Sugars, obesity, and cardiovascular disease: results from recent randomized control trials
Eur J Nutr
Sugars, obesity, and cardiovascular disease: results from recent randomized control trials
James M. Rippe 0 1 2 3
Theodore J. Angelopoulos 0 1 2 3
0 Rippe Lifestyle Institute , 21 North Quinsigamond Avenue, Shrewsbury, MA 01545 , USA
1 Theodore J. Angelopoulos
2 Based on a presentation made at the 12th European Nutrition Conference FENS 2015, Nutrition and Health Throughout the Life Cycle-Science for the European Consumer as part of the session “Controversies about Sugar Consumption” first presented on October 21 , 2015
3 School of Health Sciences, Emory and Henry College , Emory, VA 24327 , USA
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, nonalcoholic 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 highfructose 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.
Sugars; High-fructose corn syrup; Sucrose; Obesity; Cardiovascular disease
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The world is in the midst of twin epidemics of obesity and
diabetes often lumped together as diabesity (T2D) [1–6]. It
has been estimated that there are over one billion individuals
worldwide who are currently obese [1]. This number is
anticipated to rise to 1.5 billion individuals by the year 2030 if
current trends continue [1]. In the USA, it has been estimated
that 33.8 % of adults, over 66 million individuals, are obese,
while an additional 74 million are overweight [7]. The
prevalence of obesity grew a shocking 40 % over the last 30 years
[8]. The obesity epidemic is truly global. In European
countries, obesity ranges from 20 to 30 % and is even higher in
Australia, South America, Middle-East, and Polynesia [1].
The International Diabetes Federation estimates that
there are over 300 million individuals currently living with
diabetes [5]. This number is predicted to double by the
year 2035 [6, 7]. Heart disease remains the leading cause
of mortality worldwide and accounts for over 37 % of all
mortality in the USA on an annual basis [9]. Non-alcoholic
fatty liver disease (NAFLD) now represents the leading
cause of liver failure and the need for liver transplantation
worldwide [10, 11]. Multiple studies have now showed that
these metabolic conditions are inter-related.
With these grim statistics in mind, it is not surprising
that investigators have looked at various aspects of
nutrition to delineate potential underlying associations and
causes and recommend possible ways of ameliorating these
inter-related metabolic conditions. Recent attention has
been focused on the consumption of sugars, in general, and
fructose containing sugars in particular [12, 13]. Some
epidemiologic studies have linked consumption of added
sugars to increased risk of weight gain and obesity [14–16],
increased risk factors for cardiovascular disease (CVD)
[17] including hypertension [18–20] and dyslipidemia [21,
22], and increased risk factors for diabetes [23–25].
Potential linkages between added sugars and various
diseases have not only public health implications, but also
impact on public policy. The World Health Organization
(WHO) has issued guidelines recommending that added
sugars should constitute no more than 5 % of overall
calorie consumption [26]. The Scientific Advisory
Committee on Nutrition in England (SACN) [27] has also
recommended an upper limit not to exceed 5 %, while the 2015
Dietary Guidelines Advisory Committee (2015 DGAC) in
the USA has recommended an upper limit not to exceed
10 % of calories [2 (...truncated)