adam drewnowski

Adam DrewnowskiLos Humanos y el Dulzor:¿Por qué nos gustan las

cosas dulces?

Los Humanos y el Dulzor:¿Por qué nos gustan las cosas dulces?

Adam Drewnowski, PhDDirector, Center for Public Health NutritionDirector, UW Center for Obesity Research

School of Public Health and Community MedicineUniversity of Washington

Seattle, WA

Serie Cientifica LatinoamericanaSimposio de Edulcorantes no Caloricos, Bogota, Colombia, Agosto 24 y 25,

2011

Consumer

Cost

Variety

FoodBehavior

We choose foods by tasteEnergy density

Health

Taste

Access/time

Taste

Pleasure

Whatever is the most delicious is also the most nutritiousMagninus of Milan 17th C

If the human body is healthy, then the foods that taste the best are also the most nutritious Aldebrandin of Siena 1606

Good-tasting foods were once viewed as the most nutritious

Jean-Pierre Flandrin Histoire de l’Alimentation, Paris, 1996

• Sugar is the universal flavoring; its applications have an infinite variety…

• Mixed with water, sugar produces sugar water, a refreshing, healthy, pleasant drink.

Sugar is delicious: France 1825

Jean Anthelme Brillat-Savarin 1825

Jean Anthelme Brillat-Savarin 1825

The energy of sunshine is crystallized in Dextrose sugar

Sugar is nutritious: US 1948

Taste is the main influence on food behavior

Consumer

Cost

Variety

FoodBehavior

Energy density

Health

Taste

Access/time

Taste

Pleasure

Sweetness equals nutritionBitterness equals dietary danger

• A single taste cell has many receptors for bitter and sweet

• Humans have 3-4 different taste receptors for sweet

• Sugars and intense sweeteners are structurally related

• Humans have 40-80 different taste receptors for bitter

• Compounds that elicit bitter taste are completely unrelated

• Bitter compounds are often toxic

Infants like sweet!

0

2

4

6

8

10

12

14

16

18

0.05 0.1 0.2 0.3

Sugar concentration (mol/L)M

ean

volu

me

cons

umed

(ml)

SucroseWater

Desor, Maller and Greene, 1978

Infants prefer sweet liquidsto plain water

Sweet Sour Bitter

Facial expressions of 3-day old infants Steiner, 1977

3-day old infants like sweet and reject bitter tastes

Mennella and Beauchamp, Nutr Rev 1998

Liking

for sweetRejectionof bitter

Best liked (-2 to +2) Least liked (-2 to +2)

1.91 Chocolate1.88 Chocolate biscuits1.88 Crisps1.88 Yogurt1.84 Ice cream1.83 Ice lolly1.83 Fruit squash1.77 Bread1.67 Chicken1.63 Plain biscuits

-0.62 Avocado-0.59 Leeks-0.56 Courgette-0.49 Melon-0.45 Cottage cheese-0.44 Sweet peppers-0.31 Onion-0.29 Liver-0.25 Cabbage-0.05 Parsnips

Wardle et al., Appetite 2001;37:217-223

Children like familiar sweet foods

-1

-0.5

0

0.5

1

1.5

2

0 20 40 60 80 100 120Have tried the food before (%)

Pre

fere

nc

e

tofu

avocado melon

chocolate

leeks

Pre fe re n c e Sc o re (ra n g e -2 to +2 )

2. 01. 51. 0. 50. 0-. 5-1. 0

En

erg

y D

en

sit

y (

kJ

/g)

5. 0

4. 0

3. 0

2. 0

1. 0

0. 0

st r awb/ r aspber r ies

peach/ pear / plum

m elon

gr apes

banana

apr icot

apple

leeks

let t uce/ cuc/ celer y

t om at oes

par s/ t ur nip/ swede

br occ/ spin/ gr eens

peas

gr een/ r unner / br oad

pot at oes

cit r us

car r ot

cabbage

r ed peppercaulif lower

m ar r ow/ cour get t e

beans

Banana

Potatoes

GrapesApple

Children liked energy-dense fruit best

Wardle al, Appetite 2003

What do adults “crave”?

Foods that are energy-dense, with fat, sugar, and/or salt

Consumer

Cost

Variety

FoodBehavior

Energy density

Health

Taste

Access/time

Taste

Pleasure

Sweet beverages are liked but are not “craved” like chocolate.Their energy density is too low

0

10

20

30

40

0 10 20 30 40 50 60 70 80 90 100

water content (g/100g)

En

erg

y d

ensi

ty (

MJ/

kg)

Fats Sweets

Energy density (MJ/kg) and water content

oil

butter

sugar

soft drinks

candy

oil = 9 kcal/g

water = 0 kcal/g

0

10

20

30

40

0 10 20 30 40 50 60 70 80 90 100


En

erg

y d

ensi

ty (

MJ/

kg)

Fats Sweets Meat Dairy


butter

sugar

soft drinks

candy

meat

cheese

milk

oil

ice cream

carbohydrate = 4 kcal/g

oil = 9 kcal/g

water = 0 kcal/g

0

10

20

30

40

0 10 20 30 40 50 60 70 80 90 100


En

erg

y d

ensi

ty (

MJ/

kg)

Fats Sweets Grains Meat Dairy


butter

sugar

soft drinks

candy

meat

milk

grains

oiloil

cheese

ice cream

water = 0 kcal/g

carbohydrate = 4 kcal/g

0

10

20

30

40

0 10 20 30 40 50 60 70 80 90 100


En

erg

y d

ensi

ty (

MJ/

kg)

Fats Sweets Grains Vegetables Fruit Meat Dairy


butter

sugar

soft drinks

candy

meat

milk

grains

oiloil

cheese

ice cream

water = 0 kcal/g

What is the impact of sweet foods and beverages on the diet?

Where do sugar calories come from?

Consumer

Cost

Variety

FoodBehavior

Energy density

Health

Taste

Access/time

Taste

Pleasure

Soda, sports & energy drinks

5.5%

Added sugars consumption (tsp/d) declines with age – obesity and diabetes go up

Thompson et al. Added sugars intake, SES and race/ethnicity JADA 2009;109:1376

0

10

20

30

18-39 40-59 >60 18-39 40-59 >60

add

ed s

ug

ar (

teas

po

on

s)

Men Women

NHANES 2003-4 24h NHIS 2005 screener

0

10

20

30

18-29 30-39 40-49 50-59 60-69

ob

esit

y p

reva

len

ce

Obesity Diabetes

Added sugars intake by age Obesity and diabetes by age

Mokdad et al. Prevalence of obesity, diabetes, and obesity related health risk factors JAMA 2003:289:76-79

Thompson et al. Added sugars intake, SES and race/ethnicity JADA 2009;109:1376

0

10

20

30

White

Hispa

nic

Black

<12y

12

y

12-1

6y

Ad

de

d s

ug

ars

(ts

p/d

)

Men Women

Added sugars, obesity and diabetes by race/ethnicity and education

Data are estimated least square mean intakes of added sugars in tsp/d (1 tsp = 4g)

0

10

20

30

40

White Hispanic Black <12y 12y 12-16y

Pre

vale

nce

(%

)

Obesity Diabetes

Added sugars intake by age Obesity and diabetes by age

• Is it true that liquid calories have no satiating power?

• What do we know about the effects of low calorie sweeteners on satiety?

• Can low calorie beverages help in the management of body weight?

What about sweetness, satiety, and appetite control?

Solids versus liquids: still not settled• Liquified foods (soups) are more satiating than solids, as measured by food

intake reduction.– Kissileff AJCN 1985

• Solid carbohydrates (jelly beans) elicited precise 100% dietary compensation; liquids (soda) elicited none.

– DiMeglio & Mattes IJO 2000

• Solid watermelon led to more compensation at lunch compared to watermelon juice (24% vs 6%). Beverages elicited a weaker compensatory response than did solid foods. No effect on hunger or satiety ratings was observed.

– Mourao, Bressan, Campbell & Mattes IJO 2007

• Solid apples, semisolid apple sauce, and liquid apple juice (300 kcal) did lead to different hunger/satiety ratings. No effect on energy intakes was observed.

– Mattes & Campbell JADA 2009

0

100

200

300

400

500

600

Protein Carb Fat

En

erg

y in

take

(M

J/d

)

Solid Liquid

Mourao, Campbell and Mattes Int J Obesity 2007; 31: 1688.

Hunger and energy intakes at lunch after solid vs. liquid preloads (125 or 225 kcal)

0

10

20

30

40

50

60

Protein Carb Fat

Hu

ng

er

rati

ng

s (

% d

iffe

ren

ce

)

Solid Liquid

Protein = milk versus cheeseCarbohydrate = watermelon versus watermelon juiceFat = coconut meat versus coconut milk

The preload study design that we use

Next meal

time

Solid

Appetitive ratingsHunger, fullness, desire to eat, thirstLiquid

satiation

This meal

satiety

Food records

Expectation: Subjects ingesting a preload will eat less at this/next meal

Variable interval: 15 min – 6h

Lunch meal: 1734 kcalAdditional servings of the same foods

available from a side buffet

Is if food form (liquid versus solid)or is it time?

Composition Cola Raspberry cookie

Carbohydrate (g) 81.5 69.0

Sugar (g) 81.5 48.0

Protein (g) 0 3.0

Fat (g) 0 0

Fiber (g) 0 1.5

Serving size 710 ml(24 oz)

87 g(6 units)

Total kcal 300 300

Almiron-Roig, Flores, Drewnowski, Physiol & Behav 2004;82:671

Keep energy constant (300 kcal)– vary texture and time lag

Lunch

Lunch

Lunch

Lunch

2h

2h

20 min

20 min

Study design: 2 time delays

Breakfast

Breakfast

Breakfast

Breakfast

1.5h

1.5h

3.5 h

3.5 h

Almiron-Roig, Flores, Drewnowski, Physiol&Behav 2004;82:671

1

2

3

4

5

6

7

8

9

930 1000 1030 1100 1130 1200 1230 1300

Hu

ng

er

(9-p

oin

t s

ca

le)

Early cola Early cookie Late cola Late cookie

Hunger, satiety, thirst after soda or cookies

Almiron-Roig, Flores, Drewnowski, Physiol & Behav 2004;82:671

1

2

3

4

5

6

7

8

9

930 1000 1030 1100 1130 1200 1230 1300

De

sir

e t

o e

at

(9 p

oin

t)

1

2

3

4

5

6

7

8

9

930 1000 1030 1100 1130 1200 1230 1300

Fu

lln

es

s (

9-p

oin

t s

ca

le)

1

2

3

4

5

6

7

8

9

930 1000 1030 1100 1130 1200 1230 1300

Th

irs

t (9

-po

int

sc

ale

)

Breakfast

Lunch

Can cola spoil your appetite? Yes

*

400

450

500

550

600

650

700

750

800

850

Early cola Earlycookie

Late cola Late cookie

Pre

va

len

ce

(%

)

Early cola Early cookie

Late cola Late cookie

Prediction: Degree of compensation may depend on time to the next meal. Short interval = more compensation.

Long interval = little or no compensation.

Compare diet and regular beverages

Next meal

time

Calories

Appetitive ratingsHunger, fullness, desire to eat, thirst

LCS

satiety

Expectation: calorie effects and volume effects have different time course

Interval 60-90 min

Beverage volume affects satiety

• N = 37 volunteers (19 men; 18 women), age 23y• Body mass index: 23.4 (men), 21.9 (women)• Hunger, thirst, fullness, and desire to eat measured every 30

min (9-point scale)• Lunch foods pre-weighed by experimenters. Plate and water

waste measured.

Beverage Volume Calories

HFCS 42 475 214

HFCS 55 525 213

Sucrose 525 213

Aspartame 475 4

1% milk 495 213

No beverage 0 0

0

10

20

30

40

50

60

70

80

90

100

9:40 10:00 10:30 10:50 11:10 11:30 11:50 12:10 12:30 13:00Time (h)

Hu

ng

er (

100

mm

VA

S)

HFCS 42 HFCS 55 SucroseAspartame Milk no bev

PRELOAD

LUNCH

Hunger and satiety after 6 beverages

Perrigue et al. Presentation at Experimental Biology 2006 in San Francisco April 2006

0

10

20

30

40

50

60

70

80

90

100

9:40 10:00 10:30 10:50 11:10 11:30 11:50 12:10 12:30 13:00Time (h)

Hu

ng

er (

100

mm

VA

S)

Hu

ng

erF

ull

nes

s

0

10

20

30

40

50

60

70

80

90

100

9:40 10:00 10:30 10:50 11:10 11:30 11:50 12:10 12:30 13:00Time (h)

Hu

ng

er (

100

mm

VA

S)

Aspartame Milk no bev

PRELOAD

LUNCH

Hunger and satiety after LCS and milk

Perrigue et al. AJCN 2007

0

10

20

30

40

50

60

70

80

90

100

9:40 10:00 10:30 10:50 11:10 11:30 11:50 12:10 12:30 13:00Time (h)

Hu

ng

er (

100

mm

VA

S)

Hu

ng

erF

ull

nes

s

Diet soft drink did not affect food consumption at lunch

0 200 400 600 800 1000 1200

HFCS 42

HFCS 55

Sucrose

1% milk

Aspartame

No Bev

preload lunch


Same as for no beverage

0 200 400 600 800 1000 1200

HFCS 42

HFCS 55

Sucrose

1% milk

Aspartame

No Bev


Some compensation (not much)

Lunch consumption after 6 beverages

What the science tells us

• Liquids are as satiating as solids– Soft drinks vs. cookies

• Liquid sugars have satiating power– Soft drinks vs. juices or milk

• Low calorie sweeteners do not promote hunger– Aspartame vs. milk

Final question:

Who are LCS consumers and what is their diet quality?

Underweight (BMI<18.5)[1]

Healthy-weight(BMI 18.5-24.9)

Overweight(BMI 25-29.9)

Obese(BMI ≥ 30)

P Heterogeneit

y

Crude

% consuming no LCS - 78.3 (73.7, 82.2) 73.2 (68.7, 77.2) 66.8 (61.7, 71.6)<0.001

% consuming any LCS - 21.7 (17.8, 26.3) 26.8 (22.8, 31.3) 33.2 (28.4, 38.3)

Age-adjusted[2]

% consuming no LCS - 76.7 (72.3, 80.5) 74.1 (69.6, 78.0) 68.7 (64.5, 72.6)<0.001


Age-adjusted (men)

% consuming no LCS - 85.4 (76.6, 89.9) 77.4 (72.3, 81.9) 70.7 (65.6, 75.3)<0.001


Age-adjusted (women)

% consuming no LCS - 70.0 (65.6, 74.1) 68.6 (64.0, 72.8) 67.0 (62.0, 71.7)0.12


Who are LCS consumers?

Data from 2001-2 NHANES Rehm and Drewnowski

Was there a reduction in added sugar and carbs?

Survey-weighted mean[1] and 95% CI

Variable of interest No low-calorie

sweetener (n=3,287)Any low-calorie

sweetener (n=1,039)p-value

Energy (kcal) 2,206 (2,161, 2,251) 2,119 (2,053, 2,185) 0.002

Macronutrients

Total fat (gm) 72 (71, 73) 80 (78, 83) <0.001

Saturated fat (gm) 23 (23, 23) 25 (24, 26) 0.002

Protein (gm) 73 (72, 74) 82 (80, 83) <0.001

Carbohydrate (gm) 258 (255, 262) 235 (228, 241) <0.001

Added sugars (tsp) 22 (20, 23) 14 (13, 15) <0.001

Alcohol (gm) 9.3 (7.6, 11) 7.1 (5.6, 8.7) 0.004

[1] Mean is adjusted for age group, gender and energy. Values represent those for individuals who consume 2,000 calories.


What are their diets like?Survey-weighted mean[1] and 95% CI

Variable of interest No low-calorie

sweetener (n=3,287)Any low-calorie

sweetener (n=1,039)p-value

Energy (kcal) 2,206 (2,161, 2,251) 2,119 (2,053, 2,185) 0.002

Healthy Eating Index (2005) 51.1 (50, 52.2) 54.7 (53, 56.4) 0.001

HEI 1 – Total fruit 2.3 (2.1, 2.4) 2.2 (1.9, 2.4) 0.278

HEI 2 – Whole fruit 1.9 (1.8, 2.1) 2.1 (1.9, 2.3) 0.144

HEI 3 – Total vegetables 3.0 (2.9, 3.1) 3.3 (3, 3.5) 0.096

HEI 4 – Dark green and orange vegs 1.3 (1.2, 1.4) 1.3 (1.1, 1.4) 0.12

HEI 5 – Total grains 4.2 (4.1, 4.3) 4.4 (4.3, 4.5) 0.004

HEI 6 – Whole grains 1.0 (0.9, 1.1) 1.3 (1.1, 1.5) 0.002

HEI 7 – Milk 4.6 (4.5, 4.8) 5.2 (4.9, 5.6) 0.004

HEI 8 – Meat and beans 8.0 (7.8, 8.1) 8.3 (8.1, 8.6) 0.023

HEI 9 – Oils 5.2 (5, 5.4) 6.1 (5.8, 6.4) <0.001

HEI 10 – Saturated fat 6.5 (6.3, 6.6) 5.7 (5.2, 6.2) 0.009

HEI 11 – Sodium 4.6 (4.4, 4.8) 3.3 (3, 3.6) <0.001

HEI 12 – SoFAAS 8.5 (7.9, 9.1) 11.5 (10.9, 12.2) <0.001


Did diet soda consumers have better diets? Yes

Recent issues about LCS:

• The press has raised questions about LCS:– They over-stimulate sweet taste receptors.– They make you hungry.– They trick the body into overeating.– They create sweet taste addictions.– They may fuel the obesity epidemic.

• What does science tell us?

What the science tells us

• Low calorie sweeteners (LCS) provide sweet taste without calories.

• LCS have no impact on satiety beyond a transient volume effect.

• The addition of LCS to a plain beverage does not lead to overeating.

• LCS may lead to lower energy intakes at the end of the day

• In replacing SSB, LCS have contributed to weight loss.

Food Selection

Taste

Eating behaviorCost

Money

Health

Time

Access

Nutrient density

Nutritionknowledge Weight

concerns

How people choose foods

Energy density

adam drewnowski

Health & Medicine

bitter taste

sugar water

different taste receptors

dextrose sugar

bitter compounds

single taste cell

jean anthelme brillatsavarin

adam drewnowskilos humanos