Translation and implementation of added sugars consumption recommendations: a conference report from the American Heart Association Added Sugars Conference 2010.

BACKGROUND: A 2-day forum was convened to (1) discuss ways to translate the 2009 American Heart Association added sugars recommendations into actions in areas such as regulation, food labeling, nutrient content claims, and practical application in the American diet; (2) review surveillance methodology and metrics for tracking and understanding the impact of reducing added sugars in the diet; and (3) initiate the development of a framework for future collaboration to help Americans implement science-based guidance relative to added sugars. METHODS AND RESULTS: More than 100 multinational participants representing scientists from academia and government and stakeholders engaged in food production, development, and processing, food manufacturing and servicing, food and nutrition policy, and nutrition recommendations for the public attended the conference. Presentations included definitions and examples of added sugars, current US and international added sugars perspectives, added sugars in diets of individuals and in the food supply, food technology behind added sugars, added sugars and health, food manufacturer perspectives, added sugars food-labeling considerations, and examples of positive approaches to improve eating behaviors and the food environment. Facilitated breakout sessions were conducted after the plenary sessions to allow participants to contribute their expertise and thoughts. CONCLUSION: The American Heart Association Added Sugars Conference is the first step in an important process that facilitates collaboration across science, public health, and industry to foster innovation, partnerships, policy, and implementation of new products and services for the benefit of the health and well-being of the American public. Science has advanced in the area of added sugars and health, creating mounting pressure to use better methods for translation and dissemination of the science for consumer education and for food companies to respond by producing foods and beverages with fewer added sugars. The new science also reinforces the importance of preventing, rather than simply treating diseases, especially overweight and obesity, diabetes mellitus, high blood pressure, heart disease, and stroke. Reducing added sugars consumption is a good target for addressing obesity, along with other sources of excess calories. However, the potential unintended consequences of substituting added sugars with ingredients that may not reduce calories and of increasing other macronutrients or food groups that may not result in a net health gain must be considered. Although there are many challenges to incorporating added sugars to the food label as was discussed during the conference, disclosure of added sugars content on food and beverage labels is an essential element in consumer education and can provide the information and motivation for making healthier food choices. This conference demonstrated the value of interactive dialogue among multiple sectors and disciplines. More disciplines should be at the table to bring expertise to discuss cross-cutting issues related to public policies and offer diverse insights to finding a solution.

Utilizing biotechnology in producing fats and oils with various nutritional properties.

The role of dietary fat in health and wellness continues to evolve. In today's environment, trans fatty acids and obesity are issues that are impacted by dietary fat. In response to new information in these areas, changes in the amount and composition of edible fats and oils have occurred and are occurring. These compositional changes include variation in fatty acid composition and innovation in fat structure. Soybean, canola, and sunflower are examples of oilseeds with varied fatty acid composition, including mid-oleic, high-oleic, and low-linolenic traits. These trait-enhanced oils are aimed to displace partially hydrogenated vegetable oils primarily in frying applications. Examples of oils with innovation in fat structure include enzyme interesterified (EIE) fats and oils and diacylglycerol oil. EIE fats are a commercial edible fat innovation, where a lipase is used to modify the fat structure of a blend of hard fat and liquid oil. EIE fats are aimed to displace partially hydrogenated vegetable oils in baking and spread applications. Diacylglycerol and medium-chain triglyceride (MCT)-based oils are commercial edible oil innovations. Diacylglycerol and MCT-based oils are aimed for individuals looking to store less of these fats as body fat when they are used in place of traditional cooking and salad oils.

Isoflavone supplements containing predominantly genistein reduce hot flash symptoms: a critical review of published studies.

OBJECTIVE: Several reviews have evaluated the clinical evidence relating isoflavone treatment to the relief of menopausal hot flash symptoms. The majority of these reviews included a variety of isoflavone sources, often without discriminating between the identities of individual isoflavones contained in the study product. An evaluation of published studies using well-characterized isoflavone-containing supplements was conducted to determine whether the observed effects, or lack thereof, were attributable to differences in the composition of isoflavones in study products. DESIGN: Eleven studies that met the inclusion criteria were stratified according to specific isoflavone composition. RESULTS: All 11 studies contained similar total isoflavone doses. In five studies, involving a total of 177 treated participants, the study product provided more than 15 mg genistein (calculated as aglycone equivalents) per treatment. Each of these five studies consistently reported a statistically significant decrease in hot flash symptoms. In the six studies involving a total of 201 treated participants that provided less than 15 mg genistein per treatment, only one reported a statistically significant decrease in hot flash symptoms. Thus, the reduction in hot flashes was related to genistein dose, not total isoflavone content of the treatments. CONCLUSION: Reports concluding that isoflavone supplements do not significantly reduce hot flash symptoms may be incorrect. The lack of discrimination between individual isoflavones contained in heterogeneous isoflavone mixtures from differing sources can be misleading when designing studies, interpreting results, and conducting reviews. In light of these observations, evaluation of isoflavone effects should focus greater attention to the specific composition within supplements in future studies.

Nutritional characteristics of DAG oil.

Excess calorie intake in industrialized countries has prompted development of fat substitutes and other lower-calorie dietary items to enhance health. DAG cooking oils, with a 1,3 configuration, taste and have the texture of commonly used TAG cooking oils. Because they are not hydrolyzed to 2-MAG in the gut, the absorption and metabolism of DAG oil differs from that of TAG. Among the physiological differences are lower postprandial lipemia and an increased proportion of FA being oxidized instead of stored. Preliminary studies suggest that these differences in energy partitioning between DAG and TAG may be usefully exploited to reduce the amount of fat stored from cooking oil and oil components of food items. Over 70 million bottles of DAG oil have been sold in Japan since its introduction in February 1999, and the product is being test-marketed in the United States. It is hoped that wider use of DAG oil may provide one additional means of preventing obesity.

Trans fatty acid intakes and food sources in the U.S. population: NHANES 1999-2002.

Because of efforts to decrease trans fatty acids (TFA) in the food supply, intake should be assessed in the population to establish a baseline TFA intake. The 1999-2002 National Health and Nutrition Examination Survey (NHANES) was used to identify a benchmark for TFA intake. TFA was estimated by mean, median, and quintile of intake, TFA intake data were weighted using the NHANES 4-year sample weights. The main outcome measures included TFA intake in grams per day and percentage of energy in the top 25 food sources of TFA. Data are reported for 16,669 individuals ≥ 3 years of age. Median TFA intake was 2.3 % of calories (5 g/day) with 0.9-4.5 % of energy (1.5-13.1 g/day) over different quintiles of intake. Mean TFA intake was 2.5 % of energy (6.1 g/day). The range of TFA intake in the fifth quintile was very large, i.e., 3.5-12.5 % of energy or 8.8-92.4 g/day. Increasing quintiles of TFA intake were associated with increases in total fat (26.7-37.6 % of energy), saturated fat (7.6-10.5 % of energy), and calories (for those >20 years of age: 2,416-2,583 for men and 1,679-1,886 for women). Major food sources of dietary TFA were cakes, cookies, pies, and pastries. Based on current dietary guidance to consume as little industrial TFA as possible, much progress is needed to attain this goal, including food industry efforts to remove TFA from the food supply and educating the public about making healthy food choices.

Predicted changes in fatty acid intakes, plasma lipids, and cardiovascular disease risk following replacement of trans fatty acid-containing soybean oil with application-appropriate alternatives.

The varied functional requirements satisfied by trans fatty acid (TFA)--containing oils constrains the selection of alternative fats and oils for use as potential replacements in specific food applications. We aimed to model the effects of replacing TFA-containing partially hydrogenated soybean oil (PHSBO) with application-appropriate alternatives on population fatty acid intakes, plasma lipids, and cardiovascular disease (CVD) risk. Using the National Health and Nutrition Examination Survey 24-hour dietary recalls for 1999-2002, we selected 25 food categories, accounting for 86 % of soybean oil (SBO) and 79 % of TFA intake for replacement modeling. Before modeling, those in the middle quintile had a mean PHSBO TFA intake of 1.2 % of energy. PHSBO replacement in applications requiring thermal stability by either low-linolenic acid SBO or mid-oleic, low-linolenic acid SBO decreased TFA intake by 0.3 % of energy and predicted CVD risk by 0.7-0.8 %. PHSBO replacement in applications requiring functional properties with palm-based oils reduced TFA intake by 0.8 % of energy, increased palmitic acid intake by 1.0 % of energy, and reduced predicted CVD risk by 0.4 %, whereas replacement with fully hydrogenated interesterified SBO reduced TFA intake by 0.7 % of energy, increased stearic acid intake by 1.0 % of energy, and decreased predicted CVD risk by 1.2 %. PHSBO replacement in both thermal and functional applications reduced TFA intake by 1.0 % of energy and predicted CVD risk by 1.5 %. Based solely on changes in plasma lipids and lipoproteins, all PHSBO replacement models reduced estimated CVD risk, albeit less than previously reported using simpler replacement models.

Fructose and non-fructose sugar intakes in the US population and their associations with indicators of metabolic syndrome.

BACKGROUND: Relationships of sugar intakes with indicators of metabolic syndrome are important concerns for public health and safety. For individuals, dietary intake data for fructose and other sugars are limited. METHOD: Descriptive statistics. The data from 25,506 subjects, aged 12-80 yr, contained in the NHANES 1999-2006 databases were analyzed for sugar intakes and health parameters. RESULTS: Dietary fructose was almost always consumed with other sugars. On average, fructose provided 37% of total simple sugar intake and 9% of energy intake. In more than 97% of individuals studied, fructose caloric contribution was lower than that of non-fructose sugars. Fructose and non-fructose sugar intakes had no positive association with blood concentrations of TG, HDL cholesterol, glycohemoglobin, uric acid, blood pressure, waist circumference, and BMI in the adults studied (aged 19 to 80 yr, n=17,749). CONCLUSION: Daily fructose intakes with the American diet averaged approximately 37% of total sugars and 9% of daily energy. Fructose was rarely consumed solely or in excess over non-fructose sugars. Fructose and non-fructose sugar ordinary consumption was not positively associated with indicators of metabolic syndrome, uric acid and BMI.

Lack of association between dietary fructose and hyperuricemia risk in adults.

BACKGROUND: High serum uric acid concentration (hyperuricemia) has been studied for its relationship with multiple adverse health outcomes, such as metabolic syndrome. Intervention studies have produced inconsistent outcomes for the relationship between fructose intake and serum uric acid concentration. METHODS: The association of dietary fructose intake with hyperuricemia risk in adults was examined using logistic regression and U.S. NHANES 1999-2004 databases. A total of 9,384 subjects, between the ages 20 and 80 years, without diabetes, cancer, or heart disease, were included. RESULTS: The highest added or total fructose intake (quartiles by grams or % energy) was not associated with an increase of hyperuricemia risk compared to the lowest intake with or without adjustment (odds ratios = 0.515-0.992). The associations of alcohol and fiber intakes with the risk were also determined. Compared to the lowest intake, the highest alcohol intake was associated with increased mean serum uric acid concentration (up to 16%, P < 0.001) and hyperuricemia risk (odds ratios = 1.658-1.829, P = 0.057- < 0.001); the highest fiber intake was correlated with decreases of uric acid concentration (up to 7.5%, P < 0.002) and lower risk (odds ratios = 0.448-0.478, P = 0.001- < 0.001). Adults who were over 50 y old, male, or obese had significantly greater risk. CONCLUSIONS: The data show that increased dietary fructose intake was not associated with increased hyperuricemia risk; while increased dietary alcohol intake was significantly associated with increased hyperuricemia risk; and increased fiber intake was significantly associated with decreased hyperuricemia risk. These data further suggest a potential effect of fructose consumption in an ordinary diet on serum uric acid differs from results found in some short-term studies using atypical exposure and/or levels of fructose administration.

Dietary fats and oils: technologies for improving cardiovascular health.

The role of dietary lipids in the etiology of coronary heart disease (CHD) continues to evolve as we gain a better understanding of the metabolic effects of individual fatty acids and their impact on surrogate markers of risk. A recent meta-analysis of 60 human studies suggests that for each 1% energy replacement of carbohydrates in the diet with saturated fat or trans fat, serum low-density lipoprotein cholesterol concentrations increase by 0.032 (1.23 mg/dL) and 0.04 mmol/L (1.54 mg/dL), respectively. Current dietary recommendations to keep saturated fat and trans fat intake as low as possible, and to increase the intake of cis mono-unsaturated and polyunsaturated fatty acids, as well as growing recognition of these recommendations by consumers and food regulatory agencies in the United States, have been major driving forces for the edible oil industry and food manufacturers to develop alternative fats and oils with nutritionally improved fatty acid compositions. As solutions for use of trans fatty acids are being sought, oilseeds with modified fatty acid compositions are being viewed as a means to provide such solutions. Additionally, oilseeds with modified fatty acid composition, such as enhanced content of long-chain omega-3 fatty acids or conjugated linoleic acid, have been developed as a way to increase delivery of these fatty acids directly into the food supply or indirectly as use for feed ingredients for livestock. New processing technologies are being utilized around the world to create dietary fats and oils with specific physiologic functions relevant to risk factors for cardiovascular disease.