Introduction
The peer-reviewed article ‘Effect of consuming different caloric sweeteners on bone health and possible mechanisms’ by Embedzayi Tsanzi, Cindy W Fitch, and Janet C Tou, 2008, published in Nutrition Reviews Vol. 66, no. 6, pp.301–309, were retrieved from the PubMed database after using the search term “effect of caloric sweeteners on bone health”.
Purpose and Relevance
The research problem that this article studies focuses on is the issue of the high consumption of sugar in its various forms and the implications that this high level of sugar consumption has on the health of the bone of an individual. Sucrose was the traditionally used sweetener, but in recent times high-fructose corn syrup has started taking over this role from sucrose and hence the assessment of the impact of sucrose, glucose, and fructose on the health of the bone of an individual. High consumption of soft drinks in which caloric sweeteners are added is a reality. The purpose of the study is to reveal the implications on bone health that consumption of soft drinks has and compare the deleterious effects of sucrose, glucose, and fructose on the health of the bone of an individual
The Joint World Health Organization/Food and Agriculture Organization of the United Nations Expert Consultation report, ‘Diet, Nutrition and the Prevention of Chronic Diseases, 2003 in its recommendations of added sugars (caloric sweeteners) intake has kept the level of this intake to less than ten percent of the total energy in the diet since sugars by themselves provide high levels of energy without any other specific nutrient value.
Furthermore, recommendation on added sugars DHHS and USDA in the United States of America require their minimal use. Yet, many of the foods and beverages consumed by children and adults contain high levels of sugars the United States of America. For instance, flavored yogurts contain between 23-27 grams of caloric sweeteners, making up for 46 to 48 percent of calories and flavored milk contains about 15 to16 grams of caloric sweeteners, making up about 35-40 percent of calories (Stalling & Yaktine, 2007).
These figures show that excess consumption of caloric sweeteners is gaining endemic proportions in the United States of America and a matter of public health, requiring greater awareness on the negative impact on health that such excess consumption of caloric sweeteners can have.
This study offers to consolidate all that is currently known on the effect that consumption of soft drinks and the various caloric sweeteners of sucrose, glucose, and fructose has on bone health and through that offers health science and total and comparative picture of caloric sweeteners and the implications of the excessive consumption of any. Through the comparison, it also offers an understanding of whether any of the caloric sweeteners have a milder impact on bone health, which paves the way for its use in preference of the others, particularly for those individuals, who are prone to osteoporosis. In other words, this study contributes to providing evidence-based practice in the recommendations for diet for all individuals and particularly those individuals prone to osteoporosis. In addition, it provides evidence for health professionals to be pro-active against practices of the food industry in the use of large quantities and unsatisfactory caloric sweeteners in their products, which are detrimental to the health of the general public and also products of the food industry that pose a risk for chronic health problems in the later stages of life. This is particularly relevant as the percentage of elderly in the population of countries is increasing, with the increased life spans that individuals currently enjoy.
Sampling and Methodology
This study has used a qualitative research design for the study. The qualitative research design used is the literature review. A literature review is well suited to explore a particular topic to know what constitutes the current body of knowledge on the topic. In other words, it throws up what is currently known on the topic and what is not known on the topic. It thereby has the additional advantage of showing the direction to new pathways of research to increase the body of knowledge on the topic. However, by itself, it does not throw new light on the topic or does not increase the existing body of knowledge.
Since the study is based on a literature review, the study has fallen back on the available research articles available. Unfortunately, it does not by itself show the inclusion and exclusion criteria for the research articles used in the study. However, from Table -1 the Effect of soft drinks on bone parameters, it is possible to discern some aspects of the articles used in the literature review.
The study has based its findings on the effects of soft drink consumption on bone health in seven research articles. This small number raises the doubt whether the study incorporates all that is known about the health implications of consumption of caloric sweeteners in excess. The study would probably be more valid on this count were at least twelve research articles reviewed.
This aspect is amplified, when we take into consideration the date of publications of the research articles. Only two of the articles have been published in the last five years and among the remaining five, two go as far back as more than ten years or more. Thus four articles fall in the bracket of being published between five and ten years earlier. The current value of the literature garnered becomes in doubt, reducing the validity of the current body of knowledge that this article provides. The study would have had greater reliability had more current research studies been included in the literature review.
In a similar vein, this research article uses only six research articles to compare the effects of sucrose, glucose, and fructose on bone health and all these articles have been published eight years previously or more. Again for the effect of different caloric sweeteners on mineral homeostasis, only seven research articles have been used that were published more than eight years or earlier and one even as far back as thirty-eight years earlier.
There is the possibility of there being a paucity of the number of current research articles for the authors to review, but nowhere in the body of the article has this been mentioned and pointed out as a limitation. Such a limitation from the authors would have the benefit of making it aware that there is a paucity of research currently on the topic and more research is required to update the body of knowledge on the topic, negating one of the merits of a literature review.
One of the essential features of valid and reliable research is that it should be replicable to produce the same results. The problem here is that the authors have not provided how they managed to retrieve these articles. In this aspect, we are talking about whether these research articles used in the literature review were secured as hard copies from some library or whether they were sourced from databases with the assistance of the Internet. In case the research articles were sourced from the Internet, then specifying the databases and the search terms used would assist anyone trying to replicate this research study to provide similar results and thereby increasing both the reliability and the validity (Hart, 1998).
Data Analysis
The data presentation and analysis in the research article come in two parts, as table format presentations of the data and critical evaluations of the data. Table -1 Effect of soft drinks on bone parameters provides a picture of the deleterious effects on bone health through the consumption of sweetened soft drinks. The authors have in a table format provided the essentials of the research articles used and the findings of these research articles used.
This table format has been well designed making it easy for a reader to understand details on the authors and year of publication, the sample population used in the studies, the type of study undertaken, and the impact on bone health that the consumption of sweetened soft drinks has. Table formats in the presenting of data for data analysis is a simple and effective means for both quantitative and qualitative data (Hart, 1998).
The authors have used the table format effectively to provide an easy understanding of the data and make an analysis of it easy. However, the authors mention that Table -1 Effect of soft drinks on bone parameters displays evidence from animal and human studies, but there are no animal studies included.
Table – 2 projects the effect of different caloric sweeteners on bone parameters, bone cells, and bone markers. The table format provides the details of the author and date of the research, type of caloric sweetener, sampling, and findings, making it easy to understand the impact that different caloric sweeteners have on bone parameters.
Table -3 gives the effect of different caloric sweeteners on mineral homeostasis. The table format provides the details of the author and date of the research, type of caloric sweetener, sampling, and findings, making it easy to understand the impact that different caloric sweeteners have on mineral homeostasis.
The second part is the critical evaluation of the findings of the research articles used for the literature review, broken up into five parts of soft drink consumption and bone health, types of caloric sweeteners, sucrose intake and bone health, glucose intake, and bone health, and fructose and bone health. The critical evaluation of the data from the research articles is the added strength of this literature review for it has clarity and reinforces the understanding that is received from the tables in the article.
Results of the Study
Caloric sweeteners and non-caloric sweeteners are used in soft drinks. Intake of soft drinks hurts bone health particularly in the case of girls and women. This makes it necessary to ascertain the impact of each of the different sweeteners used in soft drinks on bone health. The caloric sweeteners of importance to human consumption are sucrose, glucose, and fructose. Comparison of the absorption rates of fructose and glucose show that the absorption of fructose is slower than glucose and in the presence of glucose this absorption rate is speeded up. The differences in the absorption rates of glucose and fructose may have an influence on mineral absorption and through that an influence on bone health.
Results from animal studies suggest that sucrose consumption could weaken bones and that there is a gender bias in this impact. However, the findings of studies on human subjects are not reliable, because of the confounding factor of varying fat levels and the lack of measurement of mineral homeostasis.
Findings from studies into the influence of glucose consumption and bone health also do not provide clear-cut evidence. Some studies have suggested increased calcium absorption in the presence of glucose, while others indicate increased renal clearance of calcium with glucose consumption. There is no evidence to clarify whether the excess renal clearance is due to the increased absorption of calcium. There are indications that the absorption of calcium in the presence of glucose is influenced by the amount of calcium available for absorption. This picture of the current knowledge on the influence of glucose on calcium absorption suggests that gaps exist and more studies are required to clarify the situation of the influence of glucose on the absorption and excretion of calcium. There is increasing use of fructose as a caloric sweetener.
Similarly, evidence on the basis of studies on the influence of fructose on mineral absorption and excretion provides an unclear picture of the influence of fructose on mineral balance in the human body. Some studies suggest that fructose has a positive influence on the balance of minerals of calcium, magnesium, and phosphorus in the human body, while others indicate otherwise. The methodologies used may be the cause of conflicting evidence. However, one clear observation that can be made is there is not enough clarity on the influence of fructose on the mineral balance in the human body and through that its impact on bone health. Based on these findings it can be concluded that more studies with the appropriate methodologies are required for a clear picture of the influence of sucrose, glucose, and fructose absorption.
My Evaluation
Barring the limitations of fewer studies that are not current, this literature review has been done well with adequate critical analysis to arrive at the result of insufficient clear-cut evidence of the influence of sucrose, glucose, and fructose consumption on bone health. I agree with the results and the conclusion of the authors. My agreement with their findings and conclusion is based on the well-laid-out critical analysis of the evidence available on the influence of sucrose, glucose, and fructose on the absorption of minerals, which have a direct impact on bone health.
The importance of this article is that it makes it clarifies the extent of the body of knowledge on the topic of the influence of caloric sweeteners on bone health and points to the gap that is present in this body of knowledge.
The point that I find most interesting is that though this issue is of importance to public health with the increasing use of caloric sweeteners, scant attention has been paid to it in the form of the adequate undertaking of research to fill the gaps in the body of knowledge. Was I undertaking such a study, the only changes that I would incorporate would be an increase in the number of research articles in the literature review and giving importance to the current status of the research articles by excluding all articles published ten years and earlier.
Literary References
Hart, C. (1998). Doing a literature review: releasing the social science research imagination. Thousand Oaks, California: SAGE Publications.
Stallings, V. A. & Yaktine, A. L. (2007). Nutrition standards for foods in schools. Washington, D.C.: National Academies Press.
Tsanzi, E., Fitch, C. W. & Tou, J. C. (2008). Effect of consuming different caloric sweeteners on bone health and possible mechanisms. Nutrition Reviews, 66(6), 301-309.