XIII Congreso Peruano de Nutrición

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1 XIII Congreso Peruano de Nutrición Low or no-calorie Sweeteners and Sweet Taste their role in weight management Expositor: Dr. Ph. France BELLISLE Laval University, Department of Kinesiology Quebec, Canada and CRNH Ile-de-France, Bobigny, France Lima/Santiago 2017

2 Declaration of Interests Scientific Advisory Committees: General Mills Iglo CreaBio International Sweeteners Association ISA European Fruit Juice Association Cereal Partners Worldwide Symposium travel and honoraria: Mondelez ILSI Tate & Lyle

3 Sweetness and sweeteners in the scientific literature: Sweetness as a very potent bio-psychological stimulus (what is so special about sweetness? The role of No- or Low-calorie Sweeteners Observational studies Intervention studies Randomized Controlled Trials Systematic Reviews and Meta-Analyses

4 What is so special about sweetness? Sweetness is a very potent psycho-biological stimulus that contributes to the palatability of numerous foods and drinks

5 Gustave Callebotte Fruits sur un stand,

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7 Has the world become obesogenic? What is the contribution of sweetness (and sugar) to this situation????

8 Sweetness and the Human Consumer

9 Mean volume consumed (ml) From birth, people like sweetness Facial expressions of newborn infants Steiner, 1977 Infants prefer sweet liquids to plain water Sucrose Water Sugar concentration (mol/l) Desor, Maller and Greene, 1978 Sweet Sour Bitter

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11 Why is such an innate response present? Selected by Natural Evolution Survival advantage when the young spontaneously accept sources of energy (mother s milk, fruits, etc.) Genetic basis shared with many other species (Mennella et al 2005; Savage et al 2007)

12 Later in life Early appetite for sweetness decreases with age (in parallel with growth) A phenomenon also observed in other mammals Large inter-individual differences in taste for sweetness influenced by genetics, ethnicity, individual food experiences (family, culture) No difference in preferred intensity based on body weight.

13 At the origin of the sweetness sensation

14 Sweet tasting substances Sugars (mono and di-saccharides) Glucose, fructose, sucrose, maltose Polyols (sugar alcohols) Sorbitol, Mannitol, Lactitol, Xylitol, etc. Low or No-calorie sweeteners Saccharin, sucralose, cyclamate, aspartame, thaumatin, stevia All bind to and activate T1R2+T1R3 receptors (tongue, mouth, gut) They all taste sweet but are all different

15 How can low calorie sweeteners affect appetite and satiety?

16 Sweeteners and Appetite Non-nutritive sweeteners make it possible to uncouple the pleasant sweet taste from the energy load (4 kcal/gram) Theoretically, this might be a good idea, as it could allow consumers to enjoy their preferred sweet foods without the energy intake associated with sugars In fact, many important questions have to be asked: Will this affect energy intake? In what direction? Will this affect body weight control? Can this exacerbate the appetite for sweet-tasting substances?

17 Many approaches in the scientific literature 40+ years of research Animal Models Observational studies Experimental studies Systematic Reviews Meta-Analyses

18 And many aspects of body weight control Weight Loss Maintenance of weight loss Prevention of weight gain

19 Observational Studies in the general population Use of low energy sweeteners is often associated with - higher BMI (reverse causality) BUT - better diet (lower intake of sugar and energy) suggesting that LCS are used for weight control purposes

20 An observational study in North American Weight loss maintainers Phelan et al, Int J Obes 2009 Subjects recruited by advertising Weight loss maintainers (WLM) formerly overweight or obese, lost >10% weight for > 5yrs and be weight stable Normal weight (NW) Control group never overweight Weight loss maintainers reported that compared to NW they Consumed less fat and more fat-modified foods Had higher dietary restraint which correlated with lower fat and energy intake Consumed more low/no energy-sweetened beverages Were physically more active

21 Experimental Trials tests of causality

22 A randomized controlled trial: the CHOICE study Piernas et al adults (BMI = 35 kg/m²) replaced their sweet beverages by either Water «Diet» drinks For 6 months Hypothesis: daily intake of diet drinks will stimulate consumption of sugar-containing foods

23 Results Same decrease in daily energy intake in both groups at end of follow-up Same changes in body weight Participants in «diet» drink group ate less Desserts Sugar Results opposite to hypothesis

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25 Over the years, many systematic reviews and meta-analyses published

26 Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Rogers et al, Obesity Animal studies 12 Prospective cohort studies (n>500, follow-up > 1 year) Short-term ( 1 day) randomized controlled trials (129 comparisons of sweeteners versus sugar, water or nothing) in children and adults Sustained randomized controlled trials (10 comparisons) in children and adults

27 Sustained RCTs, adults and children, Rogers et al, Obesity 2015 : Weight Change, LES versus sugar Forest plots showing individual and combined effect sizes for sustained intervention studies comparing the effects on BW of LES versus sugar. Mean difference is weight change in the LES condition minus weight change in the sugar condition over the intervention period. BW, body weight; LES, low energy sweetener.

28 Sustained RCTS, Adults, Rogers et al, Obesity 2015 : Weight change, LES versus water Forest plots showing individual and combined effect sizes for sustained intervention studies comparing the effects on BW of LES vs water. Mean difference is weight change in the LES condition minus weight change in the water condition over the intervention period. BW, body weight; LES, low energy sweetener.

29 Conclusions from Rogers et al 2015 Considerable weight of evidence in favor of consumption of low energy sweeteners in place of sugar as helpful in reducing relative energy intake and body weight Importantly, the effects of low energy sweetened beverages on body weight also appear neutral relative to water, or even beneficial.

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35 Conclusions Over 40 years of research about low calorie sweeteners: observational studies and randomized controlled trials, children, adults, short-term, long-term No confirmation that low calorie sweeteners might exacerbate appetite for sweet products or induce loss of control over eating. Results of intervention trials suggest that they Decrease energy intake (energy density of beverages) Facilitate weight loss (small effects) Facilitate maintenance of weight loss Satiate the appetite for sweetness No magic effect : they are not the answer to obesity but a useful tool in a particular cultural context