Sucrose/fructose in the diet and the metabolic syndrome. Bjørn Richelsen

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1 Sucrose/fructose in the diet and the metabolic syndrome Bjørn Richelsen

2 Sucrose/fructose Sucrose- sweetened soft drink (SSSD) Artificial- sweetened soft drink (ASSD) -obesity? -Metabolic syndrome? -CVD? -- is ASSD better? ETC

3 SSSD/ASSD and obesity and metabolic syndrome. Observational studies Positive associations between SSSD intake and obesity, type2dm, and (CVD) - Nurses Health Study, Am J Clin Nutr 2006;84:274 & JAMA 2004;292:927 Positive associations between artificially sweetened soft drinks (ASSD) and obesity, metabolic syndrome, and Type 2DM

type2dm, and (CVD) - Nurses Health Study, Am J Clin Nutr 2006;84:274 & JAMA

4 Relative Risk of Type 2 Diabetes According to Frequencies of Sugar- Sweetened Beverage Consumption in Women. SSSD!! Copyright restrictions may apply. Schulze, M. B. et al. JAMA 2004;292:

5 Observational studies: SSSD and health complications - type 2 diabetes increased risk 2- (3) fold - weight gain/obesity???? (age, sex etc increased in children and adolescents) -Blood pressure increased risk 2 fold - Athersclerosis (and AMI) increade by 2 fold - cancer??? Associations? But what about cause- effect relationship? ( reverse causation )

??? (age, sex etc increased in children and adolescents) -Blood pressure increased risk

6 Dietary intervention Sucrose (energy) milk (energy) aspartame (no energy) water(no energy) Overweight subjects were randomized to 4 groups drinking 1 L of one of these beverages for 6 months - otherwise live as they usually were doing.

were randomized to 4 groups drinking 1 L of one of these

7 A 6-mo randomized intervention study Long term study Four different beverages were investigated 1. 1 L SSSD (Coca Cola) daily 2. 1L skimmed milk (isocaloric with 1) 3. 1L ASSD (diet Cola aspartam sweetened) 3. 1L water (control) Investigated in overweight to obese individuals Investigations: body composition (DXA), visceral fat (MR), liver- and muscle fat (MRI-spectroscopy) Metabolic factors: blood lipids, insulin/homa, inflammatory markers AIM - effect of beverages on 1. Ectopic fat accumulation 2. Body weight and fat mass 3. Metabolic factors Maersk et al. Am J Clin Nutr 2012

1L water (control) Investigated in overweight to obese individuals Investigations: body composition (DXA), visceral fat (MR), liver- and muscle

8 The beverages used in the study: Energy and nutrition content REGULAR COLA MILK DIET COLA WATER Carbohydrate (g/100ml) Protein (g/100ml) Fat (g/100ml) Energy per day (kj) Volume (ml) Energy density (kj/g) < kcal 460 kcal

Energy per day (kj) Volume (ml) Energy density (kj/g) 10.6 4.7 0 0 0 3.4 <0.

9 Subcutaneous and intrabdominal adipose tissue MR-scanning

10 MR-spectroscopy to determine the fat content in the liver

11 Relative changes in ectopic fat accumulation. The intervention 6 months VAT ( visceral adipose tissue) Anova P<0.05 Liver fat P<0.01 -Relative changes from baseline to 6mo Muscle fat P<0.05 Maersk et al Am J Clin Nutr 2012

12 Effects of the beverages on blood lipids Triacylglyceride (%) Triglycerides ** ** ** A Total cholesterol (%) Total cholesterol * ** * B -30 reg cola milk diet cola water -15 reg cola milk diet cola water

cholesterol (%) 20 15 10 5 0-5 -10 Total cholesterol * ** * B

13 Effect on blood pressure. 6 mo intervention Systolic BP Diastolic BP

14 Protein supplementation lowers blood pressure in overweight adults SBP DBP Am J Clin Nutr 2012

15 Conclusions: Intake for SSSD (1 L daily) increases ectopic fat accumulation (e.g. fat liver, visceral fat depot) and lipids (triglycerides and total cholesterol) the risk of NASH (non-alcoholic steatohepatitis) likely to enhance the risk of metabolic diseases and CVD weight gain was similar with the milk group but more fat accumulate than in the milk group --- role for obesity?? these effects seem independent of the caloric content ASSD (aspartam) has no negatively metabolic effects in this study (very similar effects as water)

likely to enhance the risk of metabolic diseases and CVD weight gain was similar with the milk group but more fat accumulate than in

16 Sugar and metabolic complications The reason for our findings: may be due to the composition of SSSD - the fructose hypothesis

17 Sucrose (added sugar) Glucose FRUCTOSE Sucrose generally produced from sugar cane ( sukkerrør) and sugar beets (sukkerroer). Sucrose a new ingredient in our diet within the last 100 years. Laktose = glukose + galaktose =

Metabolic differences between glucose and fructose- same energy content Glucose Fructose Fruktose optages ikke i β-cellen og øger ikke insulinsekretionen Det glykæmiske index af fruktose

19 Metabolic differences between glucose and fructose- same energy content Glucose Fructose Fruktose optages ikke i β-cellen og øger ikke insulinsekretionen Det glykæmiske index af fruktose (glucose-stigningen) er under 19% af glukose Fruktose optages primært i leveren Energiindholdet i et molekyle fruktose = et molekyle glukose Niveau i blodet ( glukose omkring 5 mm; fruktose omkring mm)

(glucose-stigningen) er under 19% af glukose Fruktose optages primært i leveren Energiindholdet i

20 Effect of fructose and glucose beverages Double-blinded parallel arm study: 8-week outpatient human intervention with glucose- and fructose beverages J Clin Invest 2009;119:1322

21 J Clin Invest 2009;119:1322 Plasma TG. 24-hour circulating TG concentrations in subjects before and after 2, 8, and 10 weeks of consuming glucose-sweetened beverages (A) or fructose-sweetened beverages (B) Glucose Fructose

22 Metabolism of fructose in the liver Fructose to energy vs fat depends of the energy state of the liver/body Production of fat and triglycerides

23 Man kan få metabolisk syndrom af overspisning og fedme, men også af specifikke næringsstoffer (fruktose) uafhængigt af fedme Obesity Metabolic syndrome/ inflammation Diet fructose Aging Diabetes Fat liver NASH?

kulhydrater Tilsat hvidt sukker Kostfibre (ikke optagelige) 1 stk Magnum 32 g sukker = 16 g fruktose Bolcher 94,2 g 94,2 g - 0 g Dragée 73,9 g 73,9 g - 0 g Flødebolle 65,3 g 64,8 g 64 g 0,5 g

24 Tilsvarende fruktoseindtag fra andre kilder Cola: 10.6 sukrose/100 ml = 106 g sukker i 1L ( = 53 g fruktose) 1 is + en pose slik + en kage i løbet af dagen giver ca 76 g fruktose ekstra per dag 16g + 35g + 25 g Slik (100 g) Kulhydrater i alt Optagelige kulhydrater Tilsat hvidt sukker Kostfibre (ikke optagelige) 1 stk Magnum 32 g sukker = 16 g fruktose Bolcher 94,2 g 94,2 g - 0 g Dragée 73,9 g 73,9 g - 0 g Flødebolle 65,3 g 64,8 g 64 g 0,5 g Karameller 71,4 g 71,4 g 48 g 0 g Lakrids, salt 82,1 g 82,1 g 36 g 0 g Lakrids, sød 78,1 g 78,1 g 41 g 0 g Lakridskonfekt 82,7 g 82,7 g 50 g 0 g Skumfiduser 79,2 g 79,1 g - 0,1 g Tyggegummi med sukker 90,6 g 88,2 g 68 g 2,4 g Kager: g sukker per 100 g = ca 25 g fruktose Tyggegummi uden sukker 86,1 g 83,7 g 1 g 2,4 g Slik (100 g) Kulhydrater i alt Optagelige kulhydrater Tilsat hvidt sukker Kostfibre (ikke optagelige) Vingummier 78,6 g 78,6 g 40,6 g 0 g

25 Fructose

US sweetener consumption, 1966-2009, in dry pounds.

26 US sweetener consumption, , in dry pounds. It is apparent from this graph that overall sweetener consumption, and in particular glucose-fructose mixtures, has increased since the introduction of HFCS. Thus, the amount of fructose consumed in the United States has increased since the early 1980s

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