A Novel Urinary Biomarker Approach Reveals Widespread Exposure to Multiple Low-CalorieSweeteners in Adults

Abstract

Background Observational investigations into the health impacts of low-calorie sweeteners (LCSs) in humans fail to adequately identify or fully characterize LCS consumption. Objectives We aimed to utilize a novel biomarker approach to investigate exposure to 5 LCSs and to test whether reported low-calorie sweetened beverage (LCSB) consumption effectively identifies exposure to LCSs in adults. Methods In this cross-sectional analysis, 2 population studies were conducted in adults. Urinary excretions of 5 LCSs, namely acesulfame-K, saccharin, cyclamate, sucralose, and steviol glycosides, were simultaneously determined using LC tandem-MS. In Study 1, previously collected 24-h urine samples (n = 357) were analyzed. In Study 2, previously collected 24-h urine samples (n = 79) were analyzed to compare urinary excretions of LCSs with self-reported LCSB consumption for identifying LCS exposure. Exposure to LCSs was characterized using descriptive statistics and chi-square tests were performed to assess associations between age-groups and LCS excretion, and to assess the proportion of individuals identified as LCS consumers using biomarker data or reported LCSB consumption. Results A total of 341 adults (45% men) and 79 adults (39% men) were included in the final analysis of Studies 1 and 2, respectively. In Study 1, >96% of samples contained ≥1 LCS and almost 60% contained ≥3 LCSs. A greater proportion of younger adults (<40 y old) excreted ≥3 LCSs than older adults (>40 y old) (P < 0.001). In Study 2, a much higher prevalence of LCS consumption was observed using biomarker data (92%) than reported LCSB consumption (6%) (P < 0.001). Conclusions This work indicates widespread exposure to LCSs, suggesting that population-based research to date into LCS exposure and health may be flawed. Therefore, a urinary biomarker approach offers considerable potential for more robust investigations in this area.

A Systematic Review of Metabolomic Biomarkers for the Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages

“…The systematic literature search strategy yielded 1130 non-duplicated records from the four electronic databases. After abstract reading, full text reading for eligibility assessment, and secondary search, 17 studies were included [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ], as shown in Figure 1 .…”

“…Table 1 summarizes the study characteristics and candidate biomarkers identified. There were eight cross-sectional studies [ 29 , 30 , 33 , 34 , 36 , 38 , 39 , 44 , 45 ] and eight controlled intervention studies [ 31 , 32 , 35 , 37 , 40 , 41 , 42 , 43 ]. For comparison with dietary intake, dietary assessment tools such as 24-h recall, 4-day and 7-day food records, and FFQS were used.…”

“…Three studies investigated the potential biomarkers of low-calorie sweeteners (LCSs) commonly used in LCSBs, identifying urinary excretion of acesulfame-K, saccharin, cyclamate, sucralose, and steviol glycosides among the consumers of LCSs/LCSBs [ 36 , 37 , 43 ]. Logue et al [ 37 ] investigated the urinary excretion of commonly used LCSs following dietary exposure to LCSBs, using a double-blind, randomized crossover dose−response study.…”

“…In a separate study, Logue et al [ 36 ] further investigated the use of a 24-h urinary biomarker approach to detect dietary exposure to LCSB in two adult population-based studies, targeting the five LCSs investigated previously in their controlled study [ 37 ]. The 24-h urinary biomarker was compared with LCSB consumption, as self-reported in 7-d food diaries of the participants ( n = 79), who were randomly selected from a large study regarding the prevalence of the widespread consumption of LCSs ( n = 357).…”

Updated Database and Trends of Declared Low- and No-Calorie Sweeteners From Foods and Beverages Marketed in Spain

“…One major limitation of this study was the inability to evaluate the actual content of LNCS to be able to estimate dietary intakes. In this regard, biomarker analysis could be combined with dietary assessment as suggested by Logue et al ( 28 ), who used a novel urinary biomarker approach for the determination of up to five LNCS to characterize consumption in adults.…”