Primary role of sweeteners in the body mass indexes of women from developing countries: implications for risk of chronic disease

Sunlight, Nutrition and Health Research Center (SUNARC)
2107 Van Ness Avenue, Suite 403B
San Francisco, CA 94109-2536
E-mail: wgrant{at}sunarc.org

Dear Sir:

The recent Sugars and Health Workshop concluded that "there are few health concerns for which a direct association of sugar can be established" (1). However, it is important to note that the workshop was sponsored by the sugar industry and those who sell sweetened foods. The workshop’s conclusion flies in the face of strong evidence to the contrary (2-4). Overweight and obesity are important risk factors for several chronic, adverse health conditions and diseases (4), including Alzheimer disease, cancer, cardiovascular disease, type 2 diabetes, hypertension, osteoarthritis, sleep apnea, and upper respiratory obstruction.

One way to show that sweeteners are important risk factors is to show their link to obesity. Two studies published since the workshop are useful in this regard. One was a study of dietary intake, eating behavior, and physical activity in rural communities (5). Persons with a higher body mass index (BMI; in kg/m²) were significantly more likely to drink sweetened beverages, to order supersized portions, and to eat while doing other activities, such as watching television. The other study found that consumption of sweetened beverages, sweets, and low-quality foods (fats or oils, sweets, and salty snacks) was positively associated with overweight among 10-y-old children: the odds ratio, including the 95% CI, was >1.0 for European Americans (6).

Another way to show the link between sweeteners and obesity is by comparing international data on BMI and diet. Data on BMI are available from many countries for women aged 15–49 y for the late 1980s (7), and dietary supply data are available for 30 of these countries for 1984–1986 (8). Not all of the dietary supply is consumed by humans, but it is assumed that the difference is about the same for all countries (9). Three dietary factors (sweeteners, animal products, and total energy) were used in a regression analysis (with data averaged by geopolitical region). Sweeteners accounted for 55% of the variance among subjects with a BMI >30, whereas nonsweetener sources of energy accounted for 15% of the variance.

In the United States, self-reported obesity rates doubled from 1986 to 2000 (10). During this period, per capita daily consumption of sweeteners increased from 573 to 710 kcal and that of flour and cereal products increased from 653 to 902 kcal (8, 11). Total per capita energy increased from 3165 to 3850 kcal (8, 10). Sweeteners, flour, and cereal products accounted for 56% of the total increase. It is also interesting to note that consumption of high-fructose corn syrup increased from 8.6 kg (19.0 pounds) per person in 1980 to 29 kg (63.8 pounds) per person in 2000 (10). Fructose does not invoke the insulin response that glucose and sucrose (which contains both fructose and glucose) do, but it has a similar propensity to produce triacylglycerols and be stored as fat. Simple carbohydrates contribute more to weight gain than do fats and protein because simple carbohydrates do not increase postprandial thermogenesis as much as fats and protein do (12). The difference in the effect on thermogenesis is one reason that low-carbohydrate diets are associated with weight loss; another reason is that fats provide a greater feeling of satiety than do carbohydrates, and so people eat less.

Thus, evidence continues to mount that added sweeteners have an important association with the prevalence of obesity in the United States and that obesity is an important risk factor for several chronic diseases.

REFERENCES

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11. Statistical Abstract of the United States, 2002. Washington, DC: US Census Bureau, 2002. Internet: http://www.census.gov/prod/2003pubs/02statab/health.pdf (accessed 19 October 2003).
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