The Effects of Sucrose on Metabolic Health: A Systematic Review of Human Intervention Studies in Healthy Adults

Abstract

We systematically reviewed interventions substituting sucrose for other macronutrients in apparently healthy adults to assess impact on cardiometabolic risk indicators. Multiple databases were searched to January 2012 and abstracts assessed by 2 reviewers. Twenty-five studies (29 papers) met inclusion criteria but varied in quality and duration. Weaknesses included small subject numbers, unclear reporting of allocation, unusual dietary regimes, differences in energy intake, fat composition or fibre between conditions, unhealthy subjects, heterogeneity of results, and selective reporting. Insufficient data were available to draw reliable conclusions except with regard to the substitution of sucrose for starch, where effects on plasma lipids were inconsistent, mostly explicable by other factors, or nonsignificant. Based on fewer studies, there was little evidence for significant effects on plasma glucose or insulin. Sucrose substitution for starch up to 25% energy does not appear to have adverse effects on cardiometabolic risk indicators in apparently healthy adults. Furthermore, there is no consistent evidence that restricting sucrose in an isoenergetic diet would affect risk indicators, except perhaps in people with certain preexisting metabolic abnormalities. Larger, high-quality studies, lasting several months and studying a wider range of outcomes, are needed in order to provide evidence on which to base public health initiatives.

Why Sugar Is Added to Food: Food Science 101

“…Even though the research is mixed, the overall consensus is that balancing total energy intake with calorie expenditure is the best approach to prevent weight gain (Marriott and others ; Jebb ). Foods containing added sugars do not contribute to weight gain any more than another calorie source (Van Baak and Astrup ; Gibson and others ). Finally, sugar consumption is already decreasing in the United States without added sugars being on the Nutrition Facts label (USDA and HHS ; Wittekind and Walton ).…”

Relevance of liver fat to the impact of dietary extrinsic sugars on lipid metabolism

“…The metabolic effects of dietary fructose and sucrose on lipid metabolism, body weight and NAFLD have been extensively reviewed recently (23)(24)(25)(26) . This has coincided with a furore over the link between sugar and health, and the adverse outcomes of short-term, mechanistic studies that intervened with excessive amounts of fructose or sucrose (>20 % total energy) from sugarsweetened beverages (27)(28)(29)(30)(31) .…”

Do Fructose-Containing Sugars Lead to Adverse Health Consequences? Results of Recent Systematic Reviews and Meta-analyses

“…The weight gain achieved was proportional to the degree of calorie supplementation, with partial compensation for the extra calories provided, such that the weight gain achieved was less than that which would be predicted by the extra calories (16). A similar increasing effect has been seen with TGs when energy from sugary beverages supplement background diets (38) or where added fructose-containing sugars provide extra calories in ad libitum substitutions with starch (36). However, Total follow-up was 20 y in NHS I and HPFS and 12 y in NHS II.…”

“…A WHO-commissioned systematic review and meta-analysis assessing the effect of all added fructose-containing sugars on measures of adiposity in randomized trials showed that added fructose-containing sugars compared with other sources of carbohydrate under energy-matched conditions did not affect body weight (7). Another systematic review of the available trial evidence found a similar lack of effect of added sucrose in isocaloric exchange with starch at amounts up to 25% of energy on blood lipids, glucose, and insulin control (36). However, whether there is an effect when sucrose supplies >25% of calories is unclear because there are few trials that assessed the effects above this level.…”