limit foods and drinks with added sugars? the case against
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Limit foods and drinks with added sugars? The case against. Jennie Brand-Miller Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders The University of Sydney. If everyone is thinking alike Then somebody isn’t thinking George S. Patton. The dogma. - PowerPoint PPT PresentationTRANSCRIPT
Limit foods and drinks with Limit foods and drinks with added sugars?added sugars?
The case againstThe case against
Jennie Brand-MillerJennie Brand-MillerBoden Institute of Obesity, Nutrition, Exercise and Eating DisordersBoden Institute of Obesity, Nutrition, Exercise and Eating Disorders
The University of SydneyThe University of Sydney
The dogma
Added sugars are ‘empty’ calories/kilojoules
Added sugars cause micronutrient deficiencies
Added sugars stimulate appetite
Added sugars make you fat
Cutting added sugars will cause weight loss
Reducing added sugars will prevent tooth decay
Honey in human diets
Allsop and Brand-Miller Brit J Nutr 1996
“Sugarbag”
“Intakes at various times during history may well have rivalled our current consumption of refined sugar”
A long history of bee-keeping
The Ancient Egyptians had a steady supply of honey from their domesticated bees
“Cylindrical hives were made of clay and stacked horizontally on top of each other in rows up to eight in height, a total of up to 500 hives”
From the tomb of Pabasa, 7th century BC
Rice Bubbles vs CocoPops have the same energy density and similar nutrient content
Replacing starch with sugar doesn’t alter energy densityAdded sugars have no impact on micronutrient density of breakfast cereals
Other sources of empty calories
Beer
Wine and spirits
Refined starches
Maltodextrins
Gluten
Mostly empty calories…
Refined oils
Refined grains
white rice
Low fat, low sugar snacks
Crispbreads
Cakes and biscuits
Mozzafarian et al. NEJM 2011
“Several dietary metrics that are currently emphasized, such as fat content, energy density, and added sugars, would not have reliably identified the dietary factors that we found to be associated with long term weight gain”
Observational studies don’t prove causality,
merely an association
Randomised controlled trials RCTs are the
“gold standard”
Mark Pereira Int J Obesity 2006
“The equivocal evidence on this topic makes it difficult to draw firm conclusions regarding the role of SSB in the etiology of
obesity. Many of the prospective and experimental studies are of unsatisfactory methodological rigor”
Forshee et al. Am J Clin Nutr 2008
“The quantitative meta-analysis and qualitative review found that the association between sugar-sweetened
beverages and BMI was near zero, based on the current body of scientific evidence”
Forshee et al. Am J Clin Nutr 2008
Forshee’s meta-analysis of RCTs
Favours interventionFavours control
Van Baak and Astrup Obesity Reviews 2009
Observational studies suggest a possible relationship between sugar-sweetened beverages and body weight, but there is currently insufficient supporting evidence from RCT
of sufficient size and duration
Mattes et al. Obesity Reviews 2010
The current evidence does not demonstrate conclusively that nutritively sweetened beverages have uniquely
contributed to obesity or that reducing consumption will reduce BMI levels in general
Mattes’ forest plot of RCTsEffectiveness trials aimed at decreasing consumption
Mattes et al. Obesity Reviews 2011
“These results indicate that there is no statistically significant effect overall…it is unlikely that interventions of the types studied to date could produce more than 0.05 of a SD unit
lesser BMI change…”
RCT by Ebbeling et al. 2006n = 103 adolescents, parallel design 25 wk intervention,
achieved ~1000 kJ reduction in soft drink intake
BMI
No significant difference
Control group received no attention placebo
Change in BMI in each groupn = 103 adolescents, parallel design 25 wk intervention
Control group Intervention group
Baseline BMI
Ebbeling et al. Pediatrics 2006
Baseline BMI
NS
The Carmen Study393 adults, parallel design, ad libitum low fat diet,
6 mth intervention, most foods provided
Saris, Astrup, Raben et al. Int J Obesity 2000
weight
The Australian Paradox
The observation that Australians appear to have reduced their intake of added sugars but the prevalence of obesity continues to rise
But have we really reduced our intake of added sugars?
Barclay and Brand-Miller Nutrients 2011
Soft drinks: nutritive vs ‘diet’
Drop = 64 million litres
Source: Australian Beverage Council Ltd and Dr Gina Levy (Food Logic, personal correspondence), September 2009
Children are drinking less soft drink, flavoured water & electrolyte drinks
% consuming Mean intake
Source: Analysis of the 2007 Children’s Nutrition and Physical Activity Survey undertaken for the Australian Beverages Council by Flinders University (unpublished data)
BMI vs added sugars intakeKids Eat, Kids Play 2007
Quintiles of added sugars intake
BMIZ-score
Jimmy Louie et al. unpublished data
My concern
Continuing emphasis on limiting added sugars may be counterproductive because added sugars are replaced
with undesirable nutrients
eg saturated fat, high GI starches, salt and alcohol
My take home messagesHumans have always had a concentrated source of sweetness
Sugar improves the palatability of nutritious, but bland foods
Australians have reduced their intake of added sugars yet obesity has increased
Meta-analyses of RCT consistently show no effect
There is some evidence that sugar-sweetened beverages, not total added sugars, is associated with adult weight gain
Dietary guidelines should be evidence-based