CITATION & LINK: Food Funct., 2021 Advance Article https://doi.org/10.1039/D0FO02424D

AUTHORS: Dominic O’Connor, Michelle Pang, Gabriele Castelnuova, Graham Finlayson, Ellen Blaak, Catherine Gibbons, Santiago Navas-Carretero, Eva Almiron-Roig, Jo Harrold, Anne Raben, J. Alfredo Martinez

REVIEWER: Robyn Flipse, MS, MA, RDN

The greatest value of this narrative synthesis is its deliberate focus on what the body of empirical evidence currently tells us about the effects of sweeteners and sweetness enhancers on appetite and metabolism and what we still do not know.  It also sheds much needed light on why the evidence about non-caloric sweeteners (NCS) appears to be conflicting at times. This information is imperative since the use of sugar substitutes or non-caloric sweeteners (NCS) has been steadily increasing while news about their efficacy has grown more controversial.

The authors provide a clear overview of our current understanding of the role of NCS on appetite, eating behavior, food intake, hedonic reward, and sweet taste perception and on glucose homeostasis, body weight, lipid metabolism and gastrointestinal physiology. They address the great variability in the results from trials using individual NCS versus those using commercial products containing blends of sweeteners and other ingredients and those based on animals models or in vitro studies. The paper examines the results from acute and prolonged exposure, the different doses of sweeteners used in different studies, and compares both between- and within-subject outcomes. It seeks biological and psychological mechanisms to explain any adverse effects reported and the impact of subjective differences that may influence food preferences and body weight.

The authors conclude there is consensus in the literature on the potential benefits of NCS to reduce net energy intake and assist in weight management without significant negative effects on food intake behavior or body metabolism. They also conclude the mechanisms by which NCS may impact eating behavior, glucose homeostasis, insulin metabolism, adipogenesis, and the gut microbiota “remain complex and not fully understood,” and admit answering those questions becomes more challenging as the range of NCS available in the diet increases.

Overall, the information provided by this review should make it easier for health care professionals and consumers alike to make more informed decisions about how and why they might use NCS and what knowledge we can gain from further research. 

CITATION & LINK: Eur J Nutr. 2020; 59(1):249-261

AUTHORS: Aurelie Lampuré , Solia Adriouch, Katia Castetbon, Amelie Deglaire, Pascal Schlich, Sandrine Péneau, Leopold Fezeu, Serge Hercberg, Caroline Méjean

REVIEWER: Robyn Flipse, MS, MA, RDN

OBJECTIVE:

• To investigate the prospective association between individual liking for fat-and-salt, fat-and-sweet, sweet or salt and the risk of developing cardiovascular diseases (CVDs), type 2 diabetes, and hypertension and the mediating effect of dietary intake and weight status on the relationship between sensory liking and these cardiometabolic diseases (CMDs).

BACKGROUND:

• Sensory liking of fat has already been strongly associated with higher intake of dietary fat and a lower intake of nutrient-dense foods leading to increased risk of weight gain and obesity.
• No study has investigated how overall dietary intake and body mass index (BMI) might serve as potential mediators in the relationship between high liking for fat, sweet or salt and the risk of CMDs (defined as hypertension, diabetes, and CVDs in the present study).

METHODS:

• Data was collected from a cohort of the large web-based observational NutriNet-Sante study launched in France in 2009 with a 10 year follow-up. That study was designed to investigate the relationship between nutrition and health and determinants of dietary behavior and nutritional status.
• Participants in the cohort were selected from subjects who completed the PrefQuest questionnaire to assess liking for fat-and-salt, fat-and-sweet, sweet and salt and provided the required self-reported health information.  
• During the six years of the study participants completed yearly questionnaires on health status, physical activity, height and weight, socio-economic conditions, lifestyle, and randomly assigned 24-hour food intake records.
• Cox proportional hazard models were used to calculate hazard ratios and confidence intervals for the associations between sensory liking scores and risks for CMDs risk and the mediating effect of diet and BMI.

FINDINGS:

• Sensory liking for fat-and-salt was associated with an increased risk of CVD, type 2 diabetes, and hypertension. Diet and BMI substantially explained this relationship.
• Liking for fat-and-sweet and for salt were associated with an increased risk of diabetes, mainly explained by diet and BMI.
• Sweet liking was associated with a decreased risk of diabetes suggesting that the increased risk of diabetes seen in those with a liking for fat-and-sweet was more strongly associated with the fatty component.
• No relationship was found between liking for fat-and-sweet, sweet and salt and the incidence of CVD and hypertension.

CONCLUSIONS:

• The increased risk of CMDs in those with increased liking for fat-and-salt can be explained by unhealthy food choices and higher BMIs. Having knowledge of individual sensory liking can guide the preventive measures offered by practitioners to help lower these risks and allow practitioners to provide more effective dietary counseling that supports individual food preferences.

POINTS TO CONSIDER:

• The finding that a liking for sweet taste was associated with a decreased risk of diabetes and not associated with CVD or hypertension risks may indicate a healthier dietary intake from foods providing natural sweetness, such as fruits, vegetables and whole grains.

CITATION & LINK: Advances in Nutrition. 2020; 00:1-12

AUTHORS: Paula R. Trumbo, Katherine M. Appleton, Kees de Graaf, John E. Hayes, David J. Baer, Gary K. Beauchamp, Johanna T. Dwyer, John D. Fernstrom, David M. Klurfeld, Richard D. Mattes, Paul M. Wise

REVIEWER: Robyn Flipse, MS, MA, RDN

This narrative review adds critical information to our understanding of the relationship between our exposure to sweet tasting foods and beverages and their impact on diet quality and body weight. In particular, it seeks to investigate the long-standing position held by many global health agencies that overexposure to sweetness in the diet produces changes in the perception of and preference for sweet tasting foods and beverages which leads to their excess consumption and negative health outcomes.

Belief in this chain of events is the basis for the widespread recommendations to reduce the sugar content of the diet, in many cases regardless of the source of the sweetness. The expectation is that this will blunt the likelihood of developing a preference for sweets and thereby diminish the consumption of excess calories that lead to weight gain. This hypothesis, however, is not supported by empirical evidence.

What is lacking is the proof that consuming a certain amount of sweet tasting foods can produce a subsequent preference for and overconsumption of more sweet foods and the proof that consuming lesser amounts of sweet foods will result in lower caloric intake and decreased body weight.

What is needed to support this hypothesis are (1) an effective way to measure of the sweetness of the entire diet or dietary pattern, not just the sweetness of specific foods and beverages, and (2) a reliable, affordable, and easy way to measure human perception of sweetness in foods and beverages. This paper examines the available research for both objectives, and the authors conclude there are significant challenges in each pursuit. Several critical questions must be answered before researchers can begin to combine data from different studies and populations. These include “How sweetness should be defined,” “How can quantitative data on sweetness from individual foods be translated to the sweetness of a meal, entire diet, or dietary pattern?,” and “Are different ratings of sweetness due to differences in how a person perceives sweetness or how the person uses the sweetness rating tool/scale?” Only then will we be able to understand the role, if any, of sweet-tasting foods, beverages, and diets on food preferences, energy intake, and health-related outcomes, such as obesity and dental caries.