Dietary sugar consumption and health: umbrella review.
Level 1 - systematic review of randomized trials
Umbrella review synthesizing systematic reviews and meta-analyses of randomized trials and observational studies.
PubMed 37019448 · doi:10.1136/bmj-2022-071609
What was done
Authors conducted an umbrella review searching PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and reference lists to evaluate evidence quality, validity, and potential biases regarding dietary sugar consumption and health outcomes. They included systematic reviews and meta-analyses of randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies among humans free from acute or chronic diseases. The search identified 73 meta-analyses evaluating 83 health outcomes (74 from observational studies and 9 from randomized controlled trials).
What was found
Significant harmful associations were identified between dietary sugar intake and 45 distinct health outcomes (18 endocrine/metabolic, 10 cardiovascular, 7 cancer, and 10 neuropsychiatric, dental, hepatic, osteal, or allergic outcomes). Moderate quality evidence linked high sugar consumption with increased body weight (for sugar-sweetened beverages) and ectopic fatty accumulation (for added sugars). Low quality evidence showed that each serving/week increase in sugar-sweetened beverage consumption was associated with a 4% higher risk of gout, and each 250 mL/day increment was associated with a 17% higher risk of coronary heart disease and a 4% higher risk of all-cause mortality. Each 25 g/day increment of fructose intake was associated with a 22% higher risk of pancreatic cancer.
Why it matters
This umbrella review synthesizes extensive meta-analytic data into a single reference, strengthening dietary guidelines that advise capping free or added sugars below 25 g/day and sugar-sweetened beverages to under one serving per week.
Limits
The vast majority of evaluated health outcomes (74 of 83) relied on observational studies, which cannot establish causality and are vulnerable to residual confounding and dietary measurement error. The overall quality of evidence was graded as low or moderate for primary outcomes, with an absence of high-quality evidence across most disease associations.
Cited by
- context Sugar acts as a neuroinflammatory agent, causes cardiac disease, and accelerates cancer growth.