Survey Uses Parent Data To Draw Wide Conclusions About Sugar and Sweetener Labeling

Posted by & filed under Children, Health Care Professionals, Health Professionals, Media Room.

Keith Ayoob, EdD, RDN, FAND

This study looks at parents’ ability to identify added sugar, low-and no-calorie sweeteners (LNCS), and juice in children’s beverages.

Parents were randomly assigned to view one of the following:

  1. The front of the package by itself, or
  2. The front and back/side of the package, (whichever included the nutrition facts panel (NFP) and the ingredients list, and the percentage of juice). 

The parents were offered a “Yes or No” response to indicate whether they thought the beverage contained added sugar or LNCS. They were also asked to use a sliding scale (0%-100%) in order to indicate their understanding of the beverage’s percentage of juice.

Parents were then asked to indicate whether products with names identifying the type of beverage (i.e. “juice drink” or “100% juice”, etc.) contained added sugar or LNCS. Finally, they were asked to indicate the percentage of juice the beverage contained. 

Among the findings:

  • The majority of parents, up to 90%, depending on the product, were competent in identifying beverages with added sugar.  When shown the ingredient list, their accuracy improved further. 
  • Fewer than half of the parents correctly determined that drinks did not contain added sugar, based on the beverages’ statements of identity (legal definitions).  This suggests that parents may be unfamiliar with the formal distinctions between the various beverages.

How informative is this study?  Perhaps less so than the authors had hoped, for several reasons.  First, the authors admitted the survey tool hadn’t been validated.  How should we interpret the results of a study that used an unvalidated tool?  Some in the scientific community might have difficulty taking these results seriously. 

Further, the authors’ conclusion that, “The present findings support the need for revised regulations that clearly and consistently convey drink ingredients, including added sugar, LNCS and type and percentage of juice,” is troubling.  It could also be argued that many physicians and healthcare professionals are similarly unfamiliar with legal beverage descriptions.  The authors’ conclusion stops short of suggesting that if consumers were simply more knowledgeable, then they would choose water that is unflavored, flavored water that is not sweetened with sugar or LNCS, or 100% juice, as opposed to beverages with added sugar or LNCS.  

The assumption that consumers would make different choices if more information were ‎available is baseless. Merely providing additional product ingredient information won’t necessarily alter behavior. This information may help inform choices, but it won’t necessarily change them. To suggest otherwise dismisses the consumer’s power of free choice.  Providing caloric information on menu boards at fast food restaurants, for example, doesn’t necessarily prompt consumers to order differently.  Their menu decisions, however, may be more informed.  

Moreover, in addition to 100% juice, beverages that include LNCS may be very useful options when reducing added sugars is a goal.  The 2019 policy statement of the American Academy of Pediatrics aligns, as it states: “Individuals affected by certain conditions (e.g., obesity and type 1 or 2 diabetes mellitus) may benefit from the use of LNCS if substituted for caloric sweeteners.” 

The authors also discount the possibility that the more consumers know about LNCS, the more they will realize they have no reason to fear them.  These ingredients are simply tools for reducing sugar intake.  As with all tools, they should be used wisely.  LNCS are not a “cure” for obesity, type 2 diabetes or any condition, nor should they be given the burden of being such.   

Finally, it’s doubtful that consumers are familiar with the mountain of research documenting the safety of LNCS across all populations, including children.  Although LNCS are not recommended for children under age two years, this is not due to issues of safety.  Rather, the goal in infants and toddlers is to provide a diet that doesn’t displace valuable nutrients in the often-modest volume of food and fluids this age group consumes.  Proper labeling should inform consumers about food and beverage products and their ingredients by providing accurate information that assist them in making choices that fit the needs of their children and themselves. 

Harris JL, Pomeranz JL. Misperceptions about added sugar, non-nutritive sweeteners and juice in popular children’s drinks: Experimental and cross-sectional study with U.S. parents of young children (1-5 years). Pediatr Obes. 2021 Apr 7:e12791. doi: 10.1111/ijpo.12791.

Keith Ayoob, EdD, RDN, FADN, is an Associate Clinical Professor Emeritus at the Albert Einstein College of Medicine. As a pediatric nutritionist and registered dietitian, Dr. Ayoob is also a past national spokesperson for the Academy of Nutrition and Dietetics. Dr. Ayoob is a consultant with the Calorie Control Council Advisory Board and the Global Stevia Institute (GSI), GSI is supported by PureCircle Ltd, a global leader in purified stevia leaf extract production.

Recent Survey Finds Consumers Want Healthier Beverage Options

Posted by & filed under Diabetes/Blood Sugar Management, Featured.

Rising type 2 diabetes rates are prompting many Americans to look for healthier options. The perceptions of consumers have shifted and many are buying cleaner and healthier beverages. The pandemic has only heightened concerns as consumers are becoming more mindful of their dietary intake. Within beverages, the largest source of calories is sweetened beverages, accounting for 35% according to the 2020 Dietary Guidelines Advisory Council (DGAC) Scientific Report. Consumers are cleaning up their beverage selection by limiting and avoiding sugars in the diet according to a recent survey conducted by The International Food Information Council Foundation (IFC).

As the DGAC Scientific Report noted, low-and-no calorie sweetened beverages may be a useful tool for in weight management in adults and when (LNCS) can part of a balanced diet, low-and-no calorie sweeteners empower people living with diabetes because they do not raise glucose or insulin levels. “Millions of Americans are affected by diabetes and obesity. For these individuals, nutrition plays a major role in managing disease. LNCS are not a magic bullet but they are excellent tools to help reduce sugar intake, manage blood glucose levels, and reduce overall calorie intake” says Robert Rankin, president of the Calorie Control Council (CCC).

“Low-calorie sweeteners can serve an important role in diabetes management,” says Dr. Keri Peterson, Calorie Control Council medical advisor. Though a diagnosis of type 2 diabetes necessitates lifestyle changes, it does not require an elimination of sweet treats from the diet entirely. In a survey conducted by CCC, 27% of Americans said that they consume low-calorie sweeteners to manage their blood sugar levels. Substituting sugar-sweetened drinks and regular sodas for low-calorie sweetened beverages can make a significant impact on total daily calorie and added sugar consumption.

“Low-calorie sweeteners can serve an important role in diabetes management,”
-Dr. Keri Peterson, Calorie Control Council medical advisor

Nutrition, diet and lifestyle will have the greatest impact in preventing type 2 diabetes. According to the What We Eat in America a database component of the National Health and Nutrition Examination Survey (NHANES), most Americans consume too much added sugar. In light of the recommendation in the 2020 DGAC Scientific Report to further reduce added sugars in the diet, the identification of practical methods to achieve this goal is more important than ever.

LNCS is used to reduce the amount of added sugar in many food and beverages, allowing consumers to enjoy great taste and nutrition with fewer calories. Today, there are more options than ever before for products sweetened with LNCS, available online and in stores. Products labeled as “light,” “reduced-calorie,” “reduced-sugar” or “diet” often include these ingredients. LNCS can be found in chewing gum, candies, ice cream, baked goods, fruit spreads and canned fruits, fillings and frostings beverages, yogurt and more. LNCS options can be purchased on their own to be included everyday recipes and have become so popular that they even have their own area on grocery store shelves, conveniently located next to the sugar that they’re used to replace. These products, often referred to as “tabletop sweeteners,” vary in how and in what amount they are used to substitute sugar in recipes, but directions are typically included on product packaging for ease of use.

There are plenty of resources available to help to manage diabetes through diet. CCC offers tools such as the Food Calorie Calculator which allows users to choose from thousands of foods and brands and see nutritional content, including calories and carbohydrates. Substituting LNCS for caloric options can make a blood glucose management plan more enjoyable.

About the Calorie Control Council:
The Calorie Control Council, established in 1966, is an international association representing the low- and reduced-calorie food and beverage industry. Today it represents manufacturers and suppliers of low- and reduced-calorie foods and beverages, including manufacturers and suppliers of more than two dozen different alternative sweeteners, fibers and other low-calorie, dietary ingredients. More at caloriecontrol.org

Effects of Non-nutritive Sweeteners on Sweet Taste Processing and Neuroendocrine Regulation of Eating Behavior

Posted by & filed under Sweet Taste.

TITLE:  Effects of Non-nutritive Sweeteners on Sweet Taste Processing and Neuroendocrine Regulation of Eating Behavior

CITATION & LINK: Curr Nutr Rep (2020)

AUTHORS: Alexander G. Yunker, Reshma Patel, Kathleen A. Page

REVIEWER: Robyn Flipse, MS, MA, RDN

Objective

  • To review and summarize the current literature and address the gaps in knowledge regarding the effects of both acute and chronic exposure to non-nutritive sweeteners (NNS) across the lifespan on glucose metabolism, sweet taste perception and preference, and neural systems involved in appetite and reward in humans.

Background

  • Despite the increased use of NNS over the past several decades and their being marketed as a tool in weight management, the prevalence of obesity and associated metabolic disorders has continued to rise.
  • Epidemiological evidence suggests that NNS exposure throughout the lifespan, including in utero, can contribute to risk for weight gain and metabolic disorders.
  • Experimental designs have reported that NNS have neutral or beneficial effects on body weight and glucose metabolism.
  • There is concern that NNS may uncouple the evolved relationship between sweet taste and the efficacy of brain regions related to appetite and reward to process sweet taste

Methods

  • Review and summarize the research on NNS and sweet taste perception and preference, NNS and metabolic hormones (insulin, glucagon-like peptide 1, peptide YY, gastric inhibitory polypeptide, leptin, ghrelin and glucagon), and NNS and neural systems involved in appetite and reward with an emphasis on human studies.

Findings

  • NNS exposure during early development, including during pregnancy and lactation, may influence sweet taste conditioning and acceptance in humans.
  • Neuroimaging studies provide evidence that NNS elicit differential neuronal responsivity in areas related to reward and satiation, compared with caloric sweeteners, which might increase motivation for sweet foods.
  • Available studies provide equivocal evidence on the effects of NNS consumption on hormones involved in appetite regulation and glucose homeostasis.

Conclusions

  • Given the widespread popularity of NNS and the heterogeneous findings of their effect on metabolic outcomes and neuroendocrine pathways, future studies are essential to establish the role of NNS on physiological responses.

Points to Consider

  • The available studies do not indicate whether specific concentrations and types of NNS elicit hormone secretion, whether the effects of NNS are dependent on delivery method, or whether the consumption of NNS in isolation or in the presence of carbohydrates produces different effects.
  • The impact of individual characteristics, such as habitual NNS consumption, age, sex, adiposity, and insulin resistance on the metabolic hormone responses to NNS consumption has not been fully investigated.

Robyn Flipse, MS, MA, RDN is a registered dietitian, cultural anthropologist and scientific advisor to the Calorie Control Council, whose 30+ year career includes maintaining a busy nutrition counseling practice, teaching food and nutrition courses at the university level, and authoring 2 popular diet books and numerous articles and blogs on health and fitness. Her ability to make sense out of confusing and sometimes controversial nutrition news has made her a frequent guest on major media outlets, including CNBC, FOX News and USA Today. Her passion is communicating practical nutrition information that empowers people to make the best food decisions they can in their everyday diets. Reach her on Twitter @EverydayRD and check out her blog The Everyday RD.

Variations in Marginal Taste Preference Perception by Body Mass Index Classification: A Randomized Controlled Trial

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Posted by & filed under Health Care Professionals, Health Professionals, Research Summaries, Sweet Taste.

TITLE:  Variations in Marginal Taste Preference Perception by Body Mass Index Classification: A Randomized Controlled Trial

CITATION & LINK: J Acad Nutr Diet. 2020; 120(1):45-52

AUTHORS: Aaron C. Miller, Linnea A. Polgreen, Elena M. Segre, Philip M. Polgreen

REVIEWER: Robyn Flipse, MS, MA, RDN

Objective

  • To model taste perceptions in a longitudinal or time-series fashion across the number of samples consumed
  • To determine if taste perceptions, in terms of the overall level and rate of decline, differ between normal-weight, overweight, and obese individuals
  • To analyze what effect, if any, the availability of nutritional information would have on taste perceptions

Background

  • Decisions about what and how much to consume are driven, in part, by individual taste perceptions.
  • Diminishing marginal taste perception is the decline in taste perception an individual experiences from consuming one additional unit of a given food.
  • Sensory-specific satiety is the relationship between perceived taste and the quantity of food consumed, most often used to measure the difference between pre- and post-eating quantity.
  • If the rate at which marginal taste perceptions diminish differs among normal-weight, overweight, and obese adults, the quantification of satisfaction from food may help explain why some people eat more than others and represent a new obesity risk factor or phenotype.

Methods

  • 290 adults between the ages 18-80 (80% female) were recruited; height and weight was measured with clothes and shoes on; BMI categories were defined using standard cutoffs.
  • Participants were randomized into two groups, “informed” and uninformed”, to observe the impact of nutritional information on taste perception.
    • Nutritional information for the chocolate samples was given to the “informed” group before the trial began.
  • Participants completed questionnaires on their taste perceptions with each piece of chocolate they consumed.  
    • A pretzel was provided at the start and end of the trail to determine if the changes in marginal taste perception for chocolate were driven by simple changes in hunger or sensory-specific satiety.
  • Time-series regression was used to model perceived taste changes while controlling for participant characteristics.

Findings

  • For all three BMI categories average taste perceptions decreased as sample number consumed increased.
  • Taste perceptions of normal-weight and overweight participants followed a nearly identical downward trend distinct from the curve of obese participants.
  • Obese participants reported consistently greater taste perceptions than nonobese participants and their taste perceptions decreased at a slower rate.
  • There was no evidence that nutrition information about the chocolate had any impact on a participant’s initial taste perception or rate of decline.
  • Diminishing taste perceptions were not solely the result of satiation as the pretzels consumed at the beginning of the study were reported to provide the same taste perception as pretzels consumed at the end, despite substantial declines in hunger.

Conclusions

  • A consistent association was identified between taste from food, in this case chocolate, and BMI.
  • There were no significant differences in taste perceptions between normal and overweight participants.
  • Obese participants had initial taste perceptions that were greater than nonobese participants and their taste perception declined at a more gradual rate than nonobese participants.
  • Providing nutritional information did not affect marginal taste perception in any BMI group.

Points to Consider

  • Research has shown that people are more likely to overeat when more types of food are offered.
  • The diminishing taste perceptions seen here may be due to a type of sensory boredom from repeated consumption of the same item, consistent with research on sensory-specific satiety. 
  • Other types of food (e.g. bitter or salty) may lead to different results.
  • Obese participants may need to consume a greater quantity of chocolate to experience a similar decline in taste perception to that of the nonobese participants.
  • Consuming chocolate (or other sweet foods) made with low-calorie sweeteners may help obese individuals achieve the same taste perception as lean and overweight individuals with the same quantity of food.

Robyn Flipse, MS, MA, RDN is a registered dietitian, cultural anthropologist and scientific advisor to the Calorie Control Council, whose 30+ year career includes maintaining a busy nutrition counseling practice, teaching food and nutrition courses at the university level, and authoring 2 popular diet books and numerous articles and blogs on health and fitness. Her ability to make sense out of confusing and sometimes controversial nutrition news has made her a frequent guest on major media outlets, including CNBC, FOX News and USA Today. Her passion is communicating practical nutrition information that empowers people to make the best food decisions they can in their everyday diets. Reach her on Twitter @EverydayRD and check out her blog The Everyday RD.

Obesity is associated with altered gene expression in human tastebuds

Posted by & filed under Health Care Professionals, Health Professionals, Obesity, Research Summaries, Sweet Taste.

TITLE: Obesity is associated with altered gene expression in human tastebuds

CITATION & LINK: IntJ Obes. 2019; 43:1475-1484

AUTHORS: Nicholas Archer, Jan Shaw, Maeva Cochet-Broch, et al (4)

REVIEWER: Robyn Flipse, MS, MA, RDN

Objective

  • To assess if there are underlying fundamental differences in the physiology of taste tissue between lean and obese individuals using analysis of gene expression in fungiform papillae.

Background

  • Taste and orosensory signalling are important in the cephalic phase response which impacts nutrient intake, satiety, and termination of food consumption.
  • Results of research comparing taste acuity in lean and obese individuals is mixed.
  • Both increased and decreased taste acuity has been found in those with obesity, or no association at all.
  • Studies in individuals before and after weight loss or bariatric surgery trend towards increased taste acuity following both.
  • Tastebuds are a collection of 50-100 taste cells and are composed of four different cell populations that have distinct functions or roles in taste perception.
    • Type I and III cells are associated with salt and sour taste, respectively
    • Type II cells are responsible for sweet, bitter, and umami taste detection

Methods

  • A cross-sectional design was used to analyze the transcriptomic profile (RNA-seq) of human fungiform taste papillae biopsied from 23 lean (mean BMI 22.1) and 13 obese (mean BMI37.2) Caucasian females (age 18-55) to identify differences in gene expression.
  • Fungiform taste papillae were quantified by counting the density of papillae on the tongue and biopsies were performed after a 2-hour morning fast.
  • Samples were separated into three equal groups accounting for obesity status, age group, and the doctor performing the biopsy.
  • RNA extract was converted into sequencing libraries using an input of 700 nanograms RNA per sample yielding 2.9 billion reads from the 36 participants.
  • Data analysis was completed in R (a language for statistical computing) using the R package for differential gene and transcript expression analysis of RNA-seq experiments.

Findings

  • Taste receptor genes were present in all samples and there was no difference observed in the density of fungiform taste papillae between the two groups.
  • Obesity status was the key factor influencing variability in gene expression between individuals, with no evidence for an age-related influence.
  • A total of 62 genes showed significantly different expression levels between the lean and obese participants with a consistent reduction in the expression of taste-related genes in the obese group.
    • The reduction in type II taste cell genes seen in the obese group is consistent with findings in animal studies.

Conclusions

• The gene expression of the human fungiform papillae is distinctly different between lean and obese people.
• The majority of the taste genes showing expression differences between lean and obese were type II taste cells.
• Type I and III taste cells showed similar expression level between lean and obese groups.

Points to Consider

  • Chronic inflammatory processes in obese individuals may account for some of the variability in fungiform papillae profiles seen in the lean and obese groups.
  • A reduction in type II taste cells in obese individuals may provide evidence of a link between taste and obesity.
  • Taste cells turnover every 7-24 days raising the possibility of preferentially influencing type II taste cells to reverse back to a lean profile.

Robyn Flipse, MS, MA, RDN is a registered dietitian, cultural anthropologist and scientific advisor to the Calorie Control Council, whose 30+ year career includes maintaining a busy nutrition counseling practice, teaching food and nutrition courses at the university level, and authoring 2 popular diet books and numerous articles and blogs on health and fitness. Her ability to make sense out of confusing and sometimes controversial nutrition news has made her a frequent guest on major media outlets, including CNBC, FOX News and USA Today. Her passion is communicating practical nutrition information that empowers people to make the best food decisions they can in their everyday diets. Reach her on Twitter @EverydayRD and check out her blog The Everyday RD.

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