EAL

NNNS: Food Intake (2006)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

The review highlights the nutritional implications of the consumption of reduced energy foods produced by the use of substitutes for sugar or fat, considering what these materials might replace and focusing on potential influences on macronutrient intakes and weight control in the general population.

Inclusion Criteria:

None.

Exclusion Criteria:

None.

Description of Study Protocol:

Data Collection Summary:

Description of Actual Data Sample:

Summary of Results:

Intense sweeteners can deliver a sweetness intensity which would equate to 10 to 20,000 or more times greater than sucrose and are either not metabolized or appear in foods at concentrations so low as to make a negligible contribution to energy intakes.

Approximate Sweetness (Sucrose Equivalents)


Intense Sweeteners
Acesulfame K	200
Aspartame	180
Cyclamate	30
Neohesperidin dihydrochlcone	200
Saccharin	300
Sucralose	600
Thaumatin	2,500

Primary concerns, which have promoted development and marketing of substitutes relate to dental caries, glycemic control and energy balance.

Experimental data and theoretical considerations suggest that replacement of sugars with intense sweetners should lead to a reduction in CHO intake, but also to a higher proportion of dietary energy being derived from fat.
In a prospective trial, high sucrose consumers who adopted the use of reduced sugar products significantly increased the proportion of energy from fat in their diets (Geatenby et al, 1997; Mela 1997).
Limited cross-sectional data do not support a link between intense-sweetener use and either sugar or fat intakes. (Chen, Parham, 1991; Anderson, Leiter, 1996).
Little experimental data on how the use of sugar substitutes relates to macronutrient intake.
Chen, Parham 1991, a cross-sectional study, found no evidence that greater use of intense sweeteners was associated with lower sugar consumption.
Little data exists to support restriction of sugar consumption as part of a weight-loss strategy.
Kanders et al, 1988, a pilot study, is often cited as to the benefits of use of intense sweeteners in slimming.
Studies have focused on the ability to suppress hunger and subsequent eating (satiety) by using a fixed preload, followed by measurement of ad libitum intake of a test meal comprising a range of food items. The studies indicate that there is a tendency toward compensation for most or all moderate covert reductions in energy content of preloads through the use of sugar and fat substitutes in place of traditional ingredients, if subjects are allowed ad libitum access to a wide choice of foods.

Author Conclusion:

There is little clear evidence of dietary benefits from sugar substitutes as used, while there are concerns that their use may produce compensatory increases in fat consumption.
Modest use of fat and sugar substitutes seems unlikely to cause harmful (beneficial) changes in nutritional variables, although there are concerns relating to specific ingredients.

Funding Source:

Not-for-profit

Foundation associated with industry:

Reviewer Comments:

Quality Criteria Checklist: Review Articles
Relevance Questions
	1.	Will the answer if true, have a direct bearing on the health of patients?	Yes
	2.	Is the outcome or topic something that patients/clients/population groups would care about?	Yes
	3.	Is the problem addressed in the review one that is relevant to dietetics practice?	N/A
	4.	Will the information, if true, require a change in practice?	Yes

Validity Questions
	1.	Was the question for the review clearly focused and appropriate?	Yes
	2.	Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described?	No
	3.	Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased?	No
	4.	Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible?	No
	5.	Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?	No
	6.	Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?	No
	7.	Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?	No
	8.	Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included?	No
	9.	Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?	No
	10.	Was bias due to the review's funding or sponsorship unlikely?	Yes