Dietary sugars and body weight: Systematic review and meta-analyses of randomised controlled trials and cohort studies

Departments of Human Nutrition and Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
BMJ Clinical Research (Impact Factor: 14.09). 01/2013; 346:e7492. DOI: 10.1136/bmj.e7492
Source: PubMed


To summarise evidence on the association between intake of dietary sugars and body weight in adults and children.
Systematic review and meta-analysis of randomised controlled trials and prospective cohort studies.
OVID Medline, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Web of Science (up to December 2011).
Eligible studies reported the intake of total sugars, intake of a component of total sugars, or intake of sugar containing foods or beverages; and at least one measure of body fatness. Minimum duration was two weeks for trials and one year for cohort studies. Trials of weight loss or confounded by additional medical or lifestyle interventions were excluded. Study selection, assessment, validity, data extraction, and analysis were undertaken as specified by the Cochrane Collaboration and the GRADE working group. For trials, we pooled data for weight change using inverse variance models with random effects. We pooled cohort study data where possible to estimate effect sizes, expressed as odds ratios for risk of obesity or β coefficients for change in adiposity per unit of intake.
30 of 7895 trials and 38 of 9445 cohort studies were eligible. In trials of adults with ad libitum diets (that is, with no strict control of food intake), reduced intake of dietary sugars was associated with a decrease in body weight (0.80 kg, 95% confidence interval 0.39 to 1.21; P<0.001); increased sugars intake was associated with a comparable weight increase (0.75 kg, 0.30 to 1.19; P=0.001). Isoenergetic exchange of dietary sugars with other carbohydrates showed no change in body weight (0.04 kg, -0.04 to 0.13). Trials in children, which involved recommendations to reduce intake of sugar sweetened foods and beverages, had low participant compliance to dietary advice; these trials showed no overall change in body weight. However, in relation to intakes of sugar sweetened beverages after one year follow-up in prospective studies, the odds ratio for being overweight or obese increased was 1.55 (1.32 to 1.82) among groups with the highest intake compared with those with the lowest intake. Despite significant heterogeneity in one meta-analysis and potential bias in some trials, sensitivity analyses showed that the trends were consistent and associations remained after these studies were excluded.
Among free living people involving ad libitum diets, intake of free sugars or sugar sweetened beverages is a determinant of body weight. The change in body fatness that occurs with modifying intakes seems to be mediated via changes in energy intakes, since isoenergetic exchange of sugars with other carbohydrates was not associated with weight change.

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Available from: Lisa A Te Morenga, Oct 03, 2015
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    • "Excessive intake of energy-dense foods and drinks is a major factor in the development of obesity from infancy onwards. Dietary habits including consumption of sugary drinks [6], fast foods and energy-dense foods (such as processed foods which are high in saturated fat, sugar and salt) [7] will increase the likelihood of positive energy balance and excessive fat storage. Regular consumption of large portions of foods with energy density >225 kcals/100 g (941 kJ/100 g) are associated with increased risk of weight gain [7]. "
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    ABSTRACT: It is estimated that over half the population of the European Union (EU) is overweight or obese due to an imbalance between energy expenditure and energy intake; this is related to an obesogenic environment of sociocultural, economic and marketing challenges to the control of body weight. Excess body fat is associated with nine cancer sites - oesophagus, colorectum, gall bladder, pancreas, postmenopausal breast, endometrium, ovary, kidney and prostate (advanced) - and 4-38% of these cancers (depending on site and gender) can be attributed to overweight/obesity status. Metabolic alterations which accompany excess body weight are accompanied by increased levels of inflammation, insulin, oestrogens and other hormonal factors. There are some indications that intentional weight loss is associated with reduced cancer incidence (notably in postmenopausal breast and endometrial cancers). Excess body weight is also a risk factor for several other diseases, including diabetes and heart disease, and is related to higher risk of premature death. In reviewing the current evidence related to excess body fat and cancer, the European Code against Cancer Nutrition Working Group has developed the following recommendation: 'Take action to be a healthy body weight'. Copyright © 2015 International Agency for Research on Cancer. Published by Elsevier Ltd.. All rights reserved.
    07/2015; 8. DOI:10.1016/j.canep.2015.01.017
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    • "It is well established that sugar intake has a major contributory role in the progression of dental caries (Moynihan & Kelly, 2014; Sheiham & James, 2014). Conversely, the potential impact of sugar consumption, especially in the form of sugar-sweetened beverages (SSB), on adiposity , cardio-metabolic risk factors is still under debate (Te Morenga, Mallard, & Mann, 2013; van Buul, Tappy, & Brouns, 2014). "
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    ABSTRACT: Current UK intake of non-milk extrinsic sugars (NMES) is above recommendations. Reducing the sugar content of processed high sugar foods through reformulation is one option for reducing consumption of NMES at a population level. However, reformulation can alter the sensory attributes of food products and influence consumer liking. This study evaluated consumer acceptance of a selection of products that are commercially-available in the UK; these included regular and sugar-reduced baked beans, strawberry jam, milk chocolate, cola and cranberry & raspberry juice. Sweeteners were present in the reformulated chocolate (maltitol), cola (aspartame and acesulfame-K) and juice (sucralose) samples. Healthy, non-smoking consumers (n = 116; 55 men, 61 women, age: 33 ± 9 years; BMI: 25.7 ± 4.6 kg/m2) rated the products for overall liking and on liking of appearance, flavor and texture using a nine-point hedonic scale. There were significant differences between standard and reduced sugar products in consumers’ overall liking and on liking of each modality (appearance, flavor and texture; all P < 0.0001). For overall liking, only the regular beans and cola were significantly more liked than their reformulated counterparts (P < 0.0001). Cluster analysis identified three consumer clusters that were representative of different patterns of consumer liking. For the largest cluster (cluster 3: 45%), there was a significant difference in mean liking scores across all products, except jam. Differences in liking were predominantly driven by sweet taste in 2 out of 3 clusters. The current research has demonstrated that a high proportion of consumers prefer conventional products over sugar-reduced products across a wide range of product types (45%) or across selected products (27%), when tasted unbranded, and so there is room for further optimization of commercial reduced sugar products that were evaluated in the current study. Future work should evaluate strategies to facilitate compliance to dietary recommendations on NMES and free sugars, such as the impact of sugar-reduced food exposure on their acceptance.
    Food Research International 03/2015; DOI:10.1016/j.foodres.2015.03.012 · 2.82 Impact Factor
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    • "In 2011, the European Food Safety Authority (EFSA) rejected a claim for non-nutritive sweeteners in weight loss, partly on the grounds that a cause and effect relationship between sugar intake and obesity had not been proven and partly because some of the evidence cited related to beverages rather than LCS-containing products in general (EFSA NDA 2011). However, evidence is steadily accruing from randomized controlled trials, and recent reviews have concluded that using LCS to replace sugars results in (modest) weight loss (<1 kg over several weeks) (Te Morenga et al. 2013) and a reduction in fat mass and waist circumference (Miller & Perez 2014). However, many studies included large amounts of sugars or SSB as the control, while others found significant effects only in subgroups, for example, overweight subjects or Hispanics. "
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    ABSTRACT: Conclusions (1). LCS do not increase appetite and have no discernible effect on satiety. (2). LCS help to reduce energy when used in place of higher energy ingredients. (3). LCS can enhance weight loss under real-life conditions when used as part of a behavioural weight loss programme. (4). LCS may have a beneficial effect on post-prandial glucose and insulin in healthy individuals and in people with diabetes. (5). LCS have dental benefits when used in food, beverages, toothpaste and medications, provided other constituents are also non-cariogenic and non-erosive.
    Nutrition Bulletin 12/2014; DOI:10.1111/nbu.12116
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