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  • 1. Sugar and Body Weight Control Richard D M tt Ri h d D. Mattes, MPH PhD RD MPH, PhD, Purdue University West Lafayette, IN, USA W f IN
  • 2. WHO Monica Study y (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) Silventoinen et al., Intl J Obes 2004; 28: 710.
  • 3. Dansinger et al., JAMA 2005;293:
  • 4. There are now over 1 Billi overweight Billion i ht and about 800 million u de ou s ed o undernourished people in the world
  • 5. CDC/NCHS, Health, United States, 2006
  • 6. Venus of Willendorf "The Tuscan General" (24,000-22,000BC) Alessandro del Borro, 1645.
  • 7. When did this problem begin? Fogel RW. Am Econ Rev 1994;84:369-395.
  • 8. When did this problem begin? Data based on the Union Army Veterans data set (~15,000 white males who served in the Union Army during the Civil War (1861-1865) and who, after the war, applied for a pension. Helmchen, LA. http://home.uchicago.edu/~lahelmch. Sept 2001.
  • 9. Costa & Steckel, In: Natl Bureau Econ Res 1997, Pp. 47-89.
  • 10. Bua J, Olsen LW, Sorensen T. Obesity 2007 15(4):977-985.
  • 11. Prevalence Trends of Overweight in Danish Children Bua J, Olsen LW, Sorensen T. Obesity 2007 15(4):977-985.
  • 12. How is it happening?
  • 13. Obesity 2007;15:2365-2370. The Th recently observed t d tl b d trend in average BMI implies that the average U.S. adult over- g consumes by ~10 kcals/d… To stop the epidemic, it suffices to decrease caloric consumption by ~10kcals or walk and extra 2 to 3 minutes per day on average. i t d
  • 14. Jebb et al., IJO 2006;30:1160-1162.
  • 15. Yanovski et al., 2000;342:861-7.
  • 16. What is the Primary Problem and Best Solution? Feeding Regulation Target Intervention Non-homeostatic Homeostatic & functional Homeostatic & dysfunctional Homeostatic + non- homeostatic
  • 17. What is the Primary Problem and Best Solution? Feeding Regulation Target Intervention Non-homeostatic Meal Pattern Homeostatic & functional Homeostatic & dysfunctional Homeostatic + non- homeostatic
  • 18. Prentice A. & Jebb S. Nutr Rev 2004;62:S98-S104.
  • 19. What is the Primary Problem and Best Solution? Feeding Regulation Target Intervention Non-homeostatic Meal Pattern Homeostatic & Accessibility functional Homeostatic & dysfunctional Homeostatic + non- homeostatic
  • 20. Macronutrient Intake Following Preload 200 * Low Energy, Non- Exerciser 150 High Energy, Non- * Exerciser Low Energy, Exerciser 100 High Energy, Exerciser + + 50 0 CARBOHYRDRATE FAT PROTEIN * P<0.05, +P<0.025, P<0.01 Long SJ et al, British Journal of Nutrition (2002), 87, 517-523
  • 21. Energy Intake A B 20 20 15 !5 10 10 5 5 5 10 15 20 5 10 15 20 EE (MJ/d) EE (MJ/d) Blundell JE, et al. Intl J Obes 22(2):S22-S29, 1998.
  • 22. Excess Energy Intake and 6 Exercise E i 5 4 3 2 1 0 -1 No Exercise 4 3 2 1 0 -1 -2 Exercise Racette S.B., et al. Am J Clin Nutr. 62:345-9 1995
  • 23. What is the Primary Problem and Best Solution? Feeding Regulation Target Intervention Non-homeostatic Meal Pattern Homeostatic & Accessibility functional Homeostatic & Diet/Lifestyle dysfunctional Homeostatic + non- homeostatic
  • 24. ERS. http://www.ers.usda.gov/briefing/CPIFoodandExpenditures/Data/table7.htm
  • 25. What is the Primary Problem and Best Solution? Feeding Regulation Target Intervention Non-homeostatic Meal Pattern Homeostatic & Accessibility functional Homeostatic & Diet/Lifestyle dysfunctional Homeostatic + non- Palatability/Reward homeostatic
  • 26. Johnson et al., Am J Clin Nutr 2007;86:899-906.
  • 27. 40 12 Non-Diet Soft Drinks Diet Soft Drinks 10 Non-Diet Soft Drink consumption n Obesity Prevalence 35 nsumption apita) apita) 8 30 (gallons per ca (gallons per ca Diet So Drink con c 6 25 oft 4 t 20 2 13% 14% 15% 23% 31% 15 0 1970 1980 1990 2000 Year
  • 28. Percent of Intense Hurricanes 40 12 Non-Diet Soft Drinks Diet Soft Drinks 10 Non-Diet Soft Drink consumption n Obesity Prevalence 35 nsumption apita) apita) 8 30 (gallons per ca (gallons per ca Diet So Drink con c 6 25 oft 4 t 20 2 13% 14% 15% 23% 31% 15 0 1970 1980 1990 2000 Year http://www.capmag.com/article.asp?ID=4418
  • 29. “The mechanism was related to the inability of fructose to acutely stimulate insulin and leptin and to inhibit ghrelin, all factors that are known to affect the satiety center in the central nervous system.” Johnson et al., Am J Clin Nutr 2007;86:899-906.
  • 30. Neuroendocrine Factors in Feeding R F di Regulation l i • Leptin • Corticosterone • TNF-alpha TNF alpha • Insulin • Serotonin • Beta-Endorphin • Amylin • Dopamine • Dynorphin • NPY • MCH • BDNF • CRH • Orexins • PYY • UCN • Ghrelin • IL 6 IL-6 • UCNII • GLP-1 • IL-1 • Galanin • GLP-2 • IL-1RA • Neurotensin • AgRP • Norepinephrine • CART • Beacon • Amino Acids • Oxytocin • Cannabinoids • PRL-RL • Alpha-MSH • GAL-LP
  • 31. Carbohydrate and Appetite, Food y pp , Choice, Energy Balance and Body Weight * Glu Insulin Glucose Hunger Intake +EB Wt Fruc Insulin Leptin *
  • 32. Leptin and Food Intake AN B d Body Leptin Anandamide A d id Fat * Intake * BED B d Body Leptin A d id L ti Anandamide Fat Anandamide ( sensitivity) iti it ) Monteleone et al., Neuropsychopharmacol 2005;30:1216-1221.
  • 33. 80 60 a 40 20 SII pg/ml LII 0 -20 -40 -60 1 3 5 7 9 11 13 15 Time points (30 minute increments) Ghrelin profiles (calculated as change from baseline) standardized to lunch time by meal group. Arrows designate the lunch times for each group. “b” Time to from nadir to peak concentration is significantly b greater than SII, p<0.05 Frecka & Mattes Am J Physiol. 2008;294: G699.
  • 34. Time Series Analysis for Ghrelin and Hunger 0.400 0 400 Lag – Hunger precedes Ghrelin 0.350 0.300 0.250 0.200 All Participants SII Group 0.150 LII Group p 0.100 0.050 0 050 0.000 Lead 90 Lead 60 Lead 30 0 Lag 30 Lag 60 -0.050 min. min. min. min. min. McKiernan et al., Physiol & Behav 2008;93:975-983.
  • 35. Properties of Sugar Associated with Increased Energy Intake • P l t bilit Palatability • Sweetener • Sweetness
  • 36. Looy H, & Weingarten HP, Chem Senses 1991;16:123-130.
  • 37. Palatability Effects on Appetite • Enhances motivation to eat – Hill et al., Appetite 1984;5:361 – Yeomans et al., Appetite 1997;29:61 • No Effect on motivation to eat – Yeoman & Symes Appetite 1999;32:383 • Diminishes motivation to eat – Warwick et al Physiol Behav 1993;53:553 al., – DeGraaf et al., Physiol Behav 1999;66:681
  • 38. Properties of Sugar Associated with Increased Energy Intake • P l t bilit Palatability • Sweetener • Sweetness
  • 39. Mechanisms By Which Sweeteners/Sweetness May Stimulate Energy Intake • Stimulate appetite • Informed use increases intake • Loss of signal fidelity • Water effects • Activation f A ti ti of reward systems d t • Training the palate • Genetics
  • 40. Positive AUC = 100; Total AUC = 100 ; Positive AUC = 120; Total AUC = 92 200 180 160 Glucos (mg/dl) 140 120 se 100 80 60 40 20 0 0 30 60 90 120 Time (min)
  • 41. Chapman et al., Am J Physiol 1998;274:R596-R603.
  • 42. Chapman et al., Am J Physiol 1998;274:R596-R603.
  • 43. Chapman et al., Am J Physiol 1998;274:R596-R603.
  • 44. Chapman et al., Am J Physiol 1998;274:R596-R603.
  • 45. Mechanisms By Which Sweeteners/Sweetness May Stimulate Energy Intake • Stimulate appetite • Informed use increases intake • Loss of signal fidelity • Water effects • Activation f A ti ti of reward systems d t • Training the palate • Genetics
  • 46. Swithers & Davidson Behav Neurosci 2008;122:161-173.
  • 47. Fig. 2. Effects of sweet taste on measures of cumulative energy Fig. 3. Effects of energy on measures of cumulative energy intake across the day in HASB and LASB. Hashed bars intake across the day in HASB and LASB. Hashed bars represent LASB solid bars represent HASB In each pair the LASB, HASB. pair, represent LASB solid bars represent HASB In each pair the LASB, HASB. pair, dark bars on the left represent consumption after the W preload, pale bars on the left represent consumption after the AS the pale bars on the right represent consumption after the AS preload, the dark bars on the right represent consumption after preload. Significant differences ( pb0.05) between Wand AS the NS preload. #Significant differences (pb0.05) between LASB preloads in LASB, no differences in HASB. #Significant and HASB, independent of preload. differences ( pb0.05) between LASB and HASB, independent of preload. Appleton & Blundell. Physiol Behav 2007;92:479-486.
  • 48. Mechanisms By Which Sweeteners/Sweetness May Stimulate Energy Intake • Stimulate appetite • Informed use increases intake • Loss of signal fidelity • Water effects • Activation f A ti ti of reward systems d t • Training the palate • Genetics
  • 49. De Araujo et al., Neuron 2008;57:930-941.
  • 50. Davis & Fox. Appetite. 2008;50:43-49.
  • 51. Mechanisms By Which Sweetness May Stimulate Energy Intake • Stimulate appetite • Informed use increases intake • Loss of signal fidelity • Water effects • Activation f A ti ti of reward systems d t • Training the palate • Genetics
  • 52. Liem & de Graaf. Physiol & Behav 2004;83:421-429.
  • 53. Energy Intake ( (N=40) ) 4000 Carbohydrate Fat Protein 3500 (Waterm ellon) (Coc onut) (Dairy ) Li ui iq * 3000 S o li d 2500 * * L iq u i K cals 2000 S o li d 1500 L iq u i 1000 S o li d 500 0
  • 54. Summary • The roots of the obesity problem may be deeper and stronger than currently recognized • The role of appetite in regulating energy intake pp g g gy is uncertain • Positive energy balance reflects total energy gy gy intake not macronutrient or sugar composition of the diet. • Multiple mechanisms have been proposed that associated sugar with obesity, but few are adequately supported b scientific evidence. d t l t d by i tifi id
  • 55. Gatenby et al., AJCN 1997;65:1867-1873.
  • 56. Franken & Muris. Appetite. 2005;45:198-201.
  • 57. Mechanisms By Which Sweeteners/Sweetness May Stimulate Energy Intake • Stimulate fat intake • Informed use increases intake • Loss of signal fidelity • Water effects • Activation f A ti ti of reward systems d t • Training the palate • Genetics
  • 58. Mattes Physiol Behav 1990;47:1037-1044.
  • 59. Naismith & Rhodes J Humn Nutr Dietet 1995;8:167-175.