biased, with evidence of AS intake in relation to health outcomes rated as low to moderate quality. Sugar-sweetened beverages (SSBs) are a major source of AS. A regular and high intake of SSBs is associated with an overall poor diet, weight gain, and cardiometabolic risks. An elevated intake of low-calorie sweetened beverages (LCSBs), often regarded as healthier alternatives to SSBs, is also increasingly associated with increased risk for metabolic dysfunction. In this review, we systematically collate evidence and provide perspectives on the use of metabolomics for the discovery of candidate biomarkers associated with the intake of SSBs and LCSBs. We searched the Medline, Embase, Scopus, and Web of Science databases until the end of December 2020. Seventeen articles fulfilled our inclusion criteria. We evaluated specificity and validity of the identified biomarkers following Guidelines for Biomarker of Food Intake Reviews (BFIRev). We report that the 13C:12C carbon isotope ratio (δ13C), particularly, the δ13C of alanine is the most robust, sensitive, and specific biomarker of SSBs intake. Acesulfame-K, saccharin, sucralose, cyclamate, and steviol glucuronide showed moderate validity for predicting the short-term intake of LCSBs. More evidence is required to evaluate the validity of other panels of metabolites associated with the intake of SSBs.

Highlights

Introduction published maps and institutional affilAdded sugar (AS) refers to sugars, syrups, or caloric sweeteners added to foods during preparation, processing in the industry, or by consumers at the table [1]
A major limitation in the application of carbon isotope-based biomarkers is the inability to detect AS refined from sources that utilize the C3 photosynthetic pathway and other sources
The panel of candidate biomarkers of Sugar-sweetened beverages (SSBs), as identified via untargeted metabolomics studies, require further investigation regarding their biochemical plausibility and validation in dose−response studies before they can be used in epidemiological studies

Summary

Introduction

Introduction published maps and institutional affilAdded sugar (AS) refers to sugars, syrups, or caloric sweeteners added to foods during preparation, processing in the industry, or by consumers at the table [1]. Organization (WHO) recommends less than 10% of the total daily energy intake from free sugars, which includes AS and sugars naturally present in honey, syrups, fruit concentrates, and juices [2]. In reference to a total energy intake of 2000 kcal per day, the WHO recommendation corresponds to 50 g of free sugars [3]. In a German cohort study, the median intake of AS ranged between 11.6% and 13.3% and free sugars between 15.2% to 17.5% in children and adolescents aged 3 to 18 years [4]. In the USA, a national survey reported a mean adjusted estimate of AS intake in children aged 2–18 years as 14% of their daily energy intake [5]

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