Use Of Low-calorie Sweeteners Research Articles

Assessing the relationship between low-calorie sweetener use and quality of life measures in adults with type 1 diabetes

BackgroundTo evaluate use of low-calorie sweeteners (LCS) among adults with type 1 diabetes (T1D) and its impact on quality of life (QOL).MethodsIn this single center, cross-sectional survey study with 532 adults with T1D, Food related QOL (FRQOL), LCS specific questionnaire (LCSSQ), Diabetes Self-Management Questionnaire (DSMQ), Food Frequency Questionnaire (FFQ), Audit of Diabetes-Dependent QOL (AddQOL), Type 1 Diabetes and Life (T1DAL) questionnaires were administered through RedCAP, a secure, HIPAA-compliant web-based application. Demographics and scores of adults who used LCS in last month (recent users) and others (non-users) were compared. Results were adjusted for age, sex, diabetes duration and other parameters.ResultsOf 532 participants (mean age 36 ± 13, 69% female), 99% heard LCS before, 68% used them in the last month, 73% reported better glucose control with LCS use and 63% reported no health concerns about LCS use. Recent LCS users were older and had a longer diabetes duration and more complications (hypertension, or any complication) than non-users. However, A1c, AddQOL, T1DAL, FRQOL scores did not differ significantly between recent LCS users and non-users. DSMQ scores, DSMQ management, diet, health care scores did not differ between two groups; however, recent LCS users had lower physical activity score than non-users (p = 0.001).ConclusionsMost of the adults with T1D have used LCS and perceived that LCS use improved their QOL and glycemic control; however, these were not verified with questionnaires. There was no difference in QOL questionnaires except DSMQ physical activity between recent LCS users and not users with T1D. However, more patients in need to increase their QOL may be using LCS; therefore, associations between the exposure and outcome can be bi-directional.

Ultraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms.

Epidemiologic evidence supports a positive association between ultraprocessed food (UPF) consumption and body mass index. This has led to recommendations to avoid UPFs despite very limited evidence establishing causality. Many mechanisms have been proposed, and this review critically aimed to evaluate selected possibilities for specificity, clarity, and consistency related to food choice (i.e., low cost, shelf-life, food packaging, hyperpalatability, and stimulation of hunger/suppression of fullness); food composition (i.e., macronutrients, food texture, added sugar, fat and salt, energy density, low-calorie sweeteners, and additives); and digestive processes (i.e., oral processing/eating rate, gastric emptying time, gastrointestinal transit time, and microbiome). For some purported mechanisms (e.g., fiber content, texture, gastric emptying, and intestinal transit time), data directly contrasting the effects of UPF and non-UPF intake on the indices of appetite, food intake, and adiposity are available and do not support a unique contribution of UPFs. In other instances, data are not available (e.g., microbiome and food additives) or are insufficient (e.g., packaging, food cost, shelf-life, macronutrient intake, and appetite stimulation) to judge the benefits versus the risks of UPF avoidance. There are yet other evoked mechanisms in which the preponderance of evidence indicates ingredients in UPFs actually moderate body weight (e.g., low-calorie sweetener use for weight management; beverage consumption as it dilutes energy density; and higher fat content because it reduces glycemic responses). Because avoidance of UPFs holds potential adverse effects (e.g., reduced diet quality, increased risk of food poisoning, and food wastage), it is imprudent to make recommendations regarding their role in diets before causality and plausible mechanisms have been verified.

Long-term consumption of the sugar substitute sorbitol alters gut microbiome and induces glucose intolerance in mice

AimsEpidemic obesity and diabetes have led to increased use of low-calorie sweeteners. Although several studies have suggested that consumption of artificial sweeteners, such as aspartame and saccharin, might have negative effects, the potential impacts of natural sweeteners on human health remain largely unknown. Main methodsThe deferential effects of short term and long term consumption of sorbitol on glucose homeostasis in mice by oral gavage. The glucose homeostasis and utility were evaluated by both oral or intraperitoneal glucose tolerance tests. Insulin levels were determined using enzyme-linked immunosorbent assay. Changes of gut microbiome were evaluated by 16S rRNA gene sequencing, and analyzed by principal components analysis. Key findingsBolus feeding of sorbitol by gavage significantly increased plasma insulin concentrations and decreased fasting blood glucose levels. Intriguingly, long-term sorbitol gavage for four weeks showed no significant effects on intraperitoneal glucose tolerance test outcomes, but it induced glucose intolerance according to the oral glucose tolerance test. Thus, we tested whether long-term sorbitol gavage might alter the relative abundances of gut microbiome constituents in mice. Principal components analysis indicated that long-term sorbitol intake indeed caused significant changes to the gut microbiome. In particular, we found that long-term sorbitol intake significantly decreased the relative abundances of Bifidobacterium, Lachnospiraceae UCG 001, Lachnospiraceae NK4A136, Eubacterium ventriosum, Candidatus Arthromitus, and Ruminococcus torques. We also found that long-term sorbitol increased the relative abundances of Helicobacter, Tyzzerella, Alistipes, and Prevotella 9. SignificanceLong-term sorbitol consumption may change the composition of the gut microbiome and potentially induce glucose intolerance.

The Use of Non-Nutritive and Low-Calorie Sweeteners in 19,915 Local and Imported Pre-Packaged Foods in Hong Kong.

This study aims to examine the use of non-nutritive (NNSs) and low-calorie sweeteners (LCSs) in pre-packaged foods in Hong Kong and the differences in the number of NNSs/LCSs used between products from different regions. In a cross-sectional audit, the types of NNSs/LCSs used in 19,915 pre-packaged foods in Hong Kong were examined by searching the ingredients list of the included products for keywords related to 20 common NNSs/LCSs and their respective E-numbers. Prevalence of use of NNSs and LCSs, the co-presence of NNSs/LCSs and free sugar ingredients (FSI), and the number of NNSs/LCSs used in the included foods were computed. Pearson’s χ2 test was used to compare the total number of NNSs and/or LCSs used in food items from different regions. Sucralose (E955) was the most commonly used NNS (1.9%), followed by acesulfame K (E950, 1.6%). Sorbitol was the most commonly used LCS (2.9%). Overall, the use of LCSs was less common compared with NNSs (3.7% vs. 4.5%). The use of different types of NNSs varied substantially between food types. Notably, 20.2% of potato crisps and 15.2% of other crisps or extruded snacks contained at least one NNS and/or LCS. Co-presence of FSIs and NNSs/LCSs were most common in confectionery (15.7%) and snack foods (15.5%). Asian prepackaged foods were more likely to contain NNSs/LCSs (10.1%) compared with those from other regions. To conclude, NNSs/LCSs were used in a wide range of non-diet pre-packaged products which could be a public health concern due to their higher consumption frequencies than “diet” products.

Assessment of the use of low-calorie sweeteners amongst Indian population and their awareness about their adverse effects

Assessment of the use of low-calorie sweeteners amongst Indian population and their awareness about their adverse effects - IJNMHS- Print ISSN No: - 2582-6301 Online ISSN No:- 2582-628X Article DOI No:- 10.18231/j.ijnmhs.2021.003, IP Journal of Nutrition, Metabolism and Health Science-J Nutr Metab Health Sci

Perceived Healthiness of Sweeteners among Young Adults in Canada.

Purpose: To compare the perceived healthiness of different sweeteners relative to table sugar and examine efforts to consume less sugars and sweeteners.Methods: As part of the 2017 Canada Food Study online survey, 1000 youth and young adults were randomized to rate the healthiness of 1 of 6 sweeteners (aspartame, sucralose, stevia, agave, high-fructose corn syrup, "raw" sugar) or 1 sweetener brand name (Splenda) compared with "table sugar".Results: Perceptions of sweeteners varied widely. For example, the majority of respondents perceived high-fructose corn syrup (63.9%) and aspartame (52.4%) as less healthy than table sugar, whereas almost half (47.8%) perceived raw sugar as being healthier than table sugar. No assessed socio-demographic variables were significantly associated with perceived healthiness of sweeteners compared with table sugar (P ≥ 0.05). More consumers had attempted to consume less sugar (65.4%) compared with less "artificial" (31.2%) or "natural" (24.0%) low-calorie sweeteners.Conclusions: Perceptions of sweetener healthiness may be related to sweeteners' perceived level of "naturalness" rather than energy content. This has important implications for understanding consumer preferences, particularly given greater use of low-calorie sweeteners in the food supply and policy developments such as sugar taxes and enhanced sugar labelling.

Low-calorie sweeteners and human health: a rapid review of systematic reviews.

Low-calorie sweeteners are increasingly prevalent in the food supply and their consumption has increased in recent decades. Although low-calorie sweeteners approved for use are considered safe from a toxicological perspective, their short- and long-term impacts on chronic disease risk remain uncertain. The aim of this review was to summarize the evidence from systematic reviews on low-calorie sweetener use and chronic conditions and risk factors in children and adults. MEDLINE and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews of randomized and nonrandomized studies that considered low-calorie sweeteners in relation to type 2 diabetes, cardiovascular disease, cancer, anthropometric measures, hypertension, hyperglycemia, hyperlipidemia, insulin resistance, and dental caries. Data were extracted from 9 reviews deemed of moderate or high quality on the basis of AMSTAR-2. Narrative synthesis suggested inconsistent evidence on low-calorie sweetener use in relation to chronic conditions and associated risk factors, with nonrandomized studies suggesting positive associations and randomized studies suggesting negative or no associations. Continued research on the long-term health impacts of low-calorie sweeteners across all life stages is warranted.

The controversial effects of low-calorie sweeteners

Substantial reviews of the most recent evidence report a strong relationship between the consumption of sugar-sweetened beverages and adverse health effects, such as the prevalence of obesity and metabolic diseases. Various public policies were recently undertaken by many countries in the hope of reducing sugar-sweetened beverage consumption amongst their population. This has led the food industries to promote low-calorie sweeteners (sugar substitutes) as a healthy alternative that would limit caloric intake without compromising the sweet taste of food and beverages. However, is the use of low-calorie sweeteners as a means of limiting or reducing energy intake without consequences for our health? This review aims to discuss the effects of low-calorie sweeteners consumption on health and to elucidate whether their use should be recommended by health professionals to their patients as part of weight management.

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.

NMR relaxometry study of gelatin based low-calorie soft candies

ABSTRACTSoft candies are popular confectionery products. The most significant concern on the consumption of these products is the high amount of sugar and thus the high calories. The use of low-calorie sweeteners is a desirable trend in confectionery research. In this study, gelatin-based soft candies were formulated by using different sweeteners and their characterisation was performed using high and low field nuclear magnetic resonance (NMR) relaxation experiments. To complement the information obtained by NMR experiments, moisture content, water activity, texture analysis and differential scanning calorimeter experiments were also conducted. T1 and T2 relaxation times were measured at both low and high fields and also temperature-dependent measurements were conducted at the high field system. Candies were formulated by substitution of sucrose with maltitol, isomalt and stevia at 30%, 50% and 70% ratios. Significant difference was observed on relaxation times. T1 values were best described by a mono-exponential model, whereas for T2 relaxation times a bi-exponential model gave better results at both fields.

Trans-α-glucosylation of stevioside by the mutant glucansucrase enzyme Gtf180-ΔN-Q1140E improves its taste profile

The adverse health effects of sucrose overconsumption, typical for diets in developed countries, necessitate use of low-calorie sweeteners. Following approval by the European Commission (2011), steviol glycosides are increasingly used as high-intensity sweeteners in food. Stevioside is the most prevalent steviol glycoside in Stevia rebaudiana plant leaves, but it has found limited applications in food products due to its lingering bitterness. Enzymatic glucosylation is a strategy to reduce stevioside bitterness, but reported glucosylation reactions suffer from low productivities. Here we present the optimized and efficient α-glucosylation of stevioside using the mutant glucansucrase Gtf180-ΔN-Q1140E and sucrose as donor substrate. Structures of novel products were elucidated by NMR spectroscopy, mass spectrometry and methylation analysis; stevioside was mainly glucosylated at the steviol C-19 glucosyl moiety. Sensory analysis of the α-glucosylated stevioside products by a trained panel revealed a significant reduction in bitterness compared to stevioside, resulting in significant improvement of edulcorant/organoleptic properties.

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.

Aspartame, low-calorie sweeteners and disease: Regulatory safety and epidemiological issues

Aspartame is a synthetic sweetener that has been used safely in food for more than 30 years. Its safety has been evaluated by various regulatory agencies in accordance with procedures internationally recognized, and decisions have been revised and updated regularly. The present review summarizes the most relevant conclusions of epidemiological studies concerning the use of low-calorie sweeteners (mainly aspartame), published between January 1990 and November 2012. In the Nurses' Health study and the Health Professionals Followup study some excess risk of Hodgkin lymphoma and multiple myeloma was found in men but not in women; no association was found with leukemia. In the NIH-AARP Diet and Health Study, there was no association between aspartame and haematopoietic neoplasms. US case-control studies of brain and haematopoietic neoplasms also showed no association. The NIH-AARP Diet and Health Study and case-control studies from California showed no association with pancreatic cancer, and a case-control study from Denmark found no relation with breast cancer risk. Italian case-control studies conducted in 1991-2008 reported no consistent association for cancers of the upper aerodigestive tract, digestive tract, breast, endometrium, ovary, prostate, and kidney. Low calorie sweeteners were not consistently related to vascular events and preterm deliveries.

The Use of Low-Calorie Sweeteners by Adults: Impact on Weight Management

The application of low-calorie sweeteners (LCS) in foods and beverages has increased over the past 35 y. At the same time, many characteristics of the American diet have changed, including variations in fat and carbohydrate content and composition, increased nutrient additions, and new dietary patterns due to changing lifestyles and attitudes toward food and the changing cost of food. During this same time period, the prevalence of overweight and obesity has increased from ~30 to 70% of adults in the United States. Clearly, these trends lead to a variety of hypotheses and efforts to explain the role of LCS in this association. The aim of this review is to gain clarity on the role of LCS in weight management and their impact on diet quality. In addition, because the majority of studies aimed at identifying associations between LCS and these outcomes are based on observational data, the pitfalls in designing and evaluating data from observational studies are also discussed. We conclude that there is no evidence that LCS can be claimed to be a cause of higher body weights in adults. Similarly, evidence supporting a role for LCS in weight management is lacking. Due to the confounders in most observational studies, randomized controlled trials are needed to advance understanding.

The Use of Low-Calorie Sweeteners by Children: Implications for Weight Management1–3

The rise in pediatric obesity since the 1970s has been well established in the United States and is becoming a major concern worldwide. As a potential means to help slow the obesity epidemic, low-calorie sweeteners (LCS) have gained attention as dietary tools to assist in adherence to weight loss plans or prevention of excess weight gain. Observational studies tend to show positive correlations between LCS consumption and weight gain in children and adolescents. Although the data are intriguing, these epidemiologic studies do not establish that LCS cause weight gain, because there are likely many lifestyle and genetic differences between children and families who choose to consume LCS and those who do not. Short-term randomized controlled trials have shown LCS use to be BMI neutral or to have modest weight-reducing effects in overweight and obese adolescents. The long-term effects of LCS in children and adolescents are unknown. Some compelling research is currently underway and may provide needed insight into the potential role of LCS in weight management. The paucity of data regarding the effects of LCS use in children and adolescents creates challenges in decision-making for health care providers and parents.

Genotoxicity Testing of Low-Calorie Sweeteners: Aspartame, Acesulfame-K, and Saccharin

Low-calorie sweeteners are chemicals that offer the sweetness of sugar without the calories. Consumers are increasingly concerned about the quality and safety of many products present in the diet, in particular, the use of low-calorie sweeteners, flavorings, colorings, preservatives, and dietary supplements. In the present study, we evaluated the mutagenicity of the three low-calorie sweeteners in the Ames/Salmonella/microsome test and their genotoxic potential by comet assay in the bone marrow cells of mice. Swiss albino mice, Mus musculus, were orally administered with different concentrations of aspartame (ASP; 7, 14, 28, and 35 mg/kg body weight), acesulfame-K (ASK; 150, 300, and 600 mg/kg body weight), and saccharin (50, 100, and 200 mg/kg body weight) individually. Concurrently negative and positive control sets were maintained. The animals were sacrificed and the bone marrow cells were processed for comet assay. The standard plate-incorporation assay was carried with the three sweeteners in Salmonella typhimurium TA 97a and TA 100 strains both in the absence and presence of the S9 mix. The comet parameters of DNA were increased in the bone marrow cells due to the sweetener-induced DNA strand breaks, as revealed by increased comet-tail extent and percent DNA in the tail. ASK and saccharin were found to induce greater DNA damage than ASP. However, none could act as a potential mutagen in the Ames/Salmonella /microsome test. These findings are important, since they represent a potential health risk associated with the exposure to these agents.