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Nutritive and Non-Nutritive Sweeteners

NNNS: High Fructose Corn Syrup (HFCS) (2010)

Citation:

Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr. 2004;  79(4): 537-543. Review. Erratum in: Am J Clin Nutr. 2004 Oct; 80(4): 1,090.

PubMed ID: 15051594
 
Study Design:
Narrative Review
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

Investigate the relation between the intake of high fructose corn syrup (HFCS) and the development of obesity.

Inclusion Criteria:

Not applicable.

Exclusion Criteria:

Not applicable.

Description of Study Protocol:

Not applicable.

Data Collection Summary:

Not applicable.

Description of Actual Data Sample:

Not applicable. 

Summary of Results:

 Key Findings

  • In the United States, HFCS is the major source of caloric sweeteners in soft drinks and many other sweetened beverages and is also included in numerous other foods; therefore, HFCS constitutes a major source of dietary fructose
  • The digestive and absorptive processes for glucose and fructose are different
  • Fructose does not stimulate insulin release
  • Fructose produces a much larger increase in lactate and a small (1.7%) increase in diet-induced thermogenesis, which again suggests that glucose and fructose have different metabolic effects
  • Consumption of high-fructose meals reduced 24-hour plasma insulin and leptin concentrations and increased postprandial fasting triacylglycerol concentrations in women but did suppress circulating ghrelin concentrations
  • Fructose facilitates the biochemical formation of triacylglycerols more efficiently than does glucose
  • In experimental animals, sweetened beverages appear to enhance caloric consumption
  • Between 1970, when HFCS was introduced into the marketplace, and 2000, the per capita consumption of HFCS in the United States increased from 0.292kg per person per year to 33.4kg per person per year, an increase of more than 100-fold. The total consumption of fructose increased nearly 30%.The consumption of free fructose showed a greater increase, which reflected the increasing use of HFCS.
  • Using age-standardized, nationally representative measures of obesity at five time points from 1960 to 1999 and data on the availability of HFCS collected annually over this same period, the authors graphed both patterns (Figure one in the article)
  • On the basis of the trend in intakes, the authors estimated HFCS intake for the most recent period of measurement from 1994 to 1998 as 132kcal per person per day. This represents a shift between 1977 to 1978 and 1994 to 1998 from 4.5% of total calories to 6.7% of total calories, or from 10.1% of carbohydrates to 13.1% of carbohydrates
  • Consumers in the top quintile of caloric sweetener intake, which represents 20% of all Americans, consume more than 11% of their calories from HFCS. The authors indicated, because of measurement techniques  or methodology, that this is a conservative estimate. This same group obtains almost one-half of its carbohydrates from caloric sweeteners and one-fifth of its carbohydrates from HFCS. 

 

Author Conclusion:
  • The authors believe that an argument can now be made that the use of HFCS in beverages should be reduced and that HFCS should be replaced with alternative non-caloric sweetener
  • Sweetness is a preferred taste as well as an acquired one that may be enhanced by exposure to sweet foods
  • The hypothesis that providing sodas and juice drinks in which caloric sweeterners are partially or completely replaced with non-caloric sweeteners will help reduce the prevalence of obesity is worth testing
  • If the intake of calorically sweetened beverages is contributing to the current epidmemic, then reducing the availability of these beverages by removing soda machines from schools would be a strategy worth considering, as would reducing the portion sizes of sodas that are commerically available.
Funding Source:
Other: funding source not listed
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? Yes
  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? ???
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  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? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? ???