JAMA Sub-Journal: Can sugar substitutes reduce calories?

Summer has just passed, and Singularity Cake found that many beverage brands this year have joined the "sugar-free sparkling water" track.
Various flavors, various sugar substitutes, and almost 0 calories make them popular, and they are afraid of getting fat.
? We have no calories! Healthy and delicious! Although these non-nutritive sweeteners provide neither calories nor nutrients, and sound as simple as H2O, previous studies have shown that their effects on body weight, appetite, and sugar metabolism seem to be mixed.
A consensus, so many researchers are still exploring
.

 In the recent JAMA Network Open magazine, researchers from the Keck School of Medicine at the University of Southern California published the results of a randomized clinical trial [1].
This is the first discovery that one of the most commonly used non-nutritive sweeteners.
Sucralose may increase the appetite of women and obese people! The trial enrolled 74 adults, aged 18-35 years old, of which 43 women, with an average age of 23.
40 years old, and BMI between 19.
18-40.
27
.

Volunteers participating in the trial did not smoke, maintained a stable weight for at least 3 months before enrollment, did not diet, did not take drugs other than oral contraceptives, and had no history of diabetes, eating disorders, illegal drug use, or other medical diagnosis.
Generally speaking, it is a relatively healthy group of young people
.

 The trial was designed as a randomized crossover trial.
The data needed for the trial was repeatedly collected for 3 times.
Participants went to the cognitive neuroimaging center where the study was conducted at about 8 am after fasting for 12 hours, and drank 300 ml of sucrose (75 g).
, Sucralose (same sweetness), or water without adding anything.
Collect blood samples at 10, 35, and 120 minutes after drinking to test blood sugar, insulin, glucagon-like peptides, and leptin, etc.
After that, they provide participants with a buffet and perform functional magnetic resonance imaging (fMRI) through a headset to detect blood oxygen level-dependent signals in response to visual signals
.

Test procedure Blood oxygen level dependent signal is also called BOLD signal.
The weaker the hypoxic blood signal, the weaker the fMRI signal in this area of ​​the brain.
Conversely, the stronger the oxygenated blood signal, the stronger the fMRI signal.
This oxygenated blood signal The enhancement is related to the increase of nerve discharge, therefore, BOLD signal can be used as an indirect measurement of nerve activity
.

 In the entire cohort, the researchers did not find a significant difference in BOLD signal between volunteers who drank sucrose water and those who drank sucralose water
.

 However, after grouping according to BMI, obese people who drink sucrose water and sucralose water have significant differences in the BOLD signal of the medial prefrontal cortex (MFC) when facing food and non-food.
When facing food, drinking trichloro Compared with those who drank sucrose water, the BOLD signal was stronger, but not in the overweight and normal BMI groups
.

Similar changes were observed in the orbitofrontal cortex (OFC)
.

 MFC and OFC are brain regions involved in the regulation of eating and rewarding food [2].
Past studies have also found that obesity is related to the stronger food prompt response they give [3,4]
.

 Not only that, they also found that this phenomenon also has gender differences
.

When women who drank sucralose water faced food, OFC's BOLD signal was enhanced, but men did not
.

The same situation also occurred in the face of high-calorie foods and sweets.
The OFC of the women who participated in the experiment, as well as the BOLD signals of MFC and OFC were stronger
.

The BOLD signal (F) of male and female OFC facing food, the BOLD signal (G) of MFC facing sweets, and the BOLD signal (H) of OFC facing sweets, the nerve signals become stronger.
The difference in calorie intake
.

The bad news is that compared with sucrose water, participants who drank sucralose water consumed significantly more calories at the buffet, but the good news is that the extra calories consumed did not exceed the calories of sucrose water (300kcal)
.

 If grouping is also based on BMI and gender, there is no significant difference in the calories consumed by participants in different BMI intervals, but the difference between women and men has continued
.

 In general, the results of this experiment show that compared with sucrose, obese people and women will have a stronger neurological response after sucralose intake, and may even increase calorie intake
.

 In a review article [5] distributed in the same period, the commentator believes that this study provides new evidence for the relationship between obesity and gender and the results of neurological and behavioral changes after ingestion of non-nutritive sweeteners, prompting us, Non-nutritive sweeteners may change the brain's response to food and affect eating behavior, especially in women
.

 She pointed out that there are still many unknowns about non-nutritive sweeteners, and it is necessary to further clarify their effects on various neurobehavioral and metabolic results before they are included in the recommended or not recommended list of healthy diets
.

 References: [1] Yunker AG, Alves JM, Luo S, et al.
Obesity and Sex-Related Associations With Differential Effects of Sucralose vs Sucrose on Appetite and Reward Processing: A Randomized Crossover Trial[J].
JAMA Network Open, 2021 , 4(9): e2126313-e2126313.
[2] Stoeckel LE, Weller RE, Cook III EW, et al.
Widespread reward-system activation in obese women in response to pictures of high-calorie foods[J].
Neuroimage, 2008 , 41(2): 636-647.
[3] Dimitropoulos A, Tkach J, Ho A, et al.
Greater corticolimbic activation to high-calorie food cues after eating in obese vs.
normal-weight adults[J].
Appetite, 2012, 58(1): 303-312.
[4] Martin LE, Holsen LM, Chambers RJ, et al.
Neural mechanisms associated with food motivation in obese and healthy weight adults[J].
Obesity, 2010, 18(2) : 254-260.
[5] Kullmann S.
Nonnutritive Sweeteners and Neural Reward Response in Women and Individuals With Obesity[J].
JAMA Network Open, 2021, 4(9): e2128047-e2128047.