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Nutritive and Non-Nutritive Sweeteners

NNNS: Effect on Appetite and Food Intake (2011)

Citation:

Beridot-Therond ME, Arts I, Fantino M, De La Gueronniere V.  Short-term effects of the flavor of drinks on ingestive behaviors in man. Appetite. 1998 Aug; 31(1) : 67-81.

PubMed ID: 9716436
 
Study Design:
Non-Randomized Controlled Trial
Class:
C - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

To examine the influence of the oro-sensory properties of different beverages on spontaneous intake of drinks.

Inclusion Criteria:
  • Non-smoker
  • Normal body weight (BMI between 19 and 23)
  • Not on any medication
  • No history of medical disorders
  • Seven-day food records showed they regularly took three meals per day, did not use regularly (or occasionally) intense sweeteners, did not nibble, were non-dieters and had no aversion for the foods that composed experimental lunches and dinners
  • Written informed consent was obtained from each before the study.

Exclusion Criteria:

Not described

Description of Study Protocol:

Recruitment  

Local student population

Design

Non-randomized trial

Blinding used

The beverages on the experimental days were not randomized

Intervention

The five beverages were given on five different experimental days as follows and in this order:

  1. Uncarbonated mineral water with low acid concentration
  2. Same mineral water flavored with orange, but unsweetened
  3. Flavored orange mineral water sweetened with 100g/L sucrose
  4. Flavored orange mineral water equally sweetened with 50mg/L aspartame
  5. Last day was always: Twice the volume of mineral water they had consumed ad libitum in session with drink A.

Statistical Analysis

Analysis of variance

  • Hedonic ratings
  • Energy intake
  • Macronutrient content.

These analysis were followed by post-hoc Newman-Keul's test (statistical level of significance: P<0.05).

Repeated measure ANOVA also used to determine whether beverage intake, thirst, hunger rating and satiation changed over time during the experimental days.

Intakes of the sucrose-sweetened beverage and the orange-flavored beverage were compared by Student's paired T-test.

Data Collection Summary:

Timing of Measurements

  • Study lasted three weeks
  • Study consisted of five different sessions of two days, each separated by 48 or 72-hour intervals
  • To evaluate hydration status of subjects, they were weighed to the nearest gram in strictly identical dress between 1130 hours and 1200 hours and total urinary excretion and the osmolarity of urine collected during the morning (from 0900 to 1200 hours) was measured
  • On experimental day, experimental beverage given at 1200 hours: Subject had ad libitum access for the whole duration of experimental session; a lunch composed of five courses and experimental beverage, without any other drink, was served in the subject's room
  • Subjects had 20 minutes to eat (1215 hours to 1235 hours)
  • Confined to control room after lunch until spontaneously requesting dinner
  • Dinner was ad libitum access to cafeteria buffet composed of 30 conventional French foods normally consumed at that time of day
  • Subjects took dinner in their room; experimental drink was available as beverage
  • Could leave lab after dinner but not eat or drink anything until breakfast the following day; on following day, they had to weigh and record all ingested foods and liquids.

 Dependent Variables

  • Energy and macronutrient contents of foods ingested during lunch and dinners
  • Pattern of hunger and satiation evaluated before and after each meal and at hourly intervals between lunch and dinner
  • Hedonic value of lunch and dinner
  • Latency to spontaneously request dinner after lunch.

 Independent Variables

  • Mineral water as experimental beverage
  • Mineral water flavored with orange and unsweetened as experimental beverage
  • Mineral water sweetened with 100g/l sucrose as experimental beverage
  • Mineral water equally sweetened with 50mg/l aspartame as experimental beverage
  • Twice the volume of mineral water that they had consumed ad libitum in session with mineral water as experimental beverage.

Control Variables

  • Effect of the order of experimental sessions
  • Sex (gender).
Description of Actual Data Sample:

Initial N

N=24: 12 males and 12 females

Attrition

Final N=24

Age

20-25 years old

Ethnicity

Not described

Anthropometrics

BMI of subjects was 19-23

Location

The study was conducted in a residential metabolic unit in the Dijon (France) University Hospital

Summary of Results:

Hydration

  • No significant differences were found between body weight, total urinary excretion and urine osmolarity
  • This indicated that subjects had a similar hydrational status at the start of each experimental session.

Drink Intake

At the start of the drinking period (1200 hours), subjects gave a significantly higher hedonic rating for the two sweetened beverages than for unsweetened orange-flavored one.

Cumulative Intake of Each Beverage

  • Increased regularly over the experimental day
  • Subjects tended to consume slightly more of the sweetened beverages (both with sucrose and aspartame) than mineral water and slightly less of the orange-flavored beverage
  • No significant difference in cumulative volumes of different beverages consumed at any particular time of measurement
  • Only paired T-test indicated that the subjects consumed significantly more of the sucrose-sweetened beverage than the orange-flavored one from 1600 hours to the end of the experimental day.

Thirst Sensations

  • Significantly differed between beverages consumed
  • Subjects were equally thirsty before they received beverage at 1200 hours, but in the first 10-minute drinking period there was a dramatic reduction in thirst, which was significantly higher in the double volume condition
  • After lunch, thirst ratings remained low and stable until the end of the experimental day.

Hunger Rating and Food Intake

  • Hunger and satiation ratings significantly changed over time
  • No difference between the beverages when the subjects were allowed to drink ad libitum
  • Hunger and satiation ratings in the double volume condition were slightly, but significantly different than those in the other conditions owing to the higher hunger and lower satiation ratings from 1500 to 1700 hours
  • Energy intake during lunch, dinner and during the following day also did not differ significantly between the different beverages
  • Total macronutrient selection was not affected by the nature of the beverage, either when expressed in terms of energy or as a percentage of total energy intake
  • Identical results were obtained when the macronutrient selection was computed separately for each meal.

Spontaneous Request for Dinner

Interval from the end of lunch to the spontaneous dinner request differed little when the subjects consumed the four different beverages ad libitum, although it was shortened by about 35 minutes on the day the subjects drank twice the normal volume of mineral water.

Absence of Sex and Order Effect

  • One-way ANOVA did not indicate any order effect of beverage presented on lunch and dinner hedonic evaluations, hunger sensation at meal time or on food intake
  • ANOVA did not reveal any significant effect of the sex of the subjects on the energy compensation or the beverage cumulative intake.
Author Conclusion:
  • Subjects consumed slightly more of the two sweetened beverages than the mineral water and slightly less of the orange-flavored beverage
  • Energy intake and macronutrient selection during lunch and dinner on the experimental days and on the following day did not differ significantly between the different conditions
  • There was a significantly higher total energy intake when the imposed beverage contained sucrose.

 

 

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
  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
  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
  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
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
 
Validity Questions
  1. Was the research question clearly stated? Yes
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.1. 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
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
  1.3. Were the target population and setting specified? Yes
  2. Was the selection of study subjects/patients free from bias? 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
  2.1. 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
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? 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
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
  3. Were study groups comparable? 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) No
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) No
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? 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
  3.3. 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
  3.4. 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
  3.5. 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
  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? N/A
4. Was method of handling withdrawals described? N/A
  4.1. Were follow-up methods described and the same for all groups? N/A
  4.1. Were follow-up methods described and the same for all groups? N/A
  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%.) N/A
  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%.) N/A
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
  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? No
5. Was blinding used to prevent introduction of bias? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? No
  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.) No
  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.) No
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  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
  5.4. 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
  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. 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
  6.1. 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
  6.2. 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? ???
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? ???
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? 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? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? Yes
  6.6. Were extra or unplanned treatments 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? Yes
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? Yes
  6.8. In diagnostic study, were details of test administration and replication sufficient? 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. 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
  7.1. 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
  7.2. 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? ???
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? ???
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? 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
  7.5. 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
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? 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. 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
  8.1. 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
  8.2. 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
  8.3. 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)? ???
  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)? ???
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? 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
  8.6. 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? ???
  8.7. If negative findings, was a power calculation reported to address type 2 error? ???
  9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
  10. Is bias due to study's funding or sponsorship unlikely? ???
10. Is bias due to study's funding or sponsorship unlikely? ???
  10.1. Were sources of funding and investigators' affiliations described? No
  10.1. Were sources of funding and investigators' affiliations described? No
  10.2. Was the study free from apparent conflict of interest? ???
  10.2. Was the study free from apparent conflict of interest? ???