Nutritive and Non-Nutritive Sweeteners

Narrative Review

R - Click here for explanation of classification scheme.

NEGATIVE: See Quality Criteria Checklist below.

To examine current scientific evidence on HFCS and energy intake regulation in humans to discern whether there may be something inherent about this sweetener that would warrant moderation beyond that of other sweeteners to curb obesity.

Not described.

Not described.

Clinical trial studies examined were those designed to measure energy intake regulation when subjects were served either fructose in the presence of other carbohydrates or HFCS.

The role of HFCS upon the regulation of energy intake needs to be explored to determine if consumption of HFCS has a greater impact upon the incidence of obesity beyond that of other sweeteners. The data collection was designed to examine the evidence of how fructose impacts endocrine and hormonal regulation of appetite and energy intake when used as it is commonly occurs, as in mixed carbohydrate foods or with glucose as in HFCS. Studies comparing sweeteners that include HFCS or fructose in combination with glucose or other carbohydrates and meals were examined.

Ten short-term clinical trials were reviewed that examined appetite rating (visual analog scale), energy intake or metabolic response to a test and comparative sweetener.

Reference	Subjects	Test Sweetener	Comparative Sweetener	Metabolic Response*
Holt et al, 2000	11 lean males	Sugared cola	Sugar-free cola	Not measured
Anderson et al, 2002	14 healthy weight males	80% fructose; 20% glucose (f per g)	Glucose, sucrose, polycose	Blood glucose significantly lower after f per g than glucose or sucrose
Almiron-Roig and Drewnowski, 2003	32 normal weight adults	HFCS	Orange juice; 1% milk	Not measured
Teff et al, 2004	12 normal weight females	Fructose beverage with meal	Glucose beverage with meal	Lower blood glucose, insulin and leptin and less ghrelin suppression after fructose
Wei and Melanson, 2006	12 obese males	Fructose milk shakes	glucose milk shakes	Lower blood glucose after fructose; higher EE and RQ
Perrigue et al, 2006	37 young adults	HFCS-55; HFCS-42	sucrose; 1% milk	Not measured
Melanson et al, 2007	30 normal weight females	HFCS beverage with meals	sucrose beverage with meals	No significant differences in blood glucose, insulin, leptin or ghrelin suppression
Zuckley et al, 2007	29 obese females	HFCS with meals	sucrose beverage with meals	No significant difference in blood glucose, insulin, leptin or ghrelin suppression
Akhavan and Anderson, 2007	31 healthy males	HFCS	sucrose, varied fructose:glucose	No significant difference in blood glucose, uric acid, insulin or ghrelin
Soenen and Westerterp-Plantenga, 2007	70 healthy males and females	HFCS	sucrose (and milk)	No significant difference in blood glucose, GLP-1, insulin or ghrelin

EE=Energy Expenditure; RQ=Respiratory Quotient.

*No significant differences in the appetite ratings or energy intake between the test and comparative sweeteners.

Evidence suggests that high consumption of pure fructose may be problematic to energy intake regulation, but HFCS is more similar to sucrose than fructose in terms of its content, appetite and metabolic response. Most studies have compared HFCS beverages with non-caloric beverages and are more relevant to the increase in caloric intake from sweeteners than to the effects of specific sweeteners on energy regulation. Insufficient evidence exists to indicate that HFCS disrupts short-term energy balance signals or energy regulation more than other tested sweeteners. A connection has not been established between hormonal and physiologic responses to HFCS and longer-term impacts upon appetite, metabolism and body weight regulation. More research is needed, exploring both mechanistic and outcome oriented foci on energy intake and body weight regulation in response to consumption of HFCS, to determine if any sweetener needs to be limited more than others.

Industry:	PepsiCo Food Company:
Other:	One author has received grants from PepsiCo