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Sugar and Sugar Alternatives—Consumption, Metabolism, and Weight Management

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (25 November 2022) | Viewed by 58124

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Dr. Kieron Rooney

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Associate Professor Kieron Rooney, Head of Discipline Exercise and Sport Science, Discipline of Exercise and Sport Science, Faculty of Health Sciences, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
Interests: obesity; type 2 diabetes; metabolic biochemistry; exercise physiology

Special Issue Information

Dear Colleagues,

It is my pleasure to announce this call for a Special Issue on sugar and sugar alternatives. Sugar consumption is arguably one of the most contentious topics in nutrition and public health. Some may say the debate has run its course given the fact that evidence for harm from excess sugar consumption has recently driven public health policy globally. Policies have principally focused on national guidelines directly recommending limits on “added” sugars or taxes on sugar sweetened beverages—as is the case in over 40 countries. However, it needs to be highlighted that the platform for such policy change has been driven by the metabolic and dental complications of excess sugar consumption.

For those in public facing roles, there are still many unanswered questions in the lay and scientific community regarding strategies and reasons for limiting sugar consumption. For example, what are the unintended consequences of shifting from sugar to sugar alternatives? Does sugar acutely effect mood and behavior? Is fruit juice another sugar-sweetened beverage? Have the efforts in public health policy been effective in addressing sugar consumption and weight management?

The aim of this Special Issue is to collate current evidence for such diverse effects of sugar and sugar alternatives in the context of influencing public health and clinical practice. Original articles (including prospective, retrospective, and observational trials as well as articles pertaining to policy development and implementation) as well as systematic reviews (with or without meta-analyses) will be considered. Any submissions reporting the use of animals for scientific purposes must submit a completed ARRIVE 2.0 checklist.

Dr. Kieron Rooney
Guest Editor

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Published Papers (10 papers)

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Research

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16 pages, 2775 KiB

Open AccessArticle

Switching from Sugar- to Artificially-Sweetened Beverages: A 12-Week Trial

by Michael D. Kendig, Julie Y. L. Chow, Sarah I. Martire, Kieron B. Rooney and Robert A. Boakes

Nutrients 2023, 15(9), 2191; https://doi.org/10.3390/nu15092191 - 4 May 2023

Cited by 3 | Viewed by 3027

Abstract

Background: Consumption of sugar-sweetened beverages (SSBs) forms the primary source of added sugar intake and can increase the risk of metabolic disease. Evidence from studies in humans and rodents also indicates that consumption of SSBs can impair performance on cognitive tests, but that removing SSB access can ameliorate these effects. Methods: The present study used an unblinded 3-group parallel design to assess the effects of a 12-week intervention in which young healthy adults (mean age = 22.85, SD = 3.89; mean BMI: 23.2, SD = 3.6) who regularly consumed SSBs were instructed to replace SSB intake with artificially-sweetened beverages (n = 28) or water (n = 25), or (c) to continue SSB intake (n = 27). Results: No significant group differences were observed in short-term verbal memory on the Logical Memory test or the ratio of waist circumference to height (primary outcomes), nor in secondary measures of effect, impulsivity, adiposity, or glucose tolerance. One notable change was a significant reduction in liking for strong sucrose solutions in participants who switched to water. Switching from SSBs to ‘diet’ drinks or water had no detectable impact on cognitive or metabolic health over the relatively short time frame studied here. This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615001004550; Universal Trial Number: U1111-1170-4543). Full article

(This article belongs to the Special Issue Sugar and Sugar Alternatives—Consumption, Metabolism, and Weight Management)

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13 pages, 934 KiB

Open AccessArticle

Exploring the Relationship between Sugar and Sugar Substitutes—Analysis of Income Level and Beverage Consumption Market Pattern Based on the Perspective of Healthy China

by Zeqi Liu, Shanshan Li and Jiaqi Peng

Nutrients 2022, 14(21), 4474; https://doi.org/10.3390/nu14214474 - 25 Oct 2022

Cited by 4 | Viewed by 3058

Abstract

This paper estimates the impact of income level on household beverage consumption, analyzes the consumption trends of sugar-sweetened beverages and sugar-free beverages in households, explores the future changes in the beverage consumption market pattern, and predicts the possible impact of the sugar industry on the development of sugar substitutes based on the beverage consumption data of Kantar Consumer Index in China from 2015 to 2017. The research results show that, firstly, there is an “inverted U-shaped” relationship between income level and household consumption of sugar-sweetened beverages, which indicates that as income rises, household consumption of sugar-sweetened beverages tends to increase and then decrease. Secondly, income level has a positive effect on the household consumption of sugar-free beverages. Finally, in the future stage, with the further growth of income and the promotion of a healthy China, a large amount of sugar substitutes will be added to beverages instead of the original sugar, and the relationship between sugar and sugar substitute consumption will change from complementary to substitution. The findings of this paper have implications for encouraging food and beverage suppliers to produce “healthy”, “nutritious” and “innovative” low-sugar products to meet the health needs of residents and ensure the healthy and orderly development of the sugar industry. Full article

(This article belongs to the Special Issue Sugar and Sugar Alternatives—Consumption, Metabolism, and Weight Management)

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14 pages, 1824 KiB

Open AccessArticle

Sugar Content and Warning Criteria Evaluation for Popular Sugar-Sweetened Beverages in Taipei, Taiwan

by Chieh Yen, Ya-Li Huang, Mei Chung and Yi-Chun Chen

Nutrients 2022, 14(16), 3339; https://doi.org/10.3390/nu14163339 - 15 Aug 2022

Cited by 3 | Viewed by 3317

Abstract

Sugar intake may increase the risk of obesity, cardiovascular disease, diabetes, and dental caries. In Taiwan, people frequently consume sugar-sweetened beverages (SSBs). This study explored the energy and sugar content of Taiwanese SSBs and evaluated them using the Chilean warning label system (>70 kcal/100 mL and >5 g sugar/100 mL) and the World Health Organization (WHO) sugar guideline (≤25 g sugar). A total of 341 SSBs with volumes ≤600 mL were analyzed. No significant differences were observed in sugar per serving among different types of SSBs, but a great variation in portion size (i.e., package size for individual consumption) was noted. The energy and sugar ratios per serving were lower in soft drinks and coffee and tea containing >1 serving than in those containing only one serving. The calorie and sugar ratios per portion were higher in all types of SSBs containing >1 serving per portion than in those containing exactly one serving. Approximately 70.0% of Taiwanese SSBs were classified as high sugar according to the Chilean criteria, and 41.6% of SSBs exceeded the WHO guideline. Moreover, 40.8% of SSBs that were not considered as high sugar according to the Chilean criteria contained >25 g sugar per portion. For individual consumption, it is more clear that nutrition labeling is based on portion rather than serving. Evaluating SSBs on sugar/portion rather than sugar/100 mL will help consumers make better choices. Full article

(This article belongs to the Special Issue Sugar and Sugar Alternatives—Consumption, Metabolism, and Weight Management)

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17 pages, 2001 KiB

Open AccessArticle

An Ecological Validity Model for the Prevention of Obesity: Non-Nutritive Sweetener Consumption in Rats and the Effects of Switching from Sugar-Sweetened to Diet Beverages

by Heidi Morahan and Kieron Rooney

Nutrients 2022, 14(13), 2758; https://doi.org/10.3390/nu14132758 - 3 Jul 2022

Cited by 2 | Viewed by 2284

Abstract

Reducing consumption of sugar-sweetened beverages (SSBs) has been encouraged due to its strong association with obesity. In parallel, consumption of “diet” or non-nutritive sweetened (NNS) beverages has significantly increased. This has led to burgeoning numbers of animal studies investigating metabolic consequences of NNS beverage consumption. However, most animal study designs do not reflect the way humans consume NNS drinks, thus reducing translational capacity. The present experiment aimed to find an ecologically valid model of NNS consumption and evidence of metabolic recovery following a switch from sucrose to NNS in female and male Sprague Dawley rats. The main behavioural outcome was consumption of commercially available NNS beverages during preference and acceptance testing, with changes to consumption following chronic sucrose consumption as a secondary outcome. The main metabolic outcome was retroperitoneal fat pad mass at culling, with body weight gain and fasting blood glucose levels (FBGLs) as secondary outcomes. In a two-phase experiment, behavioural tests were performed before and after 4 weeks of ad libitum access to 10% w/v sucrose. During Phase 2, the rats were given ad libitum access to assigned commercial NNS drinks for a further 4 weeks, with controls provided access to water only. FBGLs were measured at the end of Phases 1 and 2. Female and male rats accepted commercially available NNS beverages, although the volumes consumed varied considerably. Following the switch from sucrose to NNS (containing no sucrose), no group difference was observed in retroperitoneal fat mass, body weight change or FBGLs, suggesting both sexes exhibited limited metabolic recovery. These findings demonstrate that an ecologically valid model for NNS consumption can be developed for some commercially available NNS beverages to further enhance translational capacity. Full article

(This article belongs to the Special Issue Sugar and Sugar Alternatives—Consumption, Metabolism, and Weight Management)

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12 pages, 318 KiB

Open AccessArticle

Sweetness of Chilean Infants’ Diets: Methodology and Description

by Carmen Gloria González, Camila Corvalán and Marcela Reyes

Nutrients 2022, 14(7), 1447; https://doi.org/10.3390/nu14071447 - 30 Mar 2022

Cited by 3 | Viewed by 2042

Abstract

Sugars and other sweeteners contribute to the sweet taste of foods; exposure to this taste could alter appetite regulation and preferences for sweet products. Despite this, there is no widely accepted methodology for estimating overall diet sweetness. The objective of this study was to develop a methodology to estimate diet sweetness and describe diet sweetness in a cohort of Chilean infants. In order to estimate diet sweetness density, the sweetness intensity of foods was obtained from existing databases and from sensory evaluations in products with no available information and then linked to 24-h dietary recalls of infants at 12 and 36 months of age. Diet sweetness density was significantly and positively associated with total sugars and non-nutritive sweeteners intakes. The main food sources of sweetness at 12 months were fruits (27%) and beverages (19%). Sweetness density increased 40% between 12 and 36 months (from 1196 to 1673, p < 0.01), and sweetness density at both ages was significantly associated. At 36 months, beverages and dairy products were the main sources of sweetness (representing 32.2% and 28.6%, respectively). The methodology presented here to estimate the sweetness density of the diet could be useful for other studies to help elucidate different effects of exposure to high sweetness. Full article

(This article belongs to the Special Issue Sugar and Sugar Alternatives—Consumption, Metabolism, and Weight Management)

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12 pages, 426 KiB

Open AccessArticle

Water Wins, Communication Matters: School-Based Intervention to Reduce Intake of Sugar-Sweetened Beverages and Increase Intake of Water

by Tanja Kamin, Barbara Koroušić Seljak and Nataša Fidler Mis

Nutrients 2022, 14(7), 1346; https://doi.org/10.3390/nu14071346 - 23 Mar 2022

Cited by 6 | Viewed by 3276

Abstract

We compared three interventions designed for reducing the consumption of sugar-sweetened beverages (SSBs) aimed at decreasing the risk of overweight and obesity among children. We included three experimental (n = 508) and one control school (n = 164) in Slovenia (672 children; 10–16 years) to evaluate interventions that influence behaviour change via environmental (E), communication (C), or combined (i.e., double) environmental and communication approaches (EC) compared to no intervention (NOI). Data of children from the ‘intervention’ and ‘non-intervention’ schools were compared before and after the interventions. The quantity of water consumed (average, mL/day) by children increased in the C and EC schools, while it decreased in the E and NOI schools. Children in the C and EC schools consumed less beverages with sugar (SSBs + fruit juices), and sweet beverages (beverages with: sugar, low-calorie and/or noncaloric sweeteners) but consumed more juices. The awareness about the health risks of SSB consumption improved among children of the ‘combined intervention’ EC school and was significantly different from the awareness among children of other schools (p = 0.03). A communication intervention in the school environment has more potential to reduce the intake of SSBs than a sole environmental intervention, but optimum results can be obtained when combined with environmental changes. Full article

(This article belongs to the Special Issue Sugar and Sugar Alternatives—Consumption, Metabolism, and Weight Management)

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17 pages, 2189 KiB

Open AccessArticle

The Dose-Response Associations of Sugar-Sweetened Beverage Intake with the Risk of Stroke, Depression, Cancer, and Cause-Specific Mortality: A Systematic Review and Meta-Analysis of Prospective Studies

by Yuanxin Wang, Renqing Zhao, Bin Wang, Chen Zhao, Baishu Zhu and Xin Tian

Nutrients 2022, 14(4), 777; https://doi.org/10.3390/nu14040777 - 12 Feb 2022

Cited by 26 | Viewed by 6108

Abstract

The associations between sugar-sweetened beverage (SSB) consumption and the risk of stroke, depression, cancer, and cause-specific mortality have not been determined, and the quantitative aspects of this link remain unclear. This meta-analysis therefore conducted a systematic review and dose-response analysis to determine their causal links. The database searches were conducted in PubMed, Cochrane library, Embase, Web of Science up to 10 November 2021. The intervention effects were evaluated by relative risk (RR) with 95% confidences (CI). Thirty-two articles met the inclusion criteria. Higher levels of SSB consumption significantly increased the risk of stroke (RR 1.12, 95% CI 1.03–1.23), depression (1.25, 1.11–1.41), cancer (1.10, 1.03–1.17), and all-cause mortality (1.08, 1.05–1.11) compared with none or lower SSB intake. The associations were dose-dependent, with per 250 mL increment of SSB intake daily increasing the risk of stroke, depression, cancer, and all-cause mortality by RR 1.09 (1.03–1.15), 1.08 (1.06–1.10), 1.17 (1.04–1.32), and 1.07 (1.03–1.11), respectively. The link was curved for depression and cancer risk (p_non-linear < 0.05). Subgroup analysis suggested that higher SSB intake increased ischemic stroke by 10%, CVD-caused mortality by 13%, and cancer-caused mortality by 6.0% than none or lower SSB consumption. It is suggested that SSB accounts for a leading risk factor of stroke, depression, cancer, and mortality, and that the risk rises in parallel with the increment of SSB intake (and is affected by participant characteristics). Full article

(This article belongs to the Special Issue Sugar and Sugar Alternatives—Consumption, Metabolism, and Weight Management)

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13 pages, 302 KiB

Open AccessArticle

Sugar-Sweetened Beverage Consumption in Adults: Evidence from a National Health Survey in Peru

by Wilmer Cristobal Guzman-Vilca, Edwin Arturo Yovera-Juarez, Carla Tarazona-Meza, Vanessa García-Larsen and Rodrigo M. Carrillo-Larco

Nutrients 2022, 14(3), 582; https://doi.org/10.3390/nu14030582 - 28 Jan 2022

Cited by 8 | Viewed by 5086

Abstract

High consumption of sugar-sweetened beverages (SSB) is associated with a high risk of non-communicable diseases. Evidence of SSB consumption is needed to inform SSB-related policies, especially in countries with a high consumption, such as Peru. Using data from Peru’s National Health Survey conducted in 2017–2018, the consumption of homemade and ready-to-drink SSB was estimated from a single 24 h dietary recall, accounting for socio-demographic and health-related variables. Regression models were fitted to assess which variables were linked to a high/low SSB consumption. There were 913 people and mean age was 37.7 years (95% confidence interval (CI): 36.9–38.6). Mean consumption (8 oz servings/day) of homemade SSB (1.2) doubled that of ready-to-drink SSB (0.5). The intake of homemade and ready-to-drink SSB was higher in men (1.3 and 0.7) than women (1.1 and 0.3). The intake of ready-to-drink SSB was higher in urban (0.6) compared to rural (0.2) populations. People aware of having diabetes had a lower consumption of both ready-to-drink (0.9 vs. 0.4) and homemade SSB (1.3 vs. 0.8) than those unaware of having diabetes. Male sex and living in urban locations were associated with higher ready-to-drink SSB intake. Older age was associated with a higher intake of homemade SSB. Amongst Peruvian adults, the consumption of SSB products (particularly homemade) remains high. Population-wide interventions should also aim to improve awareness of the nutritional components of homemade beverages. Full article

(This article belongs to the Special Issue Sugar and Sugar Alternatives—Consumption, Metabolism, and Weight Management)

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13 pages, 332 KiB

Open AccessEditor’s ChoiceReview

Erythritol: An In-Depth Discussion of Its Potential to Be a Beneficial Dietary Component

by Tagreed A. Mazi and Kimber L. Stanhope

Nutrients 2023, 15(1), 204; https://doi.org/10.3390/nu15010204 - 1 Jan 2023

Cited by 26 | Viewed by 24519

Abstract

The sugar alcohol erythritol is a relatively new food ingredient. It is naturally occurring in plants, however, produced commercially by fermentation. It is also produced endogenously via the pentose phosphate pathway (PPP). Consumers perceive erythritol as less healthy than sweeteners extracted from plants, including sucrose. This review evaluates that perspective by summarizing current literature regarding erythritol’s safety, production, metabolism, and health effects. Dietary erythritol is 30% less sweet than sucrose, but contains negligible energy. Because it is almost fully absorbed and excreted in urine, it is better tolerated than other sugar alcohols. Evidence shows erythritol has potential as a beneficial replacement for sugar in healthy and diabetic subjects as it exerts no effects on glucose or insulin and induces gut hormone secretions that modulate satiety to promote weight loss. Long-term rodent studies show erythritol consumption lowers body weight or adiposity. However, observational studies indicate positive association between plasma erythritol and obesity and cardiometabolic disease. It is unlikely that dietary erythritol is mediating these associations, rather they reflect dysregulated PPP due to impaired glycemia or glucose-rich diet. However, long-term clinical trials investigating the effects of chronic erythritol consumption on body weight and risk for metabolic diseases are needed. Current evidence suggests these studies will document beneficial effects of dietary erythritol compared to caloric sugars and allay consumer misperceptions. Full article

(This article belongs to the Special Issue Sugar and Sugar Alternatives—Consumption, Metabolism, and Weight Management)

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7 pages, 243 KiB

Open AccessBrief Report

Consumption of Added Sugars by States and Factors Associated with Added Sugars Intake among US Adults in 50 States and the District of Columbia—2010 and 2015

by Seung Hee Lee, Sohyun Park and Heidi M. Blanck

Nutrients 2023, 15(2), 357; https://doi.org/10.3390/nu15020357 - 11 Jan 2023

Cited by 2 | Viewed by 3979

Abstract

Purpose: The high intake of added sugars from foods or beverages increases the risk of obesity, hypertension, dyslipidemia, and cardiovascular disease. Because state-level data are lacking, we estimated dietary intake of added sugars by state and factors associated with intake among US adults. Design: Nationally representative, cross-sectional, in-person, household survey. Setting: 50 states and DC. Sample: 52,279 US adults from pooled data from 2010 and 2015 National Health Interview Surveys. Measures: Estimated total added sugars intake (tsp/day) using the National Cancer Institute’s scoring algorithm that converts responses from the Dietary Survey Questionnaire screener to estimated total added sugars intake (tsp/day). Analysis: Mean dietary-added sugars intake estimates and standard error were calculated for adults’ characteristics and by state for all 50 states and the District of Columbia. Differences by adult’s characteristics were assessed by pairwise t-tests (p < 0.05). All analyses accounted for complex survey design and sampling weights. Results: Overall, US adults consumed 17.0 tsp of added sugars/day (range: 14.8 tsp/day in Alaska to 1.2 tsp/day in Kentucky). Added sugars intake varied by states and sociodemographic characteristics. Conclusion: Findings may inform efforts to reduce added sugars intake to lower the high burden of chronic disease. Full article

(This article belongs to the Special Issue Sugar and Sugar Alternatives—Consumption, Metabolism, and Weight Management)

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