Sugar Abstracts 1

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Sweet and sour: the impact of sugars on disease.
            (Alavi and Axford, 2008) Download
The clinical relevance of glycobiology has become the focus of considerable research, as the role of glycosylation in the development, regulation and progression of disease is, slowly but surely, being unveiled. Recent strides in the design and refinement of analytical techniques-sugar profiling, glyco-arrays and functional studies-have helped us gain a better understanding of the complexity and richness of diversity that bestow sugars with an unsurpassed, biospecific coding capacity. Cracking this 'sugar code', and unravelling the structural frameworks and recognition strategies of sugar-based interactions in biological systems that relate to both health and disease, holds tremendous promise for deciphering disease mechanisms. It will also provide a cutting edge potential for the development of novel diagnostic and therapeutic interventions.

Starches, sugars and obesity.
            (Aller et al., 2011) Download
The rising prevalence of obesity, not only in adults but also in children and adolescents, is one of the most important public health problems in developed and developing countries. As one possible way to tackle obesity, a great interest has been stimulated in understanding the relationship between different types of dietary carbohydrate and appetite regulation, body weight and body composition. The present article reviews the conclusions from recent reviews and meta-analyses on the effects of different starches and sugars on body weight management and metabolic disturbances, and provides an update of the most recent studies on this topic. From the literature reviewed in this paper, potential beneficial effects of intake of starchy foods, especially those containing slowly-digestible and resistant starches, and potential detrimental effects of high intakes of fructose become apparent. This supports the intake of whole grains, legumes and vegetables, which contain more appropriate sources of carbohydrates associated with reduced risk of cardiovascular and other chronic diseases, rather than foods rich in sugars, especially in the form of sugar-sweetened beverages.


 

Sugar-sweetened beverage, sugar intake of individuals, and their blood pressure: international study of macro/micronutrients and blood pressure.
            (Brown et al., 2011) Download
The obesity epidemic has focused attention on relationships of sugars and sugar-sweetened beverages (SSBs) to cardiovascular risk factors. Here we report cross-sectional associations of SSBs, diet beverages, and sugars with blood pressure (BP) for United Kingdom and US participants of the International Study of Macro/Micronutrients and Blood Pressure. Data collected include four 24-hour dietary recalls, two 24-hour urine collections, 8 BP readings, and questionnaire data for 2696 people ages 40 to 59 years of age from 10 US/United Kingdom population samples. Associations of SSBs, diet beverages, and sugars (fructose, glucose, and sucrose) with BP were assessed by multiple linear regression. SSB intake related directly to BP, with P values of 0.005 to <0.001 (systolic BP) and 0.14 to <0.001 (diastolic BP). SSB intake higher by 1 serving per day (355 mL/24 hours) was associated with systolic/diastolic BP differences of +1.6/+0.8 mm Hg (both P<0.001) and +1.1/+0.4 mm Hg (P<0.001/<0.05) with adjustment for weight and height. Diet beverage intake was inversely associated with BP (P 0.41 to 0.003). Fructose- and glucose-BP associations were direct, with significant sugar-sodium interactions: for individuals with above-median 24-hour urinary sodium excretion, fructose intake higher by 2 SD (5.6% kcal) was associated with systolic/diastolic BP differences of +3.4/+2.2 mm Hg (both P<0.001) and +2.5/+1.7 mm Hg (both P=0.002) with adjustment for weight and height. Observed independent, direct associations of SSB intake and BP are consistent with recent trial data. These findings, plus adverse nutrient intakes among SSB consumers, and greater sugar-BP differences for persons with higher sodium excretion lend support to recommendations that intake of SSBs, sugars, and salt be substantially reduced.

Current food classifications in epidemiological studies do not enable solid nutritional recommendations for preventing diet-related chronic diseases: the impact of food processing.
            (Fardet et al., 2015) Download
To date, observational studies in nutrition have categorized foods into groups such as dairy, cereals, fruits, and vegetables. However, the strength of the association between food groups and chronic diseases is far from convincing. In most international expert surveys, risks are most commonly scored as probable, limited, or insufficient rather than convincing. In this position paper, we hypothesize that current food classifications based on botanical or animal origins can be improved to yield solid recommendations. We propose using a food classification that employs food processes to rank foods in epidemiological studies. Indeed, food health potential results from both nutrient density and food structure (i.e., the matrix effect), both of which can potentially be positively or negatively modified by processing. For example, cereal-based foods may be more or less refined, fractionated, and recombined with added salt, sugars, and fats, yielding a panoply of products with very different nutritional values. The same is true for other food groups. Finally, we propose that from a nutritional perspective, food processing will be an important issue to consider in the coming years, particularly in terms of strengthening the links between food and health and for proposing improved nutritional recommendations or actions.

Sugar and cardiovascular disease: A statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association
            (Howard and Wylie-Rosett, 2002) Download
The purpose of this report is to review the effects of dietary sugar on health, with an emphasis on cardiovascular disease (CVD) and its risk factors. Although there are no dietary trials linking sugar consumption and CVD, there are several reasons why sugar consumption should be limited.

Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents.
            (Kearns et al., 2016) Download
Early warning signals of the coronary heart disease (CHD) risk of sugar (sucrose) emerged in the 1950s. We examined Sugar Research Foundation (SRF) internal documents, historical reports, and statements relevant to early debates about the dietary causes of CHD and assembled findings chronologically into a narrative case study. The SRF sponsored its first CHD research project in 1965, a literature review published in the New England Journal of Medicine, which singled out fat and cholesterol as the dietary causes of CHD and downplayed evidence that sucrose consumption was also a risk factor. The SRF set the review's objective, contributed articles for inclusion, and received drafts. The SRF's funding and role was not disclosed. Together with other recent analyses of sugar industry documents, our findings suggest the industry sponsored a research program in the 1960s and 1970s that successfully cast doubt about the hazards of sucrose while promoting fat as the dietary culprit in CHD. Policymaking committees should consider giving less weight to food industry-funded studies and include mechanistic and animal studies as well as studies appraising the effect of added sugars on multiple CHD biomarkers and disease development.


 

Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study.
            (Martínez Steele et al., 2016) Download
OBJECTIVES:  To investigate the contribution of ultra-processed foods to the intake of added sugars in the USA. Ultra-processed foods were defined as industrial formulations which, besides salt, sugar, oils and fats, include substances not used in culinary preparations, in particular additives used to imitate sensorial qualities of minimally processed foods and their culinary preparations. DESIGN:  Cross-sectional study. SETTING:  National Health and Nutrition Examination Survey 2009-2010. PARTICIPANTS:  We evaluated 9317 participants aged 1+ years with at least one 24 h dietary recall. MAIN OUTCOME MEASURES:  Average dietary content of added sugars and proportion of individuals consuming more than 10% of total energy from added sugars. DATA ANALYSIS:  Gaussian and Poisson regressions estimated the association between consumption of ultra-processed foods and intake of added sugars. All models incorporated survey sample weights and adjusted for age, sex, race/ethnicity, family income and educational attainment. RESULTS:  Ultra-processed foods comprised 57.9% of energy intake, and contributed 89.7% of the energy intake from added sugars. The content of added sugars in ultra-processed foods (21.1% of calories) was eightfold higher than in processed foods (2.4%) and fivefold higher than in unprocessed or minimally processed foods and processed culinary ingredients grouped together (3.7%). Both in unadjusted and adjusted models, each increase of 5 percentage points in proportional energy intake from ultra-processed foods increased the proportional energy intake from added sugars by 1 percentage point. Consumption of added sugars increased linearly across quintiles of ultra-processed food consumption: from 7.5% of total energy in the lowest quintile to 19.5% in the highest. A total of 82.1% of Americans in the highest quintile exceeded the recommended limit of 10% energy from added sugars, compared with 26.4% in the lowest. CONCLUSIONS:  Decreasing the consumption of ultra-processed foods could be an effective way of reducing the excessive intake of added sugars in the USA.

Fast food fever: reviewing the impacts of the Western diet on immunity.
            (Myles, 2014) Download
While numerous changes in human lifestyle constitute modern life, our diet has been gaining attention as a potential contributor to the increase in immune-mediated diseases. The Western diet is characterized by an over consumption and reduced variety of refined sugars, salt, and saturated fat. Herein our objective is to detail the mechanisms for the Western diet's impact on immune function. The manuscript reviews the impacts and mechanisms of harm for our over-indulgence in sugar, salt, and fat, as well as the data outlining the impacts of artificial sweeteners, gluten, and genetically modified foods; attention is given to revealing where the literature on the immune impacts of macronutrients is limited to either animal or in vitro models versus where human trials exist. Detailed attention is given to the dietary impact on the gut microbiome and the mechanisms by which our poor dietary choices are encoded into our gut, our genes, and are passed to our offspring. While today's modern diet may provide beneficial protection from micro- and macronutrient deficiencies, our over abundance of calories and the macronutrients that compose our diet may all lead to increased inflammation, reduced control of infection, increased rates of cancer, and increased risk for allergic and auto-inflammatory disease.

Corporate Funding of Food and Nutrition Research: Science or Marketing
            (Nestle, 2016a) Download
The longstanding influence of food industry funding on nutrition research, researchers, and professional societies threatens the credibility of nutrition science. So much research is sponsored by industry that health professionals and the public may lose confidence in basic dietary advice. Although most journals now require authors to disclose who pays for their work, disclosure— even done diligently—is not sufficient to alert readers to the extent to which industry funding influences research results and professional opinion. As is well established from experimental and observational research, drug company gifts and grants can have substantial effects. To recipients, however, these effects are almost always unconscious, unintentional, and unrecognized, making them especially difficult to prevent.

Food Industry Funding of Nutrition Research: The Relevance of History for Current Debates.
            (Nestle, 2016b) Download
Industry-sponsored nutrition research, like that of research sponsored by the tobacco, chemical, and pharmaceutical industries, almost invariably produces results that confirm the benefits or lack of harm of the sponsor’s products, even when independently sponsored research comes to opposite conclusions. Although considerable evidence demonstrates that those industries deliberately influenced the design, results, and interpretation of the studies they paid for, much less is known about the influence of food-company sponsorship on nutrition research. Typically, the disclosure statements of sponsored nutrition studies state that the funder had no role in their design, conduct, interpretation, writing, or publication. Without a “smoking gun” it is difficult to prove otherwise.

How Society Subsidizes Big Food and Poor Health.
            (Patel, 2016) Download
Approximately 80% of calories eaten in the United States are grown domestically. Yet, the US diet is a leading cause of morbidity. The analysis by Siegel et al in this issue of JAMA Internal Medicine suggests that through commodity subsidies that encourage poor diet we are, in part, paying for our own demise.

Association of Higher Consumption of Foods Derived From Subsidized Commodities With Adverse Cardiometabolic Risk Among US Adults.
            (Siegel et al., 2016) Download
IMPORTANCE:  Food subsidies are designed to enhance food availability, but whether they promote cardiometabolic health is unclear. OBJECTIVE:  To investigate whether higher consumption of foods derived from subsidized food commodities is associated with adverse cardiometabolic risk among US adults. DESIGN, SETTING, AND PARTICIPANTS:  Cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2001 to 2006. Our final analysis was performed in January 2016. Participants were 10 308 nonpregnant adults 18 to 64 years old in the general community. EXPOSURE:  From a single day of 24-hour dietary recall in the National Health and Nutrition Examination Survey, we calculated an individual-level subsidy score that estimated an individual's consumption of subsidized food commodities as a percentage of total caloric intake. MAIN OUTCOMES AND MEASURES:  The main outcomes were body mass index (calculated as weight in kilograms divided by height in meters squared), abdominal adiposity, C-reactive protein level, blood pressure, non-high-density lipoprotein cholesterol level, and glycemia. RESULTS:  Among 10 308 participants, the mean (SD) age was 40.2 (0.3) years, and a mean (SD) of 50.5% (0.5%) were male. Overall, 56.2% of calories consumed were from the major subsidized food commodities. United States adults in the highest quartile of the subsidy score (compared with the lowest) had increased probabilities of having a body mass index of at least 30 (prevalence ratio, 1.37; 95% CI, 1.23-1.52), a ratio of waist circumference to height of at least 0.60 (prevalence ratio, 1.41; 95% CI, 1.25-1.59), a C-reactive protein level of at least 0.32 mg/dL (prevalence ratio, 1.34; 95% CI, 1.19-1.51), an elevated non-high-density lipoprotein cholesterol level (prevalence ratio, 1.14; 95% CI, 1.05-1.25), and dysglycemia (prevalence ratio, 1.21; 95% CI, 1.04-1.40). There was no statistically significant association between the subsidy score and blood pressure. CONCLUSIONS AND RELEVANCE:  Among US adults, higher consumption of calories from subsidized food commodities was associated with a greater probability of some cardiometabolic risks. Better alignment of agricultural and nutritional policies may potentially improve population health.

Big food, food systems, and global health.
            (Stuckler and Nestle, 2012) Download
As the PLoS Medicine series on Big Food (www.ploscollections.org/bigfood) kicks off, let’s begin this Essay with a blunt conclusion: Global food systems are not meeting the world’s dietary needs. Underlying both is a common factor: food systems are not driven to deliver optimal human diets but to maximize profits.


References

Alavi, A and JS Axford (2008), ‘Sweet and sour: the impact of sugars on disease.’, Rheumatology (Oxford), 47 (6), 760-70. PubMed: 18375404
Aller, EE, et al. (2011), ‘Starches, sugars and obesity.’, Nutrients, 3 341-69. PubMed: 22254101
Brown, IJ, et al. (2011), ‘Sugar-sweetened beverage, sugar intake of individuals, and their blood pressure: international study of macro/micronutrients and blood pressure.’, Hypertension, 57 (4), 695-701. PubMed: 21357284
Fardet, A, et al. (2015), ‘Current food classifications in epidemiological studies do not enable solid nutritional recommendations for preventing diet-related chronic diseases: the impact of food processing.’, Adv Nutr, 6 629-38. PubMed: 26567188
Howard, B. V. and J. Wylie-Rosett (2002), ‘Sugar and cardiovascular disease: A statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association’, Circulation, 106 (4), 523-27. PubMed: 12135957
Kearns, CE, LA Schmidt, and SA Glantz (2016), ‘Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents.’, JAMA Intern Med, 176 (11), 1680-85. PubMed: 27617709
Martínez Steele, E, et al. (2016), ‘Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study.’, BMJ Open, 6 (3), e009892. PubMed: 26962035
Myles, IA (2014), ‘Fast food fever: reviewing the impacts of the Western diet on immunity.’, Nutr J, 13 61. PubMed: 24939238
Nestle, M (2016a), ‘Corporate Funding of Food and Nutrition Research: Science or Marketing’, JAMA Intern Med, 176 (1), 13-14. PubMed: 26595855
——— (2016b), ‘Food Industry Funding of Nutrition Research: The Relevance of History for Current Debates.’, JAMA Intern Med, 176 (11), E1. PubMed: 27618496
Patel, R (2016), ‘How Society Subsidizes Big Food and Poor Health.’, JAMA Intern Med, 176 (8), 1132-33. PubMed: 27380490
Siegel, KR, et al. (2016), ‘Association of Higher Consumption of Foods Derived From Subsidized Commodities With Adverse Cardiometabolic Risk Among US Adults.’, JAMA Intern Med, 176 (8), 1124-32. PubMed: 27379488
Stuckler, D and M Nestle (2012), ‘Big food, food systems, and global health.’, PLoS Med, 9 (6), e1001242. PubMed: 22723746