Elsevier

Appetite

Volume 97, 1 February 2016, Pages 43-48
Appetite

The impact of sugar sweetened beverage intake on hunger and satiety in minority adolescents

https://doi.org/10.1016/j.appet.2015.11.015Get rights and content

Highlights

  • High sugar sweetened beverage intake appears to be related to a decrease in fullness at an ad libitum meal.

  • Ghrelin appears to be depressed in high sugar sweetened beverage (SSB) consumers compared to low SSB.

  • Sugar sweetened beverage intake should be taken into account when looking at satiety after standardized test meals.

Abstract

Limited research has examined the effects of habitual SSB consumption on hunger/fullness ratings and gut hormones. This study hypothesized that high versus low intakes of habitual SSBs would result in greater hunger, decreased fullness, and a blunted gut hormone response, however the high versus low fiber group would exhibit decreased hunger and increased fullness. This was a randomized crossover feeding trial with 47 African American and Hispanic adolescents. The experiment included three 24-hour recalls to assess habitual dietary intake. During the test meal phase, subjects were served breakfast and lunch. During the ad libitum meal phase, subjects were fed an ad libitum dinner. During the test meal phase, blood was drawn every 30 minutes for 3 hours. During the ad libitum meal phase, hunger and fullness visual analogue scales were completed. For this analysis, subjects were grouped into the following habitual SSB categories: low SSB (≤1 SSB serv/day), medium SSB (>1 - <2 serv/day), and high SSB (≥2 serv/day). Fiber categories were created based on quartiles of intake. Mixed modeling was used to explore how SSB and fiber categories predicted ghrelin/PYY values and hunger/fullness ratings across time within and between test meals. The following a priori covariates included: sex, ethnicity, age, and obesity status. The low SSB group had higher fullness ratings over the ad libitum meal compared to the high SSB group (β =-0.49, CI=(-0.89, -0.08), p=0.02) and higher ghrelin concentrations than the medium and high SSB group over the test meal phase (β =-1.86, CI=(-2.81, -0.92), p<0.01). Habitual SSB intake appears to play a key role in moderating fullness responses possibly via ghrelin.

Introduction

African American and Hispanic adolescents are disproportionately at risk for obesity and metabolic disease (Taveras, Gillman, Kleinman, Rich-Edwards, & Rifas-Shiman, 2013), with 39% and 38% being obese, respectively, compared with 31% of Caucasian adolescents in the United States (Ogden, Carroll, Kit, & Flegal, 2014). Additionally, adolescence is a time of increasing autonomy when youth begin to make independent dietary choices, and is therefore an ideal time to improve dietary habits in a high risk population (Bassett, Chapman, & Beagan, 2008).

The increased prevalence of obesity in adolescent minority populations in the United States can be attributed to a multitude of factors. Two modifiable factors are the high intake of added sugars and the low intake of dietary fiber. A major contributor to added sugar in the diet of adolescents is sugar-sweetened beverages (SSB) such as carbonated sodas, sports drinks, and fruit drinks (Wang, Bleich, & Gortmaker, 2008). African American and Hispanic youth consume on average more calories from SSB than their Caucasian peers (Wang et al., 2008). Increased SSB intake in adolescents was associated with higher systolic blood pressure, a risk factor for hypertension and cardiovascular disease (Nguyen, Choi, Lustig, & Hsu, 2009). Additionally, SSB intake has been associated with increased body weight in adolescents (Beck et al., 2013, Berkey et al., 2004, Ebbeling et al., 2006), with a dose responsive relationship between SSB intake and obesity risk in adolescents who consume four or more eight ounce servings per week (Martin-Calvo et al., 2014). Longitudinal data has shown that a single serving of SSB per day at age 15 years increased body mass index (BMI) and waist circumference over six years (Zheng et al., 2014).

Adolescents have been found to consume more fructose than any other age group over the last 30 years, and it has been suggested this in large part is due to use of high fructose corn syrup (HFCS) (Marriott, Cole, & Lee, 2009). The principal sweetener in SSB is HFCS, which is comprised of nearly 50% more fructose than glucose (Walker, Dumke, & Goran, 2014). Total dietary fructose has been shown to be positively related to increased visceral adiposity, increased blood pressure, and HOMA-IR in a large sample of adolescents (Pollock et al., 2012). An experiment comparing glucose, HFCS, sucrose, and sucralose found that food intake after a HFCS or sucrose drink led to higher energy intake at a subsequent ad libitum meal (Van Engelen et al., 2014a, Van Engelen et al., 2014b).

Not only are adolescents more likely to consume fructose, but also adolescents are less likely to consume high fiber foods compared to other age groups. Adolescents consume on average 14 g of fiber per day, substantially below the recommended 25–30 g per day (Storey & Anderson, 2014). Increasing satiety post meal is a desirable means of controlling and reducing weight. Satiety can be qualitatively measured via visual analog scales and predicted via metabolic hormones such as peptide tyrosine tyrosine (PYY) and ghrelin (de Graaf, Blom, Smeets, Stafleu, & Hendriks, 2004). Increased dietary fiber is an attractive means to increase post meal satiety as it is easily substituted in the diet and has been associated with weight loss (Flores, Maldonado, & Durán, 2012). However current research is inconclusive regarding the effectiveness of fiber to improve satiety (Clark and Slavin, 2013, Schroeder et al., 2009). Preliminary research examining the difference between the effect of high sugar versus high fiber meals on satiety measures has shown mixed results (Pasman et al., 2003, Spruijt-Metz et al., 2009).

Previous research has focused on the satiating action of acute intake of either fiber or SSB (Chang et al., 2012, Soenen and Westerterp-Plantenga, 2007, Van Engelen et al., 2014b; A J Wanders et al., 2011; Anne J Wanders et al., 2013). Research has shown acute satiety after a sugar pre-load (Anderson & Woodend, 2003), however the effect of prolonged sugar consumption is, to date, understudied. An acute administration of a sugary beverage was associated with increased short term appetite in boys 9–14 years (Van Engelen et al., 2014a). Additionally, Cassady and colleagues has suggested lower satiety after a caloric liquid compared to an isocaloric solid, possibly due to a decreased gastric distention in the liquid as well as an aberrant endocrine response (Cassady, Considine, & Mattes, 2012). Aberrant endocrine response is a hallmark of homeostatic break down over time, such as leptin resistance and ghrelin suppression in obesity (Kalra, 2001, Tschöp et al., 2001). These acute studies do not take into account the effect of habitual, free-living, intake of fiber and SSB. Given the mixed results of high sugar versus high fiber intake on satiety and the lack of research in minority youth, this study sought to compare the effects of free-living SSB intake and fiber intake on ghrelin and PYY levels during an acute fiber and sugar test meal challenge, and perceived hunger and fullness after the meal challenge during an ad libitum meal. Along these lines, we hypothesized that free-living high SSB consumers compared to low SSB consumers would have lower ghrelin and PYY regardless of the test meal and higher hunger and lower fullness during the ad libitum meals. We also hypothesized that free-living low fiber consumers compared to high fiber consumers would exhibit lower serum ghrelin and PYY regardless of the test meal type and be more hungry and less full during the ad libitum meals.

Section snippets

Subjects and methods

Data comes from the FAME crossover feeding trial at the University of Southern California (USC). Conclusions based on the main outcomes and a detailed methodology can be found elsewhere (O'Reilly et al., 2015). This study was conducted at the USC Health Sciences campus in Los Angeles, California from 2008 to 2011. Subjects were recruited from hospitals, clinics, churches, schools, and community center around the Los Angeles area between 2007 and 2010. Hispanic and African American youth, ages

Participant characteristics

A total of 93 subjects were randomized into the initial meal study. Seven withdrew after randomization for a total of 87 participants that completed both meals. Of the 87 who completed both study visits, 47 participants had two or more diet recalls within one month of each other and test visit data. A subsample of 18 subjects, concentrations for which assayed blood samples were available, was analyzed for ghrelin and PYY. There were no significant differences in sex, caloric intake, overweight

Discussion

This is the first study to show that free-living SSB intake influences feelings of fullness and ghrelin response during a crossover meal design. Although initially there were no differences between the two meals given during the crossover meal trial, free living SSB intake revealed differences overall. High SSB consumers were on average more full during the ad libitum meal phase compared to low SSB consumers. Interestingly, SSB consumption did not influence hunger over the ad libitum meal

Source of support

This work was supported by the National Institute for Minority Health and Health Disparities (NIMHD) as part of the USC Minority Health Center of Excellence (NCHMD P60 MD002254) and the National Institutes of Cancer (NCI), NCI Centers for Transdisciplinary Research on Energetics and Cancer (TREC, U54 CA 116848) as part of the USC Center for Transdisciplinary Research on Energetics and Cancer.

Acknowledgments

The authors of this paper report no conflicts of interest. DSM, MIG, and JND were responsible for research design and conducted the experiment. GES and MJD analyzed the data and preformed statistical analysis. GES, JND, DSM, and GAO were the primary writers. GES, JND, DSM, GAO, MJD, and MIG provided edits for the paper. JND, DSM, and GES have primary responsibility for the content.

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