Epidemiology of sugar in the development of disease and population health (#58)
The suggestion that sugar might have adverse health effects has been a recurring theme for decades, but recent interest has centred around the extent to which sugars might increase the risk of obesity, the metabolic syndrome and diabetes. Inadequate study design, differences in assessing dietary intake, inconsistent findings and varying definitions of ‘sugars’ have precluded definitive conclusions. Published meta-analyses have reported inconsistent associations between sugars and obesity or other cardiometabolic risk factors. Our recent meta-analyses confirm that voluntary restriction of intake of free sugars leads to weight loss even when substitution with other carbohydrates is permitted. Conversely we showed that increased sugars intakes, particularly from increased beverages consumption, leads to weight gain. Strict isoenergetic exchange of sugars with other carbohydrates, however, was not associated with weight change, suggesting that consumption of sugars may be associated with energy imbalance rather than that they have some unique obesogenic properties. A systematic review and meta-analyses undertaken subsequently, has also shown that free sugars intakes are associated with modest increases blood lipids and blood pressure. However in this review the effects appear to be independent of effects on energy intake and body weight change. Given these apparent contributions to weight gain and cardiometabolic risk in free living individuals it seems reasonable to conclude that advice relating to sugars intake is a relevant component of a strategy to reduce the high risk of overweight and obesity in most countries.