Abstract
Consumption of sugar has been relatively high in the Nordic countries; the impact of sugar intake on metabolic risk factors and related diseases has been debated. The objectives were to assess the effect of sugar intake (sugar-sweetened beverages, sucrose and fructose) on association with type 2 diabetes, cardiovascular disease and related metabolic risk factors (impaired glucose tolerance, insulin sensitivity, dyslipidemia, blood pressure, uric acid, inflammation markers), and on all-cause mortality, through a systematic review of prospective cohort studies and randomised controlled intervention studies published between January 2000 and search dates. The methods adopted were as follows: the first search was run in PubMed in October 2010. A second search with uric acid as risk marker was run in April 2011. The total search strategy was rerun in April 2011 in SveMed+. An update was run in PubMed in January 2012. Two authors independently selected studies for inclusion from the 2,743 abstracts according to predefined eligibility criteria. The outcome was that out of the 17 studies extracted, 15 were prospective cohort studies and two were randomised controlled crossover trials. All of the studies included only adults. With respect to incident type 2 diabetes (nine studies), four of six prospective cohort studies found a significant positive association for sugar-sweetened beverage intake. In general, larger cohort studies with longer follow-up more often reported positive associations, and BMI seemed to mediate part of the increased risk. For other metabolic or cardiovascular risk factors or outcomes, too few studies have been published to draw conclusions. In conclusion, data from prospective cohort studies published in the years 2000–2011 suggest that sugar-sweetened beverages probably increase the risk of type 2 diabetes. For related metabolic risk factors, cardiovascular disease or all-cause mortality and other types of sugars, too few studies were available to draw conclusions.
Highlights
The present literature review is a part of the fifth version of the Nordic Nutrition Recommendations (NNR) project with the aim of reviewing and updating the scientific basis of the fourth edition of the NNR issued in 2004 (1)
Because the World Health Organisation is performing a systematic literature review on sugar and obesity, and because a systematic review was previously performed in association with the United States Department of Agriculture (USDA) recommendations (2), this endpoint was not included in the search
Data from prospective cohort studies published during 2000 to December 2011 suggest that sugar-sweetened beverages probably increase the risk of type 2 diabetes
Summary
The present literature review is a part of the fifth version of the Nordic Nutrition Recommendations (NNR) project with the aim of reviewing and updating the scientific basis of the fourth edition of the NNR issued in 2004 (1). The basis for the recommendation of maximum 10E% from refined sugars in the NNR from 2004 is mainly based on association with caries in the oral cavity and lower nutrient density of the food with increasing sugar intake in the Nordic countries. Interest has been revived in the potential role of sugarsweetened beverages, added sugar and total fructose intake in the development of metabolic and cardiovascular diseases and risk factors (6Á11), but whether sugar plays a causal role is still much debated (8, 11). This issue was not approached in detail in the previous NNR (1). Because the World Health Organisation is performing a systematic literature review on sugar and obesity, and because a systematic review was previously performed in association with the USDA recommendations (2), this endpoint was not included in the search
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