Intake Of Artificial Sweeteners Research Articles

Intake of Artificial Sweeteners through Soft Drinks in the Preschool- and School-Aged Population.

One of the main public health issues that has recently been observed in a greater number of children is being overweight. The cause certainly lies in the decreasing physical activity of children, but mostly in their eating habits. Soft drinks are recognized as the most significant contributor to body overweight due to high sugar content; thus, as a result of numerous campaigns, part of the sugar is replaced by artificial sweeteners (ASs). Despite their advantage due to their low caloric value, WHO recommends that they should not be used to achieve weight control or as prevention for reducing the risk of non-communicable diseases, as there is no evidence of their effectiveness. Apart from beverages, artificial sweetener combinations are also added to a variety of "low fat" and "high protein" food products, which are highly favored especially among the young population. Therefore, it is necessary to take care of the cumulative intake. The conducted study included a survey of 323 parents of children aged 1-14 years, as well as an analysis of the AS content in the products most often consumed by the respondents. The results of the survey show that a large part of children (40%) aged 3-14 often consume soft drinks. Different products (soft drinks, juices/nectars, syrups) were sampled based on the respondents' responses, and an analysis showed that 54% of them contained one or more ASs. In addition, the survey indicated parents' lack of information about the presence of AS in products, as 51% of parents declared that they do not read the declarations of the products they buy. It is necessary to persist in consumer education and changes in dietary preferences and habits, especially among children.

Associations between artificial sweetener intake from cereals, coffee, and tea and the risk of type 2 diabetes mellitus: A genetic correlation, mediation, and mendelian randomization analysis.

Previous studies have emphasized the association between the intake of artificial sweeteners (AS) and type 2 diabetes mellitus (T2DM), but the causative relationship remains ambiguous. This study employed univariate Mendelian randomization (MR) analysis to assess the causal link between AS intake from various sources and T2DM. Linkage disequilibrium score (LDSC) regression was used to evaluate the correlation between phenotypes. Multivariate and mediation MR were applied to investigate confounding factors and mediating effects. Data on AS intake from different sources (N = 64,949) were sourced from the UK Biobank, while T2DM data were derived from the DIAbetes Genetics Replication And Meta-analysis.The primary method adopted was inverse variance weighted (IVW), complemented by three validation techniques. Additionally, a series of sensitivity analyses were performed to evaluate pleiotropy and heterogeneity. LDSC analysis unveiled a significant genetic correlation between AS intake from different sources and T2DM (rg range: -0.006 to 0.15, all P < 0.05). After correction by the false discovery rate (FDR), the primary IVW method indicated that AS intake in coffee was a risk factor for T2DM (OR = 1.265, 95% CI: 1.035-1.545, P = 0.021, PFDR = 0.042). Further multivariable and mediation MR analyses pinpointed high density lipoprotein-cholesterol (HDL-C) as mediating a portion of this causal relationship. In reverse MR analysis, significant evidence suggested a positive correlation between T2DM and AS intake in coffee (β = 0.013, 95% CI: 0.004-0.022, P = 0.004, PFDR = 0.012), cereal (β = 0.007, 95% CI: 0.002-0.012, P = 0.004, PFDR = 0.012), and tea (β = 0.009, 95% CI: 0.001-0.017, P = 0.036, PFDR = 0.049). No other causal associations were identified (P > 0.05, PFDR > 0.05). The MR analysis has established a causal relationship between AS intake in coffee and T2DM. The mediation by HDL-C emphasizes potential metabolic pathways underpinning these relationships.

The Possibility of Artificial Sweeteners Replacing Added Sugar in the Diet of High Sugar Consumption Patients with Cardiovascular Disease

Artificial sweeteners have indeed been the subject of controversy and scrutiny over the past few decades. Originally developed as a supplement and a healthier alternative to added sugar, they were initially created to address shortages in sugar production. However, over time, artificial sweeteners have been mass-marketed primarily based on their low-calorie profile, with a specific focus on targeting individuals who are obese or looking to reduce calorie intake. While artificial sweeteners were designed to offer a sugar-free alternative, they have also been linked to common diseases associated with excessive sugar consumption, including cardiovascular disease (CVD). CVD is a serious condition with a high mortality rate, and numerous studies have explored the potential interrelation between the intake of artificial sweeteners and added sugars and the danger of CVD events’ occurrence. Through carrying out comparisons of the effects which artificial sweeteners and added sugars may induce on CVD, the goal of this article is to investigate the possibility of substituting added sugar with artificial sweeteners for the potential benefit of CVD patients. This is an important area of research given the rising concerns about the health impact of sugar consumption and the desire to find alternative options that can contribute to better heart health.

Assessment of knowledge and intake of artificial sweeteners among type II diabetic individuals and perspectives of registered dieticians in India

Assessment of knowledge and intake of artificial sweeteners among type II diabetic individuals and perspectives of registered dieticians in India

Intake of Artificial Sweeteners by Children: Boon or Bane?

Sugar is the main culprit in many health dysfunctions. Excessive sugar intake can negatively affect oral health, precipitate diabetes, and lead to weight gain and obesity. Sucrose is the primary form of sugar, and is strongly correlated with dental caries. Artificial sweeteners are chemically synthesized sugar substitutes that are generally regarded as being low-calorie. This review examines the current evidence in the literature for the need for artificial sweeteners and outlines its implications for the health of children. We briefly outline its adverse effects, and concerns regarding their safety. Artificial sweeteners are a widely used food additive. Six main artificial sweeteners are approved by the food and drug administration (FDA). The conflicting results and divergent regulatory norms of each sweetener are a constant cause of concern and debate. However, most studies have spotlighted the beneficial effects of artificial sweeteners. Dental caries diminish with the increase in sweetener intake. An increase in appetite and eventually weight gain is observed in individuals consuming artificial sweeteners. Artificial sweeteners are indeed a bane according to present studies, although more research on recently discovered non-nutritive artificial sweeteners is required. It also has a positive effect on overall health disorders. If one curbs the onset of dental caries, then the eventual rise is highly unlikely. Artificial sweeteners' effect on lowering dental caries will help to reduce the caries index in general. Oral hygiene is maintained, and the growth of oral bacterium is depressed. Research on novel sweeteners will help to compare their efficacy in caries prevention compared to existing ones. It is necessary to educate people on artificial sweeteners and its implication as one can use them by being aware of their properties.

Transplacental Transport of Artificial Sweeteners

The prevalence of obesity is increasing, and the origins of obesity and metabolic dysfunction may be traced back to fetal life. Currently, overweight pregnant women are advised to substitute sugar-sweetened beverages with diet drinks containing artificial sweeteners. Recent evidence suggests that the consumption of artificial sweeteners during pregnancy increases the risk of obesity in the child, but the mechanism is unknown. We hypothesized the transportation of artificial sweeteners across the placenta into the fetal circulation and the amniotic fluid. We included 19 pregnant women who were given an oral dose of acesulfame, cyclamate, saccharin, and sucralose immediately before a planned caesarean section. Nine women were included as controls, and they refrained from an intake of artificial sweeteners. The maternal and fetal blood and amniotic fluid were collected during the caesarean section, and concentrations of artificial sweeteners were measured using mass spectrometry. We found a linear relationship between the fetal plasma concentrations of artificial sweeteners and the maternal plasma concentrations, with adjusted coefficients of 0.49 (95% CI: 0.28–0.70) for acesulfame, 0.72 (95% CI: 0.48–0.95) for cyclamate, 0.51 (95% CI: 0.38–0.67) for saccharin, and 0.44 (95% CI: 0.33–0.55) for sucralose. We found no linear relationship between amniotic fluid and fetal plasma concentrations, but there were positive ratios for all four sweeteners. In conclusion, the four sweeteners investigated all crossed the placenta and were present in the fetal circulation and amniotic fluid.

Can Artificial Sweeteners Increase the Risk of Cancer Incidence and Mortality: Evidence from Prospective Studies.

Cancer has become a major challenge in the global disease burden. Artificial sweeteners are a class of chemical compounds that are used as food and beverage addition agent to replace sugar. However, the health effects of consuming artificial sweeteners are still unclear. This meta-analysis was performed to evaluate the role of artificial sweeteners on cancer. The databases PubMed, Cochrane Library, MEDLINE, Web of Science and EMBASE were searched up until July 2022. A Newcastle–Ottawa scale (NOS) was used to estimate the study quality. A total of 25 observational studies were included with a total of 3,739,775 subjects. The intake of artificial sweeteners had no apparent association with overall cancer incidence and mortality. However, in Europe, artificial sweeteners’ intake could increase the risk of cancer incidence (HR/RR = 1.07, 95% CI = [1.02, 1.12], I2 = 25.8%, P = 0.223), which appears to be related to a shift in nutritional behaviors in the countries. Significant results were also observed in subgroups with aspartame and a mixed intake of artificial sweeteners. Moreover, higher risk was observed for artificial sweeteners intake in all-cause mortality (HR/RR =1.13, 95% CI = [1.03, 1.25], I2 = 79.7%, p < 0.001) and a J-shaped association between them was found. More data from well-conducted studies and clinical trials are required.

Intake of artificial sweeteners among adults is associated with reduced odds of gastrointestinal luminal cancers: a meta-analysis of cohort and case-control studies

The association between artificial sweetener (AS) consumption and the risk of organ-specific cancers has been debated for decades. We hypothesized that AS consumption is associated with reduced risk of gastrointestinal (GI) cancers. We aimed to test this hypothesis by conducting a systematic review and meta-analysis of the association between AS and GI cancers. We searched 4 databases for comparative studies of AS consumption (exposed) versus no consumption (nonexposed) and the odds or risk of GI luminal or non–luminal cancer (primary outcome). Estimates were pooled using a random-effects model. Studies were evaluated for quality, bias, and heterogeneity. We analyzed 8 (4 prospective, 4 case-control) studies comprising data on 1,043,496 individuals, among whom 3271 pancreatic, 395 gastric, 304 esophageal, 3008 colorectal, and 598 oropharyngeal cancers occurred. While there was no significant association between AS consumption and odds of GI cancer overall, AS consumption was associated with 19% reduced likelihood of luminal GI cancer (OR 0.81, 95% CI:0.68-0.97). There was no association between AS consumption and non–luminal GI cancer. Meta-regression demonstrated no difference in effect estimates based on study type. Based on this first meta-analysis of AS and GI cancer, we demonstrated that AS consumption is associated with a significantly lower likelihood of luminal, but not non–luminal, GI cancer.

The artificial sweetener Splenda intake promotes changes in expression of c-Fos and NeuN in hypothalamus and hippocampus of rats

BackgroundObesity is the result of the interaction of multiple variables, including the excessive increase of sugar-sweetened beverages consumption. Diets aimed to treat obesity have suggested the use of artificial sweeteners. However, recent evidence has shown several health deficits after intake of artificial sweeteners, including effects in neuronal activity. Therefore, the influence of artificial sweeteners consumption such as Splenda, on the expression of c-Fos and neuronal nuclear protein (NeuN) in hypothalamus and hippocampus remains to be determined. ObjectivesWe investigated the effects on c-Fos or NeuN expression in hypothalamus and hippocampus of Splenda-treated rats. MethodsSplenda was diluted in water (25, 75 or 250 mg/100 mL) and orally given to rats during 2 weeks ad libitum. Next, animals were sacrificed by decapitation and brains were collected for analysis of c-Fos or NeuN immunoreactivity. ResultsConsumption of Splenda provoked an inverted U-shaped dose-effect in c-Fos expression in ventromedial hypothalamic nucleus while similar findings were observed in dentate gyrus of hippocampus. In addition, NeuN immunoreactivity was enhanced in ventromedial hypothalamic nucleus at 25 or 75 mg/100 mL of Splenda intake whereas an opposite effect was observed at 250 mg/100 mL of artificial sweetener consumption. Lastly, NeuN positive neurons were increased in CA2/CA3 fields of hippocampus from Splenda-treated rats (25, 75 or 250 mg/100 mL). ConclusionConsuming Splenda induced effects in neuronal biomarkers expression. To our knowledge, this study is the first description of the impact of intake Splenda on c-Fos and NeuN immunoreactivity in hypothalamus and hippocampus in rats.

Artificial Sweeteners as a Cause of Obesity: Weight Gain Mechanisms and Current Evidence

The obesity epidemic gathers growing media attention recently, as overweight and obesity’s prevalence keeps rising. This comes along with an increase in the intake of artificial sweeteners in food products. A causal relationship between the consumption of sweeteners and obesity is so far not clear in the medical literature. This paper describes the development of artificial sweeteners in a historical context. It collects epidemiological and experimental evidence that possibly relates the use of artificial sweeteners with weight gain. Finally, these effects are explained based on the neuroscience of food reward, the possible effects of glucose on the metabolism and the association between sweeteners and gut microbiota.

Longitudinal modelling of the exposure of young UK patients with PKU to acesulfame K and sucralose

ABSTRACTArtificial sweeteners are used in protein substitutes intended for the dietary management of inborn errors of metabolism (phenylketonuria, PKU) to improve the variety of medical foods available to patients and ensure dietary adherence to the prescribed course of dietary management. These patients can be exposed to artificial sweeteners from the combination of free and prescribed foods. Young children have a higher risk of exceeding acceptable daily intakes (ADI) for additives than adults, due to higher food intakes per kg body weight. Young patients with PKU aged 1–3 years can be exposed to higher levels of artificial sweeteners from these dual sources than normal healthy children and are at a higher risk of exceeding the ADI. Standard intake assessment methods are not adequate to assess the additive exposure of young patients with PKU. The aim of this study was to estimate the combination effect on the intake of artificial sweeteners and the impact of the introduction of new provisions for an artificial sweetener (sucralose, E955) on exposure of PKU patients using a validated probabilistic model. Food consumption data were derived from the food consumption survey data of healthy young children in the United Kingdom from the National Diet and Nutrition Survey (NDNS, 1992–2012). Specially formulated protein substitutes as foods for special medical purposes (FSMPs) were included in the exposure model to replace restricted foods. Inclusion of these protein substitutes is based on recommendations to ensure adequate protein intake in these patients. Exposure assessment results indicated the availability of sucralose for use in FSMPs for PKU leads to changes in intakes in young patients. These data further support the viability of probabilistic modelling as a means to estimate food additive exposure in patients consuming medical nutrition products.

Probabilistic modelling to assess exposure to three artificial sweeteners of young Irish patients aged 1–3 years with PKU and CMPA

ABSTRACTThe choice of suitable normal foods is limited for individuals with particular medical conditions, e.g., inborn errors of metabolism (phenylketonuria – PKU) or severe cow’s milk protein allergy (CMPA). Patients may have dietary restrictions and exclusive or partial replacement of specific food groups with specially formulated products to meet particular nutrition requirements. Artificial sweeteners are used to improve the appearance and palatability of such food products to avoid food refusal and ensure dietary adherence. Young children have a higher risk of exceeding acceptable daily intakes for additives than adults due to higher food intakes kg–1 body weight. The Budget Method and EFSA’s Food Additives Intake Model (FAIM) are not equipped to assess partial dietary replacement with special formulations as they are built on data from dietary surveys of consumers without special medical requirements impacting the diet. The aim of this study was to explore dietary exposure modelling as a means of estimating the intake of artificial sweeteners by young PKU and CMPA patients aged 1–3 years. An adapted validated probabilistic model (FACET) was used to assess patients’ exposure to artificial sweeteners. Food consumption data were derived from the food consumption survey data of healthy young children in Ireland from the National Preschool and Nutrition Survey (NPNS, 2010–11). Specially formulated foods for special medical purposes were included in the exposure model to replace restricted foods. Inclusion was based on recommendations for adequate protein intake and dietary adherence data. Exposure assessment results indicated that young children with PKU and CMPA have higher relative average intakes of artificial sweeteners than healthy young children. The reliability and robustness of the model in the estimation of patient additive exposures was further investigated and provides the first exposure estimates for these special populations.

Blood glucose and insulin response to artificially- and sugar-sweetened sodas in healthy men

Artificial sweeteners are commonplace in foods and beverages; perhaps most notably in diet sodas. Some epidemiology data indicate a higher rate of insulin resistance in those who regularly consume artificially-sweetened sodas, possibly due to an insulinogenic response to beverage consumption, despite the lack of calories. The possibility of an acute insulin spike with artificial sweetener consumption is a common topic of discussion in the lay press but scientific evidence is lacking. We compared the glucose and insulin response to acute ingestion of two different artificially sweetened sodas (containing sucralose or aspartame), compared to “regular” sugar-sweetened soda, and carbonated water in 12 healthy men. Blood samples collected before and at 30, 60, 90, and 120 minutes following ingestion of the beverages were analyzed for glucose and insulin. Both glucose (30 min) and insulin (30 and 60 min) were elevated significantly above baseline following intake of the regular soda; however, values remained very stable for all other conditions across time (p>0.05). Artificially sweetened sodas containing sucralose or aspartame do not result in any acute elevation in blood sugar or insulin following a 20 ounce load. There is no reason to suspect that a higher consumption would result in an elevation in these measures. Any noted insulin resistance linked to high intake of artificial sweeteners is likely a function of the excess calories and processed ingredients often included within artificially-sweetened food and beverage products.

어린이와 청소년의 비알콜성음료 섭취에 따른 인공감미료 섭취량 평가

aims of this study were to estimate daily intakes of artificial sweeteners from beverages and liquid teas as well as evaluate their potential health risks in Korean children and adolescents (1 to 19 years old). Dietary intake assessment was conducted using actual levels of aspartame, acesulfame-K, and sucralose in non-alcoholic beverages (651 beverages and 87 liquid teas), and food consumption amounts were drawn from The Fourth Korea National Health and Nutrition Examination Survey (2007～2009). To estimate dietary intake of non-alcoholic beverages, a total of 6,082 children and adolescents (Scenario Ⅰ) were compared to 1,704 non-alcoholic beverage consumption subjects (Scenario Ⅱ). estimated daily intake of artificial sweeteners was calculated based on point estimates and probabilistic estimates. values of probabilistic artificial sweeteners intakes were presented by a Monte Carlo approach considering probabilistic density functions of variables. level of safety for artificial sweeteners was evaluated by comparisons with acceptable daily intakes (ADI) of aspartame (0～40 mg/kg bw/day), acesulfame-K (0～15 mg/kg bw/day), and sucralose (0～15 mg/kg bw/day) set by the World Health Organization. For total children and adolescents (Scenario Ⅰ), mean daily intakes of aspartame, acesulfame-K, and sucralose estimated by probabilistic estimates using Monte Carlo simulation were 0.09, 0.01, and 0.04 mg/kg bw/day, respectively, and 95th percentile daily intakes were 0.30, 0.02, and 0.13 mg/kg bw/day, respectively. For consumers-only (Scenario Ⅱ), mean daily intakes of aspartame, acesulfame-K, and sucralose estimated by probabilistic estimates using Monte Carlo simulation were 0.52, 0.03, and 0.22 mg/kg bw/day, respectively, and 95th percentile daily intakes were 1.80, 0.12, and 0.75 mg/kg bw/day, respectively. For scenarios Ⅰ and Ⅱ, neither aspartame, acesulfame-K, nor sucralose had a mean and 95th percentile intake that exceeded 5.06% of ADI.

Use of dietary exposure modelling to estimate the intake of artificial sweeteners by young children with medical conditions

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Artificial sweeteners

Artificial sweeteners can be a helpful tool to reduce energy intake and body weight and thereby risk for diabetes and cardiovascular diseases (CVD). Considering the prevailing diabesity (obesity and diabetes) epidemic, this can, therefore, be an important alternative to natural, calorie-containing sweeteners. The purpose of this review is to summarize the current evidence on the effect of artificial sweeteners on body weight, appetite, and risk markers for diabetes and CVD in humans. Short-term intervention studies have shown divergent results wrt appetite regulation, but overall artificial sweeteners cannot be claimed to affect hunger. Data from longer term intervention studies are scarce, but together they point toward a beneficial effect of artificial sweeteners on energy intake, body weight, liver fat, fasting and postprandial glycemia, insulinemia, and/or lipidemia compared with sugar. Epidemiological studies are not equivocal, but large cohort studies from the USA point toward decreased body weight and lower risk of type-2 diabetes and coronory heart diseases with increased intake of artificial sweeteners compared with sugar. Artificial sweeteners, especially in beverages, can be a useful aid to maintain reduced energy intake and body weight and decrease risk of type-2 diabetes and CVD compared with sugars. However, confirmative long-term intervention trials are still needed.

Dietary intake of artificial sweeteners by the Belgian population

This study investigated whether the Belgian population older than 15 years is at risk of exceeding ADI levels for acesulfame-K, saccharin, cyclamate, aspartame and sucralose through an assessment of usual dietary intake of artificial sweeteners and specific consumption of table-top sweeteners. A conservative Tier 2 approach, for which an extensive label survey was performed, showed that mean usual intake was significantly lower than the respective ADIs for all sweeteners. Even consumers with high intakes were not exposed to excessive levels, as relative intakes at the 95th percentile (p95) were 31% for acesulfame-K, 13% for aspartame, 30% for cyclamate, 17% for saccharin, and 16% for sucralose of the respective ADIs. Assessment of intake using a Tier 3 approach was preceded by optimisation and validation of an analytical method based on liquid chromatography with mass spectrometric detection. Concentrations of sweeteners in various food matrices and table-top sweeteners were determined and mean positive concentration values were included in the Tier 3 approach, leading to relative intakes at p95 of 17% for acesulfame-K, 5% for aspartame, 25% for cyclamate, 11% for saccharin, and 7% for sucralose of the corresponding ADIs. The contribution of table-top sweeteners to the total usual intake (<1% of ADI) was negligible. A comparison of observed intake for the total population with intake for diabetics (acesulfame-K: 3.55 versus 3.75; aspartame: 6.77 versus 6.53; cyclamate: 1.97 versus 2.06; saccharine: 1.14 versus 0.97; sucralose: 3.08 versus 3.03, expressed as mg kg−1 bodyweight day−1 at p95) showed that the latter group was not exposed to higher levels. It was concluded that the Belgian population is not at risk of exceeding the established ADIs for sweeteners.

Artificial Sweetener Intake of Korean Children is Insignificant

PP-30-127 Background/Aims: With a recent increase in intake of sweetened beverage among going school children, we attempted to assess dietary intake of artificial sweeteners (AS: aspartame, acesulfame-K, saccharin sodium). Because the previously estimated intake of AS among children was minimal, we focused on intake in consumer (C) group. Methods: A food frequency questionnaire was developed to estimate the intake of artificially sweetened beverages and snacks on the basis of the result of AS monitoring by Korea Food and Drug Administration (KFDA). In all, 28 schools each were selected for elementary, junior high, and high schools in Seoul, Korea, using a stratified multistage sampling method. Students in a class from second and fifth grades at elementary school, and second grade at junior high school and high school were surveyed for the frequency and amount of artificially sweetened beverages and snacks during 1 week before the survey. The survey was repeated for 3 seasons, from June through December 2009, to compensate for any possible seasonal effect. Sweetener intake was estimated by using AS database of KFDA and compared with the acceptable daily intake (ADI). Results: A total of 10,099 children responded to the survey. The mean AS intake of group C children was 0.25 ± 0.48 mg/kg bw/d, 0.18 ± 0.44 mg/kg bw/d, and 0.22 ± 0.25 mg/kg bw/d for aspartame, acesulfame-K, and saccharin sodium, respectively. Although these values were 1.5–5.5 times higher than those of all children, the corresponding values of ADI were only 0.63%, 1.23%, and 4.42% of respective ADI values set by JECFA. Even the 95th percentile values of ADI were far lower than the safety limit: 2.48%, 4.86%, and 15.59% for aspartame, acesulfame-K, and saccharin sodium, respectively. Conclusion: This study revealed that the AS intake through beverages and snacks among children in Korea is insignificant and very safe. This study was supported by R&D fund of KFDA (0808KFDA999-101).

Sweet Eating: A Definition and the Development of the Dutch Sweet Eating Questionnaire

Previous studies have suggested that patients who are defined as so-called sweet eaters have more difficulties to lose weight and to maintain weight loss after both conservative treatment and restrictive bariatric surgery, such as gastric banding. There is, however, no agreement on the definition of sweet eating. Also, a questionnaire to measure sweet eating is not available. Therefore, the aim of our study was to agree on a definition of sweet eating and to construct a valid and reliable questionnaire that might be of help to assess the influence of sweet eating on weight loss after bariatric surgery. A Delphi Study design was chosen to define sweet eating. Based on the Delphi rounds, a questionnaire with self-reported sweets intake was constructed and validated. Nine experts with different scientific backgrounds participated in the Delphi Study which consisted of four rounds. They finally agreed on the definition that sweet eating can be defined as an eating behavior in which at least 50% of daily consumed carbohydrates consist of simple carbohydrates and which can be triggered by emotional factors (i.e., stress). They did not include the intake of artificial sweeteners in the definition. The Dutch Sweet Eating Questionnaire built on the four Delphi rounds was tested in 138 female patients and appeared to be both valid and reliable. A shortcoming of this study is that the results may not be applicable to males and to non-Western populations. The definition and the questionnaire may be useful in future research regarding sweet eating and bariatric surgery outcomes in morbidly obese patients.

Dietary factors in cancer of the lower urinary tract

This dietary study was based on 195 male and 66 female cases of lower urinary tract cancer, identified in Hawaii between 1977 and 1986. Each case was matched for sex, age, and ethnic group (Caucasian or Japanese) to 2 population-based controls. There was a decrease in risk with increasing levels of consumption of vitamin C in women (p = 0.03) and dark green vegetables in men (p = 0.02). When examined by quartile, the odds ratios for the highest quartile of intake compared to the lowest quartile were 0.4 for women and 0.6 for men, respectively. Although dark green vegetables are a source of carotenoids, the intake of total carotenoids, retinol and total vitamin A was weakly and inconsistently related to risk in both sexes. Among women only, there was also an inverse association with the consumption of regular ground coffee (p = 0.02) but not with other types of coffee. Finally, there were no statistically significant or consistent differences between cases and controls in the intake of artificial sweeteners and tea.