EAL

NNNS: Appetite (2006)

Citation:

Study Design:

Class:

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Quality Rating:

Research Purpose:

To investigate the influence of ingestion of beverages with sucrose or with intense sweeteners on food intake (FI) and on hunger ratings before and after a month of daily consumption of beverages.

Inclusion Criteria:

Healthy males and females
20 to 25 years of age
Body mass index 19kg/m² to 24kg/m²
Burgundy student population (Dijon, France)
Females took contraceptive pills.

Exclusion Criteria:

Non-smokers
No history of medical disorders.

Description of Study Protocol:

Recruitment

Protocol was approved by the Advisory Committee for the Protection for Humans in Biomedical Research, Burgandy and written informed consent was obtained from all subjects.

Design

Ten weeks
Group randomized according to a Latin-Square design
Each subject had a regular food pattern consuming three meals a day
They did not use intense sweeteners regularly, did not indulge in either snacking or nibbling and had no aversion for the foods composing the experimental meal
The subjects were instructed to maintain a constant pattern of activity during the study, to not change their eating habits and to avoid alcohol intake before each experimental period.

Blinding Used

All subjects were insturcted on the experimental procedures and techniques, although they were naive as to the true purpose of the experiment.

Intervention

Four beverages contained either sucrose (E+: 100g/l, 1,672kj) or intense sweetners (E-: Null energy content) and were flavored with either orange (O) or raspberry (R)
FI was measured in the lab during two two-consecutive day periods, carried out during two successive weeks (Session One)
The subjects drank two liters of either E+ or E- beverages on the first day of both weekly periods, according to a balanced randomized design
E+ was paired with O for 50% of subjects and with R for the other 50%
Subjects were then habituated over a four-week period to both beverages, consuming one liter of E+ beverage on odd days and one liter of E- drink on even days
After this period, the measurements of Session One were repeated (Session Two, Weeks Seven and Eight)
Finally, FI was measured for two more two-day periods (Weeks Nine and Ten) after the association between flavor and energy content was reversed (Session Three).

Statistical Analysis

Data were expressed as means (SD)
Hedonic ratings of beverages tested, foods ingested at each meals, energy intakes and macronutrient contents were compared by repeated-measures analysis of variance (ANOVA) with the type of beverage tested or session (first through third) as experimental factor
The ANOVA was followed by a post hoc multiple comparison Tukey-Kramer Test when appropriate (P<0.05)
The mean values of the parameters in a session for the different beverages were compared using Students' Paired T-test
All statistical analyses were conducted using the NCSS 2000 statistical package.

Data Collection Summary:

Dependent Variables

Variable One: Energy intakes and macronutrient contents of the foods ingested during lunch and dinner. Each subject completed a seven-day food record: Daily dietary intake was assessed in the month preceding the first experimental day from quantitative one-week food records. The subjects were instructed by a dietitican to note in detail their daily food and drink intake and the portion size, either weighed or expressed in usual household measures. The record was then reviewed and validated by the dietitian, who translated the quantities expressed as household measures into grams using a food computerized die Energy. 41 food constituents of more than 1,500 food items were analysed (compilation of Souci, Southgate and CIQUAL databases).
Variable Two: Hunger ratings at the beginning and at the end of lunches and dinners
Variable Three: The hedonic values of meals taken at lunch and dinner
Hunger and hedonic values were rated on 100mm visual analog scales (VAS). The VAS of hunger anchored "extremely hungry" at one extreme and "not at all hungry" at the other. The hedonic value of the experimental beverages was also rated on a 100mm VAS at the start of lunch and dinner on the first day of each measurement period. The VAS anchored "extremely good" at one extreme and "extremely bad" at the other.
Body weights were taken at the beginning of the study (Week One) and at the end (Week 10) to discern a possible effect of supplemental calories from beverages.

Description of Actual Data Sample:

Initial N: 24 (12 men and 12 women)
Attrition (final N): 24
Age: 20 to 25 years
Other relevant demographics: Burgandy student population
Anthropometrics: BMI 19kg/m² to 24kg/m²
Location: Department of Physiology, University Hospital, Dijon, France.

Summary of Results:

Body Weights

Weights did not change over the study period.

Total Energy Intakes

In all sessions, the total energy intake after ingestion of beverages with sucrose was significantly higher than after the ingestion of beverages with intense sweeteners (P<0.001). See Table One.

Hedonic Ratings for the Foods

Hedonic rating for the foods consumed at different meals was not significant. This indicated that the subjects liked the foods equally well for the same meal over the three sessions.
There was no significant differences in hunger ratings at the beginning of the meals except for a lower rating at the Lunch Session One, associated with the beverage sucrose, as compared to the Lunch Session Three (P<0.05).
The hunger ratings at the end of the meals did not differ between the experimental conditions.

Hedonic Ratings of Beverages

At lunch and dinner, the ratings of beverages containing intense sweeteners were lower than the ratings given to the beverages containing sucrose, especially when the subjects ingested them for the first time (session effect at lunch, P<0.01; session effect at dinner, P<0.001, following by the Tukey-Kramer test, P<0.05)
In Sessions One and Two, the subjects significantly preferred the beverages containing sucrose to those containing intense sweeteners. This preference for the beverages with sucrose declined by Session Three (P<0.001).

Author Conclusion:

Ingestion of caloric beverages induced a positive energy balance and the continuous exposure phase to these beverages over one month did not improve food intake adaptation in response to the extra energy provided by the beverages
The present study indicated that when subjects consume beverages with sucrose, their total energy intake is significantly higher than after ingestion of beverages made equally sweet with non-caloric substances
The compensation of food intake for energy provided by drinks containing sweetened calories is imprecise and no adjustment of energy intake was observed even after some weeks of consumption
The subjects do not appear to learn to take account of the calories in liquid form
These observations indicate that nutritional guidelines should include caveats about the ingestion of sugars in liquid form.

Funding Source:

Reviewer Comments:

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		Yes
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	Yes
3.	Were study groups comparable?		Yes
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	Yes
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	Yes
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	Yes
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	Yes
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		Yes
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	Yes
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	Yes
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	Yes
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	N/A
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	Yes
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	Yes
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	Yes
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	Yes
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	No
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes