Relationship between Added Sugars Consumption and Chronic Disease Risk Factors: Current Understanding

Abstract

Added sugars are a controversial and hotly debated topic. Consumption of added sugars has been implicated in increased risk of a variety of chronic diseases including obesity, cardiovascular disease, diabetes and non-alcoholic fatty liver disease (NAFLD) as well as cognitive decline and even some cancers. Support for these putative associations has been challenged, however, on a variety of fronts. The purpose of the current review is to summarize high impact evidence including systematic reviews, meta-analyses, and randomized controlled trials (RCTs), in an attempt to provide an overview of current evidence related to added sugars and health considerations. This paper is an extension of a symposium held at the Experimental Biology 2015 conference entitled “Sweeteners and Health: Current Understandings, Controversies, Recent Research Findings and Directions for Future Research”. We conclude based on high quality evidence from randomized controlled trials (RCT), systematic reviews and meta-analyses of cohort studies that singling out added sugars as unique culprits for metabolically based diseases such as obesity, diabetes and cardiovascular disease appears inconsistent with modern, high quality evidence and is very unlikely to yield health benefits. While it is prudent to consume added sugars in moderation, the reduction of these components of the diet without other reductions of caloric sources seems unlikely to achieve any meaningful benefit.

Dietary Intake of Free Sugars is Associated with Disease Activity and Dyslipidemia in Systemic Lupus Erythematosus Patients

“…Similarly, using data from the National Health and Nutrition Examination Survey, Hert et al reported that the consumption of sugar-sweetened beverages was associated with the presence of biomarkers for chronic disease risk, independently of demographic and lifestyle factors [10]. Additionally, the consumption of added sugars has been associated with an increased risk of dyslipidaemia [13,28,29] and Welsh et al reported a statistically significant correlation between dietary added sugars and dyslipidaemia among US adults [28]. Interestingly, the lack of association between dietary proteins and fats support the significance of free sugars compared to other nutrients in the disease activity of SLE patients.…”

“…O'Connor et al reported that higher intakes of free sugar was positively linked to some inflammation markers in a population-based study of adults [12]. Similarly, the excessive consumption of free sugars has been implicated in the increased risk of various diseases characterised by the presence of chronic low-grade inflammation, including obesity, diabetes, and metabolic syndrome [13]. Nevertheless, the potential role of the consumption of free sugar in autoimmune diseases has not yet been examined.…”

Lactose, Maltose, and Sucrose in Health and Disease

“…There are loose links between cognitive decline and sugar intake, although there is a sense that cognition more broadly is associated with a healthy diet. [ 7,15,16 ] Ginieis et al., [ 17 ] however, have indicated that “neuro‐cognitive research has confirmed that glucose, as a main energy substrate for the brain, can momentarily benefit cognitive performances, particularly for memory functioning.” This is not surprising in that glucose (which may be derived from relevant disaccharides and starches of course) is the key source of energy for the brain. [ 9,13,18 ] The brain requires a constant drip‐feeding of glucose from the diet.…”

“…There appears to be a positive correlation between blood triglyceride (TG), very‐low‐density lipoprotein (VLDL), and low‐density lipoprotein (LDL) and sugar consumption (especially fructose), inversely with high‐density lipoprotein (HDL), as discussed elsewhere. [ 7,16,19,28–30 ] (See also the blood lipid discussion section above.) The blood lipid profile as a consequence of excess sugar consumption is thus a real risk factor and concern for the development of cardiovascular disease.…”

“…[ 35 ] reported that a “combined intake of fructose and glucose was associated with the risk of type 2 diabetes but no significant association was observed for intakes of sucrose, lactose, or maltose.” According to Rippe et al. [ 16 ] however, “…singling out added sugars as unique culprits for metabolically based diseases such as obesity, diabetes and cardiovascular disease appears inconsistent with modern, high quality evidence and is very unlikely to yield health benefits.” Janket et al. [ 36 ] indicated that “intake of sugars does not appear to play a deleterious role in primary prevention of type 2 diabetes.” Hence, the respective role of sugars versus (excess) calorie consumption in terms of type 2 diabetes development is, according to some groups, less clear cut than other groups’ report.…”