Excessive sugar intake

Sugar consumption, metabolic disease and obesity: The state of the controversy

Type of study: literature review

Number of citations: 602

Year: 2016

Authors: K. Stanhope

Journal: Critical Reviews in Clinical Laboratory Sciences

Journal ranking: Q1

Key takeaways: Excess sugar consumption may promote cardiovascular disease and type 2 diabetes directly and indirectly through increased body weight and fat gain.

Abstract: Abstract The impact of sugar consumption on health continues to be a controversial topic. The objective of this review is to discuss the evidence and lack of evidence that allows the controversy to continue, and why resolution of the controversy is important. There are plausible mechanisms and research evidence that supports the suggestion that consumption of excess sugar promotes the development of cardiovascular disease (CVD) and type 2 diabetes (T2DM) both directly and indirectly. The direct pathway involves the unregulated hepatic uptake and metabolism of fructose, leading to liver lipid accumulation, dyslipidemia, decreased insulin sensitivity and increased uric acid levels. The epidemiological data suggest that these direct effects of fructose are pertinent to the consumption of the fructose-containing sugars, sucrose and high fructose corn syrup (HFCS), which are the predominant added sugars. Consumption of added sugar is associated with development and/or prevalence of fatty liver, dyslipidemia, insulin resistance, hyperuricemia, CVD and T2DM, often independent of body weight gain or total energy intake. There are diet intervention studies in which human subjects exhibited increased circulating lipids and decreased insulin sensitivity when consuming high sugar compared with control diets. Most recently, our group has reported that supplementing the ad libitum diets of young adults with beverages containing 0%, 10%, 17.5% or 25% of daily energy requirement (Ereq) as HFCS increased lipid/lipoprotein risk factors for CVD and uric acid in a dose–response manner. However, un-confounded studies conducted in healthy humans under a controlled, energy-balanced diet protocol that enables determination of the effects of sugar with diets that do not allow for body weight gain are lacking. Furthermore, recent reports conclude that there are no adverse effects of consuming beverages containing up to 30% Ereq sucrose or HFCS, and the conclusions from several meta-analyses suggest that fructose has no specific adverse effects relative to any other carbohydrate. Consumption of excess sugar may also promote the development of CVD and T2DM indirectly by causing increased body weight and fat gain, but this is also a topic of controversy. Mechanistically, it is plausible that fructose consumption causes increased energy intake and reduced energy expenditure due to its failure to stimulate leptin production. Functional magnetic resonance imaging (fMRI) of the brain demonstrates that the brain responds differently to fructose or fructose-containing sugars compared with glucose or aspartame. Some epidemiological studies show that sugar consumption is associated with body weight gain, and there are intervention studies in which consumption of ad libitum high-sugar diets promoted increased body weight gain compared with consumption of ad libitum low- sugar diets. However, there are no studies in which energy intake and weight gain were compared in subjects consuming high or low sugar, blinded, ad libitum diets formulated to ensure both groups consumed a comparable macronutrient distribution and the same amounts of fiber. There is also little data to determine whether the form in which added sugar is consumed, as beverage or as solid food, affects its potential to promote weight gain. It will be very challenging to obtain the funding to conduct the clinical diet studies needed to address these evidence gaps, especially at the levels of added sugar that are commonly consumed. Yet, filling these evidence gaps may be necessary for supporting the policy changes that will help to turn the food environment into one that does not promote the development of obesity and metabolic disease.

Sugar-Sweetened Beverages and Cardiometabolic Health: An Update of the Evidence

Type of study: literature review

Number of citations: 288

Year: 2019

Authors: Vasanti S. Malik, F. Hu

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Sugar-sweetened beverages are strongly associated with weight gain, type 2 diabetes, and coronary heart disease risk, emphasizing the need to reduce their intake for improved cardiometabolic health.

Abstract: Sugar-sweetened beverages (SSBs) have little nutritional value and a robust body of evidence has linked the intake of SSBs to weight gain and risk of type 2 diabetes (T2D), cardiovascular disease (CVD), and some cancers. Metabolic Syndrome (MetSyn) is a clustering of risk factors that precedes the development of T2D and CVD; however, evidence linking SSBs to MetSyn is not clear. To make informed recommendations about SSBs, new evidence needs to be considered against existing literature. This review provides an update on the evidence linking SSBs and cardiometabolic outcomes including MetSyn. Findings from prospective cohort studies support a strong positive association between SSBs and weight gain and risk of T2D and coronary heart disease (CHD), independent of adiposity. Associations with MetSyn are less consistent, and there appears to be a sex difference with stroke with greater risk in women. Findings from short-term trials on metabolic risk factors provide mechanistic support for associations with T2D and CHD. Conclusive evidence from cohort studies and trials on risk factors support an etiologic role of SSB in relation to weight gain and risk of T2D and CHD. Continued efforts to reduce intake of SSB should be encouraged to improve the cardiometabolic health of individuals and populations.

Molecular aspects of fructose metabolism and metabolic disease.

Type of study:

Number of citations: 175

Year: 2021

Authors: M. Herman, M. Birnbaum

Journal: Cell metabolism

Journal ranking: Q1

Key takeaways: Excessive fructose consumption may contribute to metabolic diseases, and understanding its unique properties may lead to new therapeutic options for treating metabolic diseases.

Sugar- and Artificially Sweetened Beverages Consumption Linked to Type 2 Diabetes, Cardiovascular Diseases, and All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Type of study: meta-analysis

Number of citations: 86

Year: 2021

Authors: Yantong Meng, Siqi Li, Jabir Khan, Z. Dai, Chang Li, Xiaosong Hu, Q. Shen, Yong Xue

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Increased consumption of sugar- and artificially sweetened beverages is associated with an increased risk of type 2 diabetes, cardiovascular diseases, and all-cause mortality.

Abstract: Although studies have examined the association between habitual consumption of sugar- (SSBs) and artificially sweetened beverages (ASBs) and health outcomes, the results are inconclusive. Here, we conducted a dose-response meta-analysis of prospective cohort studies in order to summarize the relationship between SSBs and ASBs consumption and risk of type 2 diabetes (T2D), cardiovascular diseases (CVDs), and all-cause mortality. All relevant articles were systematically searched in PubMed, Embase, and Ovid databases until 20 June 2020. Thirty-four studies met the inclusion criteria and were eligible for analysis. Summary relative risks (RRs) and 95% confidence intervals (95% CI) were estimated using random effects or fixed-effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships. With each additional SSB and ASB serving per day, the risk increased by 27% (RR: 1.27, 95%CI: 1.15–1.41, I2 = 80.8%) and 13% (95%CI: 1.03–1.25, I2 = 78.7%) for T2D, 9% (RR: 1.09, 95%CI: 1.07–1.12, I2 = 42.7%) and 8% (RR: 1.08, 95%CI: 1.04–1.11, I2 = 45.5%) for CVDs, and 10% (RR: 1.10, 95%CI: 0.97–1.26, I2 = 86.3%) and 7% (RR: 1.07, 95%CI: 0.91–1.25, I2 = 76.9%) for all-cause mortality. Linear relationships were found for SSBs with T2D and CVDs. Non-linear relationships were found for ASBs with T2D, CVDs, and all-cause mortality and for SSBs with all-cause mortality. The findings from the current meta-analysis indicate that increased consumption of SSBs and ASBs is associated with the risk of T2D, CVDs, and all-cause mortality.

Fructose metabolism and metabolic disease

Type of study:

Number of citations: 365

Year: 2018

Authors: S. Hannou, D. Haslam, N. McKeown, M. Herman

Journal: Journal of Clinical Investigation

Journal ranking: Q1

Key takeaways: Excessive fructose consumption may contribute to cardiometabolic diseases, including obesity and diabetes, due to its unique metabolic properties.

Abstract: Increased sugar consumption is increasingly considered to be a contributor to the worldwide epidemics of obesity and diabetes and their associated cardiometabolic risks. As a result of its unique metabolic properties, the fructose component of sugar may be particularly harmful. Diets high in fructose can rapidly produce all of the key features of the metabolic syndrome. Here we review the biology of fructose metabolism as well as potential mechanisms by which excessive fructose consumption may contribute to cardiometabolic disease.

Intake of Added Sugar from Different Sources and Risk of All-cause Mortality and Cardiovascular Diseases: The Role of Body Mass Index.

Type of study: non-rct observational study

Number of citations: 3

Year: 2024

Authors: Ziwei Shi, Wenmin Zhu, Zhiqun Lei, Xiaolong Yan, Xinyue Zhang, Sheng Wei, Qi Wang

Journal: The Journal of nutrition

Journal ranking: Q1

Key takeaways: Higher intake of added sugar, especially from beverages, is associated with an increased risk of all-cause mortality and cardiovascular diseases, with BMI mediating a portion of these associations.

Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association

Type of study: literature review

Number of citations: 440

Year: 2017

Authors: M. Vos, Jill L. Kaar, J. Welsh, L. V. Van Horn, D. Feig, C. Anderson, M. Patel, Jessica Cruz Muños, N. Krebs, S. Xanthakos, Rachel K. Johnson

Journal: Circulation

Journal ranking: Q1

Key takeaways: Added sugars are associated with increased cardiovascular disease risk in children, and it is recommended that children consume no more than 25g (100 cal or ≈6 teaspoons) of added sugars per day.

Abstract: Background: Poor lifestyle behaviors are leading causes of preventable diseases globally. Added sugars contribute to a diet that is energy dense but nutrient poor and increase risk of developing obesity, cardiovascular disease, hypertension, obesity-related cancers, and dental caries. Methods and Results: For this American Heart Association scientific statement, the writing group reviewed and graded the current scientific evidence for studies examining the cardiovascular health effects of added sugars on children. The available literature was subdivided into 5 broad subareas: effects on blood pressure, lipids, insulin resistance and diabetes mellitus, nonalcoholic fatty liver disease, and obesity. Conclusions: Associations between added sugars and increased cardiovascular disease risk factors among US children are present at levels far below current consumption levels. Strong evidence supports the association of added sugars with increased cardiovascular disease risk in children through increased energy intake, increased adiposity, and dyslipidemia. The committee found that it is reasonable to recommend that children consume ⩽25 g (100 cal or ≈6 teaspoons) of added sugars per day and to avoid added sugars for children <2 years of age. Although added sugars most likely can be safely consumed in low amounts as part of a healthy diet, few children achieve such levels, making this an important public health target.

Sugar Sweetened and Artificially Sweetened Beverages Consumption and Risk of Cardiovascular Health.

Type of study: meta-analysis

Number of citations: 6

Year: 2022

Authors: Chayakrit Krittanawong, Y. Qadeer, Zhen Wang, Karl Z Nadolsky, S. Virani, C. Lavie

Journal: The American journal of medicine

Journal ranking: Q1

Key takeaways: Increasing consumption of sugar-sweetened and artificially sweetened beverages may increase the risk of developing cardiovascular complications and mortality.

Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative and a Network Meta-Analysis of Prospective Studies

Type of study: meta-analysis

Number of citations: 25

Year: 2022

Authors: Bo Yang, Andrea J. Glenn, Qing Liu, Tracy E. Madsen, M. Allison, J. Shikany, J. Manson, K. Chan, Wen-Chih Wu, Jie Li, Simin Liu, K. Lo

Journal: Nutrients

Journal ranking: Q1

Key takeaways: A diet with added sugar intake ≥15% and consuming ≥1 serving of sugar-sweetened or artificially sweetened beverages may be associated with a higher risk of cardiovascular disease.

Abstract: Much remains unknown about the role of added sugar in relation to cardiovascular disease (CVD) and the relative contributions of sugar-sweetened beverages (SSB) or artificially sweetened beverages (ASB) to CVD risk. Among the 109,034 women who participated in Women’s Health Initiative, we assessed average intakes of added sugar, SSB and ASB, and conducted Cox regression to estimate the hazard ratios (HRs) and their 95% confidence intervals for CVD risk. The consistency of findings was compared to a network meta-analysis of all available cohorts. During an average of 17.4 years of follow-up, 11,597 cases of total CVD (nonfatal myocardial infarction, coronary heart disease (CHD) death, stroke, coronary revascularization, and/or incident heart failure) were confirmed. Added sugar as % energy intake daily (%EAS) at ≥15.0% was positively associated with total CVD (HR = 1.08 [1.01, 1.15]) and CHD (HR = 1.20 [1.09, 1.32]). There was also a higher risk of total CVD associated with ≥1 serving of SSB intake per day (HR = 1.29 [1.17, 1.42]), CHD (1.35 [1.16, 1.57]), and total stroke (1.30 [1.10, 1.53]). Similarly, ASB intake was associated with an increased risk of CVD (1.14 [1.03, 1.26]) and stroke (1.24 [1.04, 1.48]). According to the network meta-analysis, there was a large amount of heterogeneity across studies, showing no consistent pattern implicating added sugar, ASB, or SSB in CVD outcomes. A diet containing %EAS ≥15.0% and consuming ≥1 serving of SSB or ASB may be associated with a higher CVD incidence. The relative contribution of added sugar, SSB, and ASB to CVD risk warrants further investigation.

Added sugar intake and cardiovascular diseases mortality among US adults.

Type of study: non-rct observational study

Number of citations: 856

Year: 2014

Authors: Quanhe Yang, Zefeng Zhang, E. Gregg, W. Flanders, R. Merritt, F. Hu

Journal: JAMA internal medicine

Journal ranking: Q1

Key takeaways: Higher added sugar consumption is significantly associated with an increased risk of cardiovascular disease mortality among US adults.

Abstract: IMPORTANCE Epidemiologic studies have suggested that higher intake of added sugar is associated with cardiovascular disease (CVD) risk factors. Few prospective studies have examined the association of added sugar intake with CVD mortality. OBJECTIVE To examine time trends of added sugar consumption as percentage of daily calories in the United States and investigate the association of this consumption with CVD mortality. DESIGN, SETTING, AND PARTICIPANTS National Health and Nutrition Examination Survey (NHANES, 1988-1994 [III], 1999-2004, and 2005-2010 [n = 31,147]) for the time trend analysis and NHANES III Linked Mortality cohort (1988-2006 [n = 11 733]), a prospective cohort of a nationally representative sample of US adults for the association study. MAIN OUTCOMES AND MEASURES Cardiovascular disease mortality. RESULTS Among US adults, the adjusted mean percentage of daily calories from added sugar increased from 15.7% (95% CI, 15.0%-16.4%) in 1988-1994 to 16.8% (16.0%-17.7%; P = .02) in 1999-2004 and decreased to 14.9% (14.2%-15.5%; P < .001) in 2005-2010. Most adults consumed 10% or more of calories from added sugar (71.4%) and approximately 10% consumed 25% or more in 2005-2010. During a median follow-up period of 14.6 years, we documented 831 CVD deaths during 163,039 person-years. Age-, sex-, and race/ethnicity-adjusted hazard ratios (HRs) of CVD mortality across quintiles of the percentage of daily calories consumed from added sugar were 1.00 (reference), 1.09 (95% CI, 1.05-1.13), 1.23 (1.12-1.34), 1.49 (1.24-1.78), and 2.43 (1.63-3.62; P < .001), respectively. After additional adjustment for sociodemographic, behavioral, and clinical characteristics, HRs were 1.00 (reference), 1.07 (1.02-1.12), 1.18 (1.06-1.31), 1.38 (1.11-1.70), and 2.03 (1.26-3.27; P = .004), respectively. Adjusted HRs were 1.30 (95% CI, 1.09-1.55) and 2.75 (1.40-5.42; P = .004), respectively, comparing participants who consumed 10.0% to 24.9% or 25.0% or more calories from added sugar with those who consumed less than 10.0% of calories from added sugar. These findings were largely consistent across age group, sex, race/ethnicity (except among non-Hispanic blacks), educational attainment, physical activity, health eating index, and body mass index. CONCLUSIONS AND RELEVANCE Most US adults consume more added sugar than is recommended for a healthy diet. We observed a significant relationship between added sugar consumption and increased risk for CVD mortality.

Consumption of sugar sweetened beverages, artificially sweetened beverages and fruit juices and risk of type 2 diabetes, hypertension, cardiovascular disease, and mortality: A meta-analysis

Type of study: meta-analysis

Number of citations: 25

Year: 2023

Authors: Baoyu Li, Ni Yan, Hong Jiang, Meng Cui, Min Wu, Lina Wang, B. Mi, Zhaofang Li, Jiamiao Shi, Yahui Fan, Mougni Mohamed Azalati, C. Li, Fangyao Chen, M. Ma, Duolao Wang, Le Ma

Journal: Frontiers in Nutrition

Journal ranking: Q1

Key takeaways: Higher consumption of sugar-sweetened and artificially sweetened beverages increases the risk of cardiometabolic diseases and mortality, while fruit juice intake is linked to a higher risk of type 2 diabetes.

Abstract: Introduction Sugar-sweetened beverage (SSB) intake is associated with an increased risk of cardiometabolic diseases. However, evidence regarding associations of artificially sweetened beverages (ASBs) and fruit juices with cardiometabolic diseases is mixed. In this study, we aimed to investigate the association between the SSB, ASB and fruit juice consumption with the incidence of cardiometabolic conditions and mortality. Methods Relevant prospective studies were identified by searching PubMed, Web of Science, Embase, and Cochrane Library until December 2022 without language restrictions. The pooled relative risk (RR) and 95% confidence intervals (CIs) were estimated for the association of SSBs, ASBs, and fruit juices with the risk of type 2 diabetes (T2D), cardiovascular disease (CVD), and mortality by using random-effect models. Results A total of 72 articles were included in this meta-analysis study. Significantly positive associations were observed between the consumption of individual beverages and T2D risk (RR: 1.27; 95% CI: 1.17, 1.38 for SSBs; RR: 1.32; 95% CI: 1.11, 1.56 for ASBs; and RR:0.98; 95% CI: 0.93, 1.03 for fruit juices). Moreover, our findings showed that intakes of SSBs and ASBs were significantly associated with risk of hypertension, stroke, and all-cause mortality (RR ranging from 1.08 to 1.54; all p < 0.05). A dose-response meta-analysis showed monotonic associations between SSB intake and hypertension, T2D, coronary heart disease (CHD), stroke and mortality, and the linear association was only significant between ASB consumption and hypertension risk. Higher SSB and ASB consumptions were associated with a greater risk of developing cardiometabolic diseases and mortality. Fruit juice intake was associated with a higher risk of T2D. Conclusion Therefore, our findings suggest that neither ASBs nor fruit juices could be considered as healthier beverages alternative to SSBs for achieving improved health. Systematic Review Registration: [PROSPERO], identifier [No. CRD42022307003].

Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages and Risk of Cardiovascular Disease: A Meta-Analysis and Systematic Review

Type of study: meta-analysis

Number of citations: 130

Year: 2020

Authors: Jiawei Yin, Yalun Zhu, Vasanti S. Malik, Xiaoqin Li, Xiaolin Peng, F. Zhang, Zhilei Shan, Liegang Liu

Journal: Advances in Nutrition

Journal ranking: Q1

Key takeaways: Habitual consumption of sugar-sweetened beverages is associated with a higher risk of cardiovascular disease morbidity and mortality, while low-calorie sweetened beverages also have a higher risk.

Abstract: ABSTRACT The long-term associations between the consumption of sugar-sweetened beverages (SSBs) and low-calorie sweetened beverages (LCSBs) with cardiovascular diseases (CVDs) remains inconsistent. To synthesize the evidence, we conducted a meta-analysis of prospective cohort studies published up to 1 December, 2019 on the associations between SSB and LCSB intake and the risk of CVD incidence and mortality. Out of 5301 articles retrieved from our literature search, 11 articles evaluating the consumption of SSBs (16,915 incident CVD cases, 18,042 CVD deaths) and 8 articles evaluating the consumption of LCSBs (18,077 incident CVD cases, 14,114 CVD deaths) were included in the meta-analysis. A 1 serving/d increment of SSBs was associated with an 8% (RR: 1.08; 95% CI: 1.02, 1.14, I2 = 43.0%) and 8% (RR: 1.08; 95% CI: 1.04, 1.13, I2 = 40.6%) higher risk of CVD incidence and CVD mortality, respectively. A 1 serving/d increment of LCSBs was associated with a 7% (RR: 1.07; 95% CI: 1.05, 1.10, I2 = 0.0%) higher risk of CVD incidence. The association between LCSBs and CVD mortality appeared to be nonlinear (P = 0.003 for nonlinearity) with significant associations observed at high intake levels (>2 servings/d). Under an assumption of causality, the consumption of SSBs may be linked to 9.3% (95% CI: 6.6%, 11.9%) of predicted CVD incidence in the USA from 2015 to 2025, among men and nonpregnant women, who were aged 40–79 y in 2015–2016. The habitual consumption of SSBs was associated with a higher risk of CVD morbidity and mortality in a dose-response manner. LCSBs were also associated with a higher risk of these outcomes, however, the interpretation of these findings may be complicated by reverse causation and residual confounding.

Sugar-sweetened beverage consumption, weight gain, and risk of type 2 diabetes and cardiovascular diseases in Asia: a systematic review.

Type of study: systematic review

Number of citations: 37

Year: 2021

Authors: N. Neelakantan, S. H. Park, Guo-Chong Chen, R. V. van Dam

Journal: Nutrition reviews

Journal ranking: Q1

Key takeaways: High sugar-sweetened beverage consumption is associated with weight gain, increased risk of type 2 diabetes, and possibly certain cardiovascular diseases in Asian populations.

Abstract: CONTEXT The prevalence of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVDs) is increasing in Asia and several countries are adopting preventive policies to reduce consumption of sugar-sweetened beverages (SSBs). However, evidence on the relation between SSB consumption and cardiometabolic health in Asian populations has not been summarized. OBJECTIVE In this systematic review, the associations between consumption of SSBs and cardiometabolic outcomes, including obesity, T2DM, and CVD, are examined in Asian populations. DATA SOURCES The PubMed, Scopus, and Web of Science databases, and gray literature were searched up to October, 2020 to identify relevant articles. DATA EXTRACTION Two investigators independently extracted data from included studies. DATA ANALYSIS When sufficient studies were available, a random-effects meta-analysis was used to calculate the pooled estimates (expressed as risk ratio [RR] and 95% confidence interval [CI]). Heterogeneity was tested and quantified using the Cochrane Q test and I2 statistic, respectively. RESULTS Of the 17 studies included, 8 provided results about measures of adiposity (3 on weight change, 4 on body mass index (BMI), 2 on percent body fat, and 1 on abdominal obesity), 6 reported results about T2DM, and 3 reported on different CVD outcomes. High SSB consumption was significantly associated with greater weight gain and with a higher risk of selected CVD outcomes as compared with low consumption. In the meta-analysis, high SSB consumption was associated with greater T2DM risk before (RR, 1.51; 95%CI, 1.15-1.98 for highest vs lowest category; I2 = 76%) and after (RR, 1.38; 95%CI, 1.09-1.73; I2 = 56%) adjustment for BMI. CONCLUSIONS These findings suggest that high SSB consumption is directly associated with weight gain, risk of T2DM, and, possibly, selected CVD outcomes in Asian populations. Public health strategies to reduce SSB consumption in Asian countries are warranted. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42019129456.Keywords: adiposity. cardiovascular disease, Asia, sugar-sweetened beverages, type 2 diabetes.

Metabolism and Health Impacts of Dietary Sugars

Type of study:

Number of citations: 29

Year: 2022

Authors: Yasmine Alam, Raymond Kim, Cholsoon Jang

Journal: Journal of Lipid and Atherosclerosis

Journal ranking: Q1

Key takeaways: Excessive consumption of dietary sugars contributes to metabolic disorders like obesity, nonalcoholic fatty liver disease, cardiovascular disease, and diabetes, with unclear underlying mechanisms.

Abstract: Consumption of excessive amounts of added sugars and their effects on human health has been a major concern in the last several decades. Epidemiological data suggest that the incidence of metabolic disorders, such as obesity, nonalcoholic fatty liver disease, cardiovascular disease and diabetes, has increased due to chronic surplus consumption of these sugars. While many of these sugars have been isolated and studied for centuries, their health impacts and exact underlying mechanisms are still unclear. In this review, we discuss the pathophysiological role of 6 major simple sugars present in the human diet and the biochemical and molecular pathways related to their metabolism by different organs and gut microbiota, with a focus on the most recent investigations.

Excessive intake of sugar: An accomplice of inflammation

Type of study:

Number of citations: 140

Year: 2022

Authors: Xiao Ma, Fang Nan, H. Liang, Panyin Shu, Xinzou Fan, Xiaoshuang Song, Y. Hou, Dunfang Zhang

Journal: Frontiers in Immunology

Journal ranking: Q1

Key takeaways: Excessive intake of dietary sugars and processed foods may contribute to the occurrence and aggravation of inflammation, highlighting the need for urgent research on regulating human inflammatory diseases.

Abstract: High sugar intake has long been recognized as a potential environmental risk factor for increased incidence of many non-communicable diseases, including obesity, cardiovascular disease, metabolic syndrome, and type 2 diabetes (T2D). Dietary sugars are mainly hexoses, including glucose, fructose, sucrose and High Fructose Corn Syrup (HFCS). These sugars are primarily absorbed in the gut as fructose and glucose. The consumption of high sugar beverages and processed foods has increased significantly over the past 30 years. Here, we summarize the effects of consuming high levels of dietary hexose on rheumatoid arthritis (RA), multiple sclerosis (MS), psoriasis, inflammatory bowel disease (IBD) and low-grade chronic inflammation. Based on these reported findings, we emphasize that dietary sugars and mixed processed foods may be a key factor leading to the occurrence and aggravation of inflammation. We concluded that by revealing the roles that excessive intake of hexose has on the regulation of human inflammatory diseases are fundamental questions that need to be solved urgently. Moreover, close attention should also be paid to the combination of high glucose-mediated immune imbalance and tumor development, and strive to make substantial contributions to reverse tumor immune escape.

Perceived Associations between Excessive Sugar Intake and Health Conditions

Type of study: non-rct observational study

Number of citations: 32

Year: 2022

Authors: M. Prada, Magda Saraiva, M. Garrido, Ana Sério, Ana Teixeira, Diniz Lopes, Diana A. Silva, David L. Rodrigues

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Excessive sugar intake is associated with risk factors for cardiometabolic diseases, cardiovascular diseases, oral problems, oncological, and mental health conditions, with diabetes, overweight/obesity, and oral problems being the most common.

Abstract: Excessive sugar intake represents an increased risk of developing non-communicable diseases (e.g., obesity, cardiometabolic diseases, and dental diseases). Still, it is unclear whether people are aware of these adverse health outcomes. The current study systematically examined the extent to which people associate health conditions with excessive sugar intake. Participants (N = 1010 Portuguese volunteers) freely reported all health conditions they associated with excessive sugar consumption and rated the strength of these associations for eight specific health conditions. All participants reported health conditions associated with excessive sugar intake, with the most frequent being risk factors for cardiometabolic diseases (e.g., diabetes), cardiovascular diseases, oral problems, oncological and mental health conditions. Moreover, participants considered diabetes, overweight/obesity, and oral problems as being the conditions most related to excessive sugar intake. Women, participants with children in the household, and experts in health/nutrition rated excessive sugar intake as being more strongly linked to some of the health conditions. The identification of the health conditions that people associate with excessive sugar consumption may inform policymakers, educators, and health professionals and support interventions targeting the general public or specific groups (e.g., overweight people) in raising awareness of potential adverse health outcomes and, ultimately, contribute to reducing sugar intake.

The Impact of Free Sugar on Human Health—A Narrative Review

Type of study: literature review

Number of citations: 57

Year: 2023

Authors: Kerri M. Gillespie, E. Kemps, M. White, S. Bartlett

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Excessive added sugar consumption negatively impacts human health and wellbeing, with specific carbohydrate classes and sources influencing the impact on obesity, diabetes, cardiovascular diseases, cognition, and mood.

Abstract: The importance of nutrition in human health has been understood for over a century. However, debate is ongoing regarding the role of added and free sugars in physiological and neurological health. In this narrative review, we have addressed several key issues around this debate and the major health conditions previously associated with sugar. We aim to determine the current evidence regarding the role of free sugars in human health, specifically obesity, diabetes, cardiovascular diseases, cognition, and mood. We also present some predominant theories on mechanisms of action. The findings suggest a negative effect of excessive added sugar consumption on human health and wellbeing. Specific class and source of carbohydrate appears to greatly influence the impact of these macronutrients on health. Further research into individual effects of carbohydrate forms in diverse populations is needed to understand the complex relationship between sugar and health.

The sweet danger of added sugars.

Type of study:

Number of citations: 45

Year: 2019

Authors: L. Paglia

Journal: European journal of paediatric dentistry

Journal ranking: Q1

Key takeaways: Excessive sugar consumption is linked to increased risk of caries, obesity, cardiovascular disease, and sleep-disordered breathing, and may contribute to ADHD.

Abstract: Dietary behaviour is determined by community, family and individual factors, including availability and costs of foods. Preference for sweetness starts early in life and remains throughout childhood, and starts declining to adult levels only during mid-adolescence. This explains why children are at high risk of sugar overconsumption. The empty calories of added sugar hinder the proper growth and development, due to the lack of nutrients. The relationship between added sugar consumption and possibile negative health consequences is controversial. For added sugars we mean all those sugars added to food or drinks, or present naturally in unsweetened fruit juices, honey or syrups. It does not include natural sugar found in vegetables, fruits and milk. Some investigators claim that excessive sugar consumption is associated with increased risk of caries [Paglia et al., 2016], obesity [Costacurta et al., 2014], cardiovascular disease (CVD) [Vos et al., 2017], type-2 diabetes mellitus (T2DM), metabolic syndrome, nonalcoholic fatty liver disease (NAFLD). In addition, obesity is the primary risk factor for the development of SDB (sleep-disordered breathing). Inadeguate sleep duration and quality in children and adolescents is associated with an increase in body weight and adiposity, decreased insulin sensitivity, hyperglycemia, and prevalent cardiometabolic risk factors. Finally, the interest in attention deficit and hyperactivity disorder (ADHD) during childhood has recently increased. Some researchers are looking for a link between high sugar consumption over a long period and ADHD [Del-Ponte et al., 2019]. These statements have influenced organisations such as the American Hearth Association (AHA), the American Academy of Pediatrics (AAP) and the World Health Organization (WHO), who recommend to limit free sugars intake to less than 10% of the total energy intake for adults and children, observing that a further reduction of 5% would provide additional health benefits [WHO, 2015]. The first few months of life are crucial for the flavour learning process in humans. Early experience with different tastes is very important for later acceptance of foods, especially the healthy ones. Clinicians and parents can and should support in synergy the healthy development of children's taste preference and eating behaviour.

Sugars and Gastrointestinal Health.

Type of study:

Number of citations: 37

Year: 2021

Authors: Djésia Arnone, Caroline Chabot, A. Heba, T. Kökten, B. Caron, F. Hansmannel, Natacha Dreumont, A. Ananthakrishnan, D. Quilliot, L. Peyrin-Biroulet

Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

Journal ranking: Q1

Key takeaways: Excessive sugar intake can disrupt intestinal homeostasis, leading to increased infection susceptibility and contributing to noncommunicable diseases like diabetes and cardiovascular diseases.

Fructose and Non-Alcoholic Steatohepatitis

Type of study: systematic review

Number of citations: 50

Year: 2021

Authors: E. Roeb, R. Weiskirchen

Journal: Frontiers in Pharmacology

Journal ranking: Q1

Key takeaways: Excessive fructose consumption is associated with negative health consequences, including weight gain, negative effects on fat and carbohydrate metabolism, and non-alcoholic steatohepatitis.

Abstract: Background: The excessive consumption of free sugars is mainly responsible for the high prevalence of obesity and metabolic syndrome in industrialized countries. More and more studies indicate that fructose is involved in the pathophysiology and also in the degree of disease of non-alcoholic fatty liver disease (NAFLD). In epidemiologic studies, energy-adjusted higher fructose consumption correlates with NAFLD in overweight adults. In addition to glucose, fructose, as an equivalent component of conventional household sugar, appears to have negative metabolic effects in particular due to its exclusive hepatic metabolism. Liver-related mortality is strictly associated with the degree of fibrosis, whereas the most common cause of death in patients suffering from NAFLD and non-alcoholic steatohepatitis (NASH) are still cardiovascular diseases. In this review article, we have summarized the current state of knowledge regarding a relationship between fructose consumption, liver fibrosis and life expectancy in NASH. Method: Selective literature search in PubMed using the keywords ‘non-alcoholic fatty liver’, ‘fructose’, and ‘fibrosis’ was conducted. Results: The rate of overweight and obesity is significantly higher in both, adult and pediatric NASH patients. The consumption of free sugars is currently three times the maximum recommended amount of 10% of the energy intake. The current literature shows weight gain, negative effects on fat and carbohydrate metabolism and NASH with hypercaloric intake of fructose. Conclusions: Excessive fructose consumption is associated with negative health consequences. Whether this is due to an excess of energy or the particular metabolism of fructose remains open with the current study situation. The urgently needed reduction in sugar consumption could be achieved through a combination of binding nutritional policy measures including taxation of sugary soft drinks. Previous studies suggest that diet-related fructose intake exceeding the amount contained in vegetables and fruits lead to an increase of hepatic lipogenesis. Thus, further studies to clarify the protective contribution of low-fructose intake to positively influence NAFLD in industrial population are urgently required.

Dietary Fructose and the Metabolic Syndrome

Type of study: literature review

Number of citations: 168

Year: 2019

Authors: M. Taskinen, C. Packard, J. Borén

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Excessive fructose consumption is linked to health risk markers and the development of components of the Metabolic Syndrome, potentially contributing to type 2 diabetes and cardiovascular diseases.

Abstract: Consumption of fructose, the sweetest of all naturally occurring carbohydrates, has increased dramatically in the last 40 years and is today commonly used commercially in soft drinks, juice, and baked goods. These products comprise a large proportion of the modern diet, in particular in children, adolescents, and young adults. A large body of evidence associate consumption of fructose and other sugar-sweetened beverages with insulin resistance, intrahepatic lipid accumulation, and hypertriglyceridemia. In the long term, these risk factors may contribute to the development of type 2 diabetes and cardiovascular diseases. Fructose is absorbed in the small intestine and metabolized in the liver where it stimulates fructolysis, glycolysis, lipogenesis, and glucose production. This may result in hypertriglyceridemia and fatty liver. Therefore, understanding the mechanisms underlying intestinal and hepatic fructose metabolism is important. Here we review recent evidence linking excessive fructose consumption to health risk markers and development of components of the Metabolic Syndrome.

Sugars, obesity, and cardiovascular disease: results from recent randomized control trials

Type of study: systematic review

Number of citations: 78

Year: 2016

Authors: J. Rippe, T. Angelopoulos

Journal: European Journal of Nutrition

Journal ranking: Q1

Key takeaways: Normal sugar consumption in the human diet does not show a link to adverse metabolic and health-related effects.

Abstract: The relationship between sugar consumption and various health-related sequelas is controversial. Some investigators have argued that excessive sugar consumption is associated with increased risk of obesity, coronary heart disease, diabetes (T2D), metabolic syndrome, non-alcoholic fatty liver disease, and stimulation of reward pathways in the brain potentially causing excessive caloric consumption. These concerns have influenced organizations such as the World Health Organization, the Scientific Advisory Committee on Nutrition in England not to exceed 5 % of total energy and the Dietary Guidelines for Americans Advisory Committee 2015 to recommend upper limits of sugar consumption not to exceed 10 % of calories. Data from many randomized control trials (RCTs) do not support linkages between sugar consumption at normal levels within the human diet and various adverse metabolic and health-related effects. Fructose and glucose are typically consumed together in roughly equal proportions from high-fructose corn syrup (also known as isoglucose in Europe) or sucrose. The purpose of this review is to present data from recent RCTs and findings from recent systematic reviews and meta-analyses related to sugar consumption and its putative health effects. This review evaluates findings from recent randomized controlled trials, systematic reviews and meta-analyses into the relationship of sugar consumption and a range of health-related issues including energy-regulating hormones, obesity, cardiovascular disease, diabetes, and accumulation of liver fat and neurologic responses. Data from these sources do not support linkages between sugar consumption at normal levels within the human diet and various adverse metabolic and health-related effects.

Intestinal Fructose and Glucose Metabolism in Health and Disease

Type of study:

Number of citations: 94

Year: 2019

Authors: B. Merino, Cristina M. Fernández-Díaz, I. Cózar-Castellano, Germán Perdomo

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Excessive sugar consumption is linked to metabolic diseases and insulin resistance, affecting gut-brain axis function and affecting glucose homeostasis in health and disease.

Abstract: The worldwide epidemics of obesity and diabetes have been linked to increased sugar consumption in humans. Here, we review fructose and glucose metabolism, as well as potential molecular mechanisms by which excessive sugar consumption is associated to metabolic diseases and insulin resistance in humans. To this end, we focus on understanding molecular and cellular mechanisms of fructose and glucose transport and sensing in the intestine, the intracellular signaling effects of dietary sugar metabolism, and its impact on glucose homeostasis in health and disease. Finally, the peripheral and central effects of dietary sugars on the gut–brain axis will be reviewed.

Dietary Sugars and Endogenous Formation of Advanced Glycation Endproducts: Emerging Mechanisms of Disease

Type of study:

Number of citations: 181

Year: 2017

Authors: M. Aragno, R. Mastrocola

Journal: Nutrients

Journal ranking: Q1

Key takeaways: High dietary sugar intake, particularly fructose, can contribute to the development of metabolic diseases and organ damage, emphasizing the need to limit sugar-added foods and sweetened beverages to prevent these diseases.

Abstract: The rapid increase in metabolic diseases, which occurred in the last three decades in both industrialized and developing countries, has been related to the rise in sugar-added foods and sweetened beverages consumption. An emerging topic in the pathogenesis of metabolic diseases related to modern nutrition is the role of Advanced Glycation Endproducts (AGEs). AGEs can be ingested with high temperature processed foods, but also endogenously formed as a consequence of a high dietary sugar intake. Animal models of high sugar consumption, in particular fructose, have reported AGE accumulation in different tissues in association with peripheral insulin resistance and lipid metabolism alterations. The in vitro observation that fructose is one of the most rapid and effective glycating agents when compared to other sugars has prompted the investigation of the in vivo fructose-induced glycation. In particular, the widespread employment of fructose as sweetener has been ascribed by many experimental and observational studies for the enhancement of lipogenesis and intracellular lipid deposition. Indeed, diet-derived AGEs have been demonstrated to interfere with many cell functions such as lipid synthesis, inflammation, antioxidant defences, and mitochondrial metabolism. Moreover, emerging evidence also in humans suggest that this impact of dietary AGEs on different signalling pathways can contribute to the onset of organ damage in liver, skeletal and cardiac muscle, and the brain, affecting not only metabolic control, but global health. Indeed, the most recent reports on the effects of high sugar consumption and diet-derived AGEs on human health reviewed here suggest the need to limit the dietary sources of AGEs, including added sugars, to prevent the development of metabolic diseases and related comorbidities.

Sugar-Sweetened Beverages and Metabolic Risk in Children and Adolescents with Obesity: A Narrative Review

Type of study: literature review

Number of citations: 52

Year: 2023

Authors: V. Calcaterra, H. Cena, V. C. Magenes, A. Vincenti, Giulia Comola, A. Beretta, I. Di Napoli, G. Zuccotti

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Limiting sugar-sweetened beverage consumption in children and adolescents can help prevent obesity and related metabolic risks.

Abstract: Sugar-sweetened beverages (SSBs) are major contributors of free sugars to the diet. A strong relationship between SSB intake and weight gain is described. Methods: we performed a narrative review to present an overview of the role of SSBs as a pivotal contributor in the development of obesity and metabolism-related complications. Results: different factors influence SSB consumption in children, including economic variables, individual attributes and behaviors to environmental factors, parent features and parents’ behaviors. Data suggest that SSB intake has a negative effect on weight and obesity-related diseases. The leading mechanism linking SSB intake to the risk of gaining weight is decreased satiety and incomplete compensatory reduction in energy intake at meals following ingestion of liquid calories. Additionally, the effects of SSBs on gut microbiota and on eating behaviors were also reported. An association between SSB intake, weight gain and cardiometabolic risks is evident. Consumption of SSBs had a significant impact on the prevalence of obesity and related metabolic risks, including insulin resistance, type 2 diabetes, hypertension and metabolic syndrome. Conclusions: Limiting consumption of SSBs and increasing knowledge of the effect of SSBs on early metabolic and cardiovascular disorders will be useful in developing strategies to counteract the problem and to prevent obesity and related complications.Key future research areas for which further studies are needed include investigating the long-term effects of SSBs on health outcomes as well as analyzing the health effects of sugar consumed in solid compared to liquid forms and further elucidating the biological mechanisms of sugar addiction and energy compensation.

mTOR is a Key Protein Involved in the Metabolic Effects of Simple Sugars

Type of study: literature review

Number of citations: 40

Year: 2019

Authors: Gemma Sangüesa, N. Roglans, Miguel Baena, A. Velázquez, J. Laguna, M. Alegret

Journal: International Journal of Molecular Sciences

Journal ranking: Q1

Key takeaways: Excessive consumption of simple sugars activates mTOR, leading to metabolic effects such as obesity, type 2 diabetes, and non-alcoholic fatty liver disease.

Abstract: One of the most important threats to global human health is the increasing incidences of metabolic pathologies (including obesity, type 2 diabetes and non-alcoholic fatty liver disease), which is paralleled by increasing consumptions of hypercaloric diets enriched in simple sugars. The challenge is to identify the metabolic pathways affected by the excessive consumption of these dietary components when they are consumed in excess, to unravel the molecular mechanisms leading to metabolic pathologies and identify novel therapeutic targets to manage them. Mechanistic (mammalian) target of rapamycin (mTOR) has emerged as one of the key molecular nodes that integrate extracellular signals, such as energy status and nutrient availability, to trigger cell responses that could lead to the above-mentioned diseases through the regulation of lipid and glucose metabolism. By activating mTOR signalling, excessive consumption of simple sugars (such as fructose and glucose), could modulate hepatic gluconeogenesis, lipogenesis and fatty acid uptake and catabolism and thus lipid deposition in the liver. In the present review we will discuss some of the most recent studies showing the central role of mTOR in the metabolic effects of excessive simple sugar consumption.

Fructose- and sucrose- but not glucose-sweetened beverages promote hepatic de novo lipogenesis: A randomized controlled trial.

Type of study: rct

Number of citations: 133

Year: 2021

Authors: Bettina Geidl-Flueck, M. Hochuli, Ágota Németh, A. Eberl, Nina Derron, H. Köfeler, L. Tappy, K. Berneis, G. Spinas, P. Gerber

Journal: Journal of hepatology

Journal ranking: Q1

Key takeaways: Moderate consumption of fructose- and sucrose-sweetened beverages, but not glucose, increases hepatic lipid synthesis, potentially promoting long-term metabolic health issues.

Long-term metabolic effects of non-nutritive sweeteners

Type of study: non-rct experimental

Number of citations: 8

Year: 2024

Authors: Moran Rathaus, Loziana Azem, Rinat Livne, Sophie Ron, I. Ron, R. Hadar, G. Efroni, A. Amir, T. Braun, Yael Haberman, Amir Tirosh

Journal: Molecular Metabolism

Journal ranking: Q1

Key takeaways: Long-term consumption of commonly used non-nutritive sweeteners does not cause adverse metabolic effects, with Reb M showing a mild improvement in metabolic abnormalities.

Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes

Type of study: meta-analysis

Number of citations: 1286

Year: 2010

Authors: Vasanti S. Malik, B. Popkin, G. Bray, J. Despres, W. Willett, F. Hu

Journal: Diabetes Care

Journal ranking: Q1

Key takeaways: Higher consumption of sugar-sweetened beverages is associated with an increased risk of developing metabolic syndrome and type 2 diabetes, in addition to weight gain.

Abstract: OBJECTIVE Consumption of sugar-sweetened beverages (SSBs), which include soft drinks, fruit drinks, iced tea, and energy and vitamin water drinks has risen across the globe. Regular consumption of SSBs has been associated with weight gain and risk of overweight and obesity, but the role of SSBs in the development of related chronic metabolic diseases, such as metabolic syndrome and type 2 diabetes, has not been quantitatively reviewed. RESEARCH DESIGN AND METHODS We searched the MEDLINE database up to May 2010 for prospective cohort studies of SSB intake and risk of metabolic syndrome and type 2 diabetes. We identified 11 studies (three for metabolic syndrome and eight for type 2 diabetes) for inclusion in a random-effects meta-analysis comparing SSB intake in the highest to lowest quantiles in relation to risk of metabolic syndrome and type 2 diabetes. RESULTS Based on data from these studies, including 310,819 participants and 15,043 cases of type 2 diabetes, individuals in the highest quantile of SSB intake (most often 1–2 servings/day) had a 26% greater risk of developing type 2 diabetes than those in the lowest quantile (none or <1 serving/month) (relative risk [RR] 1.26 [95% CI 1.12–1.41]). Among studies evaluating metabolic syndrome, including 19,431 participants and 5,803 cases, the pooled RR was 1.20 [1.02–1.42]. CONCLUSIONS In addition to weight gain, higher consumption of SSBs is associated with development of metabolic syndrome and type 2 diabetes. These data provide empirical evidence that intake of SSBs should be limited to reduce obesity-related risk of chronic metabolic diseases.

Excessive Sugar Consumption May Be a Difficult Habit to Break: A View From the Brain and Body.

Type of study:

Number of citations: 120

Year: 2015

Authors: M. Tryon, K. Stanhope, E. Epel, Ashley E. Mason, Rashida R. Brown, V. Medici, P. Havel, K. Laugero

Journal: The Journal of clinical endocrinology and metabolism

Journal ranking: Q1

Key takeaways: Excessive sugar consumption may reinforce a negative feedback pathway in the brain, potentially making some individuals under stress more vulnerable to obesity and related conditions.

Abstract: CONTEXT Sugar overconsumption and chronic stress are growing health concerns because they both may increase the risk for obesity and its related diseases. Rodent studies suggest that sugar consumption may activate a glucocorticoid-metabolic-brain-negative feedback pathway, which may turn off the stress response and thereby reinforce habitual sugar overconsumption. OBJECTIVE The objective of the study was to test our hypothesized glucocorticoid-metabolic-brain model in women consuming beverages sweetened with either aspartame of sucrose. DESIGN This was a parallel-arm, double-masked diet intervention study. SETTING The study was conducted at the University of California, Davis, Clinical and Translational Science Center's Clinical Research Center and the University of California, Davis, Medical Center Imaging Research Center. PARTICIPANTS Nineteen women (age range 18-40 y) with a body mass index (range 20-34 kg/m(2)) who were a subgroup from a National Institutes of Health-funded investigation of 188 participants assigned to eight experimental groups. INTERVENTION The intervention consisted of sucrose- or aspartame-sweetened beverage consumption three times per day for 2 weeks. MAIN OUTCOME MEASURES Salivary cortisol and regional brain responses to the Montreal Imaging Stress Task were measured. RESULTS Compared with aspartame, sucrose consumption was associated with significantly higher activity in the left hippocampus (P = .001). Sucrose, but not aspartame, consumption associated with reduced (P = .024) stress-induced cortisol. The sucrose group also had a lower reactivity to naltrexone, significantly (P = .041) lower nausea, and a trend (P = .080) toward lower cortisol. CONCLUSION These experimental findings support a metabolic-brain-negative feedback pathway that is affected by sugar and may make some people under stress more hooked on sugar and possibly more vulnerable to obesity and its related conditions.

Association between Sugar-Sweetened Beverage Consumption and the Risk of the Metabolic Syndrome: A Systematic Review and Meta-Analysis

Type of study: meta-analysis

Number of citations: 16

Year: 2023

Authors: A. Muñoz-Cabrejas, P. Guallar-Castillón, M. Laclaustra, H. Sandoval-Insausti, B. Moreno-Franco

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Consumption of sugar-sweetened beverages is positively associated with an increased risk of metabolic syndrome.

Abstract: (1) Background: The increasing occurrence of the metabolic syndrome (MetS) is largely related to harmful food habits. Among them, the consumption of sugar-sweetened beverages (SSBs) is noteworthy. However, to our knowledge, there are not enough high-quality methodological studies summarizing the association between the intake of SSBs and the MetS. Therefore, the aim of this study is to examine the existing published results on this association among adults by synthesizing the existing evidence. (2) Methods: Systematic review and meta-analysis of observational studies following the PRISMA guidelines. Relevant information was extracted and presented following the PRISMA recommendations. PubMed and SCOPUS databases were searched for studies published until June 2022 that assessed the association between SSB consumption (including soft drinks, bottled fruit juices, energy drinks, and milkshakes) and the occurrence of MetS. Random effect models were used to estimate pooled odds ratios (ORs) with their 95% coefficient interval, and I2 was used to assess heterogeneity. (3) Results: A total of 14 publications from 6 different countries were included in this meta-analysis (9 cross-sectional and 5 cohort studies). For the cross-sectional studies, which included 62,693 adults, the pooled OR for the risk of MetS was 1.35 (95% CI 1.15, 1.58; I2 57%) when the highest versus the lowest categories of SSB consumption were compared. For the cohort studies, which included 28,932 adults, the pooled OR was 1.18 (95% CI 1.06, 1.32; I2 70%). (4) Conclusions: The consumption of SSBs was positively associated with an increased risk of MetS. The published literature supports public health strategies and the need to reduce the consumption of SSBs to prevent MetS.

Understanding the Link between Sugar and Cancer: An Examination of the Preclinical and Clinical Evidence

Type of study: literature review

Number of citations: 30

Year: 2022

Authors: Margeaux Epner, Peiying Yang, R. Wagner, L. Cohen

Journal: Cancers

Journal ranking: Q1

Key takeaways: Excess sugar consumption can lead to cancer development and progression, independent of the association with obesity, and may activate inflammation, glucose, and lipid metabolic pathways.

Abstract: Simple Summary The average consumption of sugar in the US is significantly higher than the World Health Organization’s, the American Cancer Society’s, and the American Heart Association’s recommendations for daily sugar consumption. This review summarizes the research on the link between added sugar and cancer and the plausible mechanisms for a causal association. Evidence from epidemiologic and preclinical studies demonstrates that excess sugar consumption can lead to development of cancer and progression of disease for those with cancer independent of the association between sugar and obesity. The mechanistic preclinical studies in multiple cancers show that high-sucrose or high-fructose diets activate several mechanistic pathways, including inflammation, glucose, and lipid metabolic pathways. Abstract Per capita sugar consumption has increased in the United States to over 45 kg per year. The average person in the US currently consumes significantly more added sugar in their diet than the World Health Organization’s, the American Cancer Society’s, and the American Heart Association’s recommendations for daily sugar consumption. Evidence from epidemiologic and preclinical studies demonstrates that excess sugar consumption can lead to development of cancer and progression of disease for those with cancer independent of the association between sugar and obesity. Human epidemiologic studies and mechanistic preclinical studies in multiple cancers support a causal link between excess sugar and cancer. Preclinical studies show that high-sucrose or high-fructose diets activate several mechanistic pathways, including inflammation, glucose, and lipid metabolic pathways. Although human studies are limited, compelling human and primate studies have explored the link between added sugar and metabolic syndrome (MetS), a risk factor for cancer. Substantial evidence suggests a causal link between MetS and added sugar, indicating important implications in the association between excess sugar consumption and cancer. Human clinical trials are needed to determine whether sugar increases cancer development and progression independently of its established role in causing obesity as well as for further exploration of the mechanisms involved.

Impact of Dietary Sugars on Gut Microbiota and Metabolic Health

Type of study:

Number of citations: 26

Year: 2022

Authors: Karina Garcia, Gonçalo Ferreira, F. Reis, S. Viana

Journal: Diabetology

Journal ranking: Q2

Key takeaways: Excessive sugar consumption, including nutritive and non-nutritive sweeteners, may negatively impact gut microbiota balance and metabolic health, leading to various disorders.

Abstract: Excessive sugar consumption is a risk factor for the development of several disorders, including metabolic, cardiovascular, neurological conditions and even some cancers, and has been linked to increased morbidity and mortality. The popularization of the typical Western diet, featured by an excessive intake of saturated fats and added sugars and a low consumption of unprocessed fruits, vegetables and fiber, may directly affect the composition and functionality of the gut microbiota, staggering the balance of the intestinal microbiome that ultimately culminates into gut dysbiosis. Although added sugars in the form of nutritive and non-nutritive sweeteners are generally considered as safe, a growing body of evidence correlate their consumption with adverse effects on gut microbial ecosystem; namely an abnormal synthesis of short-chain fatty acids, altered intestinal barrier integrity and chronic inflammation that often fuel a panoply of metabolic conditions. Accordingly, this work revisited the available preclinical evidence concerning the impact of different types of dietary sugars—nutritive and non-nutritive sweeteners—on gut microbiota and metabolic health. Future research should consider gender and species vulnerability when the impact of such substances on GM community and metabolic health is scrutinized in order to guide their adequate use at doses relevant to human use.

Impact of sugar on the body, brain, and behavior.

Type of study: literature review

Number of citations: 103

Year: 2018

Authors: Clara R Freeman, Amna Zehra, Veronica Ramirez, C. Wiers, N. Volkow, Gene-Jack Wang

Journal: Frontiers in bioscience

Journal ranking: Q2

Key takeaways: Excessive sugar consumption can trigger neuroadaptations in the reward system, leading to compulsive overeating and poor health outcomes, such as obesity, metabolic syndrome, and inflammatory diseases.

Abstract: Sugar is highly palatable and rewarding, both in its taste and nutritive input. Excessive sugar consumption, however, may trigger neuroadaptations in the reward system that decouple eating behavior from caloric needs and leads to compulsive overeating. Excessive sugar intake is in turn associated with adverse health conditions, including obesity, metabolic syndrome, and inflammatory diseases. This review aims to use recent evidence to connect sugar's impact on the body, brain, and behavior to elucidate how and why sugar consumption has been implicated in addictive behaviors and poor health outcomes.

Impact of dietary sucrose on adiposity and glucose homeostasis in C57BL/6J mice depends on mode of ingestion: liquid or solid

Type of study: non-rct experimental

Number of citations: 68

Year: 2019

Authors: J. Togo, Sumei Hu, Min Li, Chaoqun Niu, J. Speakman

Journal: Molecular Metabolism

Journal ranking: Q1

Key takeaways: Consumption of sucrose-sweetened water contributes to body fat gain in mice, while solid sucrose does not, suggesting liquid sucrose may contribute to dysregulation of body weight and related metabolic syndromes.

Sugar, non-nutritive sweetener intake and obesity risk in college students

Type of study: non-rct observational study

Number of citations: 7

Year: 2021

Authors: P. Tapanee, N. Reeder, Rebecca Christensen, Terezie Tolar-Peterson

Journal: Journal of American College Health

Journal ranking: Q2

Key takeaways: Excessive sugar and saccharin consumption is associated with higher body fat percentage in young adults.

Abstract: Abstract Objective The purpose of this study was to investigate the association between sugar and NNS consumption with body fat percentage in young adults. Methods 524 college students were asked to complete the Web-based National Institutes of Health (NIH) Diet History Questionnaire II and had their body fat percentage measured using a bioelectrical impedance analysis scale. Result One-fourth of the participants were classified as overfat/obese and of those overfat or obese, 49% of them were African American. Overfat/obese participants consumed significantly more sugar than the heathy group and the underfat group (p < 0.001). Saccharin consumption was significantly higher in the overfat/obese group compare to the underfat and normal groups (p < 0.001). The odds of becoming overfat/obese increased 1.2 times for excessive total sugar consumption (95% CI: 1.0-1.8, p < 0.05). Conclusion Excessive sugar and saccharin consumption were associated with higher body fat percentage in young adults.

How Gender-Targeted Body Image Concerns Influence People’s Sugar-Sweetened Beverages Consumption

Type of study: non-rct experimental

Number of citations: 2

Year: 2023

Authors: Sining Kong

Journal: Health Communication

Journal ranking: Q1

Key takeaways: Gender-differed body image concerns significantly influence people's attitudes and intentions towards sugar-sweetened beverages, with males more affected by muscle mass loss and females more affected by female appearance changes.

Abstract: ABSTRACT As excessive sugar intake can result in obesity, type 2 diabetes, cardiovascular disease, and even cancer, this study aims to help people reduce sugar-sweetened beverages (SSBs) intake by exploring how gender-differed body image concerns influence people’s attitude and intention of SSBs consumption. A 2 (Participants’ gender: Male vs. Female) × 2 (Image gender: Male vs. Female) × 2 (Body image concern: Gaining weight vs. Losing muscle mass) online experiment was conducted to examine how the gender-differed body image concerns influence people’s perception of SSBs. The findings showed that gender-differed body image concerns exerted a significant influence across genders. Muscle mass loss-related information is more effective in generating negative attitude toward SSBs from males. Female image-related physical appearance change is more effective in generating negative attitude toward SSBs from females. This study also contributes to targeted communication by revealing that the quality-oriented targeted information outperformed the traditional quantity-oriented targeted information. Furthermore, this study complements EPPM by discovering the underlying mechanisms of female-targeted body image concern, such as perceived severity and response efficacy.

Sugars and non-transmissible diseases

Type of study: systematic review

Number of citations: 1

Year: 2022

Authors: Chirlici Alexei, Rubanovici Vladislav, Cebanu Serghei, Rimis Constantin, Curteanu Ala

Journal: One Health &amp; Risk Management

Journal ranking: brak

Key takeaways: Excessive sugar consumption contributes to various non-communicable diseases, such as circulatory system diseases, type 2 diabetes, and obesity, and is a major cause of tooth decay.

Abstract: Introduction. Sugar consumed in reasonable quantities plays a beneficial role for the human body. In recent decades, however, it has been found that increased sugar consumption has negative effects on the health of the population. Material and methods. The paper presents a synthesis of official international and national documents and bibliographic sources on the occurrence of certain non-communicable diseases (NCDs) as a result of excessive sugar consumption. A focused search of literature sources was conducted using the Google Scholar search engine, PubMed, Research for Life, and Medline databases. The criteria for selecting the items included health problems caused by excessive sugar consumption. Results. Excessive sugar consumption contributes to the emergence of various NBTs such as circulatory system diseases, type 2 diabetes and a. Excessive sugar consumption has a major contribution to the phenomenon of overweight and obesity with its consequences. Excess sugar in the daily diet is one of the main causes of tooth decay. According to WHO recommendations, complex, multi-sectoral interventions are needed to reduce sugar consumption. Conclusions. In order to prevent NCDs associated with the nutritional factor, especially with excessive sugar consumption, in the Republic of Moldova, it is important to implement cost-effective interventions both socially and economically.

Effects of Consuming Beverages Sweetened with Fructose, Glucose, High-Fructose Corn Syrup, Sucrose, or Aspartame on OGTT-Derived Indices of Insulin Sensitivity in Young Adults

Type of study: non-rct experimental

Number of citations: 5

Year: 2024

Authors: B. Hieronimus, Valentina Medici, Vivien Lee, Marinelle V. Nuñez, Desiree M. Sigala, Andrew A. Bremer, C. L. Cox, N. Keim, Jean-Marc Schwarz, Giovanni Pacini, Andrea Tura, Peter J Havel, K. Stanhope

Journal: Nutrients

Journal ranking: Q1

Key takeaways: Consuming sugar-sweetened beverages negatively affects hepatic insulin sensitivity, while glucose has more negative effects on muscle insulin sensitivity in young adults.

Abstract: (1) Background: Clinical results on the effects of excess sugar consumption on insulin sensitivity are conflicting, possibly due to differences in sugar type and the insulin sensitivity index (ISI) assessed. Therefore, we compared the effects of consuming four different sugars on insulin sensitivity indices derived from oral glucose tolerance tests (OGTT). (2) Methods: Young adults consumed fructose-, glucose-, high-fructose corn syrup (HFCS)-, sucrose-, or aspartame-sweetened beverages (SB) for 2 weeks. Participants underwent OGTT before and at the end of the intervention. Fasting glucose and insulin, Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), glucose and insulin area under the curve, Surrogate Hepatic Insulin Resistance Index, Matsuda ISI, Predicted M ISI, and Stumvoll Index were assessed. Outcomes were analyzed to determine: (1) effects of the five SB; (2) effects of the proportions of fructose and glucose in all SB. (3) Results: Fructose-SB and the fructose component in mixed sugars negatively affected outcomes that assess hepatic insulin sensitivity, while glucose did not. The effects of glucose-SB and the glucose component in mixed sugar on muscle insulin sensitivity were more negative than those of fructose. (4) Conclusion: the effects of consuming sugar-SB on insulin sensitivity varied depending on type of sugar and ISI index because outcomes assessing hepatic insulin sensitivity were negatively affected by fructose, and outcomes assessing muscle insulin sensitivity were more negatively affected by glucose.