Caloric and Non-caloric Sweeteners and the Distribution of Adipose Tissue

摘要 背景：食品和饮料行业继续挑战显示添加糖的研究结果 (AS)增加肥胖风险，尽管越来越多的证据表明AS和人工甜味剂（ArtSw） 替代品会对健康产生影响。美国人消费食品和饮料的数量 在过去的30年里，用AS或ArtSw增甜的人的体重增加了，这与肥胖症的显著增加相对应。 此期间除了体重增加外，还发现糖和ArtSw饮料的摄入量 增加心血管疾病、代谢综合征和2型糖尿病风险。重要的是体重增加 不能解释与AS和ArtSw产品相关的慢性疾病的增加，可能取决于 对内脏脂肪组织（VAT）、心包脂肪组织（PAT）和/或肝脏中的致病性脂肪储存的影响 脂肪组织（HAT）。本提案旨在确定AS和ArtSw耗材关联的程度 在日常饮食摄入的情况下，伴有局部和异位肥胖和葡萄糖耐受不良。 目的：在青年人冠状动脉风险发展（CARDIA）研究中，我们将检查 甜味剂（AS和ArtSw）、含糖饮料（SSB）和ArtSw（减肥）饮料与 脂肪组织的5个区域：VAT、PAT、HAT、皮下脂肪组织（SAT）和肌间 第25年（Y25）时测量的脂肪组织（IMAT）和在通常情况下PAT的10年变化 饮食摄入此外，还将研究甜味剂与葡萄糖耐受不良的关系。 方法：使用CARDIA饮食史在20年内对饮食摄入进行了3次评估。帕特是 通过计算机断层扫描（CT）测量两次（Y15和Y25），以检查PAT的10年变化;以及VAT， 在Y25测量SAT、HAT和IMAT。口服葡萄糖耐量在15年内测试了3次， 线性回归将用于预测累积膳食摄入量与糖尿病的关系， 甜味剂、SSB和减肥饮料与5个区域肥胖组织。比例风险回归 将评估甜味剂/饮料与葡萄糖耐量的关系。所有车型将进行调整 混淆因素。在日常饮食摄入的情况下，检查甜味剂-脂肪的关系， 将试验西方饮食模式的改变。BMI、性别和种族的影响修正也将 得到考验期望：我们期望与AS和ArtSw的正相关，对器官来说相对较强- 与非器官相关SAT相比，相关脂肪测量VAT、PAT、HAT和IMAT以及葡萄糖耐受不良， 独立于由BMI表示的总体肥胖水平。我们进一步预计，消费者的AS，SSB， ArtSw和减肥饮料谁也消耗西方饮食模式将有最高的风险肥胖 与非西方饮食和甜味剂或饮料的消费者相比。我们的发现将提供更多 食品制造商应通过限制或改变其产品配方的证据 添加的甜味剂的类型和/或量，从而降低某些代谢状况的可能性。

Abstract Background: The food and beverage industries continue to challenge study results that show added sugar (AS) promoting obesity risk, despite growing evidence that both AS and artificial sweetener (ArtSw) alternatives have health consequences. The number of Americans consuming foods and beverages sweetened with AS or ArtSw has increased over 30 years—corresponding to the marked rise in obesity over this period. In addition to weight gain, sugar sweetened and ArtSw beverage intakes have been found to increase risk of cardiovascular disease, metabolic syndrome, and type 2 diabetes. Critically, weight gain alone does not account for the increases in chronic illness associated with AS and ArtSw products and may depend on pathogenic fat storage in visceral adipose tissue (VAT), pericardial adipose tissue (PAT) and/or hepatic adipose tissue (HAT). This proposal aims to determine the extent that AS and ArtSw consumables associate with regional and ectopic adiposity and glucose intolerance within the context of usual dietary intake. Objective: In the Coronary Artery Risk Development in Young Adults (CARDIA) study, we will examine the relations of sweeteners (AS and ArtSw), sugar sweetened beverages (SSB), and ArtSw (diet) beverages with the 5 regions of adipose tissues: VAT, PAT, HAT, subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) measured at year 25 (Y25) and 10-year change in PAT within the context of usual dietary intake. Further, relations of sweeteners with glucose intolerance will be studied. Methods: Dietary intake was assessed 3 times over 20 years using the CARDIA Diet History. PAT was measured by computed tomography (CT) twice (Y15 and Y25) to examine 10-year change in PAT; and VAT, SAT, HAT, and IMAT were measured at Y25. Oral glucose tolerance was tested 3 times over 15 years and diabetes at every exam. Linear regression will be used to predict the relations of cumulative dietary intake of sweeteners, SSB, and diet beverages with the 5 regional adiposity tissues. Proportional hazards regression will evaluate the relations of sweeteners/beverages with incident glucose tolerance. All models will be adjusted for confounding factors. To examine the sweetener-fat relations within the context of usual dietary intake, effect modification of a western diet pattern will be tested. Effect modification for each of BMI, sex, and race will also be tested. Expectation: We expect positive associations with AS and ArtSw, relatively stronger for the organ- related fat measures VAT, PAT, HAT, and IMAT and glucose intolerance than for the non-organ-related SAT, independent of overall level of obesity as represented by BMI. We further expect that consumers of AS, SSB, ArtSw and diet beverages who also consume a western diet pattern will have the highest risk of adiposity compared to non-consumers of a western diet and sweeteners or beverages. Our findings will provide more evidence that food manufacturers should change the formulation of their products by limiting or changing the type and/or amount of added sweeteners, thereby reducing the potential for some metabolic conditions.