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Objective: The aim of this study is to examine the effect of diet drinks on dental erosion among a representative sample of US adults. Methods: Adult dietary and dental data were analyzed from the 2003–2004 cycle of the National Health and Nutrition Examination Survey. Erosion was measured with a modified tooth wear index and was analyzed as a dichotomous variable. Cluster analysis was performed, and the cluster number was based on having a separate diet drink cluster and the R2 values. Survey procedure and sample weights were used. Results: Most of the population (80%) had some form of dental erosive lesions. When compared with the total sample, people with erosion were more likely to be male (52.5%) and older. People with no erosive lesions were younger (42.3%) and non-Hispanic Black (21.2%). Cluster analysis resulted in 4 distinct clusters: high water, high diet drinks, high coffee/tea, and high soda. The respective percentage of individuals in each cluster who had erosion was 78.9%, 85%, 83.9%, and 76.2%, where the “high diet drinks” cluster showed the highest erosion ( P = 0.28). Logistic regression modeling showed that the “high diet drinks” cluster had increased odds of erosion (odds ratio = 1.27; 95% CI = 0.58 to 2.77) when compared with the “high water” cluster, but the relationship was not statistically significant. Conclusion: High diet drinks consumption slightly increased the odds of dental erosion among US adults, although this relationship was not statistically significant. It is thus not yet clear that dentists should recommend diet drinks, as they might be linked to systemic diseases. Further research is needed to explore more about risk factors of erosion. Knowledge Transfer Statement: The findings of this study are suggestive, though not significantly, that diet drinks may increase risk for dental erosion. While further research is needed, it is not clear that dentists should recommend these drinks as healthy substitutes for sugary drinks.

Purpose: Evaluate associations of adolescents’ beverage marketing receptivity with sugar-sweetened beverage (SSB) perceived harm and intake. Design: School-based cross-sectional health behavior survey. Setting: Seven rural schools in California, 2019-2020. Subjects: 815 student participants in grades 9 or 10. Measures: Participants viewed 6 beverage advertisement images with brand obscured, randomly selected from a larger pool. Ads for telecommunications products were an internal control. Receptivity was a composite of recognizing, liking, and identifying the displayed brand (later categorized: low, moderate, high). Weekly SSB servings were measured with a quantitative food frequency questionnaire and perceived SSB harm as 4 levels (“no harm” to “a lot”). Analysis: Outcomes SSB intake (binomial regression) and perceived harm (ordered logistic regression) were modeled according to advertisement receptivity (independent variable), with multiple imputation, school-level clustering, and adjustment for presumed confounders (gender, age, screen time, etc.). Results: In covariable-adjusted models, greater beverage advertisement receptivity independently predicted higher SSB intake (ratio of SSB servings, high vs. low receptivity: 1.48 [95% CI: 1.15, 1.89]) and lower perceived SSB harm (odds ratio, high vs. low receptivity: 0.59 [0.40, 0.88]). Perceived SSB harm was inversely associated with SSB intake. Conclusion: Beverage advertisement receptivity was associated with less perceived SSB harm and greater SSB consumption in this population. Policy strategies, including marketing restrictions or counter-marketing campaigns could potentially reduce SSB consumption and improve health.

The aim of this work was to develop a methodology to calculate the cooling curve for the sweetened condensed milk with added whey powder production and to assess the cooling regime effect on the distribution of lactose crystals’ size and their microstructure. It is proposed to use a two-stage cooling curve. At the first stage, the cooling is carried out at a high speed, and at the second with a speed that varies depending on the rate of lactose crystallization. Electron microscopic studies have confirmed the cooling regime effect on the crystals’ microstructure. The practical use of the developed regime showed that the two-stage cooling regime allows to reduce the size of lactose crystals (P

Introduction High-quality synthesized evidence of sweet taste analgesia in neonates exists. However, Chinese databases have never been included in previous systematic reviews of sweet solutions for procedural pain. Objective To conduct a systematic review of Chinese literature evaluating analgesic effects of sweet solutions for neonates. Data sources: Wang Fang, China National Knowledge Infrastructure and Chinese Biomedical Literature Database. Data extraction and analysis: Two authors screened studies for inclusion and conducted risk of bias ratings and data extraction. A third author resolved any conflicts. Meta-analyses were performed using RevMan 5.2 software, on mean differences in pain outcomes using random effects models. Results Thirty-one trials (4999 neonates) were included; 26 trials used glucose, 4 used sucrose, and 1 trial evaluated both solutions. Sweet solutions reduced standardized mean pain scores (n = 21 studies; −1.68, 95% confidence interval −2.08, −1.27) and cry duration (n = 6 studies; −25.60, 95% confidence interval −36.47, −14.72 s) but not heart rate change (n = 7 studies; −17.64, 95% confidence interval −52.71, 17.43). No included studies cited the previously published systematic reviews of sweet solutions. Conclusions This systematic review of Chinese databases showed the same results as previously published systematic reviews. No trials included in this review cited the English systematic reviews, highlighting a parallel research agenda.

Jelly and confectionery products are high in sugar and calories. Xylitol and stevioside are natural low-calorie sweeteners and they can be used as an alternative; however, their effects on fish gelatin are unknown. The gelatin was extracted from cod skins and added to xylitol or stevioside (0, 2, 6, 10, 14, and 20% (w/v)) to form gel products. This paper investigated how xylitol and stevioside affected the physical and rheological behaviors of fish gelatin, such as color, gel strength, texture profile analysis, storage modulus (G′), loss modulus (G″), and viscosity. Results showed that the change of color and viscosity in gel products were similar when various concentrations of xylitol or stevioside were added to the fish gelatin. But the effects of xylitol/stevioside on texture profile analysis and G′, G″ were different, which might due to the structure variation in xylitol and stevioside. The linear structure of xylitol resulted in ionic interaction, hydrogen bonding, van der Waals forces, and hydrophobic association between xylitol and fish gelatin. Therefore, xylitol is a promising sweetener substitute, which was probably related to its greater solubility and number of –OH groups.

Type 2 diabetes is one of the most common noncommunicable diseases worldwide. The quality of life of people with this metabolic disorder is highly related to nutrition, given that products for glycemic control are of great importance for them. In this study, we have developed marmalades for glycemic control with the aims to investigate the most important sensory characteristics, to study the impact of the sensory properties on the acceptability of these marmalades, and to evaluate a difference in the acceptability of the marmalade samples between healthy people and people with type 2 diabetes. The main objects of the investigation were agar-, gelatin-, and pectin-based marmalades with maltitol, dried fruits, and berries for glycemic control. By means of descriptive sensory analysis, we have shown that major factors of the sensory differentiation of marmalade samples are the type of gelling agent and presence of nonsoluble components such as apple puree, which influencing the perception of “off-flavor,” “gumminess,” and “springiness” sensory attributes. Results of this research show that even with significant differences in sensory attributes it is possible to develop marmalade for glycemic control that will have no differences in the total liking score for the perception of both healthy people and patients with type 2 diabetes.

Background: The Supplemental Nutrition Assistance Program (SNAP) was designed to help low-income people purchase nutritious foods in the US. In recent years, there has been a consistent call for banning purchases of sugar drinks in SNAP. Aim: The aim of this study was to examine the association between SNAP participation and the frequency of sugar-sweetened soft drink (SSD) consumption among low-income adults in the US. Method: Data came from the 2009–2010 National Health and Nutrition Examination Survey. Low-income adults aged ≥20 years with a household income ≤250% of the Federal Poverty Level ( N = 1200) were categorized into two groups based on the household’s SNAP receipt: SNAP recipients ( n = 393) and non-recipients ( n = 807). Propensity-score matching was used to minimize observable differences between these two groups that may explain the difference in SSD consumption, generating the final sample of 393 matched pairs (SNAP recipients, n = 393; non-recipients, n = 393). An ordinal logistic regression was conducted on the matched sample. Results: SNAP recipients were more likely to report higher levels of SSD consumption, compared with non-recipients (adjusted odds ratio (AOR) = 1.55, 95% confidence interval (CI) = 1.17−2.07). Male gender (AOR = 1.69, 95% CI = 1.17−2.46), younger age (AOR = 0.97, 95% CI = 0.96−0.99), lower education level (AOR = 2.28, 95% CI = 1.33−3.89), and soda availability in homes (AOR = 2.24, 95% CI = 1.77−2.83) were also associated with higher levels of SSD consumption among low-income adults. Conclusions: SNAP participation was associated with frequent SSD consumption. To reduce SSD consumption, strategic efforts need to focus on educating people about the harms of SSD and promoting nutritious food choices with SNAP benefits.

This study tested whether parental knowledge of the American Academy of Pediatrics’ (AAP) recommendations on juice limits for children is associated with decreased consumption of juice and sugar-sweetened beverages (SSBs) among parents and children. Fifty-two parents with children 2 to 12 years old in a resident continuity clinic in East Harlem, New York, completed a survey asking about children’s and parent’s practice and quantitative consumption of juice and SSBs as well as parental knowledge of the AAP recommendations on juice limits. Parent’s total daily consumption of juice and SSBs ( P < .01), parent’s score on the test of AAP guidelines ( P = .04), and parent’s post–high school education ( P = .01) were associated with children’s juice and SSB consumption in a multivariable linear regression model. Children’s consumption of juice and SSBs is positively associated with parental consumption of juice and SSBs and negatively associated with parental formal education and knowledge of the AAP recommendations on juice limits.

Purpose:Frequent sugar-sweetened beverage (SSB) consumption is associated with chronic disease. Although physician counseling can positively affect patient behavior, physicians’ personal characteristics may influence counseling practices. We explored SSB-related topics physicians discuss when counseling overweight/obese patients and examined associations between physicians’ SSB-related counseling practices and their personal and medical practice characteristics.Design:Cross-sectional survey.Setting:DocStyles survey, 2014.Participants:A total of 1510 practicing US physicians.Measures:Physician’s SSB counseling on calories, added sugars, obesity/weight gain, health effects, consumption frequency, water substitution, and referral.Analysis:Adjusted odds ratios (aORs) were calculated with multivariable logistic regression, adjusting for physician’s personal and medical practice characteristics.Results:Most physicians (98.5%) reported SSB-related counseling. The most reported topic was obesity/weight gain (81.4%); the least reported were added sugars (53.1%) and referral (35.0%). Physicians in adult-focused specialties had lower odds than pediatricians of counseling on several topics (aOR range: 0.26-0.64). Outpatient physicians had higher odds than inpatient physicians of counseling on consumption frequency and water substitution (aOR range: 1.60-2.01). Physicians consuming SSBs ≥1 time/day (15.7%) had lower odds than nonconsumers of counseling on most topics (aOR range: 0.58-0.68).Conclusion:Most physicians reported SSB-related counseling; obesity/weight gain was discussed most frequently. Counseling opportunities remain in other topic areas. Opportunities also exist to strengthen SSB counseling practices in adult-focused specialties, inpatient settings, and among physicians who consume SSBs daily.

Purpose: To investigate the expression and function of serum response factor in podocyte epithelial–mesenchymal transition of diabetic nephropathy. Methods: The expression of serum response factor, epithelial markers and mesenchymal markers was examined in podocytes or renal cortex tissues following high glucose. Serum response factor was upregulated by its plasmids and downregulated by CCG-1423 to investigate how it influenced podocyte epithelial–mesenchymal transition in diabetic nephropathy. Streptozotocin was used to generate diabetes mellitus in rats. Results: In podocytes after high glucose treatment, serum response factor and mesenchymal markers increased, while epithelial markers declined. Similar changes were observed in vivo. Serum response factor overexpression in podocytes induced expression of Snail, an important transcription factor mediating epithelial–mesenchymal transition. Blockade of serum response factor reduced Snail induction, protected podocytes from epithelial–mesenchymal transition and ameliorated proteinuria. Conclusion: Together, increased serum response factor activity provokes podocytes’ epithelial–mesenchymal transition and dysfunction in diabetic nephropathy. Targeting serum response factor by small-molecule inhibitor may be an attractive therapeutic strategy for diabetic nephropathy.

The current work was undertaken to settle the debate about the toxicity of artificial sweeteners (AS), particularly aspartame and saccharin. Twenty-five, 7-week-old male Wistar albino rats with an average body weight of 101 ± 4.8 g were divided into a control group and four experimental groups (n = 5 rats). The first and second experimental groups received daily doses equivalent to the acceptable daily intake (ADI) of aspartame (250 mg/Kg BW) and four-fold ADI of aspartame (1000 mg/Kg BW). The third and fourth experimental groups received daily doses equivalent to ADI of saccharin (25 mg/Kg BW) and four-fold ADI of saccharin (100 mg/Kg BW). The experimental groups received the corresponding sweetener dissolved in water by oral route for 8 weeks. The activities of enzymes relevant to liver functions and antioxidants were measured in the blood plasma. Histological studies were used for the evaluation of the changes in the hepatic tissues. The gene expression levels of the key oncogene ( h-Ras) and the tumor suppressor gene ( P27) were also evaluated. In addition to a significant reduction in the body weight, the AS-treated groups displayed elevated enzymes activities, lowered antioxidants values, and histological changes reflecting the hepatotoxic effect of aspartame and saccharin. Moreover, the overexpression of the key oncogene ( h-Ras) and the downregulation of the tumor suppressor gene ( P27) in all treated rat groups may indicate a potential risk of liver carcinogenesis, particularly on long-term exposure.

Chronic consumption of high-fat-and-fructose diets (HFFD) is associated with the development of insulin resistance (InsRes) and obesity. Systemic insulin resistance resulting from long-term HFFD feeding has detrimental consequences on cognitive performance, neurogenesis, and long-term potentiation establishment, accompanied by neuronal alterations in the hippocampus. However, diet-induced hippocampal InsRes has not been reported. Therefore, we investigated whether short-term HFFD feeding produced hippocampal insulin signaling alterations associated with neuronal changes in the hippocampus. Rats were fed with a control diet or an HFFD consisting of 10% lard supplemented chow and 20% high-fructose syrup in the drinking water. Our results show that 7 days of HFFD feeding induce obesity and InsRes, associated with the following alterations in the hippocampus: (1) a decreased insulin signaling; (2) a decreased hippocampal weight; (3) a reduction in dendritic arborization in CA1 and microtubule-associated protein 2 (MAP-2) levels; (4) a decreased dendritic spine number in CA1 and synaptophysin content, along with an increase in tau phosphorylation; and finally, (5) an increase in reactive astrocyte associated with microglial changes. To our knowledge, this is the first report addressing hippocampal insulin signaling, as well as morphologic, structural, and functional modifications due to short-term HFFD feeding in the rat.

To measure the efficacy of the Glucose-Insulin Infusion--Parkland Protocol (GIPPr) compared to subcutaneous (SC) insulin, blood glucose readings were reviewed in diabetic adults admitted for surgical intervention of a soft tissue or bone infection in Dallas, Texas. Hypoglycaemia occurred in 0.69% of readings in GIPPr-treated patients compared to 4.52% in SC-treated patients. The GIPPr maintained a higher proportion of blood glucose readings between 3.89-10 mmol/L compared to SC insulin (85.40% versus 50.68%).

Sensory characteristics play a key role in determining consumers’ acceptance of functional foods. In this context, the aim of the present work was to apply a combination of sensory and consumer methodologies to the development of chocolate milk desserts enriched with resistant starch. Chocolate milk desserts containing modified waxy maize starch were formulated with six different concentrations of two types of resistant starch (which are part of insoluble dietary fiber). The desserts were evaluated by trained assessors using Quantitative Descriptive Analysis. Moreover, consumers scored their overall liking and willingness to purchase and answered an open-ended question. Resistant starch caused significant changes in the sensory characteristics of the desserts and a significant decrease in consumers’ overall liking and willingness to purchase. Consumer data was analyzed applying survival analysis on overall liking scores, considering the risk on consumers liking and willing to purchase the functional products less than their regular counterparts. The proposed methodologies proved to be useful to develop functional foods taking into account consumers’ perception, which could increase their success in the market.

In the past decades, numerous studies have looked at the anticaries effects of polyols, particularly xylitol, and a great many studies have focused on xylitol’s antimicrobial properties. Researched vehicles have mostly included chewing gums, followed by lozenges/candies, toothpastes, and others ( e.g., syrup). Good evidence supports the claims that xylitol is non-cariogenic and has a dose-/frequency-dependent antimicrobial effect on dental plaque/mutans streptococci, and that polyol use is very safe. However, interpretation of caries data has been controversial, due in part to variability in study designs, formulations/dosages tested, and outcomes reported ( e.g., many caries studies have a “no gum” control, limiting the interpretation of the polyol’s benefit; few studies have compared different polyols side-by-side, or in adults). Even when the level/strength of high-quality anticaries evidence is still limited, most recent systematic reviews have consistently concluded that the habitual use of sucrose-free xylitol or polyol-combination chewing gum/ lozenges is an effective adjunct in coronal caries prevention. Consequently, many health organizations worldwide are supporting this recommendation for at-risk populations. However, most experts agree that well-designed, placebo-controlled randomized clinical trials (RCTs) (focusing on efficacy, feasibility, adherence, dosage, vehicle, synergism with other preventive strategies, and cost) are still needed in target populations worldwide to reach definitive caries-preventive/therapeutic recommendations.

Objective Accumulation of visceral fat is one of the major risk factors for the development of cardiovascular disease in peritoneal dialysis (PD) patients. Adiponectin, an adipokine commonly regarded as a negative indicator of metabolic disease, is reported to be downregulated in its gene level in end-stage renal disease patients. Since excessive fat deposit is involved in increased reactive oxygen species (ROS), PD solution (PDS) may contribute to ROS production, resulting in dysregulation of adiponectin. In this study, we tested our hypothesis that oxidative stress induced by PDS may play a role in the regulation of adiponectin. Methods Commercial PDS containing 3.86% glucose (20 - 30 mL) was administered to SD rats for 12 weeks with and without N-acetylcysteine (NAC; 10 mmol/L). ELISA was used to quantify adiponectin in plasma and spent dialysate. For in vitro studies, fully differentiated 3T3-L1 adipocytes and adipocytes isolated from abdominal fat were treated with a high glucose solution, PDS, and H2O2. Adiponectin levels in the conditioned media were measured by ELISA and immunoblot assays. The mRNA levels of adiponectin in mature adipocytes were examined using real-time RT-PCR. Results The levels of adiponectin in plasma and spent dialysate were significantly downregulated by PDS and this effect was suppressed by NAC. In 3T3-L1 adipocytes, adiponectin secretion was inhibited by 50 mmol/L glucose, PDS diluted 2-fold, and H2O2 (200 μmol/L). In addition, H2O2 downregulated expression of adiponectin mRNA and secretion of adiponectin oligomer complexes. Conclusions Our data suggest that ROS induced by conventional glucose-based PDS may contribute to pathophysiological changes in abdominal fat and down regulate adiponectin secreted from adipocytes during long-term PD.

Objective: To describe racial and gender differences in insulin resistance—associated parameters due to sugar-sweetened beverage (SSB) intake and physical activity (PA) levels in the adolescent population. Methods: Data from individuals aged 12 to 19 years from the National Health and Nutrition Examination Survey during the years 1999-2004 were analyzed. SSB intake and PA levels were evaluated in Non-Hispanic whites, Non-Hispanic blacks, and Mexican Americans. Outcome measures included measurements of insulin sensitivity, lipids, blood pressure, waist circumference, and body mass index. Results: Multivariate linear regression analyses showed that anthropometric measurements, metabolic parameters, and indices of insulin resistance differed among the racial groups. Moreover, within each of these racial groups, they differed between the sexes. Conclusions: The differing relationships between insulin resistance—associated parameters and SSB intake and PA levels among racial groups and between the sexes illustrate the importance of race and gender in the investigation of diseases such as obesity and metabolic syndrome.

In this study, we separated for the first time the learned liking for a particular level of sweetness in a familiar drink from the infantile delight in sweetness as such (“the sweeter, the better”). It is widely assumed that sensing a liked food or drink evokes a pleasurable experience, but the only psychological evidence for this assumption has been tongue movements that are elicited specifically by sweet taste in animals and human neonates. We found that adults felt such movements in response to drinking juice at both their personally preferred level of sweetness and levels they deemed so sweet as to be undrinkable. Yet only the intolerably strong level of sweetness elicited enjoyment of the experienced movements, elevation of mood, and a sense of smiling. Hence, the pleasure that adults experience during ingestion could be exclusively linked with the congenital sweetness reflex that sends mother’s milk down an infant’s throat.

The worldwide consumption of sucrose, and thus fructose, has risen logarithmically since 1800. Many concerns about the health hazards of calorie-sweetened beverages, including soft drinks and fruit drinks and the fructose they provide, have been voiced over the past 10 years. These concerns are related to higher energy intake, risk of obesity, risk of diabetes, risk of cardiovascular disease, risk of gout in men, and risk of metabolic syndrome. Fructose appears to be responsible for most of the metabolic risks, including high production of lipids, increased thermogenesis, and higher blood pressure associated with sugar or high fructose corn syrup. Some claim that sugar is natural, but natural does not assure safety.

Plasminogen activator inhibitor 1 (PAI-1) is a known contributor of thrombus formation and cardiovascular diseases. Type 1 diabetes is associated with elevated levels of blood PAI-1 and cardiovascular disease (CVD) incidence. However, type 1 diabetic patients have elevated blood levels of ketone bodies acetoacetate (AA) and 3-β-hydroxybutyrate (BHB). This study examined the hypothesis that hyperketonemia (ketosis) contributes to increased secretion of PAI-1 from the cells that form the vascular endothelium. Human umbilical vein endothelial cells (HUVEC) were treated with different concentrations of AA or BHB in the presence or absence of high glucose (HG) and the amount of PAI-1 protein secreted by these cells into conditioned media was determined. Levels of PAI-1 secreted into conditioned media by these treated cells did not change significantly when compared to controls. High glucose induced a significant increase in PAI-1 secretion, but combination with AA or BHB did not cause significant effects on PAI-1 secretion caused by HG. These results indicate that hyperglycemia but not hyperketonemia is a significant contributor to increased blood levels of PAI-1 associated with type 1 diabetes.

Background:Whereas several literature reviews have discussed the role of excipients in drug-related reactions, no article has focused specifically on those found in oral dermatologic medications.Methods:The Compendium of Pharmaceuticals and Specialties (CPS) was used to reference the inert ingredients found in oral dermatologic medications. An extensive literature review was subsequently conducted using PubMed and MEDLINE to document adverse reactions to these excipients.Results:Sixty-three oral dermatologie medications were reviewed. Lactose was commonly used as a filler. Several medications indicated that they were dye, tartrazine, or gluten free. Three medications were found to contain soybean oil and one was found to contain peanut oil.Conclusions:Although there are documented reactions to excipients in other products in the literature, few reports outline reactions to excipients in oral dermatologie medications. Whether this low frequency is accurate or whether it is due to a lack of reporting remains unknown. If the latter reasoning is correct, dermatologists must be more aware of these possible reactions. This article serves as a reference guide for dermatologists to aid in prescribing medications to individuals with known sensitivities and to assist in working up patients with suspected reactions to inert ingredients.

When locomoting in a physically challenging environment, the body draws upon available energy reserves to accommodate increased metabolic demand. Ingested glucose supplements the body's energy resources, whereas non-caloric sweetener does not. Two experiments demonstrate that participants who had consumed a glucose-containing drink perceived the slant of a hill to be less steep than did participants who had consumed a drink containing non-caloric sweetener. The glucose manipulation influenced participants' explicit awareness of hill slant but, as predicted, it did not affect a visually guided action of orienting a tilting palmboard to be parallel to the hill. Measured individual differences in factors related to bioenergetic state, such as fatigue, sleep quality, fitness, mood, and stress, also affected perception: lower energetic states were associated with steeper perceptions of hill slant. This research shows that the perception of the spatial layout of the environment is influenced by the energetic resources available for locomotion within it. Our findings are consistent with the view that spatial perceptions are influenced by bioenergetic factors.

Background Azelastine nasal spray is a topical antihistamine with a distinctive taste that may be objectionable to some patients. The primary objectives of this clinical trial were (1) to determine if a reformulated azelastine nasal spray (Astepro) with sucralose as a taste-masking agent provides comparable efficacy to the original formulation (Astelin) and (2) to evaluate dose–response relationships between groups. Methods Eight hundred thirty-five patients with seasonal allergic rhinitis were randomized to six treatment groups: (1) original azelastine nasal spray, 1 spray/nostril b.i.d.; (2) reformulated azelastine, 1 spray/nostril b.i.d.; (3) placebo, 1 spray/nostril b.i.d.; (4) original azelastine nasal spray, 2 sprays/nostril b.i.d., (5) reformulated, 2 sprays/nostril b.i.d.; and (6) placebo, 2 sprays/nostril b.i.d. The primary efficacy variable was the change from baseline to day 14 in total nasal symptom score (TNSS) consisting of runny nose, sneezing, itchy nose, and nasal congestion. Results Original azelastine nasal spray and the reformulated spray produced comparable improvements in the TNSS at both dosages. There was a dose-related difference in TNSS comparing the 1- and 2-spray dosages. The percentage changes from baseline in the TNSS in the 2-sprays/nostril dosage groups were 27.9% (p < 0.001) with the reformulated nasal spray, 23.5% (p < 0.01) with the original formulation, and 15.4% with placebo. The incidence of bitter taste was 7% with the reformulated spray and 8% with the original at the 2-sprays/nostril dosage. Conclusion The results of this study showed efficacy both with original azelastine nasal spray and with the reformulated nasal spray and a clear dose–response difference between the 1- and 2-spray dosages.

The purpose of this blinded, crossover study of the ketogenic diet in children with the Lennox-Gastaut syndrome was to confirm, by the addition of 60 g of glucose per day to negate the ketosis, that the effectiveness of the ketogenic diet was neither the result of a placebo effect nor due to parental expectations and commitment. We found that the additional glucose did not significantly alter the frequency of electroencephalography-assessed events, but did decrease the frequency of parent-reported ``drop'' seizures (P = .07). Fasting had substantial effects on both seizures and electroencephalography-assessed events. The diet remained effective in decreasing seizures of the Lennox-Gastaut syndrome at 12 days, 6 months, and 12 months. In conclusion, the ketogenic diet is effective in decreasing the drop seizures of the Lennox-Gastaut syndrome.

Since their discovery, the safety of artificial sweeteners has been controversial. Artificial sweeteners provide the sweetness of sugar without the calories. As public health attention has turned to reversing the obesity epidemic in the United States, more individuals of all ages are choosing to use these products. These choices may be beneficial for those who cannot tolerate sugar in their diets (e.g., diabetics). However, scientists disagree about the relationships between sweeteners and lymphomas, leukemias, cancers of the bladder and brain, chronic fatigue syndrome, Parkinson's disease, Alzheimer's disease, multiple sclerosis, autism, and systemic lupus. Recently these substances have received increased attention due to their effects on glucose regulation. Occupational health nurses need accurate and timely information to counsel individuals regarding the use of these substances. This article provides an overview of types of artificial sweeteners, sweetener history, chemical structure, biological fate, physiological effects, published animal and human studies, and current standards and regulations.

Although the role of nitric oxide (NO) in peripheral glucose uptake has been thoroughly described, little is known regarding the alterations in NO metabolism during the early onset of insulin resistance. During this study we investigated the alterations in NO synthesis and bioavailability in a model for dietary modulations of insulin sensitivity. For 6 weeks, rats were fed a standard diet (C), a high-sucrose diet inducing insulin resistance (HS), or high-sucrose diets supplemented with cysteine, which endowed protection against the high-sucrose–induced insulin resistance (Ti). Several markers of NO synthesis and bioavailability were assessed and confronted with markers of insulin sensitivity. After 5 weeks, although urinary cGMP excretion did not differ between the groups, insulin resistance in HS rats was associated with both a significant increase in NO oxidation, as determined by plasma nitrotyrosine concentrations, and in the inducible NO synthase (iNOS)/endothelial NO synthase (iNOS/eNOS) mRNA ratio in skeletal muscle compared with C rats. These alterations were prevented in rats fed the cysteine-rich diets. NO production, as assessed by urinary 15 NO3− excretion following a [15N2-(guanido)]-arginine intra-venous bolus, independently and significantly correlated with insulin sensitivity but did not significantly differ between C, HS, and Ti rats; neither did the aortic eNOS protein expression or skeletal muscle insulin-induced eNOS activation. Our results indicate that in this model of dietary modulations of insulin sensitivity (i) NO production accounts for part of total inter-individual variation in insulin sensitivity, but (ii) early diet-related changes in insulin sensitivity are accompanied by changes in NO bioavailability.

Regurgitated acid entering the mouth in gastro-esophageal reflux disease can cause dental erosion. Chewing gum could induce increased swallowing frequency, thus improving the clearance rate of reflux within the esophagus. The null hypothesis of this study was that chewing gum does not have any effect on the clearance of reflux from the distal esophagus. Thirty-one subjects presenting with symptoms of reflux were given a refluxogenic meal twice and were randomly selected to chew gum for half an hour after eating the meal. Esophageal pH was measured, and pH data were analyzed and compared during the postprandial periods for 2 hrs on the 2 occasions. The median (IQ range) values for the % time pH < 4 during the postprandial period without chewing gum were 5.7 (1.7–13.5) and, with chewing gum, 3.6 (0.3–7.3), respectively (p = 0.001). Chewing sugar-free gum for half an hour after a meal can reduce acidic postprandial esophageal reflux.

Demountable calcium fluoride micro cells have been developed for use in synchrotron radiation circular dichroism (SRCD) spectroscopy. They have the advantages that they require only very small sample volumes (as low as 1 microliter) and have short path lengths (as small as 2 micrometers). Highly reproducible spectra can be obtained in consecutive loadings with these spacer-free, fixed path length cells, which enable low wavelength data collection.

When taste stimuli are presented with specific odor stimuli, the perceived intensity of taste is enhanced, a phenomenon called odor-induced taste enhancement. There is a possibility, however, that the odor substances might have stimulated the taste receptors in the oral cavity as well as odor receptors in the nasal cavity because the odor substances were dissolved in the taste solutions in some preceding studies. Schifferstein and Verlegh (1996) found that the odor-induced taste enhancement effect was not found when the subjects wore a nose clip to prevent the olfactory perception. Thus, it was suggested that the odor-induced taste enhancement did not result from the stimulation of receptors in the oral cavity. To confirm and extend their study, we presented the odor stimuli simultaneously with, but not dissolved in, the taste stimuli with a more advanced approach to stimulus presentation. The participants reported enhancement of sweetness ratings for aspartame when the taste stimuli were presented with a vanilla odor. This odor-induced taste enhancement was found when the gaseous odor stimuli were presented either by the retronasal route or by the orthonasal route. There was little possibility that the vanilla odor stimulated the taste receptors during the orthonasal stimulation because the odor stimuli were presented directly into the nasal cavity. Thus, we could show that the odor-induced taste enhancement is elicited by olfactory perception. These results also suggested that there is little functional difference between retronasal and orthonasal olfaction.

Objective The carbonyl group of glucose reacts nonenzymatically with the amino group of protein to form advanced glycosylation end-products (AGEs). AGEs are found in the peritoneum of continuous ambulatory peritoneal dialysis patients, and this AGE formation is suspected to be one of the causes of impaired peritoneal function. In order to control AGE formation in the peritoneum, AGE formation and ultrafiltration in rats were examined with peritoneal dialysates using as osmotic agents saccharides that lack a carbonyl group, the saccharic acid lactobionate [molecular weight (MW) 358.30], the sugar alcohol maltitol (MW 344.32), and the nonreducing sugar nistose (MW 666.58). Design Bovine serum albumin (BSA) (25 mg/mL) was incubated with 18, 36, and 72 mg/mL maltitol, lactobionate, nistose, and glucose at 37°C. After 3 or 6 weeks, amounts of furosine and N-(carboxymethyl) lysine were measured. A 20-mL intraperitoneal injection of a lactate-based dialysate (osmotic pressure 388 mOsm/kg) containing 4.34% maltitol, 4.52% lactobionate, or 8.4% nistose was given to Sprague–Dawley rats and, after 2, 4, or 6 hours, the quantity of effluent and levels of urea nitrogen and creatinine in the effluent and in serum were measured. Results No increases in furosine or N-(carboxymethyl) lysine were seen with maltitol, lactobionate, or nistose after 3 and 6 weeks of incubation with BSA; AGE formation was not observed. In the study in rats, the quantity of abdominal fluid after a 6-hour dwell was nistose > lactobionate > maltitol > glucose. No differences in dialysate-to-plasma ratios for urea nitrogen or creatinine were seen in any group. Conclusions AGE formation in peritoneal tissue might be controlled by using saccharides with a modified carbonyl group as osmotic agents for peritoneal dialysates. Nistose is considered to yield the most efficient dialysis.

Theresults ofthe Turku studies were soonrecognized, firstin the then-SovietUnion, wherexylitol hadbeenroutinely usedin the diets ofdiabetic subjects. Atwo-year study conducted inthe state ofKazakhstan demonstrated a >70%reduction in theoverall caries incidence in the xylitol group compared with thesucrose group. The next trials were those conducted under theauspices ofthe WorldHealth Organization. TwoWHOstudieswere successfully completed: one in French Polynesia (1981-84), andanotherin Hungary, intheearly 1980s. Theformertrialinvolved a 32-month

The health consequences of obesity are well known. Obesity is the leading predisposing factor to the development of type 2 diabetes. A study released by Nevious and colleagues from Sweden on February 24, 2009, in the British Medical Journal has highlighted the danger of being obese.1 These investigators reported that obesity increases the risk of premature death at the same rate as cigarette smoking. Among 45,000 men whose health was monitored for 38 years, being overweight at the age of 18 was found to be equivalent to being a regular smoker in terms of the risk of dying relatively early in life from preventable diseases.

The world market for chewing gum is estimated to be 560,000 tons per year, representing approximately US $5 billion. Some 374 billion pieces of chewing gum are sold worldwide every year, representing 187 billion hours of gum-chewing if each piece of gum is chewed for 30 minutes. Chewing gum can thus be expected to have an influence on oral health. The labeling of sugar-substituted chewing gum as "safe for teeth" or "tooth-friendly" has been proven beneficial to the informed consumer. Such claims are allowed for products having been shown in vivo not to depress plaque pH below 5.7, neither during nor for 30 minutes after the consumption. However, various chewing gum manufacturers have recently begun to make distinct health promotion claims, suggesting, e.g., reparative action or substitution for mechanical hygiene. The aim of this critical review-covering the effects of the physical properties of chewing gum and those of different ingredients both of conventional and of functional chewing gum-is to provide a set of guidelines for the interpretation of such claims and to assist oral health care professionals in counseling patients.

Studies on the relationship between gum-chewing and calculus formation have produced contradictory results, and it is not clear whether frequent use of chewing gum promotes or inhibits calculus formation. Also, little is known about whether the addition of a small amount of urea to the chewing gum influences calculus formation. The aim of this investigation was to study the effect of sugar-free chewing gum-with and without urea-on calculus formation and some associated clinical variables. Three three-month periods were studied in a double-blind, crossover design, during which the subjects: (1) chewed 5 pieces/day of a sugar-free, urea-containing chewing gum (20 mg urea/piece); (2) chewed 5 pieces/day of a sugar-free, non-urea-containing gum; or (3) performed no gum-chewing. Twenty-nine persons, all calculus-formers, participated. They were scored for calculus at mesio-lingual, lingual, and disto-lingual sites on the 6 anterior mandibular teeth according to the Volpe-Manhold index. Plaque and gingival bleeding index, stimulated salivary secretion rate and buffer capacity, resting plaque pH, mutans streptococci in saliva and plaque, and lactobacilli in saliva were also determined. No differences in calculus formation were found among the 3 periods. The resting plaque pH was higher after the period with urea-containing gum than after the period with non-urea-containing gum and the no-gum period (p < 0.05). A slight increase in stimulated salivary secretion rate was found after the 2 gum periods (p < 0.05). The plaque and gingival bleeding indices decreased, while resting plaque pH and salivary buffer capacity increased throughout the entire study (p < 0.05). No significant differences in prevalence of the acidogenic micro-organisms were found among the test periods. The main conclusion from this study is that three months' frequent use of sugar-free chewing gum-with or without urea-neither promotes nor inhibits calculus formation.

The aim of this study was to test the hypothesis that the chewing of xylitol- or xylitol/sorbitol-containing chewing gum reduces plaque formation and the acidogenic potential of dental plaque. Thirty healthy volunteers aged from 19 to 28 yrs were randomly allocated to one of three test groups, chewing either xylitol-, xylitol/sorbitol-, or sucrose-sweetened gums. A three-day plaque accumulation period of no oral hygiene was instituted prior to and at the termination of the chewing gum program, which lasted 33 days. Plaque quantity was assessed on the basis of protein content of individual plaque samples collected by a standardized technique. Acidogenic potential of individual baseline and test plaque samples was assessed by the quantity of various organic acids formed from D-(U-14C)glucose. Identification of extracellular and intracellular metabolites was performed by HPLC. Statistical evaluation of data was performed according to paired comparisons of individual baseline and post-chewing data. Plaque formation, acidogenic potential, and glycolytic profiles were similar at baseline and after the gum-chewing periods. Also, there was no intracellular accumulation of glycolytic metabolites within the plaque bacteria to indicate the inhibition of glycolysis. The study thus leads to the conclusion that, in young adults with low caries experience, exposure of the oral cavity to acceptable doses of xylitol or xylitol and sorbitol has no effect on the microbial deposits on the teeth.

Evidence that physiological strategies may be potential routes for oral biofilm control has come from (i) observations of the variations in the intra-oral distribution of members of the resident oral microflora, (ii) changes in plaque composition in health and disease, and (iii) data from laboratory model systems. Key physiological factors that were identified as significant in modulating the microflora included the local pH, redox potential (Eh), and nutrient availability. Increases in mutans streptococci and lactobacilli occur at sites with caries; growth of these species is selectively enhanced at low pH. In contrast, periodontal diseases are associated with plaque accumulation, followed by an inflammatory host response. The increases in Gram-negative, proteolytic, and obligately anaerobic bacteria reflect a low redox potential and a change in nutrient status due to the increased flow of gingival crevicular fluid (GCF). Consequently, physiological strategies for oral biofilm control should focus on reducing the frequency of low pH in plaque by (i) inhibiting acid production, (ii) using sugar substitutes, and (iii) promoting alkali generation from arginine or urea supplements. Similarly, strategies to make the pocket environment less favorable to periodontopathogens include (i) anti-inflammatory agents to reduce the flow of (and hence nutrient supply by) GCF, (ii) bacterial protease inhibitors, and (iii) redox agents to raise the Ehh locally. Most laboratory and clinical findings support the concept of physiological control. However, some data suggest that the ordered structure and metabolically interactive organization of mature dental plaque could generate a community with a high level of homeostasis that is relatively resistant to deliberate external manipulation.

Multivitamins and mineral preparations are widely used for infants and children. All of these preparations contain a variety of excipients (“inert ingredients”). Excipients are generally safe; however, adverse effects have been attributed to them. Complete information about the excipients in various preparations is not readily available. The information about sweeteners, dyes, and other excipients (flavorings, preservatives, stabilizers, and fillers) for 41 chewable/liquid multivitamin and mineral preparations was obtained and tabulated. Sucrose was present in 63% (26/41) of preparations followed by lactose in 29% (12/41) of preparations. On average, a preparation contained two sweeteners. The FD&C yellow #6 (sunset yellow) was the most common dye, present in 46% (19/41) of the preparations followed by FD&C Red #40 in 29% (12/41). For 34% (14/41) of the preparations, no color or dye was identified by the manufacturers. The tables listing excipients and their adverse effects are presented and should be helpful to health care providers in selecting preparations containing individual excipients when an adverse reaction occurs or there exists a contraindication for using the excipient. The mandatory listing of all excipients is the only way to assure that physicians and consumers will be fully informed about the hidden ingredients.

Variation in salivary access to different intra-oral sites is an important factor in the site-dependence of dental caries. This study explored, theoretically, how access is modified by chewing sugar-free and sugar-containing gums. A finite difference computer model, described elsewhere, was used. This allowed for diffusion and/or reaction of substrate, acid product, salivary buffers, and fixed-acid groups. Site-dependent saliva/plaque exchange was modeled in terms of a 100-μm-thick salivary film covering the plaque (a) flowing directly from the salivary ducts, (b) flowing from the intra-oral salivary pool, or (c) exchanging with the pool. Computed flow-velocities or rates of exchange were based on previous intra-oral measurements. The model was also tested against an in vitro study conducted by two of the authors. In addition, the three proposed models of saliva/plaque interaction were compared, and the effect of salivary film thickness investigate. Results suggested that: (1) although sugar-free gum chewed during a cariogenic challenge causes a rapid rise in plaque pH, sucrose-containing gums cause the pH, after a temporary rise resulting from increased salivary flow, to stay low for an extended period; (2) the computer model reproduced in vitro tests reasonably well; (3) although the three models of the plaque/saliva interaction start from different assumptions, two lead to closely related predictions; and (4) increasing the assumed salivary film thickness by a large amount ( e.g., from 50 to 200 μm) caused no change in modeled Stephan curves, as long as these changes were accompanied by appropriate reductions in film velocity, in accord, theoretically, with the practical clearance data.

The Sugar Association, representing the U.S. sugar industry, is highly critical of a WHO report on guidelines for healthy eating, which suggests that sugar should account for no more than 10 percent of a healthy diet. The association has demanded that Congress end its funding of the World Health Organization unless the WHO withdraws the guidelines, and the association and six other big food industry groups have also asked the U.S. Secretary of Health and Human Services to use his influence to get the WHO report withdrawn. The WHO strongly rejects the sugar lobby's criticisms.

The aim of the study was to investigate the efficacy of the use of xylitol-containing tooth-wipes in preventing dental caries in young children. In a double-blinded randomized controlled clinical trial, 44 mothers with active caries and their 6- to 35-month-old children were randomized to xylitol-wipe or placebo-wipe groups. The children’s caries scores were recorded at baseline and 1 year. Salivary levels of mutans streptococci and lactobacilli were enumerated at baseline, 3, 6, and 12 months. Data were analyzed by intent-to-treat modeling with imputation for caries lesions and a linear mixed-effect model for bacterial levels. Significantly fewer children in the xylitol-wipe group had new caries lesions at 1 year compared with those in the placebo-wipe group (P < 0.05). No significant differences between the two groups were observed in levels of mutans streptococci and lactobacilli at all time-points. Daily xylitol-wipe application significantly reduced the caries incidence in young children as compared with wipes without xylitol, suggesting that the use of xylitol wipes may be a useful adjunct for caries control in infants ( Clinicaltrials.gov registration number CT01468727).

For many decades, sugars have been the dietary constituents receiving the most attention in relation to their effects on dental caries. Frequently, however, there is little relationship between the amount of sugar in a food and its ability to induce caries. Therefore, it is clear that constituents in the diet can influence the ability of plaque to lower the pH of sugar solutions. For instance, replacing sugar in foods with xylitol, sorbitol, saccharin, oraspartamemay lead to areduction in the incidence of dental caries. All these sugar substitutes are non-cariogenic, and some may possess cariostatic properties. The presence of arginine-rich proteins in the diet may provide a ready source of this amino acid, which is the substrate for the arginine deiminase pathway which can result in a rapid elevation of plaque pH values. Proline can act as an acceptor for protons from lactate in the Stickland reaction. This is a major but much-neglected metabolic pathway in dental plaque. The presence of fat in experimental diets has been shown to affect their cariogenicity. The effects have been ascribed to enhanced clearance of sugars from the mouth. It is also conceivable that several fatty acids express a potent antibacterial effect. The presence of calcium and phosphorus has been shown to influence the cariogenicity of foods; the effect, however, is restricted to the food containing the minerals. Evidence suggests that pyridoxine (vitamin B6) may exert a cariostatic effect by enhancing decarboxylation activity in dental plaque. It is clear that sugar alone is not the sole determinant of whether food is cariogenic. Furthermore, myriad substances may hinder or enhance the caries-promoting properties of sugars in the diet.

The objective of these studies was to simulate the effect of chewing sugar-free and sucrose-containing chewing gums on the return of the pH to neutrality after exposure to sucrose of plaque located on the buccal (BLM) and lingual (LLM) surfaces of the lower molar teeth. In study 1, a 0.5-mm-deep artificial plaque containing Streptococcus oralis cells was exposed to 10% sucrose for one min, and a 0.1-mm-thick film of sucrose-free artificial saliva was then flowed over the plaque surface at the unstimulated salivary film velocities previously found at the BLM and LLM sites. At the time of the pH minimum (pH 4-5), one of three conditions was simulated: (a) a no-gum-chewing control, or chewing for 20 min on either (b) a sugar-free gum or (c) a sucrose-containing gum. The recovery of the plaque pH to resting values was rapid during simulation of chewing a sugar-free gum (SFG), much slower with the no-gum control, and even slower with simulation of chewing a sucrose-containing gum (SCG). The pH recovery was slower with the BLM than the LLM plaque. In study 2, the BLM plaque was exposed to a 2% sucrose solution for 20 min under stimulated salivary conditions, to simulate the consumption of a meal, followed by one of conditions (a), (b), or (c) described above. The pH recovery with simulation of chewing a SCG was faster than with the no-gum control, but much slower than with the SFG simulation. In study 3, when both BLM and LLM plaques were exposed for 20 min to the sucrose levels in chewing-gum-stimulated saliva and then unstimulated conditions were simulated, the pH fall and recovery were similar to those found by others in vivo. From the results of these studies, it would be expected that when the plaque pH has fallen, after exposure to fermentable carbohydrate, it would return to neutrality more readily with the use of sugar-free rather than sucrose-containing gums.

Six normal subjects each ingested a single 12 - oz can of a diet cola (Diet Coke) providing 184 mg aspartame (APM), of which 104 mg is phenylalanine (Phe), and, on another occasion, a single 12 - oz can of regular cola (Coke Classic). Neither cola significantly affected plasma concentrations of Phe or tyrosine over the three-hour postingestion study period. Each of five homozygous phenylketonuric (PKU) subjects (ages 11, 16, 17, 21, and 23 years) ingested a single 12 - oz can of the same diet cola. In these five subjects (three with classic PKU and two with hyperphenylalinemia), the increase in plasma Phe concentrations varied from 0.26 mg/dL to 1.77 mg/dL two or three hours after ingestion (baseline levels, 5.04 to 17.2 mg/dL) . Tyrosine concentrations did not differ significantly from baseline levels. The data indicate that ingestion of dietary Phe, as supplied in a single can of diet cola, is readily handled in both normal and PKU subjects. The small increases in plasma Phe concentrations in the homozygous PKU patients are not considered clinically significant.