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Eur J Nutr. 2016 Nov;55(Suppl 2):25-43. doi: 10.1007/s00394-016-1345-3. Epub 2016 Nov 30.

Controversies about sugars: results from systematic reviews and meta-analyses on obesity, cardiometabolic disease and diabetes.

Author information

1
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
2
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.
3
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. john.sievenpiper@utoronto.ca.
4
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada. john.sievenpiper@utoronto.ca.
5
Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada. john.sievenpiper@utoronto.ca.
6
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. john.sievenpiper@utoronto.ca.

Abstract

Fructose-containing sugars are a focus of attention as a public health target for their putative role in obesity and cardiometabolic disease including diabetes. The fructose moiety is singled out to be the primary driver for the harms of sugars due to its unique endocrine signal and pathophysiological role. However, this is only supported by ecological studies, animal models of overfeeding and select human intervention studies with supraphysiological doses or lack of control for energy. The highest level of evidence from systematic reviews and meta-analyses of controlled trials has not shown that fructose-containing sugars behave any differently from other forms of digestible carbohydrates. Fructose-containing sugars can only lead to weight gain and other unintended harms on cardiometabolic risk factors insofar as the excess calories they provide. Prospective cohort studies, which provide the strongest observational evidence, have shown an association between fructose-containing sugars and cardiometabolic risk including weight gain, cardiovascular disease outcomes and diabetes only when restricted to sugar-sweetened beverages and not for sugars from other sources. In fact, sugar-sweetened beverages are a marker of an unhealthy lifestyle and their drinkers consume more calories, exercise less, smoke more and have a poor dietary pattern. The potential for overconsumption of sugars in the form of sugary foods and drinks makes targeting sugars, as a source of excess calories, a prudent strategy. However, sugar content should not be the sole determinant of a healthy diet. There are many other factors in the diet-some providing excess calories while others provide beneficial nutrients. Rather than just focusing on one energy source, we should consider the whole diet for health benefits.

KEYWORDS:

Cardiovascular disease; Diabetes; Fructose; Obesity; Overweight; Review; Sugars

PMID:
27900447
PMCID:
PMC5174149
DOI:
10.1007/s00394-016-1345-3
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Compliance with ethical standardsConflict of interestJLS has received research support from the Canadian Institutes of health Research (CIHR), Canadian Diabetes Association (CDA), PSI Foundation, Calorie Control Council, Banting and Best Diabetes Centre (BBDC), American Society for Nutrition (ASN), Dr. Pepper Snapple Group (investigator initiated, unrestricted donation), INC International Nut and Dried Fruit Council, and The Tate and Lyle Nutritional Research Fund at the University of Toronto. He has received travel reimbursement, speaker fees, and/or honoraria from the Canadian Diabetes Association (CDA), Canadian Nutrition Society (CNS), University of Alabama at Birmingham, Abbott Laboratories, Canadian Sugar Institute, Dr. Pepper Snapple Group, The Coca-Cola Company, Dairy Farmers of Canada, Nutrition Foundation of Italy (NFI), C3 Collaborating for Health, WhiteWave Foods, Rippe Lifestyle, mdBriefcase, Alberta Milk, FoodMinds LLC, Memac Ogilvy & Mather LLC, PepsiCo, and Pulse Canada. He has ad hoc consulting arrangements with Winston & Strawn LLP, Perkins Coie LLP, and Tate & Lyle. He is a member of the European Fruit Juice Association Scientific Expert Panel. He is on the Clinical Practice Guidelines Expert Committees of the Canadian Diabetes Association (CDA), European Association for the study of Diabetes (EASD), and Canadian Cardiovascular Society (CCS), as well as an expert writing panel of the American Society for Nutrition (ASN).  He serves as an unpaid scientific advisor for the Food, Nutrition, and Safety Program (FNSP) and the Technical Committee on Carbohydrates of the International Life Science Institute (ILSI) North America. He is a member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the EASD, and Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His wife is an employee of Unilever Canada. TAK declares no conflicts of interest.

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