Breath 13CO2—evidence for a noninvasive biomarker to measure added refined sugar uptake

Roger Yazbeck, Gordon S. Howarth, Margaret Kosek, Geoffrey P. Davidson, Ross N. Butler

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Increased consumption of added sucrose and high-fructose corn syrup in the human diet has been associated with increasing incidence of obesity and metabolic disease. There are currently no reliable, objective biomarkers for added sugar intake that could be used in individuals or population settings. 13C is a stable isotope of carbon, and measurement of blood 13C content has been proposed as a marker of added sugar consumption. This study aimed to determine if breath 13CO2 could represent an alternative, noninvasive biomarker to monitor added sugar intake. We undertook retrospective analyses of eight preclinical and human 13C-breath studies to define baseline breath 13CO2 characteristics. All samples were analyzed using isotope ratio mass spectrometry, and breath 13CO2 was expressed as the delta value, d expressed as parts per thousand (%). All data are expressed as mean ± SEM, with statistical significance considered at P < 0.05. Breath d13CO2 was significantly elevated in a cumulative manner in rats and mice that consumed a diet containing at least 15% sucrose. Mice fed an American rodent chow diet containing 50% sucrose and 15% corn starch had a significantly higher breath d13CO2 compared with rodents consuming an Australian rodent chow diet. Furthermore, breath d13CO2 was significantly increased in a dose-dependent manner in humans that ingested a bolus dose of sucrose. These findings suggest application for baseline breath d13CO2 as a noninvasive biomarker for added sugar consumption, with broad application for longitudinal assessment of population sugar intake and obesity management strategies. NEW & NOTEWORTHY We have found that breath 13CO2 is increased in rats and mice consuming diets high in sucrose. We also found that human breath 13CO2 is increased in humans consuming increasing amounts of sucrose. Our collective findings suggest that breath 13CO2 represents a potential marker of added dietary sugar consumption.

Original languageEnglish
Pages (from-to)1025-1032
Number of pages8
JournalJournal of Applied Physiology
Issue number4
Publication statusPublished - Apr 2021


  • breath test
  • nutrition
  • stable isotope
  • sucrose
  • 13Carbon
  • Breath test
  • Stable isotope
  • Nutrition
  • Sucrose
  • Carbon


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