The acute effects of the non-nutritive sweeteners aspartame and acesulfame-K in UK diet cola on glycaemic response

Abstract

Substituting sugar-sweetened for artificially sweetened beverages may reduce energy intakes. This study aims to ascertain the acute glycaemic effects of the NNS aspartame and acesulfame-K in UK diet-cola (DC). Ten healthy participants attended the laboratory fasted on three occasions. Individuals drank (1) 25?g glucose in 125?mL water + 236?mL water, (2) 25?g glucose in 125?mL water with 236?mL DC and (3) 236?mL sucrose-sweetened cola with 125?mL water. Blood (glucose) was measured pre-test and every 15?minutes over a 120-minute period using portable glucometers. The glucose-control and glucose?+?DC elicited similar blood glucose rises above pre-prandial levels. Sucrose-sweetened cola showed a non-significant lower rise in postprandial glycaemia, exhibiting the lowest glycaemic index (GI) (77.0?±?9.1). GI of glucose (100.0?±?15.2) and glucose?+?DC (104.3?±?8.5) was similar and a one-way repeated-measures ANOVA showed no significant differences in glycaemic response between test drinks (F(2,29)?=?1.68, p?>?.05). Results demonstrate the glycaemic inactivity of non-nutritive sweeteners.     

Comparing the effectiveness of a multi‐component weight loss intervention in adults with and without intellectual disabilities

Background

The prevalence of obesity in adults with intellectual disabilities (ID) is rising, although the evidence base for its treatment in this population group is minimal. Weight management interventions that are accessible to adults with ID will reduce the inequalities that they frequently experience in health services. This short report compared the effectiveness of weight management in those with and without ID who completed nine sessions of a multi‐component weight management programme.

Methods

TAKE 5 is a 16‐week multi‐component weight management intervention for adults with ID and obesity [body mass index (BMI) ≥30 kg m^–2]. This intervention is an adaption of the weight management programme provided by the Glasgow & Clyde Weight Management Service (GCWMS) for adults without ID and obesity (National Health Service based). Fifty‐two participants of the TAKE 5 programme were individually matched by baseline characteristics (sex, age and BMI) with two participants without ID of the GCWMS programme. Comparisons in terms of weight and BMI change and rate of weight loss were made for those who attended all nine sessions.

Results

There were no significant differences between the groups in the amount of weight loss (median: ?3.6 versus ?3.8 kg, respectively, P = 0.4), change in BMI (median: ?1.5 versus ?1.4 kg m^–2, P = 0.9), success of achieving 5% weight loss (41.3% versus 36.8%, P = 0.9) and rate of weight loss across the 16‐week intervention.

Conclusions

A multi‐component weight loss intervention can be equally effective for adults with and without ID and obesity.

     

Usefulness of Artificial Sweeteners for Body Weight Control

Artificial sweeteners provide lower calorie food products but have been thought to increase appetite and perhaps lead to increased body weight compared with high-sucrose foods. A recent trial demonstrated that subjects supplementing their diets with artificially sweetened foods lost weight, whereas those consuming high-sucrose foods gained weight. This review sheds some light on the controversy regarding the effects of artificial sweeteners in body weight control.     

饮食营养指导结合固定配方膳食在减肥中的应用

目的研究饮食营养指导结合固定配方膳食的减肥效果。方法对128名成年肥胖患者,予以饮食营养指导结合无糖匀浆膳部分替餐进行减肥。应用自身对照法,比较128名患者减肥前和减肥30 d后的体重、体质指数、脂肪量、肌肉量、机体水百分含量、血压和血脂水平。结果 128名患者减肥干预后30 d的体重、体质指数、脂肪量、收缩压、舒张压、血清甘油三酯、低密度脂蛋白的含量显著低于减肥前（均P〈0.05）,而水分百分比、血清高密度脂蛋白水平显著高于减肥干预前（P〈0.05）,肌肉量减肥前后无显著性差异（P〉0.05）。讨论对肥胖者予以固定配方膳食的均衡营养方式,同时纠正不良的饮食习惯并结合运动可达到良好的健康减肥效果。     

Very low‐energy diets for weight loss in adults: A review

Aim: Very low‐energy diets are a weight loss strategy that utilises severe and controlled energy restriction to induce rapid weight loss. This review aimed to evaluate their use in terms of efficacy and safety, and to identify for whom they may be effective for weight loss. Methods: English‐language papers examining the use of very low‐energy diets for weight loss in adults with a body mass index ≥30 kg/m² and published between March 2003 and March 2010 were retrieved from health and medical databases. Results: Eight randomised control trials, two cohort and six pre‐post studies were eligible for inclusion and were assessed for methodological quality and had data extracted. The greatest initial weight loss was ?22 kg, after 16 weeks of a very low energy diet. Greatest weight loss after follow up was ?13.1 ± 8.0 kg and 9.1 ± 9.7 kg (7.7 ± 8.1%) after 1 and 2 years, respectively. Studies comparing the effects in males versus females yielded conflicting results. Very low‐energy diets are effective for producing short‐term weight loss. However not all initial weight loss is maintained long term. Conclusion: Future studies using very low‐energy diets should conduct more rigorous analyses of dietary adherence and physical activity and should be required to document side effects experienced in order to identify how and for whom they are effective in facilitating long‐term weight loss in adults.     

Comparative effectiveness of a standard behavioral and physical activity enhanced behavioral weight loss intervention in Black women

ABSTRACT

Black women typically lose small amounts of weight in behavioral weight loss interventions, partially due to low engagement in physical activity. Culturally relevant enhancement of the physical activity component may improve weight loss. This study compared the effectiveness of a culturally-relevant, physical activity-enhanced behavioral weight loss intervention to a standard behavioral weight loss intervention in Black women (n = 85) over 6 months. The study was conducted in two cohorts from March 2016 to February 2017 at the University of North Carolina at Chapel Hill. Participants had an average age of 48.30 ± 11.02 years with an average body mass index of 36.46 ± 4.50 kg/m². Standard and enhanced groups’ weight change (?2.83 kg and ?2.08 kg, respectively) and change in physical activity (43.93 min/ week and 15.29 min/week, respectively) did not differ between groups. Significantly more standard group participants lost 5% of baseline weight compared to enhanced group participants. This study produced typical weight loss results in Black women. Behavioral weight loss treatment remains moderately effective for Black women. Strategies to increase attendance and self-monitoring, and the inclusion of cultural contexts to weight-related behaviors are needed to improve outcomes.     

Benefits of modest weight or waist circumference loss in a remote North Queensland Indigenous population

Objective : To quantify the potential benefit to individuals of differing magnitudes of weight or waist circumference loss in an Indigenous population. Method : Data were from the Well Person's Health Check, a cohort study in 19 rural Indigenous communities in Far North Queensland. Baseline data were collected between 1998 and 2000 from 2,583 people aged 15 to 75, an estimated participation rate of 44.5%. Follow‐up data were collected between 2004 and 2007 from 729 participants. Associations between change in weight and waist circumference for those who were overweight or obese (n=486) with changes in serum lipids, fasting glucose, blood pressure and Gamma‐Glutamyltransferase (GGT) were estimated using linear regression. Results : Weight or waist circumference loss was associated in a dose response fashion with blood pressure reduction (e.g. 10% or greater weight loss compared with no weight loss was associated with reduction of 11.3 mmHg systolic (95% confidence interval ?17.8, ?4.8). Those with greater waist circumference loss had a greater reduction in GGT (?8.3, 95% confidence interval ?23.5, 6.8) but there was no apparent increase in GGT reduction with increasing weight loss, although these were measured with low precision. There was no apparent effect of either weight or waist circumference loss on serum lipids and fasting glucose in this population. Conclusions : This study shows potentially large beneficial effects of weight or waist circumference loss over several years in a remote living Indigenous cohort. The associations were large enough to be of clinical benefit, despite weight loss being modest for most.     

An exploration of the experiences and perceptions of people who have maintained weight loss

Background: In clinical weight‐loss trials, the majority of those who lose weight will regain almost all of it within 5 years, yet there is limited evidence about effective strategies to support weight maintenance. The present study aimed to increase understanding of the experiences of those who have been successful at weight maintenance. Methods: This qualitative study used a phenomenological approach. Semi‐structured interviews were undertaken with a purposive sample of 10 participants who had maintained a minimum of 10% weight loss for at least 1 year. Interviews were transcribed and then analysed using a foundational thematic approach based on the Colaizzi method. Results: Participants believed that a more relaxed approach to weight management with realistic, long‐term goals was more appropriate for long‐term control. They had a strong reason to lose weight often with a medical trigger and had elicited support to help them. Most described the presence of saboteurs. Participants took personal responsibility for their weight management and were in tune with their nutrition and activity needs. Self‐monitoring was a strategy commonly used to support this. They described the lack of positive reinforcement in the maintenance phase as a major difficulty. Conclusions: This small‐scale study provides evidence to suggest the importance of a medical prompt to lose weight; planning for how to manage saboteurs and identifying methods of minimising the impact of a reduction in positive reinforcement. It reinforces the importance of many of the strategies known to support the weight‐loss phase.     

Systematic review of the effectiveness of interventions used in the management of obesity

This paper briefly describes the principles of undertaking a systematic review of the effectiveness of obesity management interventions. Objective : To assess the effectiveness of interventions used in the prevention and treatment of obesity and the maintenance of weight loss. Background : Obesity represents a serious public health problem due to the associated risks of disease and mortality. Prevalence of the condition is increasing and the relevant Health of the Nation target is unlikely to be met. Methods and search strategy : A qualitative systematic review of the research literature, using electronic databases and contact with experts. Inclusion criteria : Randomized controlled trials evaluating the effectiveness of interventions used in managing obesity in which participants were observed for a minimum of 1 year. For studies of prevention, non-randomized controlled trials with a concurrent control group were also eligible. Results : Ninety-nine studies were included, most of which had been performed in North America. The methodological quality of many of the studies was poor. Family therapy and community education programmes were shown to be effective in preventing obesity in children and adults, respectively. Programmes based on the reduction of sedentary behaviour were effective in the treatment of obese children. For the treatment of obese adults, behavioural, diet, exercise and drug therapies can be effective when used in combination. Surgery is effective in morbidly obese patients. Weight regain is common following many types of weight loss interventions, and maintenance programmes based on continued contact may be useful. Conclusions : This review has identified some potentially effective interventions for the management of obesity. However, results should be interpreted with caution due to problems with the methodological quality of primary studies.     

分阶段减重模式对超重肥胖女性减重效果的研究

目的 探讨分阶段减重模式对超重肥胖女性减重效果,为临床减重方案提供依据。方法 选取2021年1—6月在青岛市妇女儿童医院营养门诊减重的无器质疾病的超重肥胖女性46例作为研究对象,采用一阶段极低碳水化合物饮食2周,二阶段限能量平衡饮食4周,期间配合有氧、抗阻力运动。监测干预前后减重者体重、形态学指标、体成分指标的变化。数据采用重复测量方差分析进行统计学分析。结果 46例减重者经过两阶段的饮食及运动干预,体重（F = 343.033,P＜0.001）、体质指数（body mass index,BMI）（F = 331.302,P＜0.001）、腰围（F = 124.360,P＜0.001）、臀围（F = 80.558,P＜0.001）、腰臀比（F = 8.325,P = 0.002）、体脂肪（F = 255.959,P＜0.001）、内脏脂肪面积（F = 123.372,P＜0.001）、体脂率（F = 134.714,P＜0.001）均下降,差异具有统计学意义。结论 分阶段减重模式可以明显降低超重肥胖女性的体重,改善体成分,为临床减重提供思路。     

Socioeconomic status and weight control practices in British adults

STUDY OBJECTIVE: Attitudes and practices concerning weight control in British adults were examined to test the hypothesis that variation in concern about weight and deliberate weight control might partly explain the socioeconomic status (SES) gradient in obesity. Higher SES groups were hypothesised to show more weight concern and higher levels of dieting. SETTING: Data were collected as part of the monthly Omnibus Survey of the Office of National Statistics in March 1999. PARTICIPANTS: A stratified, probability sample of 2690 households was selected by random sampling of addresses in Britain. One randomly selected person in each household was interviewed at their home. MAIN RESULTS: As predicted, higher SES men and women had higher levels of perceived overweight, monitored their weight more closely, and were more likely to be trying to lose weight. Higher SES groups also reported more restrictive dietary practices and more vigorous physical activity. CONCLUSIONS: The results are consistent with the idea that part of the protection against weight gain in higher SES groups could be a higher frequency of weight monitoring, a lower threshold for defining themselves as overweight, and a greater likelihood of deliberate efforts at weight control.     

Use of sibutramine to assist obese women with weight loss can be successful in dietitian-led clinics: another tool in the dietitian's toolbox

Background  This study investigated differences in weight loss outcomes in obese women with Type 2 diabetes (T2D) compared to those without T2D attending a 6-month dietetic led 'Lifestyle' intervention. In those who had failed to reach weight loss goals using the 'Lifestyle' approach, the study further examined the effect on weight loss with the addition of sibutramine (Reductil^®, Abbott Laboratories, USA) over a 6-month period.
Methods  The study comprised a case–control analysis of data from 38 obese female patients (18 with T2D) from the 'Lifestyle' and 'Pharmacotherapy' clinics attending a tertiary hospital in the UK.
Results  In the 'Lifestyle' treatment groups, those with T2D lost significantly less body weight than those without T2D [5.26 kg (4.54%) versus 9.89 kg (9.55%), respectively]. For subjects who had failed to lose weight via the 'Lifestyle' intervention, the addition of sibutramine resulted in a similar weight loss compared to their pair-matched 'Lifestyle' only 'successful' counterparts (9.66% versus 9.55%).
Conclusions  Not all obese women, and those with T2D in particular, will derive benefit from 'Lifestyle' advice and those who are resistant to this treatment approach may be assisted by pharmacotherapy. Dietitians can play a role in identifying those individuals who may benefit from the use of pharmacotherapy.     

Weighing the evidence: benefits of regular weight monitoring for weight control

We address the assertion that weighing obese patients in weight loss programs can be a source of distress and can lead to unfavorable outcomes. Examination of the relevant literature suggests that there is no evidence that weighing by weight loss participants is a cause of negative mood or of body dissatisfaction. Further, there is little evidence that negative mood states or body dissatisfaction lead to a poor outcome in weight loss programs. To the contrary, a number of studies consistently show that more frequent weighing is associated with better weight loss and maintenance. We offer suggestions for dealing with this issue in clinical practice.     

Detox diets for toxin elimination and weight management: a critical review of the evidence

Detox diets are popular dieting strategies that claim to facilitate toxin elimination and weight loss, thereby promoting health and well‐being. The present review examines whether detox diets are necessary, what they involve, whether they are effective and whether they present any dangers. Although the detox industry is booming, there is very little clinical evidence to support the use of these diets. A handful of clinical studies have shown that commercial detox diets enhance liver detoxification and eliminate persistent organic pollutants from the body, although these studies are hampered by flawed methodologies and small sample sizes. There is preliminary evidence to suggest that certain foods such as coriander, nori and olestra have detoxification properties, although the majority of these studies have been performed in animals. To the best of our knowledge, no randomised controlled trials have been conducted to assess the effectiveness of commercial detox diets in humans. This is an area that deserves attention so that consumers can be informed of the potential benefits and risks of detox programmes.     

The Effect of Artificial Sweeteners Use on Sweet Taste Perception and Weight Loss Efficacy: A Review

Excessive consumption of sugar-rich foods is currently one of the most important factors that has led to the development of the global pandemic of obesity. On the other hand, there is evidence that obesity contributes to reduced sensitivity to sweet taste and hormonal changes affecting appetite, leading to an increased craving for sweets. A high intake of sugars increases the caloric value of the diet and, consequently, leads to weight gain. Moreover, attention is drawn to the concept of the addictive properties of sugar and sugary foods. A potential method to reduce the energy value of diet while maintaining the sweet taste is using non-nutritive sweeteners (NNS). NNS are commonly used as table sugar substitutes. This wide group of chemical compounds features high sweetness almost without calories due to its high sweetening strength. NNS include aspartame, acesulfame-K, sucralose, saccharin, cyclamate, neohesperidin dihydrochalcone (neohesperidin DC), neotame, taumatin, and advantame. The available evidence suggests that replacing sugar with NNS may support weight control. However, the effect of NNS on the regulation of appetite and sweet taste perception is not clear. Therefore, the review aimed to summarize the current knowledge about the use of NNS as a potential strategy for weight loss and their impact on sweet taste perception. Most studies have demonstrated that consumption of NNS-sweetened foods does not increase sweetness preference orenergy intake. Nonetheless, further research is required to determine the long-term effects of NNS on weight management.