WEEK 11: CHO and Health

Question 1

Little background on diet and CVD

Answer 1

In the US, there is increase in calories, and no subsequent increase in energy expenditure, and resultant weight gain
Total calories from sugar has increased as companies removed fat and replaced with sugar to retain palatability
Children are taking more calories from SSB
Nurses health study:
Results
Women consuming high glycemic load foods increased risk of
CVD . Highest quintile intakes 2-fold higher risk cf. lowest
quintile over a 10 year follow up
Conclusions
Replacing fat/low GI foods (complex CHO/fibre) with highly
processed rapidly digested starches and sugars, raises short
term PPG, ↑ risk of CVD.

Question 2

Nurses Health Study and CVD

Answer 2

Results
Women consuming high glycemic load foods increased risk of
CVD . Highest quintile intakes 2-fold higher risk cf. lowest
quintile over a 10 year follow up
Conclusions
Replacing fat/low GI foods (complex CHO/fibre) with highly
processed rapidly digested starches and sugars, raises short
term PPG, ↑ risk of CVD.

Question 3

SSB and body weight

Answer 3

Shulz et al- liquid calories and body weight
Cross sectional/prospective studies:
- SSBs link with weight gain and obesity
- Mostly focussed on children and young adults
- Positive correlation (mostly)
- Caution-confounding
Socioeconomic , education, physical exercise, food choices
(replacement of milk), excess calories
• Meta analysis of cross sectional studies
- 12 studies – no (Forshee et al,1998)
- 88 studies- yes-positive association between SSB and body weight
(Vartanian et al , 2007)
• BMJ published a number of articles on industry bias - those with industry bias found no relation to SSB and weight gain

Interventions studies: Sugar sweetened beverages and obesity
• Study design (Raben et al AJCN 2002)
- Blinded, obese individuals, 10 weeks
- Intervention group - sucrose sweetened drinks -23% daily calories
- Control group - artificial sweetener drink
• Results
2.6 kg increase in weight with sucrose consumption
• Conclusions: When free sugars are consumed in liquid form (lower
satiation) – subsequent meals do not adjust for SSB calorie intakeover consumption- weight gain.

Question 4

SSB and Type 2 DM

Answer 4

Malik VS. Diabetes care, 2010
Study design
Meta-analysis of 11 studies, 310,819 participants. 15,043
cases of T2DM
Results
Highest quartile (>2 servings/d) vs lowest (<1 serving/month)
26% increased risk of Type 2 diabetes
20% increased risk of MetS
Conclusion
In addition to weight gain, higher consumption of added
sugars/SSB linked to T2DM - added sugars/SSB calorie dense
intake/palatable…should be limited.. TABS

Question 5

Dietary sugars and cardiometabolic risk: blood pressure

and lipids

Answer 5

Dietary sugars and cardiometabolic risk: blood pressure
and lipids: Morenga et al
• Systematic review and meta-analysis
• RCTs high sugar vs low sugar interventions
• 37 trials lipids/ 12 trials blood pressure identified
• Results: High sugar intakes > 2wks associated with modest increases in systolic/ diastolic bp identified (5-7mmHg)
• Conclusions:
Reduction in free sugar predicted to reduce bp (3-6mmHg reduce risk of CVD)
Mechanisms - increased uric acid levels - vasoconstriction
• The wrong white crystals: not salt but sugar as aetiological in hypertension and CM disease `

Question 6

Dietary sugars cause cardiometabolic risk: Mechanism of action

Answer 6

Mechanisms of action ?
• Added sugars/ liquid sugar calories – palatable/less satiating –
overconsumption-weight gain
• High glycemic index/load foods (processed starchy/sugary foods)
lead to reactive hypoglycemia, overconsumption, IR, beta cell
dysfunction
• Increased levels of dietary fructose
Fructose sensing/transport/metabolism differs to glucose
Fructose – GI peptide response attenuated. Does not suppress
Ghrelin, or induce an incretin effect (compared to glucose)
Fructose - increases hepatic lipid synthesis, increased circulating
TG, cholesterol
Fructose - Increased uric acid levels - CVD
Fructose - Na+ flux in gut/kidney – Hypertension

Question 7

Summary of CHO and CVD factors

Answer 7

Obesity, Diabetes, hypertension (MetS) prevalence↑. Risk factors for
CVD
• CHO/Fat/protein intake increased
• Observational / interventional studies
Replaced fat calories (milk) with added sugars (sucrose/HFCS) in
SSBs linked to metabolic disease
High GI/GL processed foods linked to metabolic disease
Issues: Confounding. Currently no evidence HFCS is metabolised
differently to sucrose. HFCS difficult to study. Production is
capped in the EU/UK, imports? a US story?
• New recommendation to reduce free sugar intake from 10 to 5% daily
calories
• How to achieve this?
Public health policy- Fizzy drink tax. Regulation of its availability
in schools etc.
Food industry - reduce sugar/ salt, increase fibre in products
Upto slide 38 done