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Okoro FO, Markus V. Artificial sweeteners and Type 2 Diabetes Mellitus: A review of current developments and future research directions. J Diabetes Complications 2025; 39:108954. [PMID: 39854925 DOI: 10.1016/j.jdiacomp.2025.108954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 11/12/2024] [Accepted: 01/20/2025] [Indexed: 01/27/2025]
Abstract
While artificial sweeteners are Generally Regarded as Safe (GRAS), the scientific community remains divided on their safety status. The previous assumption that artificial sweeteners are inert within the body is no longer valid. Artificial sweeteners, known for their high intense sweetness and low or zero calories, are extensively used today in food and beverage products as sugar substitutes and are sometimes recommended for weight management and Type 2 Diabetes Mellitus (T2DM) patients. The general omission of information about the concentration of artificial sweeteners on market product labels makes it challenging to determine the amounts of artificial sweeteners consumed by people. Despite regulatory authorization for their usage, such as from the United States Food and Drug Administration (FDA), concerns remain about their potential association with metabolic diseases, such as T2DM, which the artificial sweeteners were supposed to reduce. This review discusses the relationship between artificial sweetener consumption and the risk of developing T2DM. With the increasing number of recent scientific studies adding to the debate on this subject matter, we assessed recent literature and up-to-date evidence. Importantly, we highlight future research directions toward furthering knowledge in this field of study.
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Affiliation(s)
- Francisca Obianuju Okoro
- Department of Medical Biochemistry, Faculty of Medicine, Near East University, Nicosia, 99138 TRNC, Mersin 10, Turkey
| | - Victor Markus
- Department of Medical Biochemistry, Faculty of Medicine, Near East University, Nicosia, 99138 TRNC, Mersin 10, Turkey.
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Mendis S, Graham I. Prevention and control of cardiovascular disease in "real-world" settings: sustainable implementation of effective policies. Front Cardiovasc Med 2024; 11:1380809. [PMID: 39628553 PMCID: PMC11611850 DOI: 10.3389/fcvm.2024.1380809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 10/31/2024] [Indexed: 12/06/2024] Open
Abstract
Global progress in addressing cardiovascular diseases (CVD) has been insufficient to attain the nine WHO non-communicable disease (NCD) targets and the Sustainable Development Goal (SDG) target of reducing premature NCD mortality by one-third by 2030. Progress has been slowest in low- and middle-income countries (LMIC) where addressing the CVD burden is a foremost development imperative. This review examines the reasons for this situation to propose a way forward. First, we review policy instruments to address behavioral and metabolic risk factors of CVD and health system interventions to improve cardiovascular outcomes. Second, we illustrate the financial, health workforce, health system challenges, and weak national capacity that impede the implementation of these policy instruments. Third, we discuss how LMIC might move forward despite these challenges by (a) giving due consideration to contextual and other factors that determine the success of policy implementation (b) including affordable, high-impact interventions as the core of the universal health coverage health benefit package with primary health care as the foundation and (c) by taking note of the WHO guidance provided in the 2023-2030 implementation roadmap for the Global Action Plan for prevention and control of NCD.
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Affiliation(s)
- Shanthi Mendis
- Global Health, The Geneva Learning Foundation, Geneva, Switzerland
| | - Ian Graham
- Cardiovascular Medicine, Trinity College, Dublin, Ireland
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Herzog H, Zhang L, Fontana L, Neely GG. Impact of non-sugar sweeteners on metabolism beyond sweet taste perception. Trends Endocrinol Metab 2024:S1043-2760(24)00276-5. [PMID: 39551640 DOI: 10.1016/j.tem.2024.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 10/21/2024] [Accepted: 10/22/2024] [Indexed: 11/19/2024]
Abstract
Non-sugar sweeteners (NSS), low- or no-calorie alternatives to sugar, are marketed for weight loss and improved blood glucose control in people with diabetes. However, their health effects remain controversial. This review provides a brief overview of sweet taste perception and summarizes experimental findings of the impact of NSS on cardiometabolic health in animal models and humans. We also review evidence suggesting that many NSS are not metabolically inert, highlighting the challenges in related human studies. Given the conflicting and unclear data on health outcomes, additional mechanistic studies, particularly in animal models, are necessary to clarify how NSS influence feeding behaviors and energy homoeostasis.
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Affiliation(s)
- Herbert Herzog
- St Vincent's Centre for Applied Medical Research, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.
| | - Lei Zhang
- St Vincent's Centre for Applied Medical Research, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
| | - Luigi Fontana
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - G Gregory Neely
- Dr John and Anne Chong Lab for Functional Genomics, Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Camperdown, New South Wales, Australia
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Shahinfar H, Payandeh N, Zeraattalab-Motlagh S, Torabynasab K, Jayedi A, Ejtahed H, Hasani-Ranjbar S, Shab-Bidar S. Comparative effects of different beverages on weight loss in adults: a systematic review and network meta-analysis of randomized trials. Int J Obes (Lond) 2024:10.1038/s41366-024-01673-6. [PMID: 39543378 DOI: 10.1038/s41366-024-01673-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 10/30/2024] [Accepted: 10/31/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND There is a lack of clarity on the comparative effects of different beverages on weight loss in adults. OBJECTIVE This study aimed at quantifying and ranking the effects of different beverages on weight loss. METHODS We searched PubMed, Scopus, and Web of Science up to January 2023. We included randomized trials evaluating the comparative effects of two or more beverages, or compared a beverage against a control group (water, no intervention), for weight loss in adults. We conducted a random-effects network meta-analysis (NMA) with a Bayesian framework to estimate mean difference [MD] and 95% credible interval [CrI]. RESULTS In total, 78 randomized trials with 4168 participants were eligible. Low/no-calorie sweetened beverages (LNCSB) was effective for weight loss compared with water (MD: -0.79 kg, 95% CrI: -1.35, -0.18), milk (MD: -0.80 kg, 95% CrI: -1.59, -0.01), fruit juice (MD: -0.83 kg, 95% CrI: -1.47, -0.13), sugar-sweetened beverages (SSB) (MD: -1.08 kg, 95% CrI: -1.65, -0.50), and no intervention (MD: -1.19 kg, 95% CrI: -1.93, -0.41). However, in sensitivity analyses, no significant effect was seen in trials with a low risk of bias and those that implemented calorie restriction. LNCSB drinking was effective for waist circumference reduction compared with water (MD: -1.85 cm, 95% CrI: -3.47, -0.22). The certainty of evidence from most comparisons was rated low. CONCLUSIONS This study suggested evidence of low certainty that intake of LNCSBs can result in a small weight loss when used as a substitute for other beverages. Considering the low certainty of evidence, more research is needed to compare the effects of different beverages on body weight. TRIAL REGISTRATION Not applicable, but the protocol of this systematic review was registered at PROSPERO (registration number: CRD42023407937).
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Affiliation(s)
- Hossein Shahinfar
- Department of Nutrition, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
- Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nastaran Payandeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Kimia Torabynasab
- Student Research Committee, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Jayedi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Haniehsadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Hasani-Ranjbar
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Alperet DJ, Wang X, Zhu L, Dhana K, Chavarro JE, Haines J, Hu FB, Willett WC, Sun Q. Influence of consuming coffee and other beverages in adolescence on risk of type 2 diabetes in adulthood. Eur J Epidemiol 2024; 39:1183-1197. [PMID: 39503925 DOI: 10.1007/s10654-024-01165-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 10/15/2024] [Indexed: 11/27/2024]
Abstract
BACKGROUND Dietary strategies for type 2 diabetes (T2DM) prevention have mainly focused on solid foods and nutrients. Emanating evidence suggests that beverage consumption in adulthood may also influence T2DM development, whereas the role of beverages during adolescence remains unknow. OBJECTIVE To examine adolescent beverages consumption, and their changes from adolescence to adulthood in relation to T2DM risk in adulthood. METHODS This prospective cohort study, conducted within the Nurses' Health Study II (NHS II), enrolled 41,317 women who completed a food-frequency questionnaire (FFQ) regarding their diet in high school and had no diabetes, cardiovascular disease, or cancer at baseline (1997). Beverage consumption including coffee, tea, regular or diet soda, fruit juice or milk, was assessed using the FFQ. Cox proportional hazards models were utilized to estimate hazard ratios (HRs) for the association between beverage consumption in adolescence and risk of incident type 2 diabetes (T2DM) in adulthood, adjusting for potential confounders. RESULTS During 725,650 person-years of follow-up, 2,844 participants developed T2DM. After adjustment for demographic, lifestyle and dietary risk factors, comparing ≥ 1 serving/day with non-consumers, adolescent coffee [HR, 0.86 (95% confidence interval: 0.75 to 0.98); P-trend = 0.02)] and orange juice [HR, 0.83 (0.71 to 0.96); P-trend = 0.0008)] consumption was associated with lower T2DM risk, whereas, regular soda [HR, 1.37 (1.20 to 1.57); P-trend < 0.0001)] and iced tea [HR, 1.41 (1.21 to 1.65); P-trend < 0.0001)] intake was associated with higher T2DM risk. Increased coffee intake from adolescence to adulthood in 1991 was associated with a lower T2DM risk [HR, 0.70 (0.61 to 0.80); P-trend < 0.0001), comparing ≥ + 3 servings/day with no change], whereas the opposite was observed for increased regular soda [HR, 1.20 (1.06 to 1.35); P-trend = 0.004), comparing ≥ + 1 or more servings/week with no change)] and diet soda consumption [HR, 1.59 (1.41 to 1.80); P-trend = 0.0002), comparing ≥ + 2 servings/day with no change]. CONCLUSION Adolescent consumption of coffee or orange juice intake was associated with a lower risk of T2DM, whereas the opposite was observed for intake of regular soda or iced tea. In addition, increased coffee intake was associated with a lower diabetes risk, whereas the opposite was observed for regular or diet soda intake. These data highlight a potentially important role of beverage intake at early life in the etiology of diabetes during adulthood.
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Affiliation(s)
- Derrick Johnston Alperet
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 2, Room 349, 02115, Boston, MA, U.S.A
- STAR Graduate Academy, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Xiaowen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 2, Room 349, 02115, Boston, MA, U.S.A
| | - Lu Zhu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 2, Room 349, 02115, Boston, MA, U.S.A
| | - Klodian Dhana
- Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, Rush Medical College, Rush University, Chicago, IL, U.S.A
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 2, Room 349, 02115, Boston, MA, U.S.A
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, U.S.A
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, U.S.A
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A
| | - Jess Haines
- Department of Family Relations & Applied Nutrition, College of Social & Applied Human Sciences, University of Guelph, Guelph, ON, Canada
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 2, Room 349, 02115, Boston, MA, U.S.A
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, U.S.A
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 2, Room 349, 02115, Boston, MA, U.S.A
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, U.S.A
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 2, Room 349, 02115, Boston, MA, U.S.A..
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, U.S.A..
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A..
- Joslin Diabetes Center, Boston, MA, U.S.A..
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Yin X, Shi Y, Sheng T, Ji C. Early-Life Gut Microbiota: A Possible Link Between Maternal Exposure to Non-Nutritive Sweeteners and Metabolic Syndrome in Offspring. Nutr Rev 2024:nuae140. [PMID: 39348276 DOI: 10.1093/nutrit/nuae140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024] Open
Abstract
Metabolic syndrome (MetS) is recognized as a group of metabolic abnormalities, characterized by clustered interconnected traits that elevate the risks of obesity, cardiovascular and atherosclerotic diseases, hyperlipidemia, and type 2 diabetes mellitus. Non-nutritive sweeteners (NNS) are commonly consumed by those with imbalanced calorie intake, especially in the perinatal period. In the past, accumulating evidence showed the transgenerational and mediated roles of human microbiota in the development of early-life MetS. Maternal exposure to NNS has been recognized as a risk factor for filial metabolic disturbance through various mechanisms, among which gut microbiota and derived metabolites function as nodes linking NNS and MetS in early life. Despite the widespread consumption of NNS, there remain growing concerns about their transgenerational impact on metabolic health. There is growing evidence of NNS being implicated in the development of metabolic abnormalities. Intricate complexities exist and a comprehensive understanding of how the gut microbiota interacts with mechanisms related to maternal NNS intake and disrupts metabolic homeostasis of offspring is critical to realize its full potential in preventing early-life MetS. This review aims to elucidate the effects of early-life gut microbiota and links to maternal NNS exposure and imbalanced offspring metabolic homeostasis and discusses potential perspectives and challenges, which may provide enlightenment and understanding into optimal perinatal nutritional management.
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Affiliation(s)
- Xiaoxiao Yin
- Nanjing Medical Research Center for Women and Children, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu 210004, China
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Yujie Shi
- Nanjing Medical Research Center for Women and Children, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu 210004, China
| | - Tongtong Sheng
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Chenbo Ji
- Nanjing Medical Research Center for Women and Children, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu 210004, China
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu 211166, China
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Alejandro-Vega S, Hardisson A, Rubio C, Gutiérrez ÁJ, Jaudenes-Marrero JR, Paz-Montelongo S. Soft Drinks as a Dietary Source of Fluoride Exposure. Biol Trace Elem Res 2024; 202:3816-3828. [PMID: 37922070 PMCID: PMC11534846 DOI: 10.1007/s12011-023-03937-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/24/2023] [Indexed: 11/05/2023]
Abstract
High fluoride exposures can lead to adverse effects such as dental and bone fluorosis, as well as endocrine and cognitive developmental problems. Water is the main dietary source of this ion, although significant concentrations have also been detected in other beverages widely consumed by the population such as soft drinks. A total of 200 soft drink samples (60 flavoured, 70 extracts, 60 fruit juice and 10 soft drinks) were analysed by fluoride ion selective potentiometry. A consumption of 330 mL was estimated for exposure assessment and subsequent F-risk assessment by soft drink consumption. The highest average concentration was found in extract soft drinks (2.45 ± 1.15 mg/L), followed by flavoured (1.71 ± 2.29 mg/L) and carbonated soft drinks (1.38 ± 0.40 mg/L), while the lowest was found in fruit juice soft drinks (1.09 ± 0.62 mg/L). The flavours with the highest concentration were tea-melon and tea-passion fruit with 3.66 ± 0.40 and 3.17 ± 0.56 mg/L respectively and the lowest was lemon flavour with 0.69 mg/L. The contribution of these beverages, considering the UL (Upper level) reference values set by EFSA (European Food Safety Authority) are between 3.28-41.78%, depending on age group and sex.
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Affiliation(s)
- Samuel Alejandro-Vega
- Area of Toxicology, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain
- Grupo interuniversitario de Toxicología Ambiental y Seguridad de los Alimentos y Medicamentos, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain
| | - Arturo Hardisson
- Area of Toxicology, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain
- Grupo interuniversitario de Toxicología Ambiental y Seguridad de los Alimentos y Medicamentos, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain
| | - Carmen Rubio
- Area of Toxicology, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain
- Grupo interuniversitario de Toxicología Ambiental y Seguridad de los Alimentos y Medicamentos, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain
| | - Ángel J Gutiérrez
- Area of Toxicology, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain
- Grupo interuniversitario de Toxicología Ambiental y Seguridad de los Alimentos y Medicamentos, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain
| | - Juan R Jaudenes-Marrero
- Area of Toxicology, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain
- Grupo interuniversitario de Toxicología Ambiental y Seguridad de los Alimentos y Medicamentos, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain
| | - Soraya Paz-Montelongo
- Area of Toxicology, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain.
- Grupo interuniversitario de Toxicología Ambiental y Seguridad de los Alimentos y Medicamentos, Universidad de La Laguna, Canary Islands, 38071, La Laguna, Tenerife, Spain.
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McDonough C, Li YC, Vangeepuram N, Liu B, Pandey G. A Comprehensive Youth Diabetes Epidemiological Data Set and Web Portal: Resource Development and Case Studies. JMIR Public Health Surveill 2024; 10:e53330. [PMID: 38666756 PMCID: PMC11252623 DOI: 10.2196/53330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/06/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes mellitus (DM) and pre-diabetes mellitus (pre-DM) has been increasing among youth in recent decades in the United States, prompting an urgent need for understanding and identifying their associated risk factors. Such efforts, however, have been hindered by the lack of easily accessible youth pre-DM/DM data. OBJECTIVE We aimed to first build a high-quality, comprehensive epidemiological data set focused on youth pre-DM/DM. Subsequently, we aimed to make these data accessible by creating a user-friendly web portal to share them and the corresponding codes. Through this, we hope to address this significant gap and facilitate youth pre-DM/DM research. METHODS Building on data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, we cleaned and harmonized hundreds of variables relevant to pre-DM/DM (fasting plasma glucose level ≥100 mg/dL or glycated hemoglobin ≥5.7%) for youth aged 12-19 years (N=15,149). We identified individual factors associated with pre-DM/DM risk using bivariate statistical analyses and predicted pre-DM/DM status using our Ensemble Integration (EI) framework for multidomain machine learning. We then developed a user-friendly web portal named Prediabetes/diabetes in youth Online Dashboard (POND) to share the data and codes. RESULTS We extracted 95 variables potentially relevant to pre-DM/DM risk organized into 4 domains (sociodemographic, health status, diet, and other lifestyle behaviors). The bivariate analyses identified 27 significant correlates of pre-DM/DM (P<.001, Bonferroni adjusted), including race or ethnicity, health insurance, BMI, added sugar intake, and screen time. Among these factors, 16 factors were also identified based on the EI methodology (Fisher P of overlap=7.06×10-6). In addition to those, the EI approach identified 11 additional predictive variables, including some known (eg, meat and fruit intake and family income) and less recognized factors (eg, number of rooms in homes). The factors identified in both analyses spanned across all 4 of the domains mentioned. These data and results, as well as other exploratory tools, can be accessed on POND. CONCLUSIONS Using NHANES data, we built one of the largest public epidemiological data sets for studying youth pre-DM/DM and identified potential risk factors using complementary analytical approaches. Our results align with the multifactorial nature of pre-DM/DM with correlates across several domains. Also, our data-sharing platform, POND, facilitates a wide range of applications to inform future youth pre-DM/DM studies.
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Affiliation(s)
- Catherine McDonough
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yan Chak Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nita Vangeepuram
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Aravena-Rivas Y, Heilmann A, Watt RG, Broomhead T, Tsakos G. Analysis of public records of lobbying practices of the ultra-processed sugary food and drink industries in Chile: a qualitative study. LANCET REGIONAL HEALTH. AMERICAS 2024; 35:100794. [PMID: 39100991 PMCID: PMC11294830 DOI: 10.1016/j.lana.2024.100794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/03/2024] [Accepted: 05/15/2024] [Indexed: 08/06/2024]
Abstract
Background Given the role of commercial determinants on sugar consumption and health, this study aimed to describe lobbying practices of the ultra-processed sugary food and drinks industries in Chile between 2014 and 2022. Methods Official meetings between ultra-processed sugary food and drinks industries and related commercial actors and Chilean government officials were obtained from the Chilean Lobby Registry. Relevant commercial names were initially identified based on their market share and expanded iteratively based on information from relevant meetings. Qualitative analysis followed a deductive-inductive approach using the Corporate Political Activity Model to identify and classify objectives, framing and action strategies. Findings From 237 records identified, the Ministries of Health, Social Development, and Economy were the most frequently lobbied. Industry representatives sought to achieve their short- and long-term objectives by targeting a diverse range of authorities, including Ministers and Under-secretaries, using different strategies. Framing strategies focused on presenting sugary food and drinks industries as socially responsible and legitimate policy actors and criticised public health initiatives as 'bad solutions'. Action strategies aimed to influence policymaking and nurture corporate reputations. Interpretation Extensive lobbying took place by the sugary food and drinks industries between 2014 and 2022, a period when major public health policies were being discussed in Chile. Lobbying strategies varied to meet industry objectives and targeted a diverse range of government institutions including high-ranking officials. Tighter regulations to stop inappropriate industry influence in public health policymaking are urgently required. Funding Agencia Nacional de Investigación y Desarrollo (Chile)-PhD Scholarship. University College London-Open Access fees.
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Affiliation(s)
- Yanela Aravena-Rivas
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Richard G. Watt
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Tom Broomhead
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Girigosavi KB, Etta I, Kambham S, Panjiyar BK. Sweet Surprises: An In-depth Systematic Review of Artificial Sweeteners and Their Association with Cerebrovascular Accidents. Curr Nutr Rep 2024; 13:97-105. [PMID: 38598104 DOI: 10.1007/s13668-024-00537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE OF REVIEW Artificial sweeteners have become increasingly popular in today's dietary trends as a healthier and sweeter alternative to sugar. As studies emerge regarding artificial sweeteners, concerns are arising about their side effects, particularly linking them to strokes. This systematic review aims to assess the relationship between artificial sweeteners (AS) and cerebrovascular accidents (CVAs). A systematic search of studies indexed in PubMed and Google Scholar was conducted using the keywords "ASB" (artificially sweetened beverage), "Artificial Sweeteners," "Stroke," etc. These studies were screened and filtered according to our exclusion criteria. We reviewed 55 studies published in various journals and further boiled down to finalizing 12 studies for analysis using the PRISMA Statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020. RECENT FINDINGS Most studies suggest that there is a positive association between artificial sweetener consumption and CVAs including all types of strokes, particularly ischemic strokes. Poorer outcomes are seen with higher ASB intake. Increased risk is notable among women and black populations. Some studies show no association between ASB consumption and hemorrhagic stroke, however, most suggest a strong link. The current literature shows a degree of variation so it is crucial to consider possible confounders and eliminate them in future studies. Further research is necessary to determine the underlying mechanisms, especially in individuals with comorbidities. The results obtained play a role in forming dietary guidelines and alarming the public about the possible health implications, prompting caution regarding excessive consumption of artificial sweeteners, in their daily lives.
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Affiliation(s)
- Khushal B Girigosavi
- Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Maharashtra University of Health Sciences, Nashik, Maharashtra, India
| | - Indu Etta
- Kakatiya Medical College, Warangal, Telangana, India
| | - Saisravika Kambham
- Dr. B. R. Ambedkar Medical College Hospital, Bengaluru, Karnataka, India
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11
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Mumena WA, Kutbi HA. Sources of free sugar in the diet of Saudi children. Front Public Health 2024; 12:1305364. [PMID: 38660353 PMCID: PMC11041394 DOI: 10.3389/fpubh.2024.1305364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/19/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Data concerning sources of free sugar (FS) in the diet of Saudi children are limited. Identification of the top sources of FS would permit to develop tailored interventions that aid in meeting the recommendations of the World Health Organization for FS (≤ 25 g/day). This study aimed to investigate sources of FS in children's diet. Methods A cross-sectional data of healthy children ages between 6 and 12 years who reside in Saudi Arabia were gathered from their mothers using online platforms (WhatsApp, Facebook, and X) (n = 424; 210 boys and 214 girls). An interview was conducted through the phone with the mother and her child to collect data pertaining FS intake using a validated food frequency questionnaire. Results The primary sources of FS were Sweetened Beverages, followed by Sugars, Sweet Bakery Products, Other Desserts, and Candies, of which the added sugar consisted mostly of its total sugar. The consumption of FS coming from solid food sources for the highest quartile of children almost doubled the amount of FS coming from liquid food sources. Compared to boys, girls in the top quartile of FS intake consumed significantly higher amounts of solid sugars (p = 0.030). Only the intake of FS coming from Sweetened Beverages was associated negatively with age of children (p = 0.032). Discussion Public health interventions should emphasize the necessity of reducing the consumption of the top sources of FS to practically achieve the recommendations of FS intake.
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Affiliation(s)
- Walaa Abdullah Mumena
- Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Hebah Alawi Kutbi
- , Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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12
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Sonestedt E, Lukic M. Beverages - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2024; 68:10458. [PMID: 38571923 PMCID: PMC10989231 DOI: 10.29219/fnr.v68.10458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/09/2023] [Accepted: 12/20/2023] [Indexed: 04/05/2024] Open
Abstract
Background: Coffee, tea, sugar-sweetened beverages (SSBs), and low- and no-calorie sweetened beverages (LNCSBs) are generally frequently consumed in the Nordic and Baltic countries. These beverages have also been related to potential health effects. This scoping review describes the evidence for the role of coffee, tea, SSBs, and LNCSBs for health-related outcomes as a basis for setting and updating food-based dietary guidelines. We used evidence from several qualified systematic reviews (i.e. World Cancer Research Fund, US Dietary Guidelines Advisory Committee, European Food Safety Authority, and World Health Organization) and performed a search for additional systematic reviews. The evidence suggests that moderate coffee and tea consumption do not have long-term adverse health effects. The long-term favorable effects of coffee consumption are related to reduced risk of endometrial and liver cancer, type 2 diabetes, and cardiovascular deaths. However, results from randomized controlled trials (RCTs) suggest that coffee brews that are rich in diterpenes, such as boiled coffee, increase serum cholesterol concentrations. High caffeine intake in pregnancy is associated with higher risk of pregnancy loss, preterm birth, and low birth weight. High consumption of SSBs has been associated with increased risk of obesity, type 2 diabetes, hypertension, and cardiovascular disease, based on data from RCTs and prospective cohort studies. The consumption of LNCSBs may result in a small reduction in body weight in adults, likely mediated through the effect of reduced energy intake, but has neutral effects on other cardiometabolic risk markers using evidence from RCTs. However, evidence from observational studies indicates increased risk of cardiometabolic diseases among high LNCSB consumers. In conclusion, current evidence suggests that moderate coffee and tea consumption have no long-term adverse health effects. The evidence of beneficial effects of coffee consumption on liver and endometrial cancer risk, and some cardiovascular outcomes, comes from observational studies. High consumption of boiled coffee should be avoided due to negative effect on lipid profile. Pregnant women should not exceed the recommended daily dose of caffeine intake of 200 mg set by the European Food Safety Authority as a safe level for the fetus. High consumption of SSBs has consistently been associated with adverse health effects, which is mainly due to excess energy intake, and should be limited. The conflicting results from RCTs and observational studies regarding LNCSBs may be due to revere causation and should be explored further.
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Affiliation(s)
- Emily Sonestedt
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Marko Lukic
- Department of Community Medicine, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway
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13
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Guo L, Zhang M, Fei Y, Zhao W. Natural Sweetener, Glycyrrhetinic Acid 3- O-Mono-beta-d-glucuronide, for Postprandial Hyperglycemia Management. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:4747-4756. [PMID: 38335161 DOI: 10.1021/acs.jafc.3c07188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
This study examines the inhibitory effects of a range of sweeteners on α-glucosidase. Our findings revealed that only one natural sweetener, namely, glycyrrhetinic acid 3-O-mono-beta-d-glucuronide (GAMG), derived from licorice, exhibited a mixed-type inhibition against α-glucosidase with a IC50 value of 0.73 ± 0.05 mg/mL. The fluorescence intensity of α-glucosidase was quenched by GAMG in the formation of an α-glucosidase-GAMG complex. GAMG has been shown to induce conformational changes in α-glucosidase, likely through hydrogen bonding, van der Waals force, and alkyl-alkyl interactions with amino acid residues, including Arg 281, Leu 283, Trp 376, Asp 404, Asp 443, Trp 481, Asp 518, Phe 525, Ala 555, and Asp 616. Additional animal validation experiments demonstrated that GAMG slowed starch digestion, thereby attenuating the postprandial glycemic response. Taken together, these findings provide evidence that GAMG is a natural sweetener with potent inhibitory activity that selectively targets α-glucosidase. This study supports the use of GAMG as a natural sweetener, which holds a high biological value and may be beneficial for managing postprandial hyperglycemia.
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Affiliation(s)
- Lichun Guo
- School of Food Science and Technology, State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, PR China
| | - Mengqing Zhang
- School of Food Science and Technology, State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, PR China
| | - Ying Fei
- Wuxi Langke/Suzhou Langbang Biotechnological Co., Ltd., Wuxi, Jiangsu 214122, PR China
| | - Wei Zhao
- School of Food Science and Technology, State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, PR China
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14
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McClements DJ. Designing healthier and more sustainable ultraprocessed foods. Compr Rev Food Sci Food Saf 2024; 23:e13331. [PMID: 38517032 DOI: 10.1111/1541-4337.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024]
Abstract
The food industry has been extremely successful in creating a broad range of delicious, affordable, convenient, and safe food and beverage products. However, many of these products are considered to be ultraprocessed foods (UPFs) that contain ingredients and are processed in a manner that may cause adverse health effects. This review article introduces the concept of UPFs and briefly discusses food products that fall into this category, including beverages, baked goods, snacks, confectionary, prepared meals, dressings, sauces, spreads, and processed meat and meat analogs. It then discusses correlations between consumption levels of UPFs and diet-related chronic diseases, such as obesity and diabetes. The different reasons for the proposed ability of UPFs to increase the risk of these chronic diseases are then critically assessed, including displacement of whole foods, high energy densities, missing phytochemicals, contamination with packaging chemicals, hyperpalatability, harmful additives, rapid ingestion and digestion, and toxic reaction products. Then, potential strategies to overcome the current problems with UPFs are presented, including reducing energy density, balancing nutritional profile, fortification, increasing satiety response, modulating mastication and digestion, reengineering food structure, and precision processing. The central argument is that it may be possible to reformulate and reengineer many UPFs to improve their healthiness and sustainability, although this still needs to be proved using rigorous scientific studies.
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Affiliation(s)
- David Julian McClements
- Department of Food Science & Bioengineering, Zhejiang Gongshang University, Hangzhou, Zhejiang, China
- Department of Food Science, University of Massachusetts, Amherst, Massachusetts, USA
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15
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Jiang J, Fan H, Zhou J, Qin J, Qin Z, Chen M, Shen Y, Liu X. In vitro inhibitory effect of five natural sweeteners on α-glucosidase and α-amylase. Food Funct 2024; 15:2234-2248. [PMID: 38318730 DOI: 10.1039/d3fo05234f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
A promising and efficacious approach to manage diabetes is inhibiting α-glucosidase and α-amylase activity. Therefore, the inhibitory activities of five natural sweeteners (mogrosides (Mog), stevioside (Ste), glycyrrhizinic acid (GA), crude trilobatin (CT), and crude rubusoside (CR)) against α-glucosidase and α-amylase and their interactions were evaluated in vitro using enzyme kinetics, fluorescence spectroscopy, Fourier infrared spectroscopy, and molecular docking. The inhibitor sequence was CT > GA > Ste, as GA competitively inhibited α-glycosidase activity while CT and Ste exhibited mixed inhibitory effects. Compared to a positive control acarbose, the inhibitory activity of CT was higher. For α-amylase, the mixed inhibitors CT, CR, and Mog and the competitive inhibitor Ste effectively inhibited the enzyme, with the following order: CT > CR > Ste > Mog; nevertheless, the inhibitors were slightly inferior to acarbose. Three-dimensional fluorescence spectra depicted that GA, CT, and CR bound to the hydrophobic cavity of α-glucosidase or α-amylase and changed the polarity of the hydrophobic amino acid-based microenvironment and structure of the polypeptide chain backbone. Infrared spectroscopy revealed that GA, CT, and CR could disrupt the secondary structure of α-glucosidase or α-amylase, which decreased enzyme activity. GA, trilobatin and rubusoside bound to amino acid residues through hydrogen bonds and hydrophobic interactions, changing the conformation of enzyme molecules to decrease the enzymatic activity. Thus, CT, CR and GA exhibit promising inhibitory effects against α-glucosidase and α-amylase.
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Affiliation(s)
- Jiequn Jiang
- College of Light and Food Engineering, Guangxi University, Nanning 530004, China.
- Key Laboratory of Deep Processing and Safety Control for Specialty Agricultural Products in Guangxi Universities, Education Department of Guangxi Zhuang Autonomous Region, Nanning 530004, China
| | - Heliang Fan
- College of Light and Food Engineering, Guangxi University, Nanning 530004, China.
- Key Laboratory of Deep Processing and Safety Control for Specialty Agricultural Products in Guangxi Universities, Education Department of Guangxi Zhuang Autonomous Region, Nanning 530004, China
| | - Jie Zhou
- College of Light and Food Engineering, Guangxi University, Nanning 530004, China.
- Key Laboratory of Deep Processing and Safety Control for Specialty Agricultural Products in Guangxi Universities, Education Department of Guangxi Zhuang Autonomous Region, Nanning 530004, China
| | - Jingkai Qin
- College of Light and Food Engineering, Guangxi University, Nanning 530004, China.
- Key Laboratory of Deep Processing and Safety Control for Specialty Agricultural Products in Guangxi Universities, Education Department of Guangxi Zhuang Autonomous Region, Nanning 530004, China
| | - Zhongyi Qin
- College of Light and Food Engineering, Guangxi University, Nanning 530004, China.
- Key Laboratory of Deep Processing and Safety Control for Specialty Agricultural Products in Guangxi Universities, Education Department of Guangxi Zhuang Autonomous Region, Nanning 530004, China
| | - Mei Chen
- College of Light and Food Engineering, Guangxi University, Nanning 530004, China.
- Key Laboratory of Deep Processing and Safety Control for Specialty Agricultural Products in Guangxi Universities, Education Department of Guangxi Zhuang Autonomous Region, Nanning 530004, China
| | - Yuanyuan Shen
- College of Light and Food Engineering, Guangxi University, Nanning 530004, China.
- Key Laboratory of Deep Processing and Safety Control for Specialty Agricultural Products in Guangxi Universities, Education Department of Guangxi Zhuang Autonomous Region, Nanning 530004, China
| | - Xiaoling Liu
- College of Light and Food Engineering, Guangxi University, Nanning 530004, China.
- Key Laboratory of Deep Processing and Safety Control for Specialty Agricultural Products in Guangxi Universities, Education Department of Guangxi Zhuang Autonomous Region, Nanning 530004, China
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Eshaghian N, Zare MJ, Mohammadian MK, Gozidehkar Z, Ahansaz A, Askari G, Asadi M, Milajerdi A, Sadeghi O. Sugar sweetened beverages, natural fruit juices, and cancer: what we know and what still needs to be assessed. Front Nutr 2023; 10:1301335. [PMID: 38178975 PMCID: PMC10764622 DOI: 10.3389/fnut.2023.1301335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Cancer is known as one of the leading causes of death in the world. In addition to early mortality, cancer is associated with disability in affected patients. Among environmental risk factors, special attention has been paid to the role of dietary factors. In recent decades, the consumption of sugar-sweetened beverages (SSBs) and natural fruit juices has increased. Several studies have assessed the effects of these beverages on human health and found that a higher intake of SSBs is associated with a greater risk of obesity, diabetes, cardiovascular diseases, hypertension, and non-alcoholic fatty liver disease. However, current evidence for cancer incidence and mortality is not conclusive. In the current review, we concluded that SSBs intake might be positively associated with cancer incidence/mortality through their increasing effects on obesity, inflammatory biomarkers, serum levels of insulin-like growth factor-I (IGF-I), and advanced glycation end-products. Such a positive association was also seen for natural fruit juices. However, types of natural fruit juices were not considered in most previous studies. In addition, some types of cancer including brain, lung, and renal cancers were not assessed in relation to SSBs and natural fruit juices. Therefore, further studies are needed in this regard.
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Affiliation(s)
- Niloofar Eshaghian
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Javad Zare
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Zohre Gozidehkar
- Department of Public Health, Birjand University of Medical Sciences, Birjand, Iran
| | - Afsaneh Ahansaz
- Department of Food Science and Technology, Faculty of Agriculture, University of Tabriz, Tabriz, Iran
| | - Gholamreza Askari
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoomeh Asadi
- Department of Operating Room Nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Alireza Milajerdi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Omid Sadeghi
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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Venson AH, Cardoso LB, Santiago FS, de Souza KB, Bielemann RM. Price elasticity of demand for ready-to-drink sugar-sweetened beverages in Brazil. PLoS One 2023; 18:e0293413. [PMID: 37910576 PMCID: PMC10619800 DOI: 10.1371/journal.pone.0293413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023] Open
Abstract
The taxation of sugar-sweetened beverages is a policy that has been adopted in many countries worldwide, including Latin American, to reduce sugar consumption. However, little is known about how taxation on these products may affect their demand. The present study aims to estimate the price elasticity of demand for sugar-sweetened beverages in Brazil. This study advances the literature by proposing a breakdown between ready-to-drink sugar-sweetened beverages and sugar-sweetened beverages that require some preparation before being consumed. With this disaggregation, it is possible to obtain more accurate elasticities for the group of products that will be effectively taxed. We estimated a Quadratic Almost Ideal Demand System (QUAIDS) model using the Household Budget Survey 2017-2018 microdata. The results show that ready-to-drink beverages is more consumed but less sensitive to changes in price than prepared beverages. The price elasticity of demand for ready-to-drink and prepared sugar-sweetened beverages was -1.19 and -3.38. Additionally, we observe heterogeneity in these price elasticities across household incomes, with a more elastic demand among lower-income households for ready to drink beverages. The findings suggest that taxing ready-to-drink sweetened beverages could potentially reduce sugar consumption directly through a decrease in the consumption of sugary drinks and this effect could be reinforced by reducing the consumption of other sugar-rich products. Therefore, the taxation police should effective contribute to minimize health risks associated to the sugar consumption.
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Affiliation(s)
| | - Larissa Barbosa Cardoso
- Faculty of Administration, Accounting and Economic Sciences, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Flaviane Souza Santiago
- Faculty of Economics, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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18
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Tran QD, Nguyen THH, Le CL, Hoang LV, Vu TQC, Phan NQ, Bui TT. Sugar-sweetened beverages consumption increases the risk of metabolic syndrome and its components in adults: Consistent and robust evidence from an umbrella review. Clin Nutr ESPEN 2023; 57:655-664. [PMID: 37739720 DOI: 10.1016/j.clnesp.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/20/2023] [Accepted: 08/01/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Sugar-sweetened beverages (SSBs) are potential modifiable risk factors for reducing the risk of metabolic syndrome (MetS); however, there is a lack of an umbrella review that robustly synthesizes the evidence. This review aims to synthesize the evidence linking habitual SSBs intake with MetS in adults, emphasizing the need for policy and regulatory actions. METHODS Four databases were comprehensively searched for relevant meta-analyses of prospective studies up to July 2023. Two authors independently conducted the screening for eligibility, data extraction, and quality assessment. The outcome of interest was MetS in adults, encompassing its component conditions. The present review was registered with PROSPERO (CRD42023402549). RESULTS Of the 16 eligible meta-analyses identified, 30 summary estimates were obtained for the impact of SSBs consumption on obesity, type 2 diabetes, hypertension, and MetS. Seven were rated as 'High' methodological quality, with the rest classified as 'Moderate' and 'Low' quality, consisting of three and six references, respectively. A comparison of the highest and lowest levels of SSBs consumption revealed an increased risk of 18% (95% CI: 13%-24%), 12% (95% CI: 11%-14%), 29% (95% CI: 25%-32%), and 29% (95% CI: 7%-52%) for obesity, hypertension, type 2 diabetes, and MetS, respectively. Consistently, the findings from dose-response analyses are in agreement with and corroborate the existing evidence that SSBs are a significant risk factor for the development of MetS and its related conditions. Noticeably, the quality of evidence was predominantly deemed as highly suggestive and convincing. Moreover, consensus on specific criteria to identify studies related to SSBs in literature searching was lacking, and most primary studies were conducted in developed countries and Europe. CONCLUSIONS Our findings suggest that more rigorous and targeted policy interventions are warranted to curtail SSBs consumption, in order to alleviate the global burden of MetS.
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Affiliation(s)
- Quang Duc Tran
- College of Health Sciences, VinUniveristy, Vinhomes Ocean Park, Gia Lam District, Hanoi, Viet Nam.
| | - Thi Hoa Huyen Nguyen
- College of Health Sciences, VinUniveristy, Vinhomes Ocean Park, Gia Lam District, Hanoi, Viet Nam.
| | - Cu Linh Le
- College of Health Sciences, VinUniveristy, Vinhomes Ocean Park, Gia Lam District, Hanoi, Viet Nam.
| | - Lan Van Hoang
- College of Health Sciences, VinUniveristy, Vinhomes Ocean Park, Gia Lam District, Hanoi, Viet Nam.
| | - Thi Quynh Chi Vu
- Nutrition Department, Dong A University, 33 Xo Viet Nghe Tinh Hoa Cuong Nam Ward, Hai Chau District, Danang, Viet Nam.
| | - Ngoc Quang Phan
- The Center Service for Technology Science of Medi-Phar, Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh, Viet Nam.
| | - Thi Thuy Bui
- National Institute of Nutrition, 48B Tang Bat Ho Street, 100000, Hanoi, Viet Nam.
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McDonough C, Li YC, Vangeepuram N, Liu B, Pandey G. Facilitating youth diabetes studies with the most comprehensive epidemiological dataset available through a public web portal. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.02.23293517. [PMID: 37577465 PMCID: PMC10418570 DOI: 10.1101/2023.08.02.23293517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
The prevalence of type 2 diabetes mellitus (DM) and prediabetes (preDM) is rapidly increasing among youth, posing significant health and economic consequences. To address this growing concern, we created the most comprehensive youth-focused diabetes dataset to date derived from National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. The dataset, consisting of 15,149 youth aged 12 to 19 years, encompasses preDM/DM relevant variables from sociodemographic, health status, diet, and other lifestyle behavior domains. An interactive web portal, POND (Prediabetes/diabetes in youth ONline Dashboard), was developed to provide public access to the dataset, allowing users to explore variables potentially associated with youth preDM/DM. Leveraging statistical and machine learning methods, we conducted two case studies, revealing established and lesser-known variables linked to youth preDM/DM. This dataset and portal can facilitate future studies to inform prevention and management strategies for youth prediabetes and diabetes.
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Affiliation(s)
- Catherine McDonough
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yan Chak Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nita Vangeepuram
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Dumith SC, Martins OPL, Moreira MKV, Paulitsch RG, Simões MO, Marmitt LP, Silva PEA, Silva MP. Is the increment of diabetes mellitus in Brazil associated with the consumption of artificially sweetened beverages? A time trend analysis with 757,386 adults from 2006 to 2020. Public Health 2023; 221:66-72. [PMID: 37421755 DOI: 10.1016/j.puhe.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To describe trends in the prevalence of diabetes mellitus (DM) in Brazil and to analyze its association with the consumption of artificially sweetened beverages among individuals aged 18 years or older. STUDY DESIGN This was a repeated cross-sectional study. METHODS Annual data from VIGITEL surveys (2006-2020) were used, which included adults from all Brazilian state capitals. The outcome was the prevalence of DM (type 1 and type 2). The main exposure variable was consuming beverages like soft drinks and artificial juices, either in its 'diet, light, or zero' form. Covariates included sex, age, sociodemographic characteristics, smoking, alcohol consumption, physical activity, fruit consumption, and obesity. The temporal trend in the indicators and the etiological fraction (population attributable risk [PAR]) were calculated. Analyses were performed using Poisson regression. The association between DM and consumption of beverages was tested, excluding the year 2020 due to the pandemic; restricting the analysis to the final three years (2018-2020). RESULTS Overall, 757,386 subjects were included. The prevalence of DM increased from 5.5% to 8.2%, with an annual growth of 0.17 percentage points (95% CI 0.11-0.24). Among those who consumed diet/light/zero beverages, the annual percentage change of DM was four times greater. The PAR corresponding to the consumption of diet/light/zero beverages on the occurrence of DM was 17%. CONCLUSIONS An increasing prevalence of DM was observed, while diet/light/zero beverages consumption remains stable. A substantial reduction in the annual percentage change of DM could be observed if people stopped consuming diet/light soda/juice.
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Affiliation(s)
- S C Dumith
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil; Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
| | - O P L Martins
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil; Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
| | - M K V Moreira
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, CEP: 96020-220, Brazil
| | - R G Paulitsch
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Empresa Brasileira de Serviços Hospitalares, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
| | - M O Simões
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Universidade Vale do Rio Doce, Governador Valadares, MG, CEP: 35020-220, Brazil
| | - L P Marmitt
- Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil; Postgraduate Program in Biosciences and Health, Universidade do Oeste de Santa Catarina, Joaçaba, SC, CEP: 89600-000, Brazil.
| | - P E A Silva
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil
| | - M P Silva
- Postgraduate Program in Health Sciences, Universidade Federal de Rio Grande. Rio Grande, RS, CEP: 96203-900, Brazil; Grupo de Pesquisa em Atividade Física e Saúde Pública, Universidade Federal do Rio Grande, Rio Grande, RS, CEP: 96203-900, Brazil
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Mohamadi A, Shiraseb F, Mirzababaei A, Barekzai AM, Clark CCT, Aali Y, Mirzaei K. Inflammatory markers may mediate the relationship between processed meat consumption and metabolic unhealthy obesity in women: a cross sectional study. Sci Rep 2023; 13:9261. [PMID: 37286588 DOI: 10.1038/s41598-023-35034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/11/2023] [Indexed: 06/09/2023] Open
Abstract
Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO) are known to be affected by diet and inflammatory factors (such as TGF-β1, IL-β1, MCP1). We sought to survey that consume of processed meat could effect on MHO and MUHO phenotypes, mediated through inflammatory markers, in overweight and obese Iranian women. The current cross-sectional study was done on 224 women 18-48 years, with a body mass index (BMI) ≥ 25 kg/m2. A 147- item food frequency questionnaire (FFQ) was used to evaluate dietary intake. In all participants, anthropometric indices and biochemical factors, as well as metabolic health phenotypes based on Karelis score, were evaluated. According to results, 22.6% of participants had MHO and 75.7% had MUHO phenotypes. There was an association between higher adherence to processed meats and increasing odds of MUHO phenotype in Iranian women (OR:2.54; 95% CI 0.009, 7.51; P = 0.05). Moreover, we found that the relation can be affected by agents such as TGF-β1, IL-β1, and MCP1; however, more research is needed to confirm these results and finding.
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Affiliation(s)
- Azam Mohamadi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Farideh Shiraseb
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran.
| | - Ahmad Mujtaba Barekzai
- Department of Public Health, Spinghar Institute of Higher Education, Kabul Campus, Kabul, Afghanistan
- Spinghar Institute of Higher Education, Kabul Campus, Kabul, Afghanistan
- World FoodProgram, KIC, Kabul, Afghanistan
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - Yasaman Aali
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6117, Tehran, Iran.
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22
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Miller B, Branscum P. Evaluating the Association Between Artificial Sweetener Intake and Indicators of Stress and Anxiety. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 43:339-342. [PMID: 34080916 DOI: 10.1177/0272684x211022150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to evaluate the association between non-nutritive sweetener (NNS) consumption and stress and anxiety, among a sample of college students. Two-hundred and twenty-seven students from a large mid-western university participated in this cross-sectional study. Students completed an online survey that evaluated NNS using a validated food frequency questionnaire. Stress and anxiety were evaluated using previously validated instruments. Most students reported very low/low/average concern for stress (63.9%), and had low/moderate anxiety (82.3%). Participants experiencing high and very high levels of stress had significantly higher NNS consumption compared to those with a very low and low risk, and concern for stress (p < .046; d = 0.28). There was no difference however for NNS intake and anxiety. Reduction of artificial sweetener intake may be associated with stress levels among college students. However, more research is needed to examine any causal relationship between artificial sweetener intake and stress.
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Affiliation(s)
- Benjamin Miller
- Department of Kinesiology and Health, Miami University, Oxford, Ohio, United States
| | - Paul Branscum
- Department of Kinesiology and Health, Miami University, Oxford, Ohio, United States
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23
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Li B, Yan N, Jiang H, Cui M, Wu M, Wang L, Mi B, Li Z, Shi J, Fan Y, Azalati MM, Li C, Chen F, Ma M, Wang D, Ma L. Consumption of sugar sweetened beverages, artificially sweetened beverages and fruit juices and risk of type 2 diabetes, hypertension, cardiovascular disease, and mortality: A meta-analysis. Front Nutr 2023; 10:1019534. [PMID: 37006931 PMCID: PMC10050372 DOI: 10.3389/fnut.2023.1019534] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/21/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionSugar-sweetened beverage (SSB) intake is associated with an increased risk of cardiometabolic diseases. However, evidence regarding associations of artificially sweetened beverages (ASBs) and fruit juices with cardiometabolic diseases is mixed. In this study, we aimed to investigate the association between the SSB, ASB and fruit juice consumption with the incidence of cardiometabolic conditions and mortality.MethodsRelevant prospective studies were identified by searching PubMed, Web of Science, Embase, and Cochrane Library until December 2022 without language restrictions. The pooled relative risk (RR) and 95% confidence intervals (CIs) were estimated for the association of SSBs, ASBs, and fruit juices with the risk of type 2 diabetes (T2D), cardiovascular disease (CVD), and mortality by using random-effect models.ResultsA total of 72 articles were included in this meta-analysis study. Significantly positive associations were observed between the consumption of individual beverages and T2D risk (RR: 1.27; 95% CI: 1.17, 1.38 for SSBs; RR: 1.32; 95% CI: 1.11, 1.56 for ASBs; and RR:0.98; 95% CI: 0.93, 1.03 for fruit juices). Moreover, our findings showed that intakes of SSBs and ASBs were significantly associated with risk of hypertension, stroke, and all-cause mortality (RR ranging from 1.08 to 1.54; all p < 0.05). A dose-response meta-analysis showed monotonic associations between SSB intake and hypertension, T2D, coronary heart disease (CHD), stroke and mortality, and the linear association was only significant between ASB consumption and hypertension risk. Higher SSB and ASB consumptions were associated with a greater risk of developing cardiometabolic diseases and mortality. Fruit juice intake was associated with a higher risk of T2D.ConclusionTherefore, our findings suggest that neither ASBs nor fruit juices could be considered as healthier beverages alternative to SSBs for achieving improved health.Systematic Review Registration: [PROSPERO], identifier [No. CRD42022307003].
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Affiliation(s)
- Baoyu Li
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Ni Yan
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Hong Jiang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Meng Cui
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Min Wu
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Lina Wang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Baibing Mi
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Zhaofang Li
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Jia Shi
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Yahui Fan
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | | | - Chao Li
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Fangyao Chen
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Mao Ma
- The First Affiliated Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
- *Correspondence: Mao Ma, ; Duolao Wang, ; Le Ma,
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- *Correspondence: Mao Ma, ; Duolao Wang, ; Le Ma,
| | - Le Ma
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi’an Jiaotong University), Ministry of Education of China, Xi’an, China
- *Correspondence: Mao Ma, ; Duolao Wang, ; Le Ma,
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Gillespie KM, Kemps E, White MJ, Bartlett SE. The Impact of Free Sugar on Human Health-A Narrative Review. Nutrients 2023; 15:889. [PMID: 36839247 PMCID: PMC9966020 DOI: 10.3390/nu15040889] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
The importance of nutrition in human health has been understood for over a century. However, debate is ongoing regarding the role of added and free sugars in physiological and neurological health. In this narrative review, we have addressed several key issues around this debate and the major health conditions previously associated with sugar. We aim to determine the current evidence regarding the role of free sugars in human health, specifically obesity, diabetes, cardiovascular diseases, cognition, and mood. We also present some predominant theories on mechanisms of action. The findings suggest a negative effect of excessive added sugar consumption on human health and wellbeing. Specific class and source of carbohydrate appears to greatly influence the impact of these macronutrients on health. Further research into individual effects of carbohydrate forms in diverse populations is needed to understand the complex relationship between sugar and health.
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Affiliation(s)
- Kerri M. Gillespie
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Eva Kemps
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA 5042, Australia
| | - Melanie J. White
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Selena E. Bartlett
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
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Sugar-Sweetened Beverages and Metabolic Risk in Children and Adolescents with Obesity: A Narrative Review. Nutrients 2023; 15:nu15030702. [PMID: 36771409 PMCID: PMC9918944 DOI: 10.3390/nu15030702] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
Sugar-sweetened beverages (SSBs) are major contributors of free sugars to the diet. A strong relationship between SSB intake and weight gain is described. METHODS we performed a narrative review to present an overview of the role of SSBs as a pivotal contributor in the development of obesity and metabolism-related complications. RESULTS different factors influence SSB consumption in children, including economic variables, individual attributes and behaviors to environmental factors, parent features and parents' behaviors. Data suggest that SSB intake has a negative effect on weight and obesity-related diseases. The leading mechanism linking SSB intake to the risk of gaining weight is decreased satiety and incomplete compensatory reduction in energy intake at meals following ingestion of liquid calories. Additionally, the effects of SSBs on gut microbiota and on eating behaviors were also reported. An association between SSB intake, weight gain and cardiometabolic risks is evident. Consumption of SSBs had a significant impact on the prevalence of obesity and related metabolic risks, including insulin resistance, type 2 diabetes, hypertension and metabolic syndrome. CONCLUSIONS Limiting consumption of SSBs and increasing knowledge of the effect of SSBs on early metabolic and cardiovascular disorders will be useful in developing strategies to counteract the problem and to prevent obesity and related complications.Key future research areas for which further studies are needed include investigating the long-term effects of SSBs on health outcomes as well as analyzing the health effects of sugar consumed in solid compared to liquid forms and further elucidating the biological mechanisms of sugar addiction and energy compensation.
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Ma E, Ohira T, Hirai H, Okazaki K, Nagao M, Hayashi F, Nakano H, Suzuki Y, Sakai A, Takahashi A, Kazama JJ, Yabe H, Maeda M, Yasumura S, Ohto H, Kamiya K, Shimabukuro M. Dietary Patterns and New-Onset Type 2 Diabetes Mellitus in Evacuees after the Great East Japan Earthquake: A 7-Year Longitudinal Analysis in the Fukushima Health Management Survey. Nutrients 2022; 14:4872. [PMID: 36432558 PMCID: PMC9694161 DOI: 10.3390/nu14224872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Dietary patterns may be linked to the incidence of type 2 diabetes mellitus (T2DM) after disasters. We investigated the association between dietary patterns and new-onset T2DM in evacuees of the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. Methods: Among the 22,740 non-diabetic participants aged 20-89 years who completed the dietary assessment in the Fukushima Health Management Survey between July 2011 and November 2012, the incidence of T2DM was evaluated until 2018. Principal component analysis with varimax rotation was applied to derive dietary patterns based on a validated, short-form food frequency questionnaire. The identified dietary patterns were categorized as typical Japanese, juice, and meat. Results: The cumulative incidence of T2DM was 18.0 and 9.8 per 1000 person-years in men and women, respectively, during the follow-up period. The multiple-adjusted hazard ratio (95% confidence interval) of the highest vs. lowest quartile of the typical Japanese pattern scores for T2DM was 0.80 (0.68, 0.94; P for trend = 0.015) in total, 0.85 (0.68, 1.06; P for trend = 0.181) in men, and 0.76 (0.60, 0.95; P for trend = 0.04) in women. Conclusions: A typical Japanese dietary pattern may be associated with a reduced new-onset T2DM risk in evacuees, especially women, after the Great East Japan Earthquake and the FDNPP accident.
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Affiliation(s)
- Enbo Ma
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tetsuya Ohira
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hiroyuki Hirai
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Kanako Okazaki
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Physical Therapy, Fukushima Medical University School of Medical Sciences, Fukushima 960-8516, Japan
| | - Masanori Nagao
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Fumikazu Hayashi
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hironori Nakano
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yuriko Suzuki
- Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
| | - Akira Sakai
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Atsushi Takahashi
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Junichiro J. Kazama
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Masaharu Maeda
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Research Institute for Radiation Biology and Medicine, Hiroshima, University, Hiroshima 734-8553, Japan
| | - Michio Shimabukuro
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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27
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Sánchez-Rosales AI, Guadarrama-López AL, Gaona-Valle LS, Martínez-Carrillo BE, Valdés-Ramos R. The Effect of Dietary Patterns on Inflammatory Biomarkers in Adults with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2022; 14:4577. [PMID: 36364839 PMCID: PMC9654560 DOI: 10.3390/nu14214577] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Some evidence supports the fact that chronic low-grade inflammation contributes to the physiopathology of type 2 diabetes mellitus (T2DM), and circulating markers of inflammation (e.g., C-reactive protein (CRP), pro- and anti-inflammatory biomarkers (e.g., adiponectin), and endothelial function markers could indicate an ongoing pathology. Following certain dietary patterns (DPs) may result in favorable changes in inflammatory biomarkers. The overarching aim of this systematic review and meta-analysis is to explore the inflammatory effect of healthy DPs on inflammatory biomarkers in adults with T2DM. A systematic search of the literature was conducted using the electronic databases MEDLINE, SCOPUS, and Cochrane Central Register of Controlled Trials. A total of 10 randomized controlled clinical trials (RCTs) were analyzed. In our linear meta-analysis, the random-effects model was applied to estimate standardized mean differences (SMD) to associate the effect of the interventions. Dietary Approaches to Stop Hypertension (DASH), Diabetes UK healthy eating, Mediterranean Diet (MD), Diabetes Prevention Program (DPP), and the American Heart Association’s Therapeutic Lifestyle Changes diet were associated with a significant reduction in CRP (SMD: −0.83, 99% CI −1.49, −0.17, p < 0.001; I2 94%), while plasma levels of adiponectin were significantly higher with the intake of MD, DPP, and Diabetes UK healthy eating (SMD: 0.81, 99% CI 0.06,1.56, p < 0.005; I2 96%), both of which indicate less inflammation. Sensitivity analyses were carried out, and potential publication bias was examined. In conclusion, low- moderate-quality evidence from RCTs suggests that, for the DPs evaluated, there are favorable changes in CRP and adiponectin.
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Affiliation(s)
| | - Ana L. Guadarrama-López
- Multidisciplinary Clinic of Health, Universidad Autónoma del Estado de México, Toluca 50180, Mexico
| | - Laura S. Gaona-Valle
- Centro Médico Lic. Adolfo López Mateos, Instituto de Salud del Estado de México (ISEM), Toluca 50010, Mexico
| | | | - Roxana Valdés-Ramos
- Faculty of Medicine, Universidad Autónoma del Estado de México, Toluca 50180, Mexico
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28
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Khadem A, Shiraseb F, Mirzababaei A, Ghaffarian-Ensaf R, Mirzaei K. Association of Lifelines Diet Score (LLDS) and metabolically unhealthy overweight/obesity phenotypes in women: a cross-sectional study. BMC Womens Health 2022; 22:374. [PMID: 36096807 PMCID: PMC9469615 DOI: 10.1186/s12905-022-01957-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/02/2022] [Indexed: 11/22/2022] Open
Abstract
Background Previous studies have shown the association of a number of dietary quality scores with metabolically phenotypes of obesity. Recently, the Lifelines Diet Score (LLDS), which is a fully food-based score based on the 2015 Dutch dietary guidelines and underlying international literature, has been proposed as a tool for assessing the quality of the diet. Therefore, this study was performed to investigate the association between LLDS and metabolically healthy/unhealthy overweight and obesity (MHO/MUHO) phenotypes. Methods This study was performed on 217 women, aged 18–48 years old. For each participant anthropometric values, biochemical test and body composition were evaluated by standard protocols and methods. The LLDS was determined based on 12 components using a valid and reliable food frequency questionnaire (FFQ) containing 147 items. The metabolically healthy (MH) was evaluated using the Karelis criteria. Results Among the total participants in this study, 31.3% of the subjects were MHO while 68.7% were MUHO. After adjustment for potential confounding variables (age, energy intake, and physical activity), participants in highest LLDS tertile had a lower odds of MUHO compared with those in the lowest tertile (OR: 1.18; 95% CI: 0.23, 5.83; P-trend = 0.03). Also, after further adjustment with BMI, provided only small changes in "OR" and did not attenuate the significance (OR: 1.28; 95% CI: 0.23, 6.91; P-trend = 0.02). Conclusions The present evidence indicates that individuals with higher adherence to the LLDS had lower odds of metabolically unhealthy (MUH).
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29
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Fu T, Chen H, Chen X, Sun Y, Xie Y, Deng M, Hesketh T, Wang X, Chen J. Sugar-sweetened beverages, artificially sweetened beverages and natural juices and risk of inflammatory bowel disease: a cohort study of 121,490 participants. Aliment Pharmacol Ther 2022; 56:1018-1029. [PMID: 35848057 PMCID: PMC9546432 DOI: 10.1111/apt.17149] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/19/2022] [Accepted: 07/05/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) have been related to high-sugar dietary patterns, but the associations of different types of beverages with IBD risk are largely unknown. AIMS To examine any associations between intake of sugar-sweetened beverages, artificially sweetened beverages and natural juices and IBD risk METHODS: This cohort study included 121,490 participants in the UK Biobank who were free of IBD at recruitment. Intake of beverages was obtained from repeated 24-h diet recalls in 2009-2012. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of beverage intake with IBD risk. RESULTS During a mean (standard deviation) follow-up of 10.2 (1.5) years, we documented 510 incident IBD cases, (143 Crohn's disease (CD) and 367 ulcerative colitis (UC)). Compared to non-consumers, participants consuming >1 unit per day of sugar-sweetened beverages were at significantly higher risk of IBD (HR 1.51, 95% CI 1.11-2.05), but the trend was non-significant (p-trend = 0.170). This association was significant for CD (HR 2.05, 95% CI 1.22-3.46), but not for UC (HR 1.31, 95% CI 0.89-1.92). We did not observe significant associations for the consumption of artificially sweetened beverages or natural juices. CONCLUSIONS Our findings suggest an association between consumption of sugar-sweetened beverages, rather than artificially sweetened beverages or natural juices, and IBD risk.
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Affiliation(s)
- Tian Fu
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Hui Chen
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuejie Chen
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yuhao Sun
- Centre for Global Health, Zhejiang University, Hangzhou, China
| | - Ying Xie
- Centre for Global Health, Zhejiang University, Hangzhou, China
| | - Minzi Deng
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Therese Hesketh
- Centre for Global Health, Zhejiang University, Hangzhou, China.,Institute for Global Health, University College London, London, UK
| | - Xiaoyan Wang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jie Chen
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China.,Centre for Global Health, Zhejiang University, Hangzhou, China
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30
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Santos LP, Gigante DP, Delpino FM, Maciel AP, Bielemann RM. Sugar sweetened beverages intake and risk of obesity and cardiometabolic diseases in longitudinal studies: A systematic review and meta-analysis with 1.5 million individuals. Clin Nutr ESPEN 2022; 51:128-142. [DOI: 10.1016/j.clnesp.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022]
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31
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Navarro JA, Decara J, Medina-Vera D, Tovar R, Lopez-Gambero AJ, Suarez J, Pavón FJ, Serrano A, de Ceglia M, Sanjuan C, Baltasar YA, Baixeras E, Rodríguez de Fonseca F. Endocrine and Metabolic Impact of Oral Ingestion of a Carob-Pod-Derived Natural-Syrup-Containing D-Pinitol: Potential Use as a Novel Sweetener in Diabetes. Pharmaceutics 2022; 14:pharmaceutics14081594. [PMID: 36015220 PMCID: PMC9416495 DOI: 10.3390/pharmaceutics14081594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 02/05/2023] Open
Abstract
The widespread use of added sugars or non-nutritive sweeteners in processed foods is a challenge for addressing the therapeutics of obesity and diabetes. Both types of sweeteners generate health problems, and both are being blamed for multiple complications associated with these prevalent diseases. As an example, fructose is proven to contribute to obesity and liver steatosis, while non-nutritive sweeteners generate gut dysbiosis that complicates the metabolic control exerted by the liver. The present work explores an alternative approach for sweetening through the use of a simple carob-pod-derived syrup. This sweetener consists of a balanced mixture of fructose (47%) and glucose (45%), as sweetening sugars, and a functional natural ingredient (D-Pinitol) at a concentration (3%) capable of producing active metabolic effects. The administration of this syrup to healthy volunteers (50 g of total carbohydrates) resulted in less persistent glucose excursions, a lower insulin response to the hyperglycemia produced by its ingestion, and an enhanced glucagon/insulin ratio, compared to that observed after the ingestion of 50 g of glucose. Daily administration of the syrup to Wistar rats for 10 days lowered fat depots in the liver, reduced liver glycogen, promoted fat oxidation, and was devoid of toxic effects. In addition, this repeated administration of the syrup improved glucose handling after a glucose (2 g/kg) load. Overall, this alternative functional sweetener retains the natural palatability of a glucose/fructose syrup while displaying beneficial metabolic effects that might serve to protect against the progression towards complicated obesity, especially the development of liver steatosis.
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Affiliation(s)
- Juan A. Navarro
- Laboratorio de Medicina Regenerativa, Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (J.D.); (D.M.-V.); (R.T.); (A.J.L.-G.); (J.S.); (F.J.P.); (A.S.); (M.d.C.)
- Facultad de Medicina, Campus de Teatinos s/n, Universidad de Málaga, 29010 Málaga, Spain
| | - Juan Decara
- Laboratorio de Medicina Regenerativa, Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (J.D.); (D.M.-V.); (R.T.); (A.J.L.-G.); (J.S.); (F.J.P.); (A.S.); (M.d.C.)
| | - Dina Medina-Vera
- Laboratorio de Medicina Regenerativa, Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (J.D.); (D.M.-V.); (R.T.); (A.J.L.-G.); (J.S.); (F.J.P.); (A.S.); (M.d.C.)
- Facultad de Medicina, Campus de Teatinos s/n, Universidad de Málaga, 29010 Málaga, Spain
- Unidad de Gestión del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Facultad de Ciencias, Campus de Teatinos s/n, Universidad de Málaga, 29010 Málaga, Spain
| | - Ruben Tovar
- Laboratorio de Medicina Regenerativa, Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (J.D.); (D.M.-V.); (R.T.); (A.J.L.-G.); (J.S.); (F.J.P.); (A.S.); (M.d.C.)
- Facultad de Medicina, Campus de Teatinos s/n, Universidad de Málaga, 29010 Málaga, Spain
| | - Antonio J. Lopez-Gambero
- Laboratorio de Medicina Regenerativa, Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (J.D.); (D.M.-V.); (R.T.); (A.J.L.-G.); (J.S.); (F.J.P.); (A.S.); (M.d.C.)
- Facultad de Ciencias, Campus de Teatinos s/n, Universidad de Málaga, 29010 Málaga, Spain
| | - Juan Suarez
- Laboratorio de Medicina Regenerativa, Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (J.D.); (D.M.-V.); (R.T.); (A.J.L.-G.); (J.S.); (F.J.P.); (A.S.); (M.d.C.)
- Departamento de Anatomía Humana, Medicina Legal e Historia de la Ciencia, Universidad de Málaga, 29010 Málaga, Spain
| | - Francisco Javier Pavón
- Laboratorio de Medicina Regenerativa, Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (J.D.); (D.M.-V.); (R.T.); (A.J.L.-G.); (J.S.); (F.J.P.); (A.S.); (M.d.C.)
- Unidad de Gestión del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Antonia Serrano
- Laboratorio de Medicina Regenerativa, Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (J.D.); (D.M.-V.); (R.T.); (A.J.L.-G.); (J.S.); (F.J.P.); (A.S.); (M.d.C.)
| | - Marialuisa de Ceglia
- Laboratorio de Medicina Regenerativa, Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (J.D.); (D.M.-V.); (R.T.); (A.J.L.-G.); (J.S.); (F.J.P.); (A.S.); (M.d.C.)
| | - Carlos Sanjuan
- Euronutra S.L. Calle Johannes Kepler, 3, 29590 Málaga, Spain; (C.S.); (Y.A.B.)
| | | | - Elena Baixeras
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Málaga, 29010 Málaga, Spain
- Correspondence: (E.B.); (F.R.d.F.); Tel.: +34-655373093 (E.B.); +34-669426548 (F.R.d.F.)
| | - Fernando Rodríguez de Fonseca
- Laboratorio de Medicina Regenerativa, Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (J.D.); (D.M.-V.); (R.T.); (A.J.L.-G.); (J.S.); (F.J.P.); (A.S.); (M.d.C.)
- Correspondence: (E.B.); (F.R.d.F.); Tel.: +34-655373093 (E.B.); +34-669426548 (F.R.d.F.)
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Kobel S, Wartha O, Dreyhaupt J, Feather KE, Steinacker JM. Intervention effects of a school-based health promotion programme on children’s nutrition behaviour. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01726-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Aim
The programme “Join the Healthy Boat” promotes amongst other things a healthy diet in primary school children. In order to evaluate the programme’s effectiveness, this study longitudinally investigated children’s nutrition behaviour.
Subject and methods
A total of 1564 children (7.1 ± 0.6 years) participated in a cluster-randomised study. Teachers delivered lessons including behavioural contracting and budgeting. Nutritional behaviours of parents and child were assessed via parental report. Anthropometrics were measured on site.
Results
After one year, children in the intervention group (IG) showed a significant reduction in the consumption of pure juices (p ≤ 0.001). Soft drink consumption reduced in both groups, although with a trend towards a slightly greater reduction in the IG. Children with fathers of normal weight as well as first graders showed a significant reduction of soft drink consumption in the IG (p = 0.025 and p = 0.022 respectively). Fruit and vegetable intake increased significantly for first graders (p = 0.050), children from families with a high parental education level (p = 0.023), and for children with an overweight father (p = 0.034). Significant group differences were found for fruit and vegetable intake of children with migration background (p = 0.01) and children of parents with a high school degree could be observed (p = 0.019).
Conclusion
This shows that the programme appeals to a wider range of children, and is therefore more likely to compensate for differences due to origin or other social inequalities, which also shows that active parental involvement is vital for successful interventions.
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Carlsson S. Lifestyle or Environmental Influences and Their Interaction With Genetic Susceptibility on the Risk of LADA. Front Endocrinol (Lausanne) 2022; 13:917850. [PMID: 35846274 PMCID: PMC9276967 DOI: 10.3389/fendo.2022.917850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background LADA is a common form of diabetes described as a mix between type 1 and type 2 diabetes. Understanding of how genes and environmental factors interact in the development of LADA is central for future efforts to prevent the disease. This review aims to synthesize the literature on lifestyle factors linked to LADA risk and discuss their potential interaction with genetic susceptibility. Findings Current knowledge on environmental risk factors for LADA is primarily based on observational data from Scandinavian populations. Increasing evidence suggest that lifestyle factors promoting type 2 diabetes such as obesity, sedentariness, low birth weight and smoking, is implicated in the risk of LADA. Data from mendelian randomization studies support that the link between LADA and obesity, low birth weight and smoking is causal. Limited evidence indicates that dietary factors including consumption of red meat, coffee and sweetened beverages may increase the risk while consumption of alcohol and omega-3 fatty acids may reduce the risk. Several lifestyle factors, including smoking and obesity, seem to interact with human leukocyte antigen genes associated with autoimmunity, conferring much stronger effects on disease risk among those exposed to both factors. Summary Available studies suggest that lifestyle modification has the potential for prevention of LADA, particularly for individuals with high risk of disease such as those with genetic susceptibility. Research into risk factors of LADA is however limited, confirmations are warranted, many factors remain to be explored, and there is a need for intervention studies to assess causality.
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Affiliation(s)
- Sofia Carlsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Donini LM, Penzavecchia C, Muzzioli L, Poggiogalle E, Giusti AM, Lenzi A, Pinto A. Efficacy of front-of-pack nutrition labels in improving health status. Nutrition 2022; 102:111770. [DOI: 10.1016/j.nut.2022.111770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/10/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022]
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Vellakkal S, Khan Z, Alavani H, Fledderjohann J, Stuckler D. Effects of public policies in the prevention of cardiovascular diseases: a systematic review of global literature. Public Health 2022; 207:73-81. [PMID: 35567826 DOI: 10.1016/j.puhe.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/28/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Given the growing interest worldwide in applying public policies to improve human health, we undertook a systematic review of studies investigating whether public policies targeting unhealthy products could reduce cardiovascular diseases. STUDY DESIGN This study was a systematic review of the literature. METHODS We searched research studies published in 2000-2020 from major databases, including MEDLINE and Embase. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and narratively synthesized the studies based on vote counting and direction of the intervention effect. RESULTS Ninety-eight studies, mostly from high-income countries, met the inclusion criteria. Most studies were on public policies targeting sugar-sweetened beverages and tobacco, followed by alcohol, sugar, salt, and junk foods. Overall, many reported that several fiscal, regulatory, and educational policies generated beneficial effects of reducing the diseases. Those studies that reported no or limited effects highlighted several sociodemographic and health risk characteristics and design and implementation aspects of the policy interventions as factors limiting the policy effects; most of these are modifiable with appropriate policy interventions. For instance, low magnitude of tax, substitution with other unhealthy products, firms' competitive response strategies, pre-existence of smoking bans, incremental enactment of smoking regulations, degree of enforcement, and various sociocultural factors minimized the effects of the policies. CONCLUSION The literature supports a growing consensus on the beneficial effects of public policy for improving human health. The design and implementation of public policies must address various impeding factors and incorporate appropriate remedial measures. Further research is needed from low- and middle-income countries and on whether and how multiple policy instruments work in tandem.
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Affiliation(s)
- S Vellakkal
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kalyanpur, Uttar Pradesh, India.
| | - Z Khan
- IIPH Bhubaneshwar, Bhubaneshwar, Odisha, India
| | - H Alavani
- Department of Economics and Finance, BITS Pilani, KK Birla Goa Campus, Zuarinagar, Goa, India
| | - J Fledderjohann
- Department of Sociology, Lancaster University, Lancaster, UK
| | - D Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
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Giussani M, Lieti G, Orlando A, Parati G, Genovesi S. Fructose Intake, Hypertension and Cardiometabolic Risk Factors in Children and Adolescents: From Pathophysiology to Clinical Aspects. A Narrative Review. Front Med (Lausanne) 2022; 9:792949. [PMID: 35492316 PMCID: PMC9039289 DOI: 10.3389/fmed.2022.792949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/21/2022] [Indexed: 01/09/2023] Open
Abstract
Arterial hypertension, dyslipidemia, alterations in glucose metabolism and fatty liver, either alone or in association, are frequently observed in obese children and may seriously jeopardize their health. For obesity to develop, an excessive intake of energy-bearing macronutrients is required; however, ample evidence suggests that fructose may promote the development of obesity and/or metabolic alterations, independently of its energy intake. Fructose consumption is particularly high among children, because they do not have the perception, and more importantly, neither do their parents, that high fructose intake is potentially dangerous. In fact, while this sugar is erroneously viewed favorably as a natural nutrient, its excessive intake can actually cause adverse cardio-metabolic alterations. Fructose induces the release of pro-inflammatory cytokines, and reduces the production of anti-atherosclerotic cytokines, such as adiponectin. Furthermore, by interacting with hunger and satiety control systems, particularly by inducing leptin resistance, it leads to increased caloric intake. Fructose, directly or through its metabolites, promotes the development of obesity, arterial hypertension, dyslipidemia, glucose intolerance and fatty liver. This review aims to highlight the mechanisms by which the early and excessive consumption of fructose may contribute to the development of a variety of cardiometabolic risk factors in children, thus representing a potential danger to their health. It will also describe the main clinical trials performed in children and adolescents that have evaluated the clinical effects of excessive intake of fructose-containing drinks and food, with particular attention to the effects on blood pressure. Finally, we will discuss the effectiveness of measures that can be taken to reduce the intake of this sugar.
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Affiliation(s)
- Marco Giussani
- Cardiologic Unit, Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulia Lieti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonina Orlando
- Cardiologic Unit, Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), Milan, Italy
| | - Gianfranco Parati
- Cardiologic Unit, Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), Milan, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Simonetta Genovesi
- Cardiologic Unit, Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), Milan, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Arroyo-Quiroz C, Brunauer R, Alavez S. Sugar-Sweetened Beverages and Cancer Risk: A Narrative Review. Nutr Cancer 2022; 74:3077-3095. [PMID: 35486421 DOI: 10.1080/01635581.2022.2069827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cancer continues to be a major public health challenge worldwide, not only for being one of the leading causes of death but also because the number of incident cases is projected to grow in the next decades. Meanwhile, sugar-sweetened beverages (SSB) consumption has risen since the past century and constitutes a considerable fraction of added sugars in daily diet. Several studies have analyzed the relationship between SSB intake and health and found substantial evidence for effects on obesity, type 2 diabetes and metabolic syndrome. However, there is little knowledge about the relationship of SSB with cancer risk. It may be speculated that there is an indirect relationship between SSB and cancer through obesity and metabolic syndrome, but obesity-independent associations through hormonal imbalances or chronic inflammation could also exist. In this review, we describe the epidemiological evidence of the association of SSB and the risk of cancer in adults. Although the epidemiological evidence linking SSB consumption and cancer risk is still limited, prospective studies suggest that high SSB intake may increase the risk of obesity-related cancers, breast and prostate cancer.
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Affiliation(s)
- Carmen Arroyo-Quiroz
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana, Lerma de Villada, Mexico
| | - Regina Brunauer
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Silvestre Alavez
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana, Lerma de Villada, Mexico.,Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México, México City, Mexico
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Bragg MA, Rummo PE, Greene T, Arshonsky J, Anekwe AV, Mezzacca TA, Farley SM. Beverage Availability and Price: Variations by Neighborhood Poverty Level in New York City. Health Equity 2022; 6:322-329. [PMID: 35557551 PMCID: PMC9081063 DOI: 10.1089/heq.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To describe the variability in the availability and price of sugary drinks, low-calorie drinks, and water/seltzer across high- and low-poverty census tracts in the five boroughs of New York City (NYC). Design Cross-sectional study. Our primary analysis compared the overall sample of beverages. Secondary analyses included tests for differences in the availability of beverage categories by neighborhood poverty level. Setting We collected data from 106 stores (31 supermarkets, 29 convenience stores, 29 pharmacies, 9 Targets, and 8 Dollar Trees) in NYC. Fifty-four stores were located in high-poverty census tracts and 52 were located in low-poverty census tracts. Results The mean Price per 0.03-liter of sugary drinks across the sample was $0.08, which was significantly higher than the price of low-calorie drinks ($0.07, p=0.01) but not different from water/seltzer ($0.08, p=0.65). Sugary drinks and water/seltzer were available in 91% of retailers, and low-calorie drinks were available in 87% of retailers. There was no statistical difference in availability of sugary drinks compared with low-calorie drinks or water/seltzer overall or within high- or low-poverty census tracts. Analyzed by store type, the mean price per ounce of sugary drinks differed significantly from water/seltzer at convenience stores, pharmacies, and Target stores (bodegas: $0.08 vs. $0.09, p=0.03; pharmacies: $0.11 vs. $0.08, p=0.02; Target stores: $0.07 vs. $0.09, p=0.01). Conclusions Sugary drinks were available in most food retail settings in NYC, with little variation by census tract poverty level. Interventions that raise the price of sugary drinks to make healthier alternatives, such as water, the more affordable option should be considered.
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Affiliation(s)
- Marie A. Bragg
- Department of Population Health, New York University School of Medicine, New York, New York, USA
- New York University College of Global Public Health, New York, New York, USA
| | - Pasquale E. Rummo
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Tenay Greene
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Josh Arshonsky
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Amaka V. Anekwe
- New York City Department of Health and Mental Hygiene, Bureau of Chronic Disease Prevention and Tobacco Control, Long Island City, New York, USA
| | | | - Shannon M. Farley
- ICAP, Columbia University, Columbia University Mailman School of Public Health, New York, NY USA
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Viveros-Watty PE, López-Franco O, Zepeda RC, Aguirre G, Rodríguez-Alba JC, Gómez-Martínez MA, Castillo-Martínez L, Flores-Muñoz M. Effects on cardiometabolic risk factors after reduction of artificially sweetened beverage consumption in overweight subjects. A randomised controlled trial. ENDOCRINOL DIAB NUTR 2022; 69:168-177. [PMID: 35396115 DOI: 10.1016/j.endien.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/23/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The consumption of artificially sweetened beverages (ASBs) has been linked to metabolic alterations. The effect of reducing the regular consumption of these beverages on the metabolism is currently unknown. OBJECTIVE To evaluate the effect of reducing consumption of ASBs on the metabolism in overweight young adults. DESIGN A randomised, single-blind, controlled, 12-week, clinical trial was performed in overweight young adults who regularly consume ASBs. The 45 subjects who participated in the study were randomly divided into two groups: (1) control group (n=21) and (2) intervention group (no intake of ASBs, n=24). Body weight and composition, fasting plasma concentrations of glucose, triglycerides, insulin, cholesterol, low-density lipoproteins and high-density lipoproteins were measured at the beginning and end of the study. and the HOMA-IR was calculated. RESULTS At the end of 12 weeks, the intervention group showed a significant decrease (as opposed to an increase in the control group) in the percentage of change in body weight (-1.22% vs 1.31%, p<0.004), body fat (-6.28% vs 6.15%, p<0.001) and insulin resistance index (-12.06 vs 38.21%, p<0.00002), as well as in levels of glucose (-4.26% vs 0.51%, p<0.05), triglycerides (-14.74% vs 19.90%, p<0.006), insulin (-8.02% vs 39.23%, p<0.00005), cholesterol (-8.71% vs 0.77%, p<0.01) and LDL (-9.46% vs 9.92%, p<0.004). CONCLUSION A reduction in habitual consumption of ASBs in overweight young adults decreases biochemical measurements, body weight and composition, suggesting a participation in the metabolic processes.
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Affiliation(s)
- Paulina E Viveros-Watty
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Oscar López-Franco
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Rossana C Zepeda
- Laboratorio de Biomedicina Integral y Salud. Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa Enríquez, Xalapa, Veracruz, Mexico
| | - Gisela Aguirre
- Laboratorio de Innovación en Diagnóstico Molecular Hakken Enterprise, Morelos, Mexico
| | - Juan C Rodríguez-Alba
- Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Unidad de Citometría de Flujo, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Manuel A Gómez-Martínez
- Clínica de Insuficiencia Cardiaca y Respiratoria, Departamento de Cardiología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosio Villegas", Ciudad de México, Mexico
| | - Lilia Castillo-Martínez
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Mónica Flores-Muñoz
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico.
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Dillard JP, Li SS, Cannava K. Talking about Sugar-Sweetened Beverages: Causes, Processes, and Consequences of Campaign-Induced Interpersonal Communication. HEALTH COMMUNICATION 2022; 37:316-326. [PMID: 33124466 DOI: 10.1080/10410236.2020.1838107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Media campaigns may influence audience members directly, via message exposure, or indirectly, via conversations about the campaign. Either process has the potential to produce persuasion or counter-persuasion (i.e., boomerang). A laboratory experiment (N = 297) was conducted in which individuals viewed three anti-sugar-sweetened beverage PSAs under three conditions: Prompt (discussion allowed with instructions to evaluate the effectiveness of the PSAs), no prompt (discussion allowed, but not guided), and discussion not allowed. Conversations between dyad members were coded for quantity of on-topic talk and frequency of cognitive process words (e.g., because, therefore). Results showed persuasion and counter-persuasion via direct and indirect processes. On-topic talk and cognitive process words predicted intentions to reduce beverage consumption among heavy drinkers. The study is among the few to examine conversations provoked by media messages and to demonstrate how an experimental manipulation can guide the quantity and quality of those interactions.
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Affiliation(s)
- James Price Dillard
- Department of Communication Arts & Sciences, The Pennsylvania State University
| | - Shu Scott Li
- Department of Communication Arts & Sciences, The Pennsylvania State University
| | - Kaitlin Cannava
- Department of Communication Arts & Sciences, The Pennsylvania State University
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Thow AM, Rippin HL, Mulcahy G, Duffey K, Wickramasinghe K. Sugar-sweetened beverage taxes in Europe: learning for the future. Eur J Public Health 2022; 32:273-280. [PMID: 35218361 PMCID: PMC8975536 DOI: 10.1093/eurpub/ckab211] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Sugar-sweetened beverage (SSB) taxes are recommended globally as part of measures to prevent diet-related NCDs. However, their uptake in the World Health Organization (WHO) European Region has been limited. The aim of this study was to inform strategic, cross-sectoral, public health policy engagement to support the uptake and effective implementation of SSB taxation. Methods We conducted a policy analysis of SSB taxes in the WHO European Region, drawing on theories of policy making and diffusion of innovation. Data were collected from policy documents and media, secondary contextual sources and qualitative interview data (n = 20) to analyze factors influencing the adoption of taxes in 10 countries. Results Belgium, Finland, France, Hungary, Ireland, Latvia, Monaco, Norway, Portugal and the UK had current SSB taxes, but Monaco was excluded from the findings due to its unique taxation context. All countries were characterized by policy priority for NCD prevention, and in many there was a fiscal imperative to raise revenue. The taxes took the form of excises or levies, and the tax base and rate varied between countries. SSB taxation was fostered by constructive engagement between health and fiscal policy makers, but also influenced by external industry and public health stakeholders. Policy learning from national and international experience was evident in all countries. Conclusions This study points to the value of ongoing policy learning for improving tax design, and the importance of constructive collaboration between finance and health policy makers. It also suggests regional bodies could play a greater role in supporting SSB taxation.
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Affiliation(s)
- Anne Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Holly L Rippin
- WHO European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Georgina Mulcahy
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Keeva Duffey
- WHO European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Kremlin Wickramasinghe
- WHO European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
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Aggarwal M, Freeman AM, Ros E, Allen K, Sikand G, Aspry K, Kris-Etherton P, Devries S, Reddy K, Singh T, Litwin SE, O'Keefe J, Miller M, Andrus B, Blankstein R, Batiste C, Belardo D, Wenger C, Batts T, Barnard ND, White BA, Ornish D, Williams KA, Ostfeld RJ. Trending Nutrition Controversies #3: Top Controversies in 2021. Am J Med 2022; 135:146-156. [PMID: 34509452 DOI: 10.1016/j.amjmed.2021.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/27/2022]
Abstract
Each year, patients are bombarded with diverging and even contradictory reports concerning the impact of certain additives, foods, and nutrients on cardiovascular health and its risk factors. Accordingly, this third review of nutrition controversies examines the impact of artificial sweeteners, cacao, soy, plant-based meats, nitrates, and meats from grass compared to grain-fed animals on cardiovascular and other health outcomes with the goal of optimizing clinician-led diet counseling.
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Affiliation(s)
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo
| | - Emilio Ros
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic, Barcelona and Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Geeta Sikand
- Heart Disease Prevention Program, University of California Irvine, Irvine
| | - Karen Aspry
- Division of Cardiology, Lifespan Cardiovascular Institute, and Brown University, Providence, RI
| | | | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Ill; Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Koushik Reddy
- Division of Cardiology, James A Haley VA Medical Center, University of South Florida, Tampa
| | - Tamanna Singh
- Division of Cardiovascular Medicine, Heart, Vascular, Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sheldon E Litwin
- Division of Cardiology, University of South Carolina, Charleston; Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC
| | - James O'Keefe
- Saint Luke's Mid America Heart Institute, Kansas City, Mo
| | - Michael Miller
- Division of Cardiology, University of Maryland School of Medicine, Baltimore
| | - Bruce Andrus
- Division of Cardiology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Ron Blankstein
- Division of Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Columbus Batiste
- Division of Cardiology, Kaiser Permanente Riverside Medical Center, Riverside, Calif
| | | | | | - Travis Batts
- Division of Cardiology, Department of Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, Tex
| | - Neal D Barnard
- Adjunct Faculty, George Washington University School of Medicine, Washington, DC; Physici Committee for Responsible Medicine, Washington, DC
| | - Beth A White
- Division of Cardiology, Marshall Health/Joan C. Edward School of Medicine, Huntington, WV
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, Calif; Deparment of Medicine, University of California, San Francisco, San Francisco
| | - Kim A Williams
- Division of Cardiology, Rush University Medical Center, Chicago, Ill
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Stevioside ameliorates hyperglycemia and glucose intolerance, in a diet-induced obese zebrafish model, through epigenetic, oxidative stress and inflammatory regulation. Obes Res Clin Pract 2022; 16:23-29. [PMID: 35031270 DOI: 10.1016/j.orcp.2022.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 09/07/2021] [Accepted: 01/06/2022] [Indexed: 02/07/2023]
Abstract
Obesity is an independent risk factor for type 2 diabetes and epigenetic regulatory mechanisms affect obesity-related mechanisms. Due to weight gain concern in society, artificial sweeteners with no nutritional value have been increasingly consumed. Stevia is a sweet natural glycoside and a calorie-free sweetner extracted from the leaves of Stevia rebaudiana Bertoni and used as a substitute for artificial sweetners. This study evaluates the effects of stevioside on glucose tolerance, epigenetic and metabolic regulators of insulin resistance, oxidant-antioxidant status and tissue histology in a diet-induced obese (DIO) zebrafish model. After 15 days of overfeeding body weight, and fasting blood glucose, lipid peroxidation and nitric oxide levels and the expressions of fbf21, lepa, ll21, tnfα were elevated, where as there was impaired glucose tolerance and lower superoxide dismutase and glutathione S-transferase activities, dnmt3a expression which is an epigenetic tool of insulin resistance. Beneficial effects of stevioside were observed on glucose tolerance, oxidative stress and inflammatory mediators linking obesity to insulin resistance and its epigenetic regulation, in DIO model.
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Zhilinskaya N, Atayev M, Ivanchenko O, Kuznetsova T, Musta N, Blandov A. Comparative study of micronutrient content in soft rice beverages based on green and black tea. BIO WEB OF CONFERENCES 2022. [DOI: 10.1051/bioconf/20224802009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Soft beverages based on rice (“rice milk”) are hypoallergenic, increase immunity, supply the body with energy, and normalize the nervous system. Earlier, we developed soft rice beverage recipes based on boiled rice filtrate, green (black) tea water concentrate, stevia extract as a natural sweetener. Physico-chemical analysis of the content of micronutrients in soft rice-tea beverages was carried out. Comparative analysis of content of vitamins E (alpha-tocopherol) and C (ascorbic acid) showed that vitamins are presented in both types of beverages during production, but in different amounts. The rice beverage combined with green tea concentrate contains 1.33 times more potassium ions and 1.13 times less magnesium ions than the beverage based on black tea. The rice beverage combined with black tea contains 3.81 times more sodium ions compared to the beverage based on green tea. There were no significant differences in the number of magnesium ions. Both samples contained traces of manganese and iron ions. The produced soft rice-tea beverages with stevia extract could be recommended as a functional food.
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Hosseinpour-Niazi S, Aghayan M, Mirmiran P, Azizi F. Does weight change modify the association between the consumption of sugar-sweetened beverages and 100% fruit juice and the risk of metabolic syndrome? Clin Nutr 2021; 40:5261-5268. [PMID: 34534895 DOI: 10.1016/j.clnu.2021.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 08/02/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND & AIMS This study aimed to determine the prospective relationship between the consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice and metabolic syndrome (MetS) and to investigate whether weight change can modify this association in a representative sample of the population of Tehran, Iran. METHODS In this 8.9-year follow-up study, the consumption of SSBs and 100% fruit juice by 1915 individuals, who participated in Tehran Lipid and Glucose Study (TLGS), was examined using a validated food frequency questionnaire. The MetS was defined according to the Joint Interim Statement. Participants were categorized as those who lost weight (≥-2%), those with weight stability (-1.9%-1.9%), and those who gained weight (≥2%). The Cox regression model was used to determine the relationship between the consumption of SSBs and 100% fruit juice and the risk of MetS and weight gain ≥2%. Also, the modifying effect of weight change including weight loss, weight stability and weight gain on the relationship between SSBs and 100% fruit juice consumption and the incidence of MetS was assessed. RESULTS There was no significant association between the consumption of SSBs and the risk of MetS in the crude model; however, after adjustments for confounders, a significant positive association was found between the consumption of SSBs and the risk of MetS (HR: 1.33; 95% CI: 1.07-1.66). Also, no significant association was observed between the consumption of 100% fruit juice and the risk of MetS in the crude model. However, after adjustments for the potential confounders, 100% fruit juice was inversely associated with the MetS risk (HR: 0.78; 95% CI: 0.63-0.95). The consumption of SSBs and 100% fruit juice was positively associated with weight gain (≥2% during the follow-up). Nevertheless, after adjustments for lifestyle and dietary factors, there was no significant association between the consumption of SSBs and weight gain. On the other hand, the consumption of 100% fruit juice was positively associated with the increased risk of weight gain (HR: 1.41; 95% CI: 1.20-1.65). Among participants with weight loss, the first, second and third tertiles of 100% fruit juice reduced the risk of MetS by 29% (HR: 0.71; 95% CI: 0.51-0.99), 47% (HR: 0.53; 95% CI: 0.37-0.75) and 35% (HR: 0.65; 95% CI: 0.46-0.92), respectively. CONCLUSION Although 100% fruit juice reduced the risk of MetS, its consumption must be limited due to its positive effect on weight gain. On the other hand, the consumption of 100% fruit juice reduced the risk of MetS, depending on the individual's weight change. Also, high consumption of SSBs was associated with the incidence of MetS.
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Affiliation(s)
- Somayeh Hosseinpour-Niazi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Aghayan
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Tseng TS, Lin WT, Gonzalez GV, Kao YH, Chen LS, Lin HY. Sugar intake from sweetened beverages and diabetes: A narrative review. World J Diabetes 2021; 12:1530-1538. [PMID: 34630905 PMCID: PMC8472506 DOI: 10.4239/wjd.v12.i9.1530] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/05/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is one of the fastest growing public health concerns around the world. Sugar-sweetened beverage (SSB) consumption has been proven to be associated with adverse health consequences in the diabetic population. Reducing SSB consumption, body weight control, healthy diets, and increased physical activity have been suggested as strategies to improve diabetes prevention and management. This literature review provides an overview of: (1) The association between SSB consumption and the risk of T2DM; (2) Types of SSB consumption and T2DM; (3) The effect of obesity and inflammation on the association between SSB consumption and risk of T2DM; and (4) SSB consumption in T2DM patients. There is still work to be done to determine how SSB consumption is related to T2DM, but the current research on identifying the association between SSB consumption and T2DM is promising, with the most promising studies confirming the connection between SSBs, T2DM risk, and diabetes management. Future studies should explore more effective SSB related diabetes prevention and management interventions.
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Affiliation(s)
- Tung-Sung Tseng
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Wei-Ting Lin
- Department of Global Community Health and Behavioral Sciences, School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA 70112, United States
| | - Gabrielle V Gonzalez
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Yu-Hsiang Kao
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Lei-Shih Chen
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, United States
| | - Hui-Yi Lin
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
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Andrade L, Lee KM, Sylvetsky AC, Kirkpatrick SI. Low-calorie sweeteners and human health: a rapid review of systematic reviews. Nutr Rev 2021; 79:1145-1164. [PMID: 33236063 DOI: 10.1093/nutrit/nuaa123] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSION Continued research on the long-term health impacts of low-calorie sweeteners across all life stages is warranted.
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Affiliation(s)
- Lesley Andrade
- the School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kirsten M Lee
- the School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Allison C Sylvetsky
- the Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Sharon I Kirkpatrick
- the School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Meng Y, Li S, Khan J, Dai Z, Li C, Hu X, Shen Q, Xue Y. Sugar- and Artificially Sweetened Beverages Consumption Linked to Type 2 Diabetes, Cardiovascular Diseases, and All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Nutrients 2021; 13:2636. [PMID: 34444794 PMCID: PMC8402166 DOI: 10.3390/nu13082636] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022] Open
Abstract
Although studies have examined the association between habitual consumption of sugar- (SSBs) and artificially sweetened beverages (ASBs) and health outcomes, the results are inconclusive. Here, we conducted a dose-response meta-analysis of prospective cohort studies in order to summarize the relationship between SSBs and ASBs consumption and risk of type 2 diabetes (T2D), cardiovascular diseases (CVDs), and all-cause mortality. All relevant articles were systematically searched in PubMed, Embase, and Ovid databases until 20 June 2020. Thirty-four studies met the inclusion criteria and were eligible for analysis. Summary relative risks (RRs) and 95% confidence intervals (95% CI) were estimated using random effects or fixed-effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships. With each additional SSB and ASB serving per day, the risk increased by 27% (RR: 1.27, 95%CI: 1.15-1.41, I2 = 80.8%) and 13% (95%CI: 1.03-1.25, I2 = 78.7%) for T2D, 9% (RR: 1.09, 95%CI: 1.07-1.12, I2 = 42.7%) and 8% (RR: 1.08, 95%CI: 1.04-1.11, I2 = 45.5%) for CVDs, and 10% (RR: 1.10, 95%CI: 0.97-1.26, I2 = 86.3%) and 7% (RR: 1.07, 95%CI: 0.91-1.25, I2 = 76.9%) for all-cause mortality. Linear relationships were found for SSBs with T2D and CVDs. Non-linear relationships were found for ASBs with T2D, CVDs, and all-cause mortality and for SSBs with all-cause mortality. The findings from the current meta-analysis indicate that increased consumption of SSBs and ASBs is associated with the risk of T2D, CVDs, and all-cause mortality.
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Affiliation(s)
- Yantong Meng
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Siqi Li
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Jabir Khan
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Zijian Dai
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Chang Li
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Xiaosong Hu
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
| | - Qun Shen
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
- Key Laboratory of Plant Protein and Grain Processing, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - Yong Xue
- National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (Y.M.); (S.L.); (J.K.); (Z.D.); (C.L.); (X.H.)
- Key Laboratory of Plant Protein and Grain Processing, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
- Xinghua Industrial Research Centre for Food Science and Human Health, China Agricultural University, Xinghua 225700, China
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Viveros-Watty PE, López-Franco O, Zepeda RC, Aguirre G, Rodríguez-Alba JC, Gómez-Martínez MA, Castillo-Martínez L, Flores-Muñoz M. Effects on cardiometabolic risk factors after reduction of artificially sweetened beverage consumption in overweight subjects. A randomised controlled trial. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00159-2. [PMID: 34274304 DOI: 10.1016/j.endinu.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The consumption of artificially sweetened beverages (ASBs) has been linked to metabolic alterations. The effect of reducing the regular consumption of these beverages on the metabolism is currently unknown. OBJECTIVE To evaluate the effect of reducing consumption of ASBs on the metabolism in overweight young adults. DESIGN A randomised, single-blind, controlled, 12-week, clinical trial was performed in overweight young adults who regularly consume ASBs. The 45 subjects who participated in the study were randomly divided into two groups: (1) control group (n=21) and (2) intervention group (no intake of ASBs, n=24). Body weight and composition, fasting plasma concentrations of glucose, triglycerides, insulin, cholesterol, low-density lipoproteins and high-density lipoproteins were measured at the beginning and end of the study. and the HOMA-IR was calculated. RESULTS At the end of 12 weeks, the intervention group showed a significant decrease (as opposed to an increase in the control group) in the percentage of change in body weight (-1.22% vs 1.31%, p<0.004), body fat (-6.28% vs 6.15%, p<0.001) and insulin resistance index (-12.06 vs 38.21%, p<0.00002), as well as in levels of glucose (-4.26% vs 0.51%, p<0.05), triglycerides (-14.74% vs 19.90%, p<0.006), insulin (-8.02% vs 39.23%, p<0.00005), cholesterol (-8.71% vs 0.77%, p<0.01) and LDL (-9.46% vs 9.92%, p<0.004). CONCLUSION A reduction in habitual consumption of ASBs in overweight young adults decreases biochemical measurements, body weight and composition, suggesting a participation in the metabolic processes.
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Affiliation(s)
- Paulina E Viveros-Watty
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Oscar López-Franco
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Rossana C Zepeda
- Laboratorio de Biomedicina Integral y Salud. Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa Enríquez, Xalapa, Veracruz, Mexico
| | - Gisela Aguirre
- Laboratorio de Innovación en Diagnóstico Molecular Hakken Enterprise, Morelos, Mexico
| | - Juan C Rodríguez-Alba
- Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Unidad de Citometría de Flujo, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Manuel A Gómez-Martínez
- Clínica de Insuficiencia Cardiaca y Respiratoria, Departamento de Cardiología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosio Villegas", Ciudad de México, Mexico
| | - Lilia Castillo-Martínez
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Mónica Flores-Muñoz
- Laboratorio de Medicina Traslacional, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico; Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa, Veracruz, Mexico.
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50
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Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus. ENDOCRINOL DIAB NUTR 2021; 68:277-287. [PMID: 34266640 DOI: 10.1016/j.endien.2020.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022]
Abstract
Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity, and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis, the Spanish Diabetes Society, and the Spanish Society of Internal Medicine.
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