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Eur J Nutr. 2016 Nov;55(Suppl 2):17-23. doi: 10.1007/s00394-016-1340-8. Epub 2016 Nov 23.

A review of recent evidence relating to sugars, insulin resistance and diabetes.

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Queen's Medical Centre, School of Life Sciences, University of Nottingham Medical School, University of Nottingham, Clifton Boulevard, Nottingham, NG7 2UH, UK.


The potential impact on health of diets rich in free sugars, and particularly fructose, is of major concern. The focus of this review is the impact of these sugars on insulin resistance and obesity, and the associated risk of developing type 2 diabetes. Much of the concern is focussed on specific metabolic effects of fructose, which are argued to lead to increased fat deposition in the liver and skeletal muscle with subsequent insulin resistance and increased risk of diabetes. However, much of the evidence underpinning these arguments is based on animal studies involving very large intakes of the free sugars. Recent human studies, in the past 5 years, provide a rather different picture, with a clear dose response link between fructose intake and metabolic changes. In particular, the most marked effects are observed when a high sugars intake is accompanied by an excess energy intake. This does not mean that a high intake of free sugars does not have any detrimental impact on health, but rather that such an effect seems more likely to be a result of the high sugars intake increasing the chances of an excessive energy intake rather than it leading to a direct detrimental effect on metabolism.


Diabetes mellitus; Fructose; Glucose; HFCS; Insulin resistance; Sucrose; Sugars

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Conflict of interest statement

Ian Macdonald is a member of the UK Government Scientific Advisory Committee on Nutrition and Chaired its recent Carbohydrates and Health Working Group, Treasurer of the Federation of European Nutrition Societies, Treasurer of the World Obesity Federation, a member of the Mars Scientific Advisory Council, the Mars Europe Nutrition Advisory Board, Scientific Adviser to the Waltham Centre for Pet Nutrition and has a UK Government Research Grant (from Innovate UK) for a project which is led by Mars UK. He is also the Academic lead for the University of Nottingham’s strategic research partnership with Unilever, advises the Nestle Research Center on Nutrition and Health across the lifecycle, is on the Diet and Health Advisory Board of IKEA, and is co-chair of the Carbohydrates Task Force for ILSI Europe.

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