Low-calorie Sweetened Beverages Research Articles

1160-P: Low-Calorie Sweeteners and Quality of Life in Youth with Type 1 Diabetes

Background: Low calorie sweeteners (LCSs) are often used by youth with Type 1 Diabetes (T1D), as LCS can provide added sweetness to food and beverages at a reduced glycemic load. Whether LCS consumption is helpful or harmful for T1D management among youth is debated; however, little attention has been given to potential benefits of LCS consumption on psychosocial outcomes among youth with T1D. This is important because a diabetes diagnosis pervades all aspects of a child's life and LCS use may provide children with T1D with a sense of normalcy, potentially increasing their health-related quality of life (HRQOL). Objective: To examine associations between LCS consumption and HRQOL among youth with T1D. Methods: Sixty youth ages 11-17 with a diagnosis of T1D (Mage 12.9±1.8, 57.1% female, 70% Non-Hispanic White) and their parents (83.3% female, 71.6% Non-Hispanic White) were recruited from the Washington Nationals Diabetes Care Complex at Children's National Hospital (DCC) in Washington D.C. (N=20) and nationally using social media (N=40). Eligible youth and their parent attended a virtual study visit, where they provided demographic information, and completed a LCS consumption questionnaire (developed by the team for a previous study), along with the validated Type 1 Diabetes and Life measure (T1DAL). Means and frequencies were used to summarize the survey data, as appropriate, and associations between LCS intake and HRQOL were examined using multivariable linear regression, with adjustment for relevant covariates. Results: Mean LCS consumption was 3.3±2.8 servings per day. No associations between LCS consumption (total, LCS beverage consumption, LCS food consumption) and HRQOL (total and subscales) were observed. Conclusion: In our sample of youth with T1D, LCS intake was not associated with HRQOL. These results demonstrate that LCS use may not benefit psychosocial outcomes of youth with T1D, further reiterating the need to determine their metabolic and health effects in this high-risk patient population. Disclosure H.R.Moore: None. M.Fagundes grilo: None. N.Vallone: None. F.R.Cogen: None. R.Streisand: None. A.Sylvetsky: Consultant; Abbott. Funding Milken Institute School of Public Health

Interrelationships between Habitual Beverage Consumption, Plasma Biomarkers and Risk of Type 2 Diabetes: Results From a Prospective Case-Control Study

ObjectivesTo elucidate potential pathways of dietary risk of type 2 diabetes (T2D) by defining a model that describes how identified patterns of habitual beverage consumption associate with identified networks of circulating cardiometabolic plasma biomarkers. MethodsThis study included 1,231 cases and 1,560 controls from a nested case-control study of T2D within the Nurses’ Health Study I. Participants completed validated food frequency questionnaires assessing their habitual beverage intake and provided plasma samples to assess 27 different plasma biomarkers of cardiometabolic risk. Common exploratory factor analysis (EFA) was used to identify common factors that separately described beverage consumption patterns and biomarker networks. False discovery rate corrected multivariable-adjusted regression elucidated the relationships between beverage and biomarker factors, and their associations with T2D risk. ResultsEFA revealed five factors describing beverage consumption patterns and seven factors explaining underlying biomarker networks. Preferential consumption of alcoholic beverages was associated with reduced risk of T2D (P < 0.0001) and lower concentrations of detrimental biomarkers of endothelial dysfunction (P = 0.014). Also, a preferential consumption of low-calorie sweetened beverages (LCSBs) was associated with increased risk of T2D (P < 0.0001), and lower concentrations of insulin-like growth factor binding protein 1 and 2, and soluble leptin receptor (P = 0.010). ConclusionsThese analyses provide new mechanistic insight into how different patterns of beverage consumption may relate to T2D risk, and indicate that preferential consumption of LCSB may exert diabetogenic effects through mechanisms involving the disruption of insulin-like growth factor and leptin signalling. Funding SourcesNational Institutes of Health.

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

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.

Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES).

Recent studies using data from the National Health and Nutrition Examination Survey (NHANES) have used inconsistent approaches to identify and categorize beverages, especially those containing low-calorie sweeteners (LCS), also referred to as low-calorie sweetened beverages (LCSBs). Herein, we investigate the approaches used to identify and categorize LCSBs in recent analyses of NHANES data. We reviewed published studies examining LCS consumption in relation to dietary and health outcomes and extracted the methods used to categorize LCS as reported by the authors of each study. We then examined the extent to which these approaches reliably identified LCSBs using the Internet Archive Wayback Machine to examine beverage ingredients lists across three NHANES cycles (2011–2016). None of the four general strategies used appeared to include all LCSBs while also excluding all beverages that did not contain LCS. In some cases, the type of sweetener in the beverage consumed could not be clearly determined; we found 9, 16, and 18 of such “mixed” beverage identifiers in the periods 2011–2012, 2013–2014, and 2015–2016, respectively. Then, to illustrate how heterogeneity in beverage categorization may impact the outcomes of published analyses, we compared results of a previously published analysis with outcomes when “mixed” beverages were grouped either all as LCSBs or all as sugary beverages. Our results suggest that caution is warranted in design and interpretation of studies using NHANES data to examine dietary and health correlates of sweetened beverage intake.

Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages and Risk of Cardiovascular Disease: A Meta-Analysis and Systematic Review

ABSTRACTThe long-term associations between the consumption of sugar-sweetened beverages (SSBs) and low-calorie sweetened beverages (LCSBs) with cardiovascular diseases (CVDs) remains inconsistent. To synthesize the evidence, we conducted a meta-analysis of prospective cohort studies published up to 1 December, 2019 on the associations between SSB and LCSB intake and the risk of CVD incidence and mortality. Out of 5301 articles retrieved from our literature search, 11 articles evaluating the consumption of SSBs (16,915 incident CVD cases, 18,042 CVD deaths) and 8 articles evaluating the consumption of LCSBs (18,077 incident CVD cases, 14,114 CVD deaths) were included in the meta-analysis. A 1 serving/d increment of SSBs was associated with an 8% (RR: 1.08; 95% CI: 1.02, 1.14, I2 = 43.0%) and 8% (RR: 1.08; 95% CI: 1.04, 1.13, I2 = 40.6%) higher risk of CVD incidence and CVD mortality, respectively. A 1 serving/d increment of LCSBs was associated with a 7% (RR: 1.07; 95% CI: 1.05, 1.10, I2 = 0.0%) higher risk of CVD incidence. The association between LCSBs and CVD mortality appeared to be nonlinear (P = 0.003 for nonlinearity) with significant associations observed at high intake levels (>2 servings/d). Under an assumption of causality, the consumption of SSBs may be linked to 9.3% (95% CI: 6.6%, 11.9%) of predicted CVD incidence in the USA from 2015 to 2025, among men and nonpregnant women, who were aged 40–79 y in 2015–2016. The habitual consumption of SSBs was associated with a higher risk of CVD morbidity and mortality in a dose-response manner. LCSBs were also associated with a higher risk of these outcomes, however, the interpretation of these findings may be complicated by reverse causation and residual confounding.

Low-calorie sweeteners in the human diet: scientific evidence, recommendations, challenges and future needs. A symposium report from the FENS 2019 conference.

Abstract

The effects of 7-day deprivation of low-calorie sweetened beverages (LCSB) on craving, energy intake and mood in frequent consumers

The effects of 7-day deprivation of low-calorie sweetened beverages (LCSB) on craving, energy intake and mood in frequent consumers

Relation of Change or Substitution of Low Calorie Sweetened Beverages with Cardiometabolic Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Abstract Objectives Low calorie sweetened beverages (LCSBs) are associated with increased cardiometabolic diseases using prevalent exposure of LCSBs. Although this association is at high risk of reverse causality, it has led to concerns that LCSBs may not have the intended benefits, with recommendations to replace sugar-sweetened beverage (SSBs) with water and not LCSBs. To address this issue of reverse causality as part of the update of the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of prospective cohort studies of the relation of LCSBs with cardiometabolic outcomes using change and substitution analyses. Methods MEDLINE, EMBASE, and the Cochrane Library were searched through June 2019. We included prospective cohort studies of ≥1 year assessing change in LCSBs or substitution of LCSBs for SSBs in relation to cardiometabolic outcomes. Independent reviewers extracted data and assessed risk of bias. Data were pooled using random effects models and expressed as mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CI). GRADE assessed the certainty of evidence. Results Nine studies (n = 218,880) inclusive of people at risk for or with diabetes were included. An Increase of 1 serving/day of LCSBs was associated with reduced body weight (MD, −0.07 kg [95% CI, −0.10 to −0.04]) and waist circumference (−1.35 cm [−2.60 to −0.05]) in change analyses. Substitution of LCSBs for SSBs was associated with a reduction in body weight (−0.47 kg [−0.55 to - 0.39]) and risk of diabetes (RR, 0.94 [0.90 to 0.98]), cardiovascular mortality (0.95 [0.90 to 0.99]) and total mortality (0.96 [0.94 to 0.98]), while substitution of LCSBs for water was not associated with any changes. The certainty of evidence was very low for all outcomes. Conclusions Substitution of LCSBs for SSBs is associated with reductions in major cardiometabolic outcomes with similar benefits to water as a replacement strategy for SSBs. The certainty of the available evidence is very low with a high likelihood that more studies will alter our estimates in people at risk for or with diabetes.(ClinicalTrials.gov identifier, NCT04245826) Funding Sources Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes, Canadian Institutes of Health Research, Diabetes Canada.

Beverage Consumption and Longitudinal Changes in Lipid Concentrations and Incident Dyslipidemia in U.S. Adults: The Framingham Heart Study (P18-017-19)

ObjectivesLimited data are available on the prospective relationship between beverage consumption and plasma lipid and lipoprotein concentrations in population-based studies. Two major sources of sugar in the US diet are sugar-sweetened beverages (SSB; sodas and fruit drinks) and 100% fruit juices (FJ). Low-calorie sweetened beverages (LCSB) are common replacements for SSB and FJ. MethodsFasting plasma triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) concentrations were measured at up to 5 exams in the Framingham Heart Study offspring and up to 2 exams in generation 3 cohorts (1998–2005; N = 6730). Consumption of SSB, FJ, and LCSB were estimated from food frequency questionnaires and intakes were categorized. Mixed-effect linear regression models were used to examine changes in lipid concentrations, and Cox proportional hazard models were used to estimate hazard ratios (HR) for incident dyslipidemia, adjusting for potential confounding factors. Results were statistically significant at a Bonferroni-corrected P-value < 0.017 (0.05/3 outcomes). ResultsIn multivariate-adjusted models, SSB intake was associated with smaller mean 4-year changes in HDL-C [high (>1 serving/day) vs. low intake category (<1 serving/month) (H vs. L): β ± SE: −1.0 ± 0.3 mg/dl, p trend < 0.0001] and greater mean 4-year changes in TG concentrations (H vs. L: β ± SE: 5.7 ± 2.1 mg/dl, p trend = 0.0003), along with a higher incidence of low HDL-C [H vs. L HR (95% CI): 1.64 (1.06–2.54), p for trend = 0.01] and high TG concentrations [H vs. L HR (95% CI): 1.46 (1.05–2.03); p trend = 0.009]. LCSB intake was associated with a higher incidence of low HDL-C [H vs. L HR (95% CI): 1.38 (1.02–1.86), p trend = 0.01] and high LDL-C concentrations [H vs. L HR (95% CI): 1.19 (1.00–1.41); p trend = 0.01]. No other significant associations between beverage consumption and lipid concentrations or incident dyslipidemia were observed. ConclusionsSSB intake was associated with changes in HDL-C and TG concentrations and higher risk of dyslipidemia, suggesting that SSB consumption should be limited. LCSB intake was not associated with changes in lipid concentrations, but higher intake was associated with risk of dyslipidemia. Thus, limiting LCSB intake is recommended based on these study findings. Funding SourcesNIH, AHA, and ARS, USDA.

Consumption of low-calorie sweetened beverages is associated with higher total energy and sugar intake among children, NHANES 2011-2016.

To examine associations between consumption of low-calorie sweetened beverages (LCSBs), sugar, and total energy intake in children in the United States. We used 24-hour dietary recalls from 7026 children enrolled in the National Health and Nutrition Examination Survey (NHANES) 2011 to 2016 to assess energy and macronutrient intake among LCSB (≥4 oz LCSB, <4 oz SB), SB (≥4 oz SB, <4 oz LCSB), and LCSB + SB consumers (≥4 oz each) compared with water consumers (≥4 oz water, <4 oz LCSB and SBs). Sample weights and complex survey procedures were used for all analyses. Adjusting for body mass index (BMI) percentile, LCSB, SB, and LCSB + SB consumption was associated with 196, 312, and 450 more total calories and 15, 39, and 46 more grams of added sugar, which amounts to 60, 156, 184 more calories from added sugar, compared with water consumers (P < .05 for all pairwise comparisons). No differences in energy intake were observed between LCSB and SB consumers. [Correction added on 28 May 2019, after first online publication: In the preceding sentence, quantities of added sugar reported are in grams. The corresponding calories have also been specified in this version.] CONCLUSIONS: These findings challenge the utility of LCSB for weight management in children and adolescents.

Trends in Low-Calorie Sweetener Consumption Among Pregnant Women in the United States

ABSTRACTBackgroundMinimizing consumption of added sugars is recommended to prevent excessive weight gain among pregnant women. A common approach to lowering sugar intake is the use of low-calorie sweeteners (LCSs), yet little is known about LCS use during pregnancy or its effects on infant weight and health.ObjectiveThe aim of the study was to investigate temporal trends in LCS consumption by source (foods, beverages, or packets) among pregnant women in the United States from 1999 to 2014 and to compare recent LCS consumption patterns across sociodemographic subgroups and product categories.MethodsData were collected from pregnant women aged 20–39 y (n = 1,265) who participated in the NHANES from 1999–2000 through 2013–2014. Prevalence of LCS consumption was assessed using two 24-h dietary recalls. Analytical procedures for complex survey design were used, and sampling weights were applied to estimate national prevalence of LCS use. Rao–Scott modified chi-square tests were used to compare consumption prevalence across sociodemographic subgroups, and logistic regression was used to examine trends in LCS use over time.ResultsThe prevalence of LCS consumption among pregnant women increased by approximately 50% rising from 16.2% in 1999–2004 to 24.0% in 2007–2014, P = 0.04, with the highest prevalence observed in 2005–2006 (38.4%). This trend was driven predominantly by increases in LCS beverage use (9.9% in 1999–2004 compared with 18.3% in 2007–2014, P = 0.02). Prevalence of LCS consumption was highest among non-Hispanic white women and increased with education and income. No differences were observed based on prepregnancy weight status or trimester of pregnancy.ConclusionsApproximately one-quarter of pregnant women in the United States reported consumption of LCS during at least 1 of 2 dietary recalls. Given the widespread LCS consumption during pregnancy, research to elucidate potential effects of early life LCS exposure on taste preferences, weight trajectory, and risk of later metabolic disease is needed.

Do low-calorie sweetened beverages help to control food cravings? Two experimental studies

Low-calorie sweetened (LCS) beverages may help consumers to satisfy hedonic food cravings without violating dieting goals, however this remains unexplored. The present research investigated the effect of priming hedonic eating motivations on ad libitum energy intake in frequent and non-consumers of LCS beverages. It was hypothesised that energy intake would be greater after the hedonic eating prime relative to a control prime in non-consumers, but that frequent LCS beverage consumers would be protected from this effect. In Study 1 (N = 120), frequent and non-consumers were exposed to either chocolate or neutral cues (craving vs. control condition) and then completed a beverage-related visual probe task with concurrent eye-tracking. Ad libitum energy intake from sweet and savoury snacks and beverages (including LCS) was then assessed. Study 2 followed a similar protocol, but included only frequent consumers (N = 172) and manipulated the availability of LCS beverages in the ad libitum eating context (available vs. unavailable). Measures of guilt and perceived behavioural control were also included. In Study 1, as hypothesised, non-consumers showed greater energy intake in the craving condition relative to the control condition, but frequent consumers had similar energy intake in both conditions. Frequent consumers (but not non-consumers) also demonstrated an attentional bias for LCS beverage stimuli compared to both sugar and water stimuli. In contrast, in Study 2 frequent consumers showed greater energy intake in the craving condition relative to the control condition; however, overall energy intake was significantly greater when LCS beverages were unavailable compared to when they were available. Ratings of guilt were higher and perceived control was lower in the LCS-unavailable condition relative to the LCS-available condition. Conclusions: LCS beverages did not consistently protect consumers from craving-induced increases in energy intake. However, frequent consumers consumed fewer calories overall when LCS beverages were available (relative to unavailable), as well as perceiving more control over their food intake and feeling less guilty.

Consumption of low-calorie sweetened beverages and water is associated with lower intake of carbohydrates and sugars and not associated with glycemic response in U.S. non-diabetic adolescents: Results from the 2001–2014 National Health and Nutrition Examination Surveys

ObjectivesConsumption of no- and low-calorie sweetened beverages (LCSBs) in the United States appears to be on the rise. To our knowledge, the relationships between LCSB consumption and dietary intake and metabolic outcomes in adolescents have not been thoroughly investigated. The aim of this study was to evaluate possible associations between LCSB and water consumption with nutrient intake and prediabetes criteria among adolescents who were free of diabetes. MethodsThis cross-sectional study evaluated possible associations between LCSB consumption and water consumption using a 24-h diet recall from the National Health and Nutrition Examination Survey (NHANES) 2001–2014 in 8868 adolescents 12 to 18 y of age who were free of diabetes. ResultsCompared with consuming <1 serving/d, consuming ≥1 serving/d of either LCSB or water was significantly associated with lower consumption of carbohydrates (LCSB: –22 g; water: –15 g), total sugars (LCSB: –29 g; water: –20 g), and added sugars (LCSB: –5.7 tsp eq; water: –6 tsp eq). Neither LCSB nor water intake were associated with any measures of glycemic response. ConclusionsThese findings suggest that consuming ≥1 serving/d of either LCSB or water is not associated with an increased risk for prediabetes. Confirmation of these findings with a larger sample within the context of a randomized clinical trial would further suggest that LCSBs may represent an additional beverage option other than water for adolescents to help moderate overall dietary sugar intake.

Low-Calorie Sweetened Beverages and Cardiometabolic Health: A Science Advisory From the American Heart Association.

In the United States, 32% of beverages consumed by adults and 19% of beverages consumed by children in 2007 to 2010 contained low-calorie sweeteners (LCSs). Among all foods and beverages containing LCSs, beverages represent the largest proportion of LCS consumption worldwide. The term LCS includes the 6 high-intensity sweeteners currently approved by the US Food and Drug Administration and 2 additional high-intensity sweeteners for which the US Food and Drug Administration has issued no objection letters. Because of a lack of data on specific LCSs, this advisory does not distinguish among these LCSs. Furthermore, the advisory does not address foods sweetened with LCSs. This advisory reviews evidence from observational studies and clinical trials assessing the cardiometabolic outcomes of LCS beverages. It summarizes the positions of government agencies and other health organizations on LCS beverages and identifies research needs on the effects of LCS beverages on energy balance and cardiometabolic health. The use of LCS beverages may be an effective strategy to help control energy intake and promote weight loss. Nonetheless, there is a dearth of evidence on the potential adverse effects of LCS beverages relative to potential benefits. On the basis of the available evidence, the writing group concluded that, at this time, it is prudent to advise against prolonged consumption of LCS beverages by children. (Although water is the optimal beverage choice, children with diabetes mellitus who consume a balanced diet and closely monitor their blood glucose may be able to prevent excessive glucose excursions by substituting LCS beverages for sugar-sweetened beverages [SSBs] when needed.) For adults who are habitually high consumers of SSBs, the writing group concluded that LCS beverages may be a useful replacement strategy to reduce intake of SSBs. This approach may be particularly helpful for persons who are habituated to a sweet-tasting beverage and for whom water, at least initially, is an undesirable option. Encouragingly, self-reported consumption of both SSBs and LCS beverages has been declining in the United States, suggesting that it is feasible to reduce SSB intake without necessarily substituting LCS beverages for SSBs. Thus, the use of other alternatives to SSBs, with a focus on water (plain, carbonated, and unsweetened flavored), should be encouraged.

Reprint of "Beverages containing low energy sweeteners do not differ from water in their effects on appetite, energy intake and food choices in healthy, non-obese French adults"

The usefulness of replacement of caloric sugars by low-calorie sweeteners (LCS) for weight management has been questioned on the grounds that the uncoupling of LCS sweet taste and dietary energy may confuse physiological mechanisms, leading potentially to higher energy and sugar intake. The aim of the present study was to determine whether LCS beverages compared to water, when consumed with meals, differ in their effects on energy and food intake in acute trials and after long-term habituation. Ad libitum food intake of 166 (80 women; 86 men) healthy non-obese adults (BMI between 19 and 28 kg/m2), infrequent consumers of LCS was measured in four 2-consecutive-day testing sessions (Day 1 in the laboratory, Day 2 free-living). During the first 3 sessions, held one-week apart, participants were required to drink either water or commercial non-carbonated LCS lemonade (330 ml) with their main meals (randomised cross-over design). On Day 1, motivational ratings were obtained using visual analogue scales and ad libitum food intakes (amounts and types of foods selected) were measured using the plate waste method. On Day 2, participants reported their ad libitum intakes using a food diary. After Session 3, participants were randomly assigned to the LCS habituation group or to the water control group. The habituation (660 ml LCS lemonade daily vs 660 ml water) lasted 5 weeks. The fourth and final test session measured food intakes and motivational ratings after habituation. Water and LCS beverage did not differ in their effects on total energy intake, macronutrient intakes or the selection of sweet foods and on motivational ratings. Similar results were obtained in both LCS-naïve and LCS-habituated individuals.

Beverages containing low energy sweeteners do not differ from water in their effects on appetite, energy intake and food choices in healthy, non-obese French adults

The usefulness of replacement of caloric sugars by low-calorie sweeteners (LCS) for weight management has been questioned on the grounds that the uncoupling of LCS sweet taste and dietary energy may confuse physiological mechanisms, leading potentially to higher energy and sugar intake. The aim of the present study was to determine whether LCS beverages compared to water, when consumed with meals, differ in their effects on energy and food intake in acute trials and after long-term habituation. Ad libitum food intake of 166 (80 women; 86 men) healthy non-obese adults (BMI between 19 and 28 kg/m2), infrequent consumers of LCS was measured in four 2-consecutive-day testing sessions (Day 1 in the laboratory, Day 2 free-living). During the first 3 sessions, held one-week apart, participants were required to drink either water or commercial non-carbonated LCS lemonade (330 ml) with their main meals (randomised cross-over design). On Day 1, motivational ratings were obtained using visual analogue scales and ad libitum food intakes (amounts and types of foods selected) were measured using the plate waste method. On Day 2, participants reported their ad libitum intakes using a food diary. After Session 3, participants were randomly assigned to the LCS habituation group or to the water control group. The habituation (660 ml LCS lemonade daily vs 660 ml water) lasted 5 weeks. The fourth and final test session measured food intakes and motivational ratings after habituation. Water and LCS beverage did not differ in their effects on total energy intake, macronutrient intakes or the selection of sweet foods and on motivational ratings. Similar results were obtained in both LCS-naïve and LCS-habituated individuals.

Metabolic and cognitive improvement from switching to saccharin or water following chronic consumption by female rats of 10% sucrose solution

High consumption of sugar-sweetened beverages (SSBs) is a risk factor for weight gain and metabolic disease. Whether this risk is reduced by switching to ‘diet’ beverages containing low-calorie sweeteners (LCS) is controversial. Two experiments modeled whether a switch from SSB to LCS beverages produced positive outcomes on behavioral and metabolic measures. Both experiments consisted of a Stage 1, in which adult female rats received unrestricted access to 10% sucrose solution in addition to chow and water for 4 (Experiment 1) or 8 weeks (Experiment 2). In Stage 2 rats were switched to either saccharin (Suc-Sacch) or water (Suc-Water) or remained on 10% sucrose (Suc-Suc) for a further 4 (Experiment 1) or 7 weeks (Experiment 2). Experiment 2 contained a fourth group that was maintained on water throughout (Water-Water). In both experiments energy intake and weight gain in Stage 2 was reduced for Suc-Sacch and Suc-Water groups relative to the Suc-Suc groups and at cull the Suc-Suc groups showed poorer insulin sensitivity and greater g/kg fat than Suc-Water and Suc-Sacch groups. In Experiment 2 short-term place recognition memory was impaired at the end of Stage 1 but recovered to a similar extent in the Suc-Water and Suc-Sacch groups; when the latter groups were compared with the Water-Water group, recovery was found to be essentially complete. A higher saccharin concentration in Experiment 2 than in Experiment 1 increased absolute amounts of saccharin ingested but intake solution volumes remained low. These results show that switching from sucrose to either water or saccharin produces equivalent improvements on both metabolic and cognitive measures.

Consumption of Low-Calorie Sweeteners among Children and Adults in the United States

BackgroundConsumption of low-calorie sweeteners (LCSs) has increased markedly during the past several decades, yet the prevalence of LCS consumption in recent years is currently unknown. ObjectiveThe aim of this study was to describe LCS consumption in the United States and to characterize consumption by sociodemographic subgroups, source, frequency, eating occasion, and location. DesignCross-sectional study using National Health and Nutrition Examination Survey data from 2009 to 2012. The prevalence of LCS consumption was assessed using two 24-hour dietary recalls, while the frequency (number of times per day), occasion (meal vs snack vs alone), and location of LCS consumption (at home vs away from home) was assessed using data from the one, in-person, 24-hour dietary recall. ParticipantsNational Health and Nutrition Examination Survey participants (2 years old or older) either in 2009-2010 (n=9,047) or in 2011-2012 (n=7,939). After excluding participants with implausible energy intake (n=44), the final sample size was 16,942. Main outcome measuresThe primary outcome was the proportion of individuals consuming one or more foods, beverages, or packets containing LCSs during at least one of their two dietary recalls. Statistical analyses performedData were weighted to provide national estimates and Stata frequency procedures for complex survey design were used for all analyses. ResultsOur findings were that 25.1% of children and 41.4% adults reported consuming LCSs. Most LCS consumers reported use once daily (80% of children, 56% of adults) and frequency of consumption increased with body weight in adults. LCS consumption was higher in females compared with males among adults, and in obese individuals, compared with overweight and normal-weight individuals. Individuals of non-Hispanic white race/ethnicity also had higher prevalence of consumption compared with non-Hispanic blacks and Hispanics and those in the highest tertile of income had higher LCS consumption compared with individuals of middle or low income across LCS product categories in adults, and for LCS beverages and LCS foods in children. Most LCS consumers reported consuming LCS with meals (64% of adults, 62% of children) and the majority of LCS consumption occurred at home (71% and 72% among adults and children, respectively). ConclusionsLCS consumption is highly prevalent in the United States, among both children and adults. Well-controlled, prospective trials are required to understand the health impact of this widespread LCS exposure.

The use of low-calorie sweeteners is associated with self-reported prior intent to lose weight in a representative sample of US adults.

Background:Low-calorie sweeteners (LCSs) are said to be a risk factor for obesity and diabetes. Reverse causality may be an alternative explanation.Methods:Data on LCS use, from a single 24-h dietary recall, for a representative sample of 22 231 adults were obtained from 5 cycles of the National Health and Nutrition Examination Survey (1999–2008 NHANES). Retrospective data on intent to lose or maintain weight during the prior 12-months and 10-year weight history were obtained from the weight history questionnaire. Objectively measured heights and weights were obtained from the examination. Primary analyses evaluated the association between intent to lose/maintain weight and use of LCSs and specific LCS product types using survey-weighted generalized linear models. We further evaluated whether body mass index (BMI) may mediate the association between weight loss intent and use of LCSs. The association between 10-year weight history and current LCS use was evaluated using restricted cubic splines.Results:In cross-sectional analyses, LCS use was associated with a higher prevalence of obesity and diabetes. Adults who tried to lose weight during the previous 12 months were more likely to consume LCS beverages (prevalence ratio=1.64, 95% confidence interval (CI) 1.54–1.75), tabletop LCS (prevalence ratio=1.68, 95% CI 1.47–1.91) and LCS foods (prevalence ratio=1.93, 95% CI 1.60–2.33) as compared with those who did not. In mediation analyses, BMI only partially mediated the association between weight control history and the use of LCS beverages, tabletop LCS, but not LCS foods. Current LCS use was further associated with a history of prior weight change (for example, weight loss and gain).Conclusions:LCS use was associated with self-reported intent to lose weight during the previous 12 months. This association was only partially mediated by differences in BMI. Any inference of causality between attempts at weight control and LCS use is tempered by the cross-sectional nature of these data and retrospective self-reports of prior weight loss/maintenance intent.

Socio-demographic correlates and trends in low-calorie sweetener use among adults in the United States from 1999 to 2008.

Replacing added sugars in beverages and foods with low-calorie sweeteners (LCSs) is one strategy to reduce calories and manage body weight. There are few studies on LCS consumption by product category and by consumer socio-demographic status. Data for a representative sample of 22 231 adults were obtained from five cycles of the National Health and Nutrition Examination Survey (1999-2008 NHANES). A single 24-h recall was used to identify consumers of LCS beverages, foods and tabletop sweeteners. Time-trend analyses were conducted for total LCS consumption and for LCS beverages. Approximately 30% of US adults consumed some type of LCS, with 19.5% consuming LCS beverages, 11.4% consuming tabletop LCS and 4.6% consuming LCS foods. LCS consumption by product category peaked at different ages, with older adults more likely to consume tabletop LCS and LCS foods. In age-adjusted analyses, LCS consumers in every product category were more likely to be women, 45-65 years old, non-Hispanic whites, US-born adults, college graduates and with higher household incomes. Predictors of LCS consumption were not altered upon adjustment for body mass index and diabetes status. LCS consumption from all sources and from LCS beverages increased between 1999 and 2008. LCS use was more common among populations with a lower burden of obesity and related chronic disease, specifically, non-Hispanic whites and those with more education/higher incomes. The reasons for this observed paradox are complex and merit additional research.