Dietary Sugar and Body Weight: Have We Reached a Crisis in the Epidemic of Obesity and Diabetes?

Sugar-sweetened drinks have been associated with several health problems. In the point narrative as presented below, we provide our opinion and review of the data to date that we need to reconsider consumption of dietary sugar based on the growing concern of obesity and type 2 diabetes. In the counterpoint narrative following our contribution, Drs. Kahn and Sievenpiper provide a defense and suggest that dietary sugar is not the culprit. Data from the National Health and Nutrition Examination Survey and U.S. Department of Agriculture dietary surveys along with commercial Homescan data on household purchases were used to understand changes in sugar and fructose consumption. Meta-analyses and randomized clinical trials were used to evaluate outcomes of beverage and fructose intake. About 75% of all foods and beverages contain added sugar in a large array of forms. Consumption of soft drinks has increased fivefold since 1950. Meta-analyses suggest that consumption of sugar-sweetened beverages (SSBs) is related to the risk of diabetes, the metabolic syndrome, and cardiovascular disease. Drinking two 16-ounce SSBs per day for 6 months induced features of the metabolic syndrome and fatty liver. Randomized controlled trials in children and adults lasting 6 months to 2 years have shown that lowering the intake of soft drinks reduced weight gain. Recent studies suggest a gene-SSB potential relationship. Consumption of calorie-sweetened beverages has continued to increase and plays a role in the epidemic of obesity, the metabolic syndrome, and fatty liver disease. Reducing intake of soft drinks is associated with less weight gain.

[1]  John M. Pogue Salt Sugar Fat: How the Food Giants Hooked Us , 2014 .

[2]  J. Mann,et al.  Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies , 2012, BMJ.

[3]  B. Popkin,et al.  Turning point for US diets? Recessionary effects or behavioral shifts in foods purchased and consumed. , 2014, The American journal of clinical nutrition.

[4]  B. Rolls,et al.  Does the consumption of caloric and non-caloric beverages with a meal affect energy intake? , 2005, Appetite.

[5]  Yoshiji Yamada,et al.  Genetic factors for human obesity , 2008, Cellular and Molecular Life Sciences.

[6]  B. Popkin,et al.  Changes in beverage intake between 1977 and 2001. , 2004, American journal of preventive medicine.

[7]  G. Bray,et al.  A short history of beverages and how our body treats them , 2008, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[8]  Anna Maria Siega-Riz,et al.  Trends in food locations and sources among adolescents and young adults. , 2002, Preventive medicine.

[9]  A. Suzuki,et al.  Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease , 2010, Hepatology.

[10]  M. Hochuli,et al.  Moderate Amounts of Fructose Consumption Impair Insulin Sensitivity in Healthy Young Men , 2012, Diabetes Care.

[11]  J. Seidell,et al.  Epidemiology of obesity. , 2002, Seminars in vascular medicine.

[12]  B. Popkin,et al.  Development of international criteria for a front of package food labelling system: the International Choices Programme , 2011, European Journal of Clinical Nutrition.

[13]  L. Gómez Morales [Sugar-sweetened beverages and genetic risk of obesity]. , 2013, Revista clinica espanola.

[14]  V. Vaccarino,et al.  Caloric sweetener consumption and dyslipidemia among US adults. , 2010, JAMA.

[15]  C. Ogden,et al.  Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999-2010. , 2013, The American journal of clinical nutrition.

[16]  M. Hochuli,et al.  Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial. , 2011, The American journal of clinical nutrition.

[17]  Bernadette P Marriott,et al.  National estimates of dietary fructose intake increased from 1977 to 2004 in the United States. , 2009, The Journal of nutrition.

[18]  B. Popkin Patterns of beverage use across the lifecycle , 2010, Physiology & Behavior.

[19]  Wei Zhang,et al.  Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. , 2009, The Journal of clinical investigation.

[20]  G. Bray Energy and Fructose From Beverages Sweetened With Sugar or High-Fructose Corn Syrup Pose a Health Risk for Some People12 , 2013, Advances in nutrition.

[21]  B. Popkin,et al.  Beverage consumption among European adolescents in the HELENA study , 2012, European Journal of Clinical Nutrition.

[22]  S. McCall,et al.  Fructose consumption as a risk factor for non-alcoholic fatty liver disease. , 2008, Journal of hepatology.

[23]  I. Fedoroff,et al.  Effects of drinks sweetened with sucrose or aspartame on hunger, thirst and food intake in men , 1990, Physiology & Behavior.

[24]  W. Dietz,et al.  Trends in energy intake among adults in the United States: findings from NHANES. , 2013, The American journal of clinical nutrition.

[25]  B. Popkin,et al.  Drinking to our health: can beverage companies cut calories while maintaining profits? , 2012, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[26]  B. Popkin,et al.  Patterns and trends of beverage consumption among children and adults in Great Britain, 1986–2009 , 2011, British Journal of Nutrition.

[27]  G. Reaven Banting lecture 1988 , 1997 .

[28]  R. Townsend,et al.  Endocrine and metabolic effects of consuming fructose- and glucose-sweetened beverages with meals in obese men and women: influence of insulin resistance on plasma triglyceride responses. , 2009, The Journal of clinical endocrinology and metabolism.

[29]  R. Mattes,et al.  Fluid calories and energy balance: The good, the bad, and the uncertain , 2006, Physiology & Behavior.

[30]  B. Popkin,et al.  High-fructose corn syrup: is this what's for dinner? , 2008, The American journal of clinical nutrition.

[31]  Roseanne Menorca,et al.  Consumption of fructose and high fructose corn syrup increase postprandial triglycerides, LDL-cholesterol, and apolipoprotein-B in young men and women. , 2011, The Journal of clinical endocrinology and metabolism.

[32]  See A Eberli Potential Health Risks From Beverages Containing Fructose Found in Sugar or High-Fructose Corn Syrup , 2013 .

[33]  Lawrence A Leiter,et al.  Effect of Fructose on Body Weight in Controlled Feeding Trials , 2012, Annals of Internal Medicine.

[34]  B. Popkin,et al.  Shifts in Patterns and Consumption of Beverages Between 1965 and 2002 , 2007, Obesity.

[35]  Tanya M. Teslovich,et al.  Association analyses of 249,796 individuals reveal 18 new loci associated with body mass index , 2010 .

[36]  B. Popkin,et al.  Use of caloric and noncaloric sweeteners in US consumer packaged foods, 2005-2009. , 2012, Journal of the Academy of Nutrition and Dietetics.

[37]  J. Seidell,et al.  A trial of sugar-free or sugar-sweetened beverages and body weight in children. , 2012, The New England journal of medicine.

[38]  A. Astrup,et al.  Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. , 2012, The American journal of clinical nutrition.

[39]  B. Popkin,et al.  Trends in intakes and sources of solid fats and added sugars among U.S. children and adolescents: 1994–2010 , 2013, Pediatric obesity.

[40]  B. Popkin,et al.  Does diet-beverage intake affect dietary consumption patterns? Results from the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial. , 2013, The American journal of clinical nutrition.

[41]  W. Willett,et al.  Global obesity: trends, risk factors and policy implications , 2013, Nature Reviews Endocrinology.

[42]  G. Reaven Role of Insulin Resistance in Human Disease , 1988, Diabetes.

[43]  Martin McKee,et al.  Relationship of soft drink consumption to global overweight, obesity, and diabetes: a cross-national analysis of 75 countries. , 2013, American journal of public health.

[44]  B. Heitmann,et al.  Intake of calorically sweetened beverages and obesity , 2009, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[45]  P. Havel,et al.  Fructose consumption: considerations for future research on its effects on adipose distribution, lipid metabolism, and insulin sensitivity in humans. , 2009, The Journal of nutrition.

[46]  R. Ness-Abramof Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial , 2012 .

[47]  G. Bray,et al.  Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. , 2004, The American journal of clinical nutrition.

[48]  J. Wells,et al.  Sugar consumption and global prevalence of obesity and hypertension: an ecological analysis , 2013, Public Health Nutrition.

[49]  G. Reaven Banting lecture 1988. Role of insulin resistance in human disease. , 1988, Diabetes.

[50]  R Todd Constable,et al.  Effects of fructose vs glucose on regional cerebral blood flow in brain regions involved with appetite and reward pathways. , 2013, JAMA.

[51]  F. Hu,et al.  Intake of sugar-sweetened beverages and weight gain: a systematic review. , 2006, The American journal of clinical nutrition.

[52]  B. Popkin,et al.  South Korea's entry to the global food economy: shifts in consumption of food between 1998 and 2009. , 2012, Asia Pacific journal of clinical nutrition.

[53]  V. Dowding Distributions of birth weight in seven Dublin maternity units. , 1982, British medical journal.

[54]  D. Ludwig Examining the health effects of fructose. , 2013, JAMA.

[55]  G. Bray,et al.  Americans on diet: results from the 1994-1996 Continuing Survey of Food Intakes by Individuals. , 2002, Journal of the American Dietetic Association.

[56]  A. Astrup,et al.  Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. , 2002, The American journal of clinical nutrition.

[57]  F. Hu,et al.  Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women , 2008, Diabetes Care.

[58]  B. Popkin,et al.  The sweetening of the world's diet. , 2003, Obesity research.

[59]  Mark A Pereira,et al.  Soft Drink and Juice Consumption and Risk of Pancreatic Cancer: The Singapore Chinese Health Study , 2010, Cancer Epidemiology, Biomarkers & Prevention.

[60]  B. Rolls,et al.  The effect of increased beverage portion size on energy intake at a meal. , 2006, Journal of the American Dietetic Association.

[61]  A. Baranova,et al.  Systematic review: the epidemiology and natural history of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis in adults , 2011, Alimentary pharmacology & therapeutics.

[62]  K. Brownell,et al.  Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. , 2007, American journal of public health.

[63]  T. Nakagawa,et al.  The effect of fructose on renal biology and disease. , 2010, Journal of the American Society of Nephrology : JASN.

[64]  F. Hu,et al.  Pro v Con Debate: Role of sugar sweetened beverages in obesity Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases , 2013 .

[65]  Richard D. Mattes,et al.  Dietary Compensation by Humans for Supplemental Energy Provided as Ethanol or Carbohydrate in Fluids , 1996, Physiology & Behavior.

[66]  R. Mattes,et al.  Effects of food form on appetite and energy intake in lean and obese young adults , 2007, International Journal of Obesity.

[67]  S. Osganian,et al.  A randomized trial of sugar-sweetened beverages and adolescent body weight. , 2012, The New England journal of medicine.

[68]  R. Loos,et al.  Genetic determinants of common obesity and their value in prediction. , 2012, Best practice & research. Clinical endocrinology & metabolism.

[69]  B. Rolls,et al.  The effect of fruit in different forms on energy intake and satiety at a meal , 2009, Appetite.

[70]  Mark A Pereira,et al.  Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes: the Singapore Chinese Health Study. , 2010, American journal of epidemiology.

[71]  K. Stanhope Role of fructose-containing sugars in the epidemics of obesity and metabolic syndrome. , 2012, Annual review of medicine.

[72]  B. Popkin,et al.  Energy intake from beverages is increasing among Mexican adolescents and adults. , 2008, The Journal of nutrition.

[73]  M. Roizen Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes: A meta-analysis , 2012 .

[74]  R. Mattes,et al.  Liquid versus solid carbohydrate: effects on food intake and body weight , 2000, International Journal of Obesity.

[75]  Habiba I. Ali,et al.  Nutrition transition in the United Arab Emirates , 2011, European Journal of Clinical Nutrition.

[76]  R. Schall,et al.  Reassessing the effects of simple carbohydrates on the serum triglyceride responses to fat meals. , 1988, The American journal of clinical nutrition.

[77]  K. Adeli,et al.  Fructose: a highly lipogenic nutrient implicated in insulin resistance, hepatic steatosis, and the metabolic syndrome. , 2010, American journal of physiology. Endocrinology and metabolism.

[78]  G. Bray,et al.  Calorie‐sweetened beverages and fructose: what have we learned 10 years later , 2013, Pediatric obesity.

[79]  O. McGuinness,et al.  Continuous low-dose fructose infusion does not reverse glucagon-mediated decrease in hepatic glucose utilization. , 2011, Metabolism: clinical and experimental.