Nutritional and Health Aspects of Sweeteners - Sweeteners: Nutritional Aspects, Applications, and Production Technology - page 352

obtained from the NHANES III (1988-1994; n = 15,979) and NHANES 1999-2004 ( n = 13,431).
They reported that, from 1988-1994 to 1999-2004 on the survey day, the percentage of adult SSB
drinkers increased from 58% to 63% ( P < 0.001), the per capita consumption of SSB increased by 46
kcal/day ( P < 0.001), and the daily SSB consumption among drinkers increased by 6 oz ( P < 0.001).
In both survey periods, per capita SSB consumption was highest among young adults (231-289
kcal/day) and lowest among the elderly (68-83 kcal/day). More adults are drinking SSBs (primarily
soda; approximately 60%), and among SSB drinkers, the average caloric consumption and quantity
consumed had increased, changes that parallel the rising prevalence of adult obesity and type 2
diabetes. Young blacks had the highest percentage of SSB drinkers and the highest per capita con-
sumption compared with white and Mexican American adults ( P < 0.05). Overweight-obese adults
with weight loss intention (compared with those without) were signiicantly less likely to drink SSB,
but they still consumed a considerable amount in 1999-2004 (278 kcal/day). Among young adults,
20% of SSB calories were consumed at work (Bleich et al. 2009).
Bremer et al. (2010) evaluated current SSB consumption trends and their association with insu-
lin resistance-related metabolic parameters and anthropometric measurements by performing a
cross-sectional analysis of the NHANES data between the years 1988 to 1994 and 1999 to 2004.
Main outcome measures included SSB consumption trends, a homeostasis model assessment of
insulin resistance, blood pressure, waist circumference, BMI, and fasting concentrations of total
cholesterol, HDL cholesterol, low-density lipoprotein cholesterol, and triglycerides. Although the
overall SSB consumption has increased, their data suggested that this increase was primarily due
to an increase in the amount of SSBs consumed by males in the high-SSB intake group alone.
Multivariate linear regression analyses also showed that increased SSB consumption was indepen-
dently associated with many adverse health parameters. Factors other than SSB consumption must
therefore be contributing to the increasing prevalence of obesity and metabolic syndrome in the
majority of U.S. children.
Schulze et al. (2004) examined the association between the consumption of SSBs and weight
change and the risk of type 2 diabetes in women. Prospective cohort analyses were conducted from
1991 to 1999 among women in the Nurses' Health Study II. The diabetes analysis included 91,249
women free of diabetes and other major chronic diseases at baseline in 1991. The weight change
analysis included 51,603 women for whom complete dietary information and body weight were
ascertained in 1991, 1995, and 1999. The researchers identiied 741 incident cases of conirmed
type 2 diabetes during 716,300 person-years of follow-up. Those with stable consumption patterns
had no difference in weight gain, but weight gain over a 4-year period was highest among women
who increased their sugar-sweetened soft drink consumption from one or fewer drinks per week
to one or more drinks per day (multivariate-adjusted means, 4.69 kg for 1991-1995 and 4.20 kg for
1995-1999) and was smallest among women who decreased their intake (1.34 and 0.15 kg for the
two periods, respectively) after adjusting for lifestyle and dietary confounders. Increased consump-
tion of fruit punch was also associated with greater weight gain compared with decreased consump-
tion. After adjustment for potential confounders, women consuming one or more sugar-sweetened
soft drinks per day had a relative risk (RR) of type 2 diabetes of 1.83 [95% conidence interval (CI),
1.42-2.36; P < 0.001 for trend] compared with those who consumed less than one of these beverages
per month. Similarly, the consumption of fruit punch was associated with increased diabetes risk
(RR for ≥1 drink per day compared with <1 drink per month, 2.00; 95% CI, 1.33-3.03; P = 0.001).
Hence, higher consumption of SSBs is associated with a greater magnitude of weight gain and an
increased risk for development of type 2 diabetes in women, possibly by providing excessive calo-
ries and large amounts of rapidly absorbable sugars.
Undoubtfully, excess of sugar intake may contribute to weight gain. Furthermore, no consistent
evidence exists to support the view that low-energy sweeteners increase appetite or food intake. On
the other hand, low-calorie sweeteners do not lead to an automatic weight loss. Calorie control and
weight management seem to be multidimensional problems that require proper lifestyle behavior.