for senior writer

The discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.

For this assignment, make sure you post your initial response to the Discussion Area by Saturday, November 16, 2013.

To support your work, use your course and text readings and also use outside sources. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Increased Body Weight

In recent years, high fructose corn syrup (HFCS) has been blamed for the increased prevalence of overweight and obesity in the U.S. (Bray, Nielsen, & Popkin, 2004). It is present in many foods, including those we would expect to find it in, such as candy, to those unexpected, including salad dressing.

You have been assigned a side for this discussion (please see this week’s announcement for your assigned side). The “pro” side will make a case that HFCS has contributed to the increased body weight of Americans as a whole. Consider why Americans may or may not choose foods with HFCS, including cost, effect on nutritional status, and what other nutrients may be provided in foods that typically contain HFCS.

You must back up your argument with reputable references, which includes scientific journal articles that can be accessed through the South University Online library. Remember that we are discussing this topic in order to learn from one another’s research and that the side that someone may be defending may not be what they truly believe; please be kind and considerate in your posts.

 

http://www.nutritionj.com/content/11/1/55

Lowndes et al. Nutrition Journal 2012, 11:55
http://www.nutritionj.com/content/11/1/55

RESEARCH Open Access

The effects of four hypocaloric diets containing
different levels of sucrose or high fructose corn
syrup on weight loss and related parameters
Joshua Lowndes1, Diana Kawiecki1, Sabrina Pardo1, Von Nguyen1, Kathleen J Melanson2, Zhiping Yu1

and James M Rippe1*

Abstract

Background: The replacement of sucrose with HFCS in food products has been suggested as playing a role in the
development of obesity as a public health issue. The objective of this study was to examine the effects of four
equally hypocaloric diets containing different levels of sucrose or high fructose corn syrup (HFCS).

Methods: This was a randomized, prospective, double blind trial, with overweight/obese participants measured for
body composition and blood chemistry before and after the completion of 12 weeks following a hypocaloric diet.
The average caloric deficit achieved on the hypocaloric diets was 309 kcal.

Results: Reductions were observed in all measures of adiposity including body mass, BMI,% body fat, waist
circumference and fat mass for all four hypocaloric groups, as well as reductions in the exercise only group for
body mass, BMI and waist circumference.

Conclusions: Similar decreases in weight and indices of adiposity are observed when overweight or obese
individuals are fed hypocaloric diets containing levels of sucrose or high fructose corn syrup typically consumed by
adults in the United States.

Keywords: High fructose corn syrup, Hypocaloric diet, Weight loss, Dietary counseling

Introduction
During the past 30 years, the consumption of added
sugars has increased [1-3]. Although this represents only
a small percentage of the overall increase in energy in-
take, this has caused some investigators to suggest a
linkage between added sugars and weight gain and obes-
ity [4-9]. The American Heart Association (AHA) re-
cently released a Scientific Statement recommending
significant restrictions on consumption of added sugars,
suggesting that daily consumption in adult males and
females should not exceed 150 and 100 calories, respect-
ively [10]. These restrictions, which are lower than levels
of added sugars currently consumed by 90% of adults,
were framed as a potential way to reduce the burden of
obesity and cardiovascular disease.

* Correspondence: Bgrady@rippelifestyle.com
1Rippe Lifestyle Institute, 215 Celebration Place, Suite 300, Celebration FL
34747, USA
Full list of author information is available at the end of the article

© 2012 Lowndes et al.; licensee BioMed Centr
Commons Attribution License (http://creativec
reproduction in any medium, provided the or

Over the years a variety of potential causes for obesity
have been posited, including increased carbohydrate con-
sumption [11] and most recently an increased consump-
tion of high fructose corn syrup (HFCS) [4]. In particular,
some studies in animals have linked consumption of
added sugars, in general, and HFCS, in particular, with
weight gain and obesity [12-14], although these studies
have been criticized for delivering amounts of added
sugars above those consumed in the human diet. Given
the complexity of energy regulation, it is unlikely that
one, single component of the diet causes obesity. None-
theless, many myths persist in this area and are given
traction when prestigious scientific organizations such as
the American Heart Association (10) recommend
restricting one specific component of the diet.
National recommendations for healthful weight loss

focus on strategies that include both overall caloric re-
striction and increased physical activity [15]. However,
few individuals actually follow these guidelines by

al Ltd. This is an Open Access article distributed under the terms of the Creative
ommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
iginal work is properly cited.

Lowndes et al. Nutrition Journal 2012, 11:55 Page 2 of 10
http://www.nutritionj.com/content/11/1/55
incorporating both dietary restriction and increased
physical activity [16]. Multiple studies have shown that
equally hypocaloric diets will result in comparable
weight loss irrespective of nutrient composition of these
diets [17-19]. Whether macronutrient content of the diet
effects weight loss, however, remains a topic of debate
and controversy [20-23]. It appears that the critical con-
sideration is adherence to whichever hypocaloric diet is
employed [14].
Many of the studies suggesting linkages between added
sugar and either cardiovascular disease, diabetes, or
other metabolic conditions are based on experiments
employing a model comparing pure fructose to pure glu-
cose [24-26], neither of which is commonly consumed in
the human diet [27], or on epidemiologic studies which
establish associations but not cause and effect [7-
9,28,29]. Very few prospective data are available explor-
ing the effects of either sucrose or HFCS (the two largest
sources of fructose in the diet) and comparing their
effects on body weight and body composition.
It has been argued that it is the fructose moiety of
both sucrose and HFCS that is particularly worrisome
in terms of potential effects on appetite and subsequent
weight gain [4,5,29]. This argument posits that differ-
ences in hepatic metabolism between fructose and glu-
cose can contribute to increased caloric consumption
because of different effects on short term energy regu-
lating hormones. In particular, studies employing a
model of 20% or 25% of total calories ingested as pure
fructose compared to similar numbers of calories
ingested from pure glucose have suggested that differ-
ences in responses of insulin, leptin and ghrelin create
circumstances where increased caloric consumption
might occur following ingestion of fructose, but not
glucose [24-26]. In particular, the failure of fructose in
these studies to stimulate insulin production, with sub-
sequent leptin production and suppression of ghrelin,
suggested a metabolic situation where increased appe-
tite and subsequent weight gain could occur.
It has been argued by some investigators that an in-
crease in sugar consumption may be a contributing fac-
tor to increases in overweight and obesity. However,
data from the U.S. Agriculture’s Economic Research Ser-
vice between 1970 and 2008 showed that the increase in
sugar intake over the past 4 decades has been only a
small percentage of the overall increase in energy intake.
Sugars and caloric sweeteners available for consumption
increased by an average of 58 calories per day (from 400
calories to 458 calories) [30] whereas total calories avail-
able for individuals in the United States increased 515
kilocalories per day from just over 2,100 calories to just
under 2,700 calories [30]. Thus, increases in sweeteners
represented approximately 11% of the calorie increase
for individuals in the American food supply.
Previous research studies in our laboratory and others
employing a model comparing sucrose to HFCS did not
reveal any differences in short term energy regulating
hormones or appetite when comparing the two sugars
[31,32]. This is not surprising given the relatively similar
composition of sucrose and HFCS. Sucrose is a disach-
haride containing 50% fructose and 50% glucose. HFCS
has two main forms commonly used in the food supply.
HFCS-55, the form of HFCS commonly used to sweeten
carbonated soft drinks in the United States consists of
55% fructose and 45% glucose. HFCS-42, the common
form of HFCS used in baked goods and other products
contains 42% fructose and 58% glucose. We elected to
include an “active” control group which utilized exercise
only (predominantly through walking) since, in our ex-
perience, control groups which do not ask participants
to make any changes in their daily lives in weight loss
studies have often resulted in extremely high rates of
dropout due to dissatisfaction with group selection. Fur-
thermore, individuals often believe that exercise will re-
sult in weight loss, despite the fact that most studies
suggest that exercise alone results in minimum weight
loss. Walking exercise was also included in the four milk
consuming groups to make the physical activity portion
of this study equivalent across all five groups. Further-
more, current recommendations for healthy weight loss
typically involve both energy restriction and physical ac-
tivity, so we wished to incorporate both of these modal-
ities in our research design.
With these considerations as background, the current
study was undertaken to explore whether two different
amounts of either sucrose or HFCS, when consumed at
current population levels (10% or 20% of calories as
fructose, representing the 25th and 50th percentile popu-
lation fructose intake levels, respectively) have any ad-
verse impact on the ability to lose weight or change
body composition when consumed as part of mixed nu-
trient, hypocaloric diets. To our knowledge, this is the
first prospective study to examine the effects of added
sugars on overweight or obese individuals attempting to
lose weight when sugars are consumed at levels typical
of the adult population in the context of hypocaloric, en-
ergy restricted diets and modest levels of physical
activities.
Methods and procedures
This study was a 12 week, randomized, prospective,
double blind trial involving 247 overweight/obese sub-
jects between the ages of 25–60 conducted at two sites
in Orlando, Florida. Staff members and subjects were
blinded as to whether or not participants in the trial
were consuming HFCS or sucrose. Staff members were,
however, aware of whether the subjects were consuming
10% or 20% of calories as added sugar since this

Lowndes et al. Nutrition Journal 2012, 11:55 Page 3 of 10
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information was required in order to prescribe the rest
of the hypocaloric diet. Subjects were counseled in pri-
vate counseling rooms in individual sessions to avoid the
possibility of subjects talking to subjects in other groups.
Both sites were supervised by the same research team
and followed identical protocols. We explored the im-
pact of consuming either sucrose or HFCS at the 25th or
50th percent population fructose consumption levels
(10% or 20% of total calories) as a component of mixed
nutrient, hypocaloric meal plans in a free-living environ-
ment. The study was approved for one site by the West-
ern Institutional Review Board and for the other site by
the University of Central Florida Institutional Review
Board. All subjects signed informed consent forms.
Men and women between the ages of 25–60 years of
age with body mass index (BMI) 27.0-35.0 were
recruited. Exclusions included current enrollment in
any commercial weight loss program, prescription med-
icines or supplements for weight loss, or a greater than
five pound weight change during the past three
months. Individuals with a history of orthopedic limita-
tions that would interfere with the ability to meet pre-
scribed exercise, a history of heart problems, a history
of major surgery within the last three months, clinically
diagnosed eating disorders or any gastrointestinal dis-
order, dietary restrictions or allergies to any component
of the diet or which would limit the ability to adhere
to dietary requirements of the study were all excluded.
Physical activity was measured utilizing daily physical
activity logs which were reviewed on a weekly basis by
exercise physiologists or nutritionists. Cigarette smok-
ing or the use of tobacco products, or consumption of
greater than 14 alcoholic beverages per week were also
excluded.
Interested individuals were initially screened over the
phone to determine eligibility based on self reported
data. A standardized screening form and phone script
were developed to ensure individuals were screened in a
consistent manner. Self reported data including height
and weight were verified during the initial clinical visit.
Fasting blood samples were also obtained to test for glu-
cose, insulin, lipids and C-reactive protein (CRP).
Each subject performed a second screening visit one
week later. During this visit, research dietitians assessed
participant dietary intake by analyzing a completed three
day food record using the Nutrient Data System Re-
search (NDS-R) Software (University of Minnesota, Min-
neapolis, Minnesota, USA). Body composition was
determined by Dual X-Ray Absorptiometry (General
Electric i-DXA). This equipment and methodology have
been validated extensively by reputable research labora-
tories over a wide variety of test subjects [33-35]. Total
lean mass, percent fat and trunk fat were all determined
by DXA Scan. All females were required to have a
negative serum pregnancy test prior to DXA testing Re-
peat measurements of body mass, waist circumference
and body composition were performed after the end of
12 weeks. At this time another fasting blood sample was
also obtained. All cholesterol samples were sent to a cer-
tified, research based laboratory with error rates of less
than 1%.
Following completion of the two qualifying visits, indi-
viduals were randomly divided into one of five groups.
All groups included a fitness walking program. Exercise
physiologists counseled all subjects on a weekly basis.
All subjects in the four intervention groups were blinded
to group assignments. A control group (exercise only)
did not change their habitual diets and this group was
considered eucaloric. The following group assignments
were made. GROUP #1 (HFCS 10%): sweetener at 10%
of total calories (25th percentile of U.S. fructose intake)
provided from High Fructose Corn Syrup, plus exercise.
GROUP #2 (HFCS 20%): 20% of total calories (50th per-
centile of U.S. fructose intake) provided through HFCS,
plus exercise. GROUP #3 (Suc 10%): 10% of total cal-
ories provided (25th percentile of U.S. fructose intake)
from sucrose, plus exercise. GROUP #4 (Suc 20%): 20%
of total calories provided from sucrose, (50th percentile
of U.S. fructose intake), plus exercise. GROUP #5 (EO):
control group, habitual (eucaloric) diet, plus exercise. All
sweeteners were supplied in 1%, low fat milk (Tetra Pak,
Denton, Texas).
All four hypocaloric diets (Groups 1–4) were based on
individualized calorie levels using the Mifflin-St Jeor cal-
culation for REE (with activity factor) minus 500 kilocal-
ories (2093 KJ). Study personnel supplied HFCS or
sucrose products to subjects on a weekly basis in
amounts appropriate to their calorie level. The total
meal plan for all four hypocaloric groups was based on
the American Diabetes Association (ADA) Exchange List
and ranged from 50% – 55% carbohydrates, 15%-20%
protein, and 25%-30% fat. These dietary plans utilized
American Diabetes Association exchange lists similar in
fructose content, so that participants in all four interven-
tion groups were prescribed a comparable amount of
fructose from sources other than the sugars provided by
the interventions.
Subjects in all four hypocaloric groups were carefully
counseled by registered dietitians at diet initiation and
weekly thereafter. Menu suggestions and recipes were
provided to all volunteers. This was intended to reduce
boredom with foods included in the diet and provide
helpful guidance for subjects. Diet checklists were used
by subjects so they could monitor appropriate consump-
tion of all foods and beverages each day. Vigilant atten-
tion to portion size and condiments was emphasized. To
promote adherence, foods within all meal plans were
those foods that were affordable and fit into most

Lowndes et al. Nutrition Journal 2012, 11:55 Page 4 of 10
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people’s lifestyle. At each weekly counseling session, die-
titians reviewed dietary checklists with all the subjects to
discuss challenges and encourage continued compliance.
Participants in the four intervention groups met with
registered dietitians every week and dietary intake pat-
terns were reviewed. At weeks six and twelve all partici-
pants in the five groups completed a three day food
record.
Individuals in the control condition followed their
usual, habitual dietary patterns and met with exercise
physiologists on a weekly basis to monitor their exercise
prescription status.
This was done to minimize the high attrition rates
often associated with subjects in control groups that re-
ceive no intervention.
The exercise prescription was the same in all five
groups and emphasized walking as the preferred form of
exercise, however, other forms of exercise were not pro-
hibited. Participants were encouraged to adhere to
recommendations for daily physical activity. Duration of
each exercise session was progressively increased from
15 minutes three days a week at the start of the study to
45 minutes three days a week at the end of three weeks
and remained at 45 minutes three days a week for the
duration of the study . Subjects exercised between 60%
and 80% of their maximal aerobic power using their pre-
determined maximal heart rate to regulate exercise in-
tensity. An additional five minutes of warm up and ten
minutes of cool down exercise were also included. To
minimize overuse injuries, subjects were encouraged to
use a variety of exercise modalities (e.g. walking, cycling,
etc.). However, walking exercise was recommended as
the main form of exercise.
Data were checked for normalcy and analyzed using a
two way (time and group assignment) Analysis of Vari-
ance with repeated measures. Only data on those who
completed the intervention were included in the ana-
lysis. Significant time X group assignment interactions
were probed by assessing the within-subject change in
each of the 5 groups independently. In addition, changes
over the course of 12 weeks (week 12 minus baseline)
were calculated and between group differences assessed
Table 1 Baseline characteristics on participants (n = 162) who
Entire population
n= 162
10% HFCS
n= 36
Age (years 42.8 ± 10.2 40.7 ± 10.3
Body Mass (kg) 87.2 ± 12.5 88.9 ± 12.3
BMI 31.9 ± 3.3 32.0 ± 3.4
Body Fat Percent 43.1 ± 6.5 43.2 ± 6.8
Blood Glucose (mmol/L) 4.9 ± 0.4 5.0 ± 0.4
Cholesterol (mmol/L) 4.9 ± 1.0 4.8 ± 1.1
Note: Attrition rates were not significantly different among the groups (37%, 47%, 4
by one way ANOVA. For all analyses the alpha value
was set at 0.05. All data were analyzed using SPSS
Advanced Statistics V18.
Result
Participants
Baseline characteristics of the 162 study finishers can be
seen in Table 1. Of the 247 participants enrolled in the
study, 162 (Male = 35, Female = 127) completed the 12-
week intervention. On average, those who dropped out
or who were withdrawn by the investigators for non-
compliance were younger than those who finished the
12-weeks (38.3 ± 10.8 vs 42.9 ± 10.3 years, p < 0.05). Lack of compliance with the consumption of the prescribed amount of milk was the primary reason for participant attrition (n = 38 out of 85), but other reasons included participant unwillingness to commit to the time required (n = 21), intolerance to the milk or unwillingness to con- sume the amount prescribed (n = 15), Moved out of town (n = 4), pregnancy (n = 3) and general dissatisfac- tion with the study (n = 4). Drop-out rates were similar across all five groups (Table 1). Dietary Intake Compliance to the sweetened milk in the four interven- tion groups was very high, with 96.6% of all prescribed servings being consumed over the 12 weeks. Compliance was measured by daily food check lists which were reviewed on a weekly basis with the subject by a re- search nutritionist. . The dietary intervention prescribed a daily caloric deficit of 500Kcal (2093KJ). Energy intake decreased by 1294KJ (p < 0.001). In the entire cohort, in- cluding the exercise group, energy intake decreased by 1231KJ per day (p < 0.001, Table 2). This was consistent across all 5 groups (interaction p > 0.05). Each dietary
group also decreased dietary fat while increasing con-
sumption of added sugars. There was also an overall de-
crease in dietary carbohydrate consumption. Actual
sucrose and/or HFCS consumption in the diets could
not be measured. Thus, actual sucrose or HFCS intake
between the groups is unknown.
completed the intervention
20% HFCS
n= 24
10% Sucrose
n=29
20% Sucrose
n=33
EO n=40
41.7 ± 11.3 41.7 ± 11.2 42.9 ± 11.2 41.4 ± 10.2
89.4 ± 12.8 87.7 ± 14.2 89.1 ± 15.1 86.5 ± 12.7
32.2 ± 3.1 31.6 ± 3.7 32.1 ± 3.3 31.8 ± 3.1
43.5 ± 6.3 44.0 ± 7.2 42.3 ± 5.8 42.4 ± 6.5
5.0 ± 0.5 5.2 ± 0.7 5.1 ± 0.7 5.1 ± 0.6
4.9 ± 1.0 5.0 ± 1.2 5.0 ± 1.0 5.0 ± 0.8
0%, 28% and 25% respectively).

Table 2 Dietary intake
HFCS 10% HFCS 20% Suc 10% Suc 20% EO All Time X group
interaction
Energy Intake (KJ) Baseline 9245± 3839 7832± 1832 7766 ± 2479 8724± 2875 7992± 2032 8361± 2793 0.099
Week 12 7171± 2150 6764± 1082 6755 ± 1953 7268± 1613 7496± 2223 7130± 1901***
Fat (g) Baseline 88.2 ± 48.5 69.4 ± 22.8 70.5 ± 26.5 84.2 ± 35.1 72.3 ±23.0 77.6 ± 34.0 <0.001 Week 12 50.5 ± 22.3*** 46.1 ±11.4*** 49.9 ± 20.1** 49.0 ± 17.7*** 69.8 ± 27.9 54.0 ± 22.9 Carbohydrates (g) Baseline 269.6 ± 108.8 236.7 ± 74.3 230.6 ± 76.2 249.8 ± 92.4 241.4 ± 67.6 246.9 ± 86.1 0.462 Week 12 241.0 ± 66.6 234.6 ± 41.8 220.1 ± 62.3 250.1 ± 49.6 212.9 ± 74.4 231.4 ± 62.4 Total Sugar (g) Baseline 117.7 ± 63.2 98.0 ± 53.6 89.2 ± 39.8 101.7 ± 56.8 92.9 ± 42.8 100.5 ± 52.5 <0.001 Week 12 143.9 ± 34.6** 163.2 ± 27.3*** 125.2 ± 34.0*** 163.3 ± 35.0*** 83.8 ± 43.8 133.1 ± 47.0 Added Sugar (g) Baseline 81.8 ± 56.0 62.0 ± 55.1 63.6 ± 38.5 74.1 ± 50.1 61.3 ± 33.2 69.1 ± 47.2 <0.001 Week 12 67.1 ± 22.5 95.8 ± 20.0* 59.1 ± 26.6 97.8 ± 21.1* 50.3 ± 32.8* 72.2 ± 31.7 Different than baseline, p < 0.05 *, p < 0.01 **, p < 0.001 ***. Lowndes et al. Nutrition Journal 2012, 11:55 Page 5 of 10 http://www.nutritionj.com/content/11/1/55 Body mass and adiposity In the entire cohort, including the non-energy restricted control group (EO), there were reductions in all mea- sures of adiposity (Table 3). Time by group interactions were significant for body mass (p < 0.01), BMI (p < 0.01), waist circumference (p < 0.05) and percent body fat (p < 0.05). Post hoc analysis for within group differences showed that reductions were seen for all measures in all four hypocaloric groups, and also for EO in body mass Table 3 Changes in body mass and measures of adiposity Base Body Mass (kg) HFCS 10% 89.3 HFCS 20% 87.0 Sucrose 10% 86.5 Sucrose 20% 87.7 EO 86.4 BMI HFCS 10% 31.4 HFCS 20% 32.3 Sucrose 10% 31.3 Sucrose 20% 31.9 EO 32.3 Waist Circumference (cm) HFCS 10% 91.8 HFCS 20% 90.0 Sucrose 10% 90.7 Sucrose 20% 92.3 EO 93.5 Body Fat% HFCS 10% 42.0 HFCS 20% 42.9 Sucrose 10% 43.7 Sucrose 20% 42.5 EO 43.4 Different than baseline, p < 0.05 *, p < 0.01 **, p < 0.001 ***. and BMI (both p < 0.05) and waist circumference (p < 0.001). In all cases the change from baseline to post testing was greater for the HFCS10% than for EO, but in no cases were there any significant difference among the four hypocaloric (Figure 1). Cholesterol and lipids Reductions in total cholesterol, triglycerides and LDL were observed in the entire cohort (p < 0.001), but no line Week 12 Time X group interaction p 9 ± 11.92 85.24 ± 11.48*** 0.003 3 ± 11.73 84.61 ± 12.60* 5 ± 13.10 83.20 ± 12.52*** 6 ± 13.25 85.77 ± 13.26*** 9 ± 12.69 85.46 ±13.36* 8 ± 3.22 30.03 ± 3.30*** 0.006 0 ± 3.26 31.39 ± 3.65* 3 ± 3.71 30.17 ± 3.80*** 0 ± 3.15 31.93 ± 3.44*** 4 ± 3.35 30.94 ± 3.52* 8 ± 8.04 87.75 ± 8.21*** 0.022 0 ± 10.88 86.40 ± 10.42*** 5 ± 7.50 86.76 ± 7.97*** 8 ± 9.47 90.01 ± 10.00*** 4 ± 8.79 91.53 ± 8.59*** 9 ± 6.98 39.65 ± 9.40** 0.017 3 ± 5.58 41.82 ± 5.94* 5 ± 7.55 42.21 ± 8.22** 4 ± 6.27 41.20 ± 6.97*** 0 ± 6.55 43.02 ± 6.55 Figure 1 Changes in body mass and measures of adiposity after 12 weeks on a (500Kcal/day) hypercaloric diet containing either 10% or 20% of calories from HFCS. Lowndes et al. Nutrition Journal 2012, 11:55 Page 6 of 10 http://www.nutritionj.com/content/11/1/55 change was observed in HDL (Table 4). Changes in these measures over the 12 weeks were similar among the groups (time X group interaction p > 0.05).
Discussion
This double blind, randomized, prospective study com-
pared changes in weight and body composition, as well
as risk factors for coronary heart disease, type 2 diabetes
and the metabolic syndrome in overweight and obese
individuals before and after a twelve week, free living
intervention during which low fat (1%) milk was pre-
scribed, sweetened by either sucrose or HFCS to deliver
10% or 20% of calories from the sweetener in the con-
text of hypocaloric, mixed nutrient meal plans. This is
the first attempt to examine the impact of prescribing ei-
ther sucrose or HFCS (10% or 20% of calories) at the
25th and 50th percentile fructose population intake levels
as a component of mixed nutrient, hypocaloric meal
plans in a free living environment. The major finding of
this prospective study is that typical population intake
levels of added sugars prescribed at the level to deliver
the 25th and 50th percentile population levels of fructose
consumption [36] does not prevent weight loss and asso-
ciated improvements in body composition when pre-
scribed in the context of a well designed and supervised
weight loss program (Figure 1).
In the current study, individuals in the four interven-
tion groups who started with normal serum cholesterol
achieved reductions in serum cholesterol ranging from
13 to 19 mg/dL which is consistent with the amount of
weight loss achieved and is clinically significant.
Initial concern was raised that there might be a unique
relationship between obesity and the consumption of
HFCS because of the temporal association between
increased use of HFCS in the American food supply to
the increased prevalence of obesity between 1970 and
2000 [4]. Despite the popularity of this suggestion, there
are numerous reasons this hypothesis should be dis-
carded. Firstly, the temporal association between HFCS
and obesity ended in 1999, when HFCS use began to
diminish [30]. Secondly, numerous countries around
the world have a similarly increasing prevalence of

Table 4 Changes in cholesterol and lipids
Baseline Week 12 Time p Time X group
interaction p
Cholesterol (mmol/L) HFCS 10% 4.78 ± 1.14 4.44 ± 1.11 0.078
HFCS 20% 4.95 ± 0.89 4.47 ± 0.76
Sucrose 10% 5.14 ± 1.18 4.81 ± 0.98
Sucrose 20% 5.01 ± 1.04 4.61 ± 0.98
EO 4.82 ± 0.08 4.77 0.96
All 4.93 ± 1.01 4.63 ± 0.98*** <0.001 Triglycerides (mmol/L) HFCS 10% 1.34 ± 0.56 1.22 ± 0.55 0.806 HFCS 20% 1.30 ± 0.71 1.07 ± 0.50 Sucrose 10% 1.33 ± 0.63 1.08 ± 0.34 Sucrose 20% 1.42 ± 0.86 1.28 ± 0.70 EO 1.55 ± 0.73 1.38 ± 0.67 All 1.40 ± 0.70 1.22 ± 0.58*** <0.001 HDL (mmol/L) HFCS 10% 1.30 ± 0.22 1.30 ± 0.27 0.182 HFCS 20% 1.37 ± 0.34 1.28 ±0.27 Sucrose 10% 1.41 ± 0.33 1.38 ± 0.35 Sucrose 20% 1.34 ± 0.35 1.29 ± 0.32 EO 1.25 ± 0.24 1.28 ± 0.23 All 1.33 ± 0.30 1.30 ± 0.28 0.090 LDL (mmol/L) HFCS 10% 2.87 ± 0.98 2.61 ± 0.91 0.372 HFCS 20% 2.99 ± 0.78 2.70 ± 0.66 Sucrose 10% 3.12 ± 1.02 2.95 ± 0.93 Sucrose 20% 2.94 ± 0.94 2.68 ± 0.85 EO 2.87 ± 0.74 2.85 ± 0.89 All 2.95 ± 0.89 2.76 ± 0.86*** <0.001 Different than baseline, p < 0.05 *, p < 0.01 **, p < 0.001 ***. Lowndes et al. Nutrition Journal 2012, 11:55 Page 7 of 10 http://www.nutritionj.com/content/11/1/55 overweight and obesity as the United States, but do not use HFCS. Lastly, subsequent research studies have shown there is no difference between HFCS or sucrose in any metabolic parameter measured in human beings including glucose, insulin, leptin, ghrelin, triglycerides, uric acid, appetite or calories consumed at the next meal [31,32,37]. Both the American Medical Associ- ation [38] and the American Dietetic Association [39] have issued statements declaring that there is nothing unique about HFCS that leads to obesity. Both of these statements note that all caloric sweeteners contain cal- ories and should be used in moderation. The present data further support the theory that, when consumed at levels up to the 50th percentile for fructose in the context of a hypocaloric diet, neither HFCS nor sucrose impedes weight loss. These data provide further sup- port to the concept that overall caloric consumption rather than one particular component of the diet is most important for achieving weight loss. Recent concern has been raised that it may be the fructose moiety of both sucrose and HFCS that could potentially contribute to obesity [5,6,29]. This argument is based on research performed showing differences in short term energy regulating hormones when comparing a pure fructose model to a pure glucose model [24-26]. Neither fructose nor glucose alone is available in the or- dinary food supply as an isolated or pure substance, and neither is consumed alone in significant amounts. It has also been argued that differences in hepatic metabolism between fructose and glucose may stimulate increased caloric consumption and, therefore, increased risk of weight gain and obesity [40-42]. Some epidemiologic studies have reported an increase in energy intake in various population groups related to increased sugar sweetened beverage consumption [7-9]. However, evidence regarding a potential positive associ- ation between sugar sweetened beverage consumption and obesity is inconsistent [43]. Because of the metabolic nature of overweight and obesity and the complexity of the western diet, it is unlikely that a single food or food group is the primary cause. Randomized, clinical feeding trials have shown inconsistent results from testing the Lowndes et al. Nutrition Journal 2012, 11:55 Page 8 of 10 http://www.nutritionj.com/content/11/1/55 effects of added sugar on weight gain. Differences in study instruments and methods, population studied and study design may have contributed to these inconsistent findings. It should be noted that since the added sugars in this study were delivered in low fat milk, the increased con- sumption of vitamin D may have contributed to some of the results observed. Indeed, in this study 50% increases in vitamin D occurred as a result of milk consumption. Deficiencies in vitamin D and low serum 25 (OH) D levels have been correlated with impaired glucose toler- ance, the metabolic syndrome and diabetes independent of obesity [44]. It should also be noted that vitamin D is essential for the metabolism of insulin and may contrib- ute to reduction in the level of CRP [45]. Furthermore, vitamin D may contribute to LDL reduction. Thus, our reported results on cholesterol parameters must be trea- ted with some caution. Our data demonstrate that equally hypocaloric diets provoked similar weight changes regardless of type or amount of sugar consumed. This finding is not surpris- ing since our research group and others have previously shown the metabolic equivalency of sucrose and HFCS [31,32]. Strengths of the current study are that it is a double blind, randomized, prospective study with a rela- tively large sample size which explores normal popula- tion consumed levels of fructose as delivered through normally-consumed sweeteners, sucrose and HFCS. Weaknesses are that subjects were only followed for twelve weeks and that children, adolescents and elderly subjects over the age of 60 were excluded. A further po- tential weakness in the current study is the 35% dropout rate, although this dropout rate is consistent with other trials of comparable size and duration [46,47]. The added amount of exercise in this study (45 minutes of walking or comparable exercise three times a week) may have also contributed to the observed weight loss, al- though most studies report that weight loss from exer- cise alone is typically modest [48,49]. It should also be noted that 78% of participants in the intervention groups were female. This may limit the ability of these data to be generalized to the public since some animal data sug- gests that gender influences response to fructose [50,51] and young women are more resistant to fructose induced hypertriglyceridemia than males and hyperinsu- linemic women are more susceptible [52-54]. Further- more, plasma leptin exhibits sexual dimorphism with higher concentrations in women as androgens have a suppressive effect on leptin secretion [55,56]. These are further gender differences which may impact on the ability to generalize from data generated largely in women. Since sucrose and/or HFCS consumptions in the diets could not be measured, the actual differences in intake of these two sugars remain unknown, which should also be taken into consideration in interpreting these data. Further studies employing larger numbers of subjects from more diverse population groups, and higher doses approaching 90th percentile fructose intakes (approxi- mately 15% of calories as fructose) of either sucrose or HFCS, with longer duration appear warranted. Common misunderstandings about HFCS [3] have dis- torted public perceptions, pressuring food manufacturers to replace HFCS with sucrose and municipal and state legislators to mandate removal of HFCS from school nu- trition programs. Our data suggest that such actions are pointless and potentially misleading to consumers, since HFCS and sucrose are nutritionally interchangeable. In conclusion, similar decreases in weight and indices of adiposity are observed when overweight or obese indi- viduals are subjected to hypocaloric diets with different prescribed levels of sucrose or high fructose corn syrup. Competing interests JM Rippe has received research funding from the Corn Refiners Association for the present study. The other study authors reported no competing interests. Authors’ contributions JL and JMR wrote and prepared the manuscript, DK, SP, VN and ZY performed regular dietary assessments and ensured interventional compliance and carried out daily measurement of study parameters, KJM provided technical and scientific assistance. All authors read and approved the final manuscript. Funding This work was supported by a grant from the Corn Refiners Association. Author details 1Rippe Lifestyle Institute, 215 Celebration Place, Suite 300, Celebration FL 34747, USA. 2Rhode Island University, 202 A Ranger Hall, Kingston, RI 02881, USA. 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Endocrinology 1999, 84:1784–1789. doi:10.1186/1475-2891-11-55 Cite this article as: Lowndes et al.: The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on weight loss and related parameters. Nutrition Journal 2012 11:55. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 1475-2891-11-55