Nonnutritive sweeteners, such as aspartame, sucralose and stevioside, are widely consumed, yet their long-term health impact is uncertain. We synthesized evidence from prospective studies to ...determine whether routine consumption of non-nutritive sweeteners was associated with long-term adverse cardiometabolic effects.
We searched MEDLINE, Embase and Cochrane Library (inception to January 2016) for randomized controlled trials (RCTs) that evaluated interventions for nonnutritive sweeteners and prospective cohort studies that reported on consumption of non-nutritive sweeteners among adults and adolescents. The primary outcome was body mass index (BMI). Secondary outcomes included weight, obesity and other cardiometabolic end points.
From 11 774 citations, we included 7 trials (1003 participants; median follow-up 6 mo) and 30 cohort studies (405 907 participants; median follow-up 10 yr). In the included RCTs, nonnutritive sweeteners had no significant effect on BMI (mean difference -0.37 kg/m
; 95% confidence interval CI -1.10 to 0.36;
9%; 242 participants). In the included cohort studies, consumption of nonnutritive sweeteners was associated with a modest increase in BMI (mean correlation 0.05, 95% CI 0.03 to 0.06;
0%; 21 256 participants). Data from RCTs showed no consistent effects of nonnutritive sweeteners on other measures of body composition and reported no further secondary outcomes. In the cohort studies, consumption of nonnutritive sweeteners was associated with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events. Publication bias was indicated for studies with diabetes as an outcome.
Evidence from RCTs does not clearly support the intended benefits of nonnutritive sweeteners for weight management, and observational data suggest that routine intake of nonnutritive sweeteners may be associated with increased BMI and cardiometabolic risk. Further research is needed to fully characterize the long-term risks and benefits of nonnutritive sweeteners.
PROSPERO-CRD42015019749.
Diabetic kidney disease (DKD) is the main cause of chronic kidney disease (CKD) and progresses faster in males than in females. We identify sex-based differences in kidney metabolism and in the blood ...metabolome of male and female individuals with diabetes. Primary human proximal tubular epithelial cells (PTECs) from healthy males displayed increased mitochondrial respiration, oxidative stress, apoptosis, and greater injury when exposed to high glucose compared with PTECs from healthy females. Male human PTECs showed increased glucose and glutamine fluxes to the TCA cycle, whereas female human PTECs showed increased pyruvate content. The male human PTEC phenotype was enhanced by dihydrotestosterone and mediated by the transcription factor HNF4A and histone demethylase KDM6A. In mice where sex chromosomes either matched or did not match gonadal sex, male gonadal sex contributed to the kidney metabolism differences between males and females. A blood metabolomics analysis in a cohort of adolescents with or without diabetes showed increased TCA cycle metabolites in males. In a second cohort of adults with diabetes, females without DKD had higher serum pyruvate concentrations than did males with or without DKD. Serum pyruvate concentrations positively correlated with the estimated glomerular filtration rate, a measure of kidney function, and negatively correlated with all-cause mortality in this cohort. In a third cohort of adults with CKD, male sex and diabetes were associated with increased plasma TCA cycle metabolites, which correlated with all-cause mortality. These findings suggest that differences in male and female kidney metabolism may contribute to sex-dependent outcomes in DKD.
School‐based healthy living interventions are widely promoted as strategies for preventing obesity. The peer‐led Healthy Buddies™ curriculum has been shown to improve obesity‐related outcomes in ...school‐aged children. We examined whether these improvements existed among subgroups of children stratified by sex, income level and urban/rural geography. In a cluster‐randomized controlled trial, elementary schools in Manitoba, Canada, were randomly allocated to Healthy Buddies™ (10 schools, 340 students) or standard curriculum (10 schools, 347 students). Healthy Buddies™ participants had 21weekly lessons on healthy eating, physical activity and self‐efficacy, delivered by children age 9–12 to children age 6–8. We assessed pre‐ and post‐intervention body mass index (BMI) z‐scores, waist circumference, healthy living knowledge, dietary intake and self‐efficacy among the younger children. Compared to standard curriculum (n = 154), Healthy Buddies™ participants (n = 157) experienced a greater reduction in waist circumference (−1.7 cm; 95% confidence interval CI−2.8, −0.5 cm) and improved dietary intake (4.6; 95% CI 0.9, 8.3), healthy living knowledge (5.9; 95% CI 2.3, 9.5) and self‐efficacy (5.3; 95% CI 1.0, 9.5) scores. In subgroup analyses, effects for waist circumference (−2.0 cm; 95% CI −3.6, −0.5), healthy living knowledge (9.1; 95% CI 4.4, 13.8) and self‐efficacy (8.3; 95% CI 3.3, 13.3) were significant among boys. Dietary intake (10.5; 95% CI 5.5, 15.4), healthy living knowledge (9.8; 95% CI 4.5, 15.0) and self‐efficacy (6.7; 95% CI 0.7, 12.7) improved among urban‐dwelling but not rural‐dwelling children. Healthy Buddies™ was effective for boys and children living in urban settings. Enhanced curricula may be needed to improve program effectiveness for select subgroups of school‐aged children.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Aim
To examine the effect of walking before dinner on 24-h glycemic control in individuals with type 2 diabetes using the standardized multi-site
E
xercise-
P
hysical
A
ctivity and
D
iabetes
G
lucose
...M
onitoring (E-PAraDiGM) Protocol.
Methods
Eighty participants were studied under two conditions (exercise vs. non-exercise control) separated by 72 h in a randomized crossover design. Each condition lasted 2 days during which standardized meals were provided. Exercise consisted of 50 min of treadmill walking at 5.0 km/h before the evening meal, while control involved 50 min of sitting. The primary outcome measure was mean glucose during the 24-h period following exercise (or sitting) measured by continuous glucose monitoring.
Results
Of the 80 participants who were initially randomized, 73 completed both exercise and control. Sixty-three participants 29 males, 34 females; age = 64 ± 8 years, body mass index = 30.5 ± 6.5 kg/m
2
and HbA1c = 51 ± 8 mmol/mol (6.8 ± 0.7%), mean ± SD complied with the standardized diets and had complete continuous glucose monitoring data. Exercise did not affect mean 24-h glucose compared to control (0.03 mmol/L; 95% CI − 0.17, 0.22,
P
= 0.778) but individual differences between conditions ranged from − 2.8 to +1.8 mmol/L. Exercise did not affect fasting glucose, postprandial glucose or glucose variability. Glucose concentrations measured by continuous glucose monitoring were reduced during the 50 min of walking in exercise compared to sitting in control (− 1.56 mmol/L; 95% CI − 2.18, − 0.95,
p
< 0.001).
Conclusion
Contrary to previous acute exercise studies, 50 min of walking before dinner in the E-PAraDiGM protocol did not affect 24-h glucose profiles. However, highly heterogeneous responses to exercise were observed.
Trial registration
: NCT02834689.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract only Objective: The purpose of this study was to determine if the behavioural economics principle “Fresh Start Effect” was evident within population-based patterns of cycling-specific active ...transportation (AT). The primary hypothesis was that cycling traffic along AT trails would not exhibit a fresh start effect, compared to cycling traffic along leisure trails. Design and Methods: We triangulated data from three data sources (n=3 million individual data counts) to test this hypothesis. First, the main outcome measure, cycling traffic was captured during summer months (May to September) from 2014 to 2019 with electromagnetic EcoCounters embedded in 5 paved multi-use trails in Winnipeg, Canada. Trails were categorized as AT (bi-modal peaks in traffic in the morning and afternoon) or leisure based on daily patterns of cycling traffic (single peaks of traffic in the afternoon). To confirm trends in AT-based cycling, we used daily bicycle parking data from 2012 to 2019 provided by one of the cities largest companies. To replicate the leisure-based Fresh Start effect trend we used data for fitness centre visits from the largest University in the city between 2017 and 2019. To estimate the weekly trends in occupational attendance we captured sales data from a local coffee shop from 2013 to 2019. Generalized linear mixed effects models compared counts between Mondays and other weekdays for all 4 datasets. Results: Cycling traffic was ~22% lower on Fridays relative to Mondays for both AT trails (-89 counts; 95% CI: -33 to -145counts for AT trails vs -86 counts). Nearly identical trends were observed for leisure type multi-use trails (-86 counts; 95% CI: -38 to -135 counts for leisure trails). Daily rates of occupational bicycle parking (i.e. cycling to work) were 14% lower on Fridays compared the beginning of the week (-7 counts; 95% CI: -4 to -10 counts). Daily rates of fitness centre attendance (i.e. leisure physical activity) were 18% lower on Fridays relative to the beginning of the week (-519 counts; 95% CI: -408 to -630 counts). In contrast to cycling and fitness centre data, daily coffee sales increased 15% on Fridays relative to the beginning of the week, (+42.8 counts; 95% CI: +34.1 - +51.5) suggesting that declines in cycling and leisure physical activity were not related to fewer people working on Fridays. Conclusions: Population-based AT and leisure-based cycling patterns are sensitive to the Fresh Start Effect. These data provide data to guide targeted public health strategies to increase AT and leisure-based cycling in urban areas.
Schools are frequently cited as a favorable venue to promote physical activity (PA), however little data exist describing times when students are least active. Our objective was to overcome this ...limitation and describe time periods when students are least active.
We used a cross-sectional design to assess patterns of PA in 923 grade 5 students mean age: 10.9 (± 0.4) years from 30 schools in Alberta, Canada. Students wore time-stamped pedometers for 9 consecutive days, providing 7 full days of data. We compared step counts adjusted for nonwear time between school days and nonschool days as well as during school hours and after school hours.
689 (75%) students provided complete data. The average daily step count was higher on school days (boys 13,476 ± 4123 step/day; girls 11,436 ± 3158 steps/day) than nonschool days (boys 11,009 ± 5542 steps/day; girls 10,256 ± 5206 steps/day). More steps were also taken during school hours than nonschool hours (boys +206 ± 420 steps/hour, P < .001; girls 210 ± 347, P < .001 steps/hour).
PA levels of children are below Canadian recommended levels for optimal growth and health. Health promotion should emphasize PA particularly among girls, outside school hours, and weekends.
To describe rates of prediabetes among youth in Canada and the associated social and biological characteristics.
We analyzed the cross-sectional data from the first (2007-2009) and second (2009-2011) ...cycles of the Canadian Health Measures Survey (CHMS) for youth aged 6-19 years. Prediabetes was defined using the glycated hemoglobin (A1C) guidelines set out by the American Diabetes Association (ADA) and the Canadian Diabetes Association (CDA) of A1C ranges 5.7-6.4% (38.8-46.4 mmol/mol) and 6.0-6.4% (42.1-46.4 mmol/mol), respectively.
An elevated A1C was observed in 22.8% of our sample (n = 3449) based on the ADA definition and 5.2% of youth using the CDA definition. Independent predictors in a fully adjusted model for prediabetes were non-White (odds ratio (OR) 2.62: 95% Confidence intervals 2.05-3.35), obese (OR 1.53: 1.19-1.96), less physically active youth (0.97: 0.95-0.99), and parents with high school education or less (1.34: 1.02-1.74). Moreover, significant regional variations were noted with higher rates for all regions except Ontario.
Prediabetes is relatively common in Canada and associated with common biologic and socioeconomic factors. Importantly, regular physical activity was significantly associated with reduced odds of prediabetes. Targeted screening and continued emphasis on physical activity may help curb the increasing rates of prediabetes.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Cardiovascular disease is the leading cause of morbidity and mortality in kidney transplant recipients (KTR). Two risk factors for cardiovascular disease that have not been examined in this ...population are arterial compliance and aerobic capacity. The primary objective was to determine small and large artery compliance and aerobic endurance in KTR. A secondary objective was to explore the relationship between aging and arterial compliance and aerobic endurance in KTR.
Sixty-two clinically stable KTR were recruited from the University of Alberta Renal Transplant Clinic. Small and large artery compliance was assessed using computerized arterial pulse waveform analysis. Aerobic endurance was determined using the six-minute walk test. Age-matched normative data from healthy individuals was used for comparison.
Small arterial compliance was lower in KTR (5.5+/-3 ml/mm Hg x 100) compared to age-matched healthy individuals' predicted values (7.9+/-0.9 ml/mm Hg x 100, P<0.0001). No difference was found for large artery compliance between KTR (16.0+/-6.6 ml/mm Hg x 10) and age-matched healthy predicted values (15.2+/-1.3 ml/mm Hg x 10, P=0.5). Small and large artery compliance were 35% (P=0.026) and 36% (P=0.005) higher in younger (<51 years) versus older (>51 years) KTR, respectively. The six-minute walk distance was 28% lower in KTR (495+/-92 m) compared to healthy age-predicted values (692+/-56 m P<0.0001).
Compromised arterial compliance and poor aerobic endurance may partially explain the high incidence of cardiovascular disease in KTR. Interventions demonstrated to improve these parameters may afford substantial clinical benefit in this population.
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