Reduce the intake of added sugar to 6 teaspoons a day to safeguard your health!!

A study by Huang Y et al., recently published in the “British Medical Journal”, highlighted the adverse health effects of higher intake of dietary sugar, particularly fructose-containing sugars, majorly related to cardiometabolic risks/diseases like weight gain, ectopic fat accumulation, obesity, and cardiovascular disease (CVD). Intake of free or added sugars should be reduced to <25 g/day (≈6 teaspoons/day) and sugar-sweetened beverages should be limited to <1 serving/week (≈200–355 mL/week) to reduce the adverse effects of sugars on health.

This study was an umbrella review of systematic reviews and meta-analyses of randomized controlled trials, cohort studies, case-control studies, or cross-sectional studies evaluating the effect of dietary sugar intake on any health outcomes in humans who did not have any acute or chronic diseases. It included 73 meta-analyses and 83 health outcomes from 8601 unique articles, including 74 unique outcomes in meta-analyses of observational studies and 9 unique outcomes in meta-analyses of randomized controlled trials. Risk ratio, odds ratio, weighted mean difference, or standardized mean difference with 95% confidence intervals were analyzed by random or fixed effects models, and heterogeneity and publication bias for each included meta-analysis were assessed. Strength of evidence was assessed by Grading of Recommendations, Assessment, Development and Evaluation (GRADE), and classification of evidence outcomes was done by evidence classification criteria. The results are summarized below.

1. Intake of dietary sugar had significantly harmful associations with endocrine/metabolic, cardiovascular (CV), cancer, and other health outcomes (Graphic A).
2. The highest intake of sugar-sweetened beverages was associated with increased body weight (Class IV evidence vs. their lowest intake; moderate-quality evidence), and intake of added sugars was associated with ectopic fatty accumulation compared to no intake of added sugars (Class IV evidence; As per moderate-quality evidence) (Graphic B).
3. A 4% higher risk of gout with each serving/week increment of sugar-sweetened beverage intake (Class III evidence; low-quality evidence), 17% higher risk of coronary heart disease (Class II evidence; low-quality evidence) and 4% higher risk of all-cause mortality (Class III evidence; low-quality evidence) with intake of each 250 mL/day increment of sugar-sweetened beverage, and 22% higher risk of pancreatic cancer (Class III evidence; low-quality evidence) with every 25 g/day increment of fructose (Graphic B).

4. Dietary sugar intake had negative association with following health outcomes:

• Endocrine and metabolic outcomes: Changes in body mass index in children, changes in body weight, changes in 1-year body weight, gout, high-density lipoprotein cholesterol, hyperuricemia, latent autoimmune diabetes in adults, low-density lipoprotein cholesterol, metabolic syndrome, obesity in children and adults, serum uric acid, type 2 diabetes, and liver and muscle fat accumulation
• CV outcomes: Coronary heart disease, CVD, CVD mortality, hypertension in children, adolescents, and adults, myocardial infarction, change in systolic blood pressure in children and adolescents, and stroke
• Risk of cancer: Higher risk of breast cancer, breast cancer mortality, hepatocellular carcinoma, prostate cancer, pancreatic cancer, overall cancer risk, and overall cancer mortality

Clinical implications

1. This is the first study to report a comprehensive summary of current evidence for association between intake of dietary sugar and all health outcomes from previously published meta-analyses of observational studies and randomized controlled trials.
2. This study highlights clinical and social significance for building preventive strategies against excessive sugar intake by combining widespread public health education and policies, particularly for children and adolescents, considering the high levels of dietary sugar intake globally.
3. As existing evidence is mostly observational and of low quality, well-designed randomized controlled trials are warranted.
4. There is still limited evidence of association between dietary sugar intake and cancer, suggesting need for further research in this field.

(Source: Huang Y, Chen Z, Chen B, Li J, Yuan X, Li J, Wang W, Dai T, Chen H, Wang Y, Wang R, Wang P, Guo J, Dong Q, Liu C, Wei Q, Cao D, Liu L. Dietary sugar consumption and health: Umbrella review. BMJ. 2023;381:e071609. Doi: 10.1136/bmj-2022-071609)