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

Abstract

Intake of added sugars (AS) is challenging to assess compared with total dietary sugar because of the lack of reliable assessment methods. The reliance on self-reported dietary data in observational studies is often cited as biased, with evidence of AS intake in relation to health outcomes rated as low to moderate quality. Sugar-sweetened beverages (SSBs) are a major source of AS. A regular and high intake of SSBs is associated with an overall poor diet, weight gain, and cardiometabolic risks. An elevated intake of low-calorie sweetened beverages (LCSBs), often regarded as healthier alternatives to SSBs, is also increasingly associated with increased risk for metabolic dysfunction. In this review, we systematically collate evidence and provide perspectives on the use of metabolomics for the discovery of candidate biomarkers associated with the intake of SSBs and LCSBs. We searched the Medline, Embase, Scopus, and Web of Science databases until the end of December 2020. Seventeen articles fulfilled our inclusion criteria. We evaluated specificity and validity of the identified biomarkers following Guidelines for Biomarker of Food Intake Reviews (BFIRev). We report that the 13C:12C carbon isotope ratio (δ13C), particularly, the δ13C of alanine is the most robust, sensitive, and specific biomarker of SSBs intake. Acesulfame-K, saccharin, sucralose, cyclamate, and steviol glucuronide showed moderate validity for predicting the short-term intake of LCSBs. More evidence is required to evaluate the validity of other panels of metabolites associated with the intake of SSBs.

Plasma Metabolite Response to Simple, Refined and Unrefined Carbohydrate-Enriched Diets in Older Adults—Randomized Controlled Crossover Trial

“…This is unexplained at this time because these metabolites tend to be associated with dietary animal protein [8,9]. Previous studies reported that plasma L-alanine, carbon-13, D-glucose and 2-piperidinone are potential plasma biomarkers of sugar sweetened beverage intake [19,20]. Similar findings in terms of the SC diet were not observed in the current study.…”

Long-term aspartame and saccharin intakes are related to greater volumes of visceral, intermuscular, and subcutaneous adipose tissue: the CARDIA study

“…By contrast, most diet studies rely on food frequency questionnaires that do not query brand name information and therefore do not capture ArtSw content apart from diet beverages. To date, no objective biomarkers of habitual ArtSw intake have been validated for ArtSw intake [ 31 , 32 ], so our approach of averaging ArtSw intake at multiple time points remains one of the more robust methods for assessing ArtSw intake. For AT outcomes, ATs and muscle composition were quantified using CT imaging, which precisely evaluates specific body AT compartment volumes.…”

Evaluating a Model of Added Sugar Intake Based on Amino Acid Carbon Isotope Ratios in a Controlled Feeding Study of U.S. Adults

“…Despite the limitations described above, the CIR Ala , alone or in combination with other CIR AA s, shows promise as a biomarker for AS or SSB intake in certain populations and warrants further study [ 34 ]. The only other proposed biomarker for AS intake is whole-tissue CIRs, which have been shown to correlate more with meat or animal protein intakes in various studies across populations [ 20 , 22 , 29 , 35 ].…”

“…Furthermore, the prediction model for AS intake developed from blood CIR demonstrated poor performance in external validation; specifically, high intakes were underestimated [ 39 ]. There has been some metabolomic exploration of SSB intake biomarkers [ 40 ], but this approach has the limitation of identifying compounds that may not be present in all SSBs (low sensitivity) or may be present in other foods (low specificity) [ 34 ]. Metabolomic biomarkers are also often limited to indicating short-term intake, whereas plasma and RBC CIR AA s integrate diet over several weeks or months [ 18 ].…”