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An Overview of Reviews on the Association of Low Calorie Sweetener Consumption With Body Weight and Adiposity 低热量甜味剂消费与体重和肥胖关系的综述。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-12-01 DOI: 10.1016/j.advnut.2024.100239
Kelly A Higgins , Rita Rawal , Matthew Kramer , David J Baer , Aaron Yerke , David M Klurfeld

Background

Numerous systematic reviews (SR) and meta-analyses (MA) on low calorie sweeteners (LCS) have been published in recent years, concluding that LCS have beneficial, neutral, or detrimental effects on various health outcomes, depending on the review.

Objectives

The objective of this overview of reviews was to determine how the methodologies of SR investigating the association between LCS consumption and body weight (BW) influence their findings and whether MA results can provide a consistent estimated effect.

Methods

Systematic searches of PubMed, Scopus, and Cochrane Library were conducted in November 2022 to identify SR of randomized controlled trials (RCT) or non-randomized studies (NRS) investigating the association between LCS consumption and BW. The methods, MA results, and conclusions were extracted from each eligible SR.

Results

Of the 985 search results, 20 SR evaluated the association between LCS and BW, drawing from publications of 75 RCT, 42 prospective cohort studies, and 10 cross-sectional studies. There was a considerable lack of overlap of studies included within each SR attributed, in part, to the inclusion of studies based on design; thus, each SR synthesized results from distinctly different studies. Evidence synthesis methods were heterogeneous and often opaque, making it difficult to determine why results from certain studies were excluded or why disparate results were observed between SR.

Conclusions

SR investigating the effect of LCS on BW implement different methodologies to answer allegedly the same question, drawing from a different set of heterogeneous studies, ignoring the basic assumptions required for MA, resulting in disparate results and conclusions. Previous MA show the large effects of study design, which results in inconsistent estimates of the effect of LCS on BW between MA of RCT and NRS. Given the availability of long-term RCT, these studies should be the basis of determining causal relationships (or lack thereof) between LCS and BW.
This trial was registered at PROSPERO as CRD42022351200.
背景:近年来发表了许多关于低热量甜味剂(LCS)的系统综述(SR)和荟萃分析(MA),其结论是 LCS 对各种健康结果具有有益、中性或有害的影响,具体取决于综述的内容:本综述旨在确定研究低碳水化合物摄入量与体重(BW)之间关系的 SR 的研究方法如何影响其研究结果,以及 MA 结果是否能提供一致的估计效应:2022 年 11 月,对 PubMed、Scopus 和 Cochrane 图书馆进行了系统检索,以确定调查食用低碳水化合物与体重之间关系的随机对照试验 (RCT) 或非随机研究 (NRS) 的 SR。从每个符合条件的SR中提取了方法、MA结果和结论:结果:在 985 项搜索结果中,有 20 项 SR 评估了低碳水化合物与体重之间的关系,其中包括 75 项 RCT、42 项前瞻性队列研究和 10 项横断面研究。每个 SR 中纳入的研究在很大程度上缺乏重叠,部分原因是根据设计纳入研究;因此,每个 SR 综合了截然不同的研究结果。证据综合方法不尽相同,而且往往不透明,因此很难确定为什么某些研究的结果被排除在外,或者为什么SR之间会出现不同的结果:调查 LCS 对生物量影响的 SR 采用不同的方法来回答据称相同的问题,从不同的异质研究中汲取资料,忽视了 MA 所需的基本假设,导致结果和结论的差异。以往的千年生态系统评估表明,研究设计的影响很大,这导致 RCT 和 NRS 的千年生态系统评估对 LCS 对体重影响的估计不一致。鉴于长期 RCT 的存在,这些研究应成为确定 LCS 与体重之间因果关系(或缺乏因果关系)的基础。该试验在 PROSPERO 注册为 CRD42022351200。
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引用次数: 0
Effects of Nonnutritive Sweeteners on the BMI of Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies 非营养型甜味剂对儿童和青少年体重指数的影响:随机对照试验和前瞻性队列研究的系统回顾和元分析》。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-12-01 DOI: 10.1016/j.advnut.2024.100292
Alan Espinosa , Kenny Mendoza , Hugo Laviada-Molina , Jorge Aarón Rangel-Méndez , Fernanda Molina-Segui , Qi Sun , Deirdre K. Tobias , Walter C. Willett , Josiemer Mattei
The effect of nonnutritive sweeteners (NNSs) on the body mass index [BMI (in kg/m2)] of children and adolescents remains unclear despite rising consumption. Detailed systematic evaluations are warranted. We aimed to summarize evidence on NNS consumption and BMI sex- and age-specific absolute changes (kg/m2) in pediatric populations, by NNS type, study design, duration, analysis type, conflicts of interest (COI), geographical region, age, sex, and baseline BMI. We searched randomized controlled trials (RCTs) and prospective cohort studies in children (2–9 y), adolescents (10–24 y), and young adults (20–24 y). Pooled estimates derived from random-effects meta-analysis for BMI changes, and the evidence quality was evaluated overall and by subgroup. From 2789 results, we included 4 RCTs [n = 1372; mean follow-up = 42.6 wk (standard deviation = 18.4); 2 (50%) with COI], and 8 prospective cohort studies [n = 35,340; median follow-up 2.5 y (interquartile range = 1.7–6.3), 2 (25%) with COI]. No identified studies evaluated NNS in food, NNS beverages compared with water, or participants aged 20–24 y. Random allocation to NNS beverages (25–2400 mg/d, from beverages) showed less BMI gain [mean difference = −0.114 kg/m2 (95% confidence interval [CI]: −0.207, −0.021); I2 = 87.02%] compared with sugar-sweetened beverages (SSBs). Stratified estimates resulted in less BMI gain in adolescents, participants with baseline obesity, consumers of mixed NNS, longer trials, and trials without COI. Pooled estimates from prospective cohorts showed a nonsignificant association between NNS beverages and BMI gain [0.05 kg/m2 (95% CI: −0.03, 0.13); I2 = 75.06%; per daily 355 mL serving]. Stratified estimates remained consistent. Removing studies with COI attenuated estimates. Evidence had low to moderate quality. In summary, pooled results from RCTs comparing NNS beverages compared with SSBs showed less BMI gain in adolescents with obesity. Meta-analyses of long-term cohort studies did not display a significant association between NNS beverages and BMI changes.
This trial was registered at PROSPERO as CRD42022352284.
尽管非营养型甜味剂(NNS)的消费量在不断增加,但其对儿童和青少年体重指数[BMI(以 kg/m2 为单位)]的影响仍不明确。有必要进行详细的系统评估。我们旨在根据 NNS 类型、研究设计、持续时间、分析类型、利益冲突 (COI)、地理区域、年龄、性别和基线 BMI,总结有关 NNS 消费量与儿科人群 BMI 性别和年龄特异性绝对变化(kg/m2)的证据。我们检索了针对儿童(2-9 岁)、青少年(10-24 岁)和年轻成人(20-24 岁)的随机对照试验 (RCT) 和前瞻性队列研究。通过随机效应荟萃分析得出了BMI变化的汇总估计值,并对证据质量进行了整体评估和分组评估。从 2789 项研究结果中,我们纳入了 4 项 RCT [n = 1372;平均随访时间 = 42.6 周(标准差 = 18.4);2 项(50%)有 COI],以及 8 项前瞻性队列研究 [n = 35340;中位数随访时间为 2.5 年(四分位间范围 = 1.7-6.3),2 项(25%)有 COI]。与含糖饮料(SSB)相比,随机分配 NNS 饮料(25-2400 毫克/天,来自饮料)显示 BMI 增加较少[平均差异 = -0.114 kg/m2(95% 置信区间 [CI]:-0.207,-0.021);I2 = 87.02%]。分层估计结果表明,青少年、基线肥胖参与者、混合 NNS 消费者、较长试验和无 COI 试验的 BMI 增幅较小。前瞻性队列的汇总估计值显示,NNS 饮料与 BMI 增长之间存在不显著的关联[0.05 kg/m2 (95% CI: -0.03, 0.13);I2 = 75.06%;每日每份 355 mL]。分层估计值保持一致。剔除有 COI 的研究会降低估计值。证据质量为中低水平。总之,将无营养饮料与固态饮料进行比较的 RCT 汇集结果显示,肥胖青少年的 BMI 增长较少。对长期队列研究进行的元分析表明,NNS 饮料与 BMI 变化之间没有显著关联。该试验在 PROSPERO 注册为 CRD42022352284。
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引用次数: 0
Tracing Zinc’s Role in Preterm Infants’ Health: A Narrative Review 追踪锌在早产儿健康中的作用:一个叙述性的回顾。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-12-01 DOI: 10.1016/j.advnut.2024.100295
Alessandra Consales , Carlo Agostoni , Roberta Cazzola , Roberta Ottria , Maria Lorella Giannì
Zinc (Zn) is a trace element involved in numerous physiological processes, including enzyme function, gene transcription, and cell signaling. Its importance is especially pronounced in preterm infants, who are at high risk of Zn deficiency due to disrupted transplacental transfer, high nutrient demands, and medical complications. The inherent risk of Zn deficiency in this population is further increased by poor Zn dietary intake. Human milk from preterm mothers contains low concentrations of Zn, although it is highly bioavailable. Additionally, the Zn content steadily declines from colostrum (first few days postpartum) to mature milk (>10–14 d postpartum). Formula milk contains higher Zn concentrations to compensate for nutrient losses during production and storage, and lower bioavailability compared with human milk, which is further decreased in case of high phytate content, such as in soy milk-based formulas. Zn supplements may prove useful in meeting the preterm infant’s needs, although caution is warranted regarding potential interactions with other nutrients within multinutrient supplements. Early detection of Zn deficiency is challenging due to the lack of reliable Zn status biomarkers, necessitating a high index of suspicion. Clinical signs of Zn deficiency can range from mild, nonspecific symptoms to severe, multisystem involvement. Chronic deficiency may lead to failure to thrive. Zn supplementation can support growth and mitigate comorbidities in preterm infants, although variability across studies complicates efforts to establish optimal dosing, and define safety and long-term effects. Although rare, Zn toxicity in preterm infants should not be overlooked, especially in infants on long-term parenteral nutrition. This narrative review aimed to consolidate existing knowledge and identify research gaps, highlighting the critical role of Zn in supporting preterm infants’ health. Further research is needed to establish evidence-based practices to improve health outcomes in this vulnerable population.
锌(Zn)是一种微量元素,参与许多生理过程,包括酶功能、基因转录和细胞信号传导。它的重要性在早产儿中尤其明显,早产儿由于胎盘转移中断、高营养需求和医学并发症而处于缺锌的高风险中。在这一人群中,锌缺乏的固有风险因饮食中锌摄入不足而进一步增加。来自早产儿母亲的母乳含有低浓度的锌,尽管它具有很高的生物利用度。此外,从初乳(产后最初几天)到成熟乳(产后10-14天),锌含量稳步下降。配方奶含有较高的锌浓度,以弥补生产和储存过程中的营养损失。与人奶相比,配方奶的生物利用度较低,在植酸盐含量较高的情况下,如豆奶配方奶,生物利用度会进一步降低。锌补充剂在满足早产儿的需要方面可能是有用的,尽管在多营养素补充剂中有必要注意与其他营养素的潜在相互作用。由于缺乏可靠的锌状态生物标志物,需要高怀疑指数,因此锌缺乏症的早期检测具有挑战性。锌缺乏症的临床症状可以从轻微的非特异性症状到严重的多系统累及。长期缺乏可能导致无法茁壮成长。补充锌可以支持早产儿的生长并减轻合并症,尽管不同研究的差异使确定最佳剂量、确定安全性和长期影响的努力复杂化。虽然罕见,锌中毒在早产儿不应被忽视,特别是在婴儿长期肠外营养。这篇叙述性综述旨在巩固现有知识并确定研究空白,强调锌在支持早产儿健康方面的关键作用。需要进一步的研究来建立基于证据的做法,以改善这一弱势群体的健康结果。
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引用次数: 0
Perspective: Food Access at Dollar Stores and Its Implications for Public Health—Report of a Workshop on Identifying Research Priorities 透视:一元店的食品获取途径及其对公众健康的影响:确定研究重点研讨会报告》。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-12-01 DOI: 10.1016/j.advnut.2024.100319
Wenhui Feng , Hailey Fromkin , J Becket Harney , Ryan Evans , Colin M Gerrity , Sean B Cash
The rapid growth of dollar stores as retail sources of food in the United States is a phenomenon with implications for diets, nutrition, and well-being. We convened a broadly interdisciplinary group of researchers and experts from government and academia at the 2-day Food Access at Dollar Stores (FADS) workshop, held in Boston, MA in 2022. The event brought together economists, social scientists, public health researchers, and advocates to discuss the concerns and research questions raised by the growth of dollar stores and their increased role in food retail and access. In-person, moderated discussions on day 2 of the workshop generated a range of topics considered important for future research. A subsequent survey, using a modified Delphi approach, identified priority research areas. Nine research area categories emerged as a result of discussion at the FADS workshop and received prioritization from the experts: Local community impacts; Health and nutrition impacts; Policy and programs; Systemic issues – racism, poverty, and food access; Store offerings and locations; Shoppers and customers; Employees and employment; Corporate distribution, strategy, and marketing; and Dollar stores compared with other food sources. The growth of dollar stores as food retailers remains an under-researched area of study for food access and nutrition that requires interdisciplinary expertise and collaboration to understand.
在美国,作为食品零售来源的一元店迅速增长,这一现象对饮食、营养和福祉产生了影响。在 2022 年于马萨诸塞州波士顿举行的为期两天的 "一元店食品获取(FADS)"研讨会上,我们召集了来自政府和学术界的跨学科研究人员和专家。此次活动汇聚了经济学家、社会科学家、公共卫生研究人员和倡导者,共同讨论一元店的发展及其在食品零售和获取方面日益重要的作用所引发的关注和研究问题。研讨会第二天的讨论由主持人主持,提出了一系列被认为对未来研究具有重要意义的议题。随后进行的一项调查采用了改良的德尔菲法,确定了优先研究领域。根据 FADS 研讨会的讨论结果,专家们确定了九个研究领域的优先次序:当地社区影响;健康和营养影响;政策和计划;系统性问题 - 种族主义、贫困和食品获取;商店产品和地点;购物者和顾客;员工和就业;企业分销、战略和营销;以及一元店与其他食品来源的对比。作为食品零售商,一元店的增长仍然是一个对食品获取和营养研究不足的领域,需要跨学科的专业知识和合作才能理解。意义说明:在过去十年中,一元店作为食品零售商在美国迅速发展。这项工作报告了一个研究研讨会的结果,并提供了一个路线图,用于确定研究课题和工具的优先次序,以了解许多消费者在获取食物的方式上发生的这一重要变化对公共健康、公平和经济的影响。
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引用次数: 0
Non-nutritive Sweeteners and Health: Reconciling Evidence and Interrogating Guideline Disconnects 非营养性甜味剂与健康:调和证据和质疑指南脱节。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-12-01 DOI: 10.1016/j.advnut.2024.100328
Tauseef A Khan , Sabrina Ayoub-Charette , John L Sievenpiper
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引用次数: 0
Rethinking Zinc—Do We Need Catch-Up Evidence or Just Catch-Up Care? 重新思考锌--我们需要的是跟进证据还是跟进护理?
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-12-01 DOI: 10.1016/j.advnut.2024.100320
Stephanie P Gilley, Nancy F Krebs
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引用次数: 0
Cultural Cuisines and Cardiovascular Care: Tailoring Dietary Interventions for Effective Prevention 文化美食与心血管护理:为有效预防而量身定制饮食干预。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-12-01 DOI: 10.1016/j.advnut.2024.100331
Alina Yang
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引用次数: 0
Reflecting on the Implications of Dollar Store Expansions on Food and Nutrition Security in the United States 反思一元店扩张对美国食品和营养安全的影响。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-12-01 DOI: 10.1016/j.advnut.2024.100337
Amy R Mobley
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引用次数: 0
Understanding the Genetic Architecture of Vitamin Status Biomarkers in the Genome-Wide Association Study Era: Biological Insights and Clinical Significance 在全基因组关联研究时代了解维生素状态生物标志物的基因结构:生物学见解和临床意义。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-12-01 DOI: 10.1016/j.advnut.2024.100344
William R Reay , Erin D Clarke , Clara Albiñana , Liang-Dar Hwang
Vitamins play an intrinsic role in human health and are targets for clinical intervention through dietary or pharmacological approaches. Biomarkers of vitamin status are complex traits, measurable phenotypes that arise from an interplay between dietary and other environmental factors with a genetic component that is polygenic, meaning many genes are plausibly involved. Studying these genetic influences will improve our knowledge of fundamental vitamin biochemistry, refine estimates of the effects of vitamins on human health, and may in future prove clinically actionable. Here, we evaluate genetic studies of circulating and excreted biomarkers of vitamin status in the era of hypothesis-free genome-wide association studies (GWAS) that have provided unprecedented insights into the genetic architecture of these traits. We found that the most comprehensive and well-powered GWAS currently available were for circulating status biomarkers of vitamin A, C, D, and a subset of the B vitamins (B9 and B12). The biology implicated by GWAS of measured biomarkers of each vitamin is then discussed, both in terms of key genes and higher-order processes. Across all major vitamins, there were genetic signals revealed by GWAS that could be directly linked with known vitamin biochemistry. We also outline how genetic variants associated with vitamin status biomarkers have been already extensively used to estimate causal effects of vitamins on human health outcomes, which is particularly important given the large number of randomized control trials of vitamin related interventions with null findings. Finally, we discuss the current evidence for the clinical applicability of findings from vitamin GWAS, along with future directions for the field to maximize the utility of these data.
维生素对人体健康起着内在作用,是通过饮食或药物方法进行临床干预的目标。维生素状态的生物标志物是一种复杂的性状和可测量的表型,是由膳食和其他环境因素与多基因遗传因素相互作用而产生的。研究这些遗传影响因素将提高我们对基本维生素生物化学的认识,完善维生素对人体健康影响的估计,并可能在未来被证明具有临床可操作性。在这里,我们评估了在无假设全基因组关联研究(GWAS)时代对维生素状态的循环和排泄生物标志物的遗传研究,这些研究为我们了解这些特征的遗传结构提供了前所未有的视角。我们发现,目前最全面、最有效的全基因组关联研究针对的是维生素 A、C、D 和 B 族维生素(B9 和 B12)的循环状态生物标志物。然后从关键基因和高阶过程两个方面讨论了每种维生素的生物标记物的 GWAS 所涉及的生物学。在所有主要维生素中,GWAS 发现了一些可与已知维生素生物化学直接关联的遗传信号。我们还概述了与维生素状态生物标志物相关的基因变异是如何被广泛用于估算维生素对人类健康结果的因果效应的,这一点尤为重要,因为大量与维生素相关的干预措施随机对照试验的结果都是无效的。最后,我们讨论了维生素基因组学研究结果临床适用性的现有证据,以及该领域最大限度地利用这些数据的未来方向。
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引用次数: 0
Targeting Cognitive Resilience through Prebiotics: A Focused Perspective 通过益生元提高认知能力:聚焦视角。
IF 8 1区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-11-16 DOI: 10.1016/j.advnut.2024.100343
Boushra Dalile , Neil B Boyle , Franco T Ruiz , Anirikh Chakrabarti , Frederique Respondek , Georgina F Dodd , Kathrin Cohen Kadosh , Piril Hepsomali , Robert J Brummer , Simon McArthur , Veerle Dam , Yoghatama Cindya Zanzer , Yannick Vermeiren , Harriet Schellekens
This perspective article is a product of the work of an expert group within the Prebiotic Task Force convened by the International Life Sciences Institute Europe, a non-profit organization that brings together experts from academia, industry, and public service to catalyze nutrition science for public benefit. An expert group was conceived in October 2023 to discuss the evidence base on the use of prebiotics to promote cognitive functioning, with a focus on highlighting knowledge gaps and proposing a list of recommendations to guide this specific area of research forward. To address this, we evaluated existing systematic reviews and meta-analyses of human intervention studies that examine the effects of prebiotics on cognitive functioning. These are predominantly conducted in healthy participants under basal conditions and have, to date, revealed limited effects. In this perspective, we propose that prebiotics should be investigated as agents to promote cognitive resilience by testing their effects on cognitive performance under certain cognition-taxing factors that individuals encounter across their lifespan. These include stress, poor sleep outcomes, sedentary behavior, and unhealthy dietary patterns, all of which have been shown to be associated with altered microbiome and impact global cognition or specific cognitive domains. In addition, we recommend identifying vulnerable populations that are either subclinical or that struggle chronically or periodically with 1 or more cognition-taxing factors, to better uncover the boundary conditions for prebiotic effectiveness. By broadening the scope of research to include diverse populations and challenging conditions in daily life or experimental settings, we can expand our understanding of the role of prebiotics not only in cognitive health or impairment, but also as potential preventative agents that may promote cognitive resilience during aging and in response to various lifestyle-related challenges.
本视角文章是欧洲国际生命科学研究所(ILSI Europe)召集的益生元特别工作组内的一个专家小组的工作成果,ILSI Europe是一个非营利组织,汇集了来自学术界、工业界和公共服务部门的专家,以促进营养科学为公众造福。2023 年 10 月,我们成立了一个专家小组,讨论使用益生元促进认知功能的证据基础,重点是强调知识差距,并提出一系列建议,以指导这一特定领域的研究向前发展。为了解决这个问题,我们评估了现有的系统综述和荟萃分析,这些综述和分析研究了益生菌对认知功能的影响。这些研究主要是在基础条件下对健康参与者进行的,迄今为止所揭示的效果有限。从这一角度出发,我们建议将益生元作为促进认知复原力的药物进行研究,方法是测试益生元在人的一生中遇到的某些影响认知的因素下对认知表现的影响。这些因素包括压力、睡眠质量差、久坐不动的行为和不健康的饮食模式,所有这些因素都已被证明与微生物组的改变有关,并对整体认知或特定认知领域产生影响。此外,我们建议确定亚临床或长期或周期性地与一种或多种影响认知的因素作斗争的脆弱人群,以便更好地揭示益生菌有效性的边界条件。通过扩大研究范围,将日常生活或实验环境中的不同人群和具有挑战性的条件纳入其中,我们不仅可以扩大对益生元在认知健康或认知障碍方面作用的了解,还可以将其作为潜在的预防药物,在衰老过程中以及在应对各种与生活方式相关的挑战时促进认知恢复能力。
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引用次数: 0
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