Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids

Morenga, Lisa Te; Howatson, Alex J; Jones, Rhiannon Mihi; Mann, Jim

doi:10.3945/ajcn.113.081521

Cited by 437 publications

(333 citation statements)

References 72 publications

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“…Even the Food and Drug Administration's proposed changes to packaged-food labels -which would newly report the amount of 'added sugars' in a product -place even more emphasis on calories than current labels by visually subordinating all other label information and highlighting calories in an enormous bold typeface (128) . What existing and planned initiatives seem not to acknowledge is that calories from added sugars and starches are worse than just 'empty' (detriment through omission); evidence suggests they are actively harmful (detriment through commission) (61,62,129,130) . While responses of individual consumers may vary (e.g.…”

Section: More-nuanced Thinking About Obesity and Related Diseasesmentioning

confidence: 99%

How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative

Lucan

DiNicolantonio

2014

Public Health Nutr.

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Prevailing thinking about obesity and related diseases holds that quantifying calories should be a principal concern and target for intervention. Part of this thinking is that consumed calories -regardless of their sources -are equivalent; i.e. 'a calorie is a calorie'. The present commentary discusses various problems with the idea that 'a calorie is a calorie' and with a primarily quantitative focus on food calories. Instead, the authors argue for a greater qualitative focus on the sources of calories consumed (i.e. a greater focus on types of foods) and on the metabolic changes that result from consuming foods of different types. In particular, the authors consider how calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases, and supportive of starchy and sugary replacements, which are likely detrimental. Shifting the focus to qualitative food distinctions, a central argument of the paper is that obesity and related diseases are problems due largely to food-induced physiology (e.g. neurohormonal pathways) not addressable through arithmetic dieting (i.e. calorie counting). The paper considers potential harms of public health initiatives framed around calorie balance sheetstargeting 'calories in' and/or 'calories out' -that reinforce messages of overeating and inactivity as underlying causes, rather than intermediate effects, of obesity. Finally, the paper concludes that public health should work primarily to support the consumption of whole foods that help protect against obesity-promoting energy imbalance and metabolic dysfunction and not continue to promote caloriedirected messages that may create and blame victims and possibly exacerbate epidemics of obesity and related diseases. KeywordsObesity Calories Carbohydrates Public health Chronic diseaseWith worldwide concerns about obesity and diseases related to it (e.g. diabetes and CVD), there is substantial interest in shifting populations to healthier weights and better health. More precisely, there is interest in reducing body fat since fat -particularly visceral or abdominal fat -may matter more than weight when it comes to health (1)(2)(3) . Nevertheless, much of the evidence regarding obesity and related diseases focuses on body weight, rather than body fat. In reviewing such evidence, therefore, the present paper will therefore also often use the imprecise term 'weight' as opposed to 'fat', pointing out when such imprecision might mislead thinking.One way such imprecision might mislead thinking is in supporting the notions that (i) 'a calorie is a calorie' † and (ii) intervening on calories is the best way to address obesity (i.e. the quantitative problem of excess pounds or kilograms on a scale as opposed to the qualitative problem † 'Calorie' -or more correctly kilocalorie (kcal), for which the word often imprecisely substitutes -is the main unit of energy used to discuss food and obesity-related issues in the USA. It is also the word used in common expressions l...

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Section: More-nuanced Thinking About Obesity and Related Diseasesmentioning

confidence: 99%

How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative

Lucan

DiNicolantonio

2014

Public Health Nutr.

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“…[75][76][77] High sugar intake has also been associated with higher blood pressure (mean difference 6.9 mmHg [95% confidence interval (CI): 3.4, 10.3 mmHg; P,0.001 compared with low sugar intake] for systolic blood pressure and 5.6 mmHg [95% CI: 2.5, 8.8 mmHg; P=0.0005] for diastolic blood pressure). 78 The other notable effect of a high sugar intake is on triglycerides (mean difference: 0.11 mmol/L; 95% CI: 0.07, 0.15 mmol/L; 78 There is also evidence that sugar intake directly influences development of T2DM. In women consuming one or more sugar-sweetened beverages per day, the diabetes relative risk was 1.83 when compared with those who had one drink per month.…”

Section: Dietary Sugarmentioning

confidence: 99%

Importance of low carbohydrate diets in diabetes management

Hall¹,

Parry‐Strong²,

Krebs³

2016

NDS

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Dietary strategies are fundamental in the management of diabetes. Historically, strict dietary control with a low carbohydrate diet was the only treatment option. With increasingly effective medications, the importance of dietary change decreased. Recommendations focused on reducing dietary fat to prevent atherosclerotic disease, with decreasing emphasis on the amount and quality of carbohydrate. As the prevalence of obesity and diabetes escalates, attention has returned to the macronutrient composition of the diet. Very low carbohydrate diets (VLCD's) have demonstrated effective initial weight loss and improvement in glycemic control, but difficult long-term acceptability and worsening lipid profile. Modifications to the very low carbohydrate (VLC) have included limiting saturated fat and increasing carbohydrate (CHO) and protein.Reducing saturated fat appears pivotal in reducing low-density lipoprotein (LDL) cholesterol and may mitigate adverse effects of traditional VLCD's. Increased dietary protein enhances satiety, reduces energy intake, and improves glycemic homeostasis, but without sustained improvements in glycemic control or cardiovascular risk over and above the effect of weight loss. Additionally, recent studies in type 1 diabetes mellitus suggest promising benefits to diabetes control with low carbohydrate diets, without concerning effects on ketosis or hypoglycemia. Dietary patterns may highlight pertinent associations. For example, Mediterranean-style and paleolithic-type diets, low in fat and carbohydrate, are associated with reduced body weight and improved glycemic and cardiovascular outcomes in type 2 diabetes mellitus (T2DM). A feature of these dietary patterns is low refined CHO and sugar and higher fiber, and it is possible that increasing sugar consumption is having a substantial effect on global escalations in obesity and T2DM. Dietary recommendations in type 1 diabetes and T2DM are changing. Dietary CHO is unquestionably important, but long-term acceptability of any diet is critical to sustain improvements in health benefits. Personalized dietary management, using a variety of dietary approaches, may be the key to optimal diabetes outcomes.

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“…They have showed that sugar has a potential of causing fluid and sodium overload [5]. According to a meta-analysis of Randomised Control Trials (RCT), it was observed that that a diet with high sugar quantity as compared with a low-sugar diet, could cause an increase in blood pressure [6] Moreover, sugar can lead to leptin resistance, which may also contribute to its BP raising effects [7]. Dietary sugar may also increase aldosterone by activation of the sympathetic nervous system, which stimulates angiotensin-II and aldosterone production from adrenal glands [8].…”

Section: Association Of Sugar and Hypertensionmentioning

confidence: 99%

Emergence of New Risk Factors for causing Hypertension

Team

2017

J Med Res Innov

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The major risk factors which we have been hearing since decades for causing hypertension are high salt diet, obesity, hyperlipidaemia, age, race, consuming tobacco, sedentary lifestyle, stress, drinking too much alcohol etc. However, there are many studies which shows that sugar, fats and low vitamin d levels are equally responsible for causing hypertension. The article will put forward some interesting points to show that sugars, fats and vitamin d levels equally play an important role in causing hypertension.

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Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids

Cited by 437 publications

References 72 publications

How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative

How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative

Importance of low carbohydrate diets in diabetes management

Emergence of New Risk Factors for causing Hypertension

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