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) 替代方案会对健康产生影响。消费食品和饮料的美国人数量 30年来，添加了AS或ArtSw的甜味剂有所增加--与过去30年肥胖率的显著上升相对应 这段时间。除了体重增加，含糖和ArtSw饮料的摄入量也被发现 增加心血管疾病、代谢综合征和2型糖尿病的风险。关键的是，仅体重增加一项 没有考虑到与AS和ArtSw产品相关的慢性病的增加，并且可能取决于 病原脂肪在内脏脂肪组织(VAT)、心包脂肪组织(PAT)和/或肝脏的储存 脂肪组织(帽子)。该提案旨在确定AS和ArtSw耗材之间的关联程度 在正常饮食摄入的情况下，患有区域性和异位肥胖症以及葡萄糖不耐受。 目的：在青年冠状动脉风险发展(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)和肌肉间 在25年(Y25)测量的脂肪组织(IMAT)和在通常情况下PAT的10年变化 饮食摄入量。此外，还将研究甜味剂与葡萄糖耐量的关系。 方法：使用CARDIA饮食史对20年来的膳食摄入量进行3次评估。帕特曾经是 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；以及增值税， 在25岁时测量了SAT、HAT和IMAT。在15年的时间里进行了3次口服葡萄糖耐量测试 每一次检查都有糖尿病。将用线性回归来预测儿童的累积膳食摄入量之间的关系 甜味剂、SSB和减肥饮料与5种区域肥胖组织。比例风险回归 将评估甜味剂/饮料与葡萄糖耐量的关系。所有型号都将进行调整 因为混杂的因素。在日常饮食摄入量的背景下，检查甜味剂和脂肪的关系，效果 对西方饮食模式的修改将进行测试。对体重指数、性别和种族的影响修改也将 接受测试。预期：我们预计AS和ArtSw有积极的联系，对器官来说相对更强- 相关脂肪测量VAT、PAT、HAT、IMAT和葡萄糖耐量，而不是非器官相关的SAT， 与BMI所代表的整体肥胖水平无关。我们还预计，AS、SSB、 食用西方饮食模式的ArtSw和减肥饮料患肥胖症的风险最高 与西方饮食和甜味剂或饮料的非消费者相比。我们的发现将提供更多 食品制造商应该通过限制或改变产品配方来改变其产品配方的证据 添加甜味剂的类型和/或数量，从而降低某些新陈代谢状况的可能性。

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.