Table 2.
Findings from published reports on the effects of free or added sugars on chronic disease in human subjects.
| Authors and Year | Design | Timeframe/ Follow-Up |
Subjects | Measures | Intervention/ Independent Variable |
Findings |
|---|---|---|---|---|---|---|
| Ahmadi-Abhari et al., 2014. [138] | Case-control study. | 6.3y (mean) | Aged 40–79y; n = 749 diabetes cases; n = 3496 controls. | FFQ (total sugars, fructose, glucose, lactose, sucrose, maltose). Physical assessment |
↑ Fructose and glucose | ↓ Risk of T2DM |
| Bazzano et al., 2008 [136]. | Prospective cohort study | 18y | Female registered nurses (NHS); aged 30–55y; n = 71,346 | FFQ (fruit juice, whole fruit, whole vegetables) Self-reported T2DM |
↑ Fruit juice | ↑ T2DM risk (Whole fruits and green leafy vegetables decreased T2DM risk) |
| Bernstein et al., 2012 [145]. | Prospective cohort study | NHS: 28y HPFS: 22y |
NHS: Women aged 30–55y; n = 84,085 HPFS: men aged 40–75y; n = 43,371 |
FFQ (SSB = soft drinks, fruit juice) Self-reported T2DM |
↑ SSB | ↑ Stroke risk |
| Colditz et al., 1992 [135]. | Prospective cohort study | 6y | Female registered nurses (NHS); aged 30–55y; n = 84,360 | FFQ (sucrose) Self-reported T2DM |
Sucrose | -Sucrose was not related to T2DM risk. |
| De Koning et al., 2012 [15]. | Prospective cohort study | 22y | Adult males; n = 42,883 | FFQ (SSB = SD, fruit punch, fruit drinks) Self-reported CHD Biomarkers (n = 18,225) |
↑ SSB | ↑ CHD risk ↑ TG ↑ Inflammatory markers ↓ HDL ↓ Leptin |
| Dhingra et al., 2007 [41]. | Prospective cohort study | 4y (mean) | Adults (FHS); n = 6039 | FFQ (SD) | ↑ SD | ↑ MetS prevalence |
| Drouin-Chartier et al., 2019 [29]. | Prospective cohort study | NHS: 1986–2012 NHS II: 1991–2013 HPFS: 1986–2012 |
NHS: women aged 30–55y; n = 76,531 NHS II: women aged 25–42y; n = 81,597 HPFS: men aged 40–75y; n = 34,224 |
FFQ (SSB = soft drinks, fruit juice) Self-reported T2DM |
↑ SSB | ↑ T2DM risk |
| Eshak et al., 2012 [25]. | Prospective cohort study | 18y | Aged 40–59; n = 43,149) | FFQ (SD) Medical records |
↑ SD | ↑ Total stroke risk ↑ Ischaemic stroke risk in women ↓ Ischaemic stroke risk in men |
| Eshak et al., 2013 [126]. | Prospective cohort study | 10y | Aged 40–59y; n = 27,585 | FFQ (soft drink, 100% fruit juice, vegetable juice) Self-reported T2DM |
↑ SD | ↑ T2DM risk in women -No relationship between fruit/vegetable juice and T2DM |
| Fagherazzi et al., 2013 [30]. | Prospective cohort study | 14y | Adult women; n = 66,118 | FFQ (SSB) Self-reported T2DM |
↑ SSB | ↑ T2DM risk |
| Ferreira-Pego et al., 2016 [42]. | Prospective cohort study | 3.24y (median) | Adults; n = 1868 | FFQ (SSB) Physical assessment |
>5 servings SSB per week | ↑ MetS risk |
| Fung et al., 2009 [16]. | Prospective cohort study | 24y | Adult females (NHS); n = 88,520 | FFQ (SSB) Medical records |
↑ SSB | ↑ CHD Incidence |
| Haslam et al., 2020 [19]. | Prospective cohort study | 12.5y (mean) | FHS Offspring: n = 3146 FHS Third generation: n = 3584 |
FFQ (SSB) Physical assessment |
↑ SSB | ↓ HDL ↑ TG |
| Hirahatake et al., 2019 [31]. | Prospective cohort study | 30y | Aged 18–30; n = 4719 | FFQ (SSB) Interviews Pathology results |
↑ SSB | ↑ T2DM risk |
| Huang et al., 2017 [32]. | Prospective cohort study | 8.4y (mean) | Adult females (aged 50–79 years; n = 64,850) | FFQ (SSB) Self-reported T2DM |
↑ SSB | ↑ T2DM risk |
| Romaguera et al., 2013 [33] | Retrospective Case-Cohort study. | NA | Adults; n = 12,403 diabetes cases; n = 16,154 controls | FFQ (SD, juice, nectar) | ↑ SSB | ↑ T2DM risk |
| Janket et al., 2003 [134]. | Prospective cohort study. | 6y (mean) | Aged 45 years and over; n = 38,480 | FFQ (sucrose, fructose, glucose, lactose) | Total sugar intake | No relationship between sugars and T2DM incidence. |
| Janzi et al., 2020 [26]. | Prospective cohort study. | 19.5y (mean) | Adults; n = 16,781 | FFQ (Added sugar, SSB, sugary treats). Physical assessment Interview |
↑ SSB | ↑ Stroke risk |
| ↑ Added sugar | ↑ Stroke risk ↓ Aortic stenosis |
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| ↑ Sugary treats | ↓ Coronary events | |||||
| Jebril et al., 2020 [121]. | Cross-sectional survey | NA | Adults; n = 1000 | FFQ (added sugar) Physical health assessment Medical records |
Added sugar intake | -No relationship between sugar and diagnosed T2DM. -Positive relationship between sugar and undiagnosed T2DM. |
| Larsson et al., 2014 [27]. | Prospective cohort study | 10.3y (mean) | Aged 44–83y; n = 68,459 | FFQ (SSB) Medical records/death register |
≥2 servings SSB per day | ↑ Total stroke ↑ Cerebral infarction |
| Le et al., 2006 [20]. | Repeated measures experimental study. | 4 weeks | Adult males; (n = 7) | High-fructose diet (1.5 g/kg). | Fructose (1.5 g/kg) | ↑ LDL ↑ TG ↑ Leptin ↓ Non-esterified fatty acids -No change in insulin resistance |
| Lowndes et al., 2015 [63]. | Randomised Parallel group study | 10 weeks | Aged 20–60y; BMI = 21–35 kg/m2; n = 198 (28–34 per study group) |
Consumption of milk containing HFCS, fructose, glucose, and sucrose, contributing 18%, 9%, 9%, and 18% of energy intake compared to controls. | Fructose 9% | ↑ Insulin ↑ Hepatic insulin resistance ↑ Weight (for all sugar intervention groups) |
| Maersk et al., 2012 [39]. | Randomised Parallel group study | 6 months | Overweight adults; aged 26–40 years; n = 47 (SD group, n = 10) |
Dietary record Physical assessment |
1 Litre SD per day (50% glucose, 50% fructose) | ↑ Visceral adipose tissue ↑ Liver fat ↑ Skeletal muscle fat ↑ TG ↑ Total cholesterol |
| Miao et al., 2021 [28] | Prospective cohort study | 16y (mean) | Adults (FHS); n = 1384 | FFQ (SSB) Hospital admission records |
↑ SSB | ↑ Stroke risk |
| Montonen et al., 2007 [146]. | Prospective cohort study | 12y | Ages 40–60y; n = 4304 | FFQ (total sugars, fructose, glucose, lactose, sucrose, maltose). | ↑ Fructose and glucose | ↑ T2DM incidence |
| O’Connor et al., 2015 [34]. | Prospective cohort study | 10.8y | Aged 40–79y; n = 25,639 | 7-day food diaries (SD, fruit juice, sweetened tea/coffee, sweetened milk) Self-reported T2DM Medical records |
↑ SD or sweetened milk drinks | ↑ T2DM risk (No effect of fruit juice or tea/coffee) |
| Odegaard et al., 2010 [35]. | Prospective cohort study | 5.7y (mean) | Aged 45–74; n = 43,580 | FFQ (SSB = Soft drink or fruit/vegetable juice). | ↑ SSB | ↑ T2DM risk |
| Pacheco et al., 2020 [17]. | Prospective cohort study | 20y | Adult women; mean age 52.1y; n = 106,178 | FFQ (SSB = caloric soft drinks, sweetened water, fruit drinks) Medical records |
↑ SSB | ↑ CVD risk |
| Palmer et al., 2008 [36]. | Prospective cohort study | 10y | Adult women; n = 43,960 | FFQ (SSB = soft drink and juice) Self-report T2DM |
↑ SSB | ↑ T2DM risk (Orange and grapefruit juice not associated with T2DM risk) |
| Papier et al., 2017 [125]. | Prospective cohort study | 8y | Adults (n = 39,175) | FFQ (SSB) Self-report T2DM |
↑ SSB | ↑ T2DM risk in women |
| Park et al., 2022 [40]. | Prospective cohort study | FHS Offspring: 6y FHS Third generation: 6.2y |
FHS Offspring: Adults; mean age 62.8y; n = 691 FHS Third generation: Adults; mean age 48.4 years; n = 945. |
FFQ (SSB) Physical assessment |
↑ SSB | ↑ NAFLD incidence ↑ Liver fat |
| Paynter et al., 2006 [147]. | Prospective cohort study | 9y | Middle-aged adults; n = 12,204 | FFQ (SSB = fruit punch, non-diet soft drink, orange juice, grapefruit juice) | SSB | -No relationship between SSB and diabetes risk (with or without juice) |
| Rahman et al., 2015 [14]. | Prospective cohort study | 11.7y (mean) | Men aged 45–79; n = 42,400 | FFQ (SSB) Medical records/death register |
↑ SSB | ↑ HF risk |
| Sakurai et al., 2014 [127]. | Prospective cohort study. | 7y | Men aged 35–55y; n = 2037 | FFQ (SSB) Pathology results |
↑ SSB | -No effect on T2DM risk |
| Schulze et al., 2004 [37]. | Prospective cohort study. | 8y | Adult women; n = 91,249 | FFQ (SSB) | ↑ SSB | ↑ T2DM risk ↑ Weight |
| Shin et al., 2018 [43]. | Cross sectional | NA | Adults; n = 12,112 | FFQ (SSB = soft drinks, fruit juices, sweetened rice drinks). Physical assessment |
↑ SSB | ↑ MetS risk in women ↑ Obesity prevalence |
| Stanhope et al., 2009 [21]. | Double-blinded parallel arm study with matched subjects. | 10 weeks | Aged 40–72y; BMI = 25–35 kg/m2; n = 32 |
Consumption of glucose- or fructose-sweetened beverages providing 25% of energy. | Fructose | ↑ Increase body fat and weight ↑ Postprandial de novo lipogenesis ↑ Fasting glucose ↑ Fasting insulin ↓ Insulin sensitivity index |
| Glucose | ↑ Increase body fat and weight ↑ TG ↓ Fasting glucose |
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| Stern et al., 2019 [38]. | Prospective cohort study | 2.16y (median) | Women aged ≥ 25 years; n = 72,667 | FFQ (SD) Self-reported T2DM |
↑ SD | ↑ T2DM incidence |
| Welsh et al., 2011 [22]. | Prospective cohort study (NHANES subgroup, 1999–2004) |
NA | Aged 12 to 18y; n = 2157 | FFQ (added sugars) Pathology results |
↑ Added sugars | ↓ HDL ↑ TG ↑ Fasting insulin in overweight individuals only ↑ Insulin resistance in overweight individuals only |
| Yang et al., 2014 [18]. | Prospective cohort study (NHANES: T1, 1988–1994; T2, 1999–2004; T3, 2005–2010) |
14.6y (median) | Adults; n = 11,733 (T1), 8786 (T2), 10,628 (T3); BMI ≥ 18.5 kg/m2 |
FFQ (added sugars) Death register |
↑ Added sugars | ↑ CVD mortality risk |
| Yu et al., 2018 [23]. | Cross-sectional survey (NHS) | NA | Women aged 30–55 years; n = 8492 | FFQ (SSB) Biospecimens |
↑ SSB | ↑ TG ↓ HDL ↑ Inflammatory biomarkers ↑ Insulin ↓ Adiponectin |
Abbreviations: y, years; FFQ, food frequency questionnaire; ↑ increased/increasing; ↓ decreased/decreasing; T2DM, type 2 diabetes mellitus; NHS, Nurse’s Health Study; HPFS, Health Professional’s Follow-up Study; FHS, Framingham Heart Study; SSB, sugar-sweetened beverage; SD, soft drink; CHD, coronary heart disease; TG, triglycerides; HDL, high-density lipoprotein; MetS, metabolic syndrome; LDL, low-density lipoprotein; BMI, Body Mass Index; CVD, cardiovascular disease; NHANES, National Health and Nutrition Examination Survey; HFCS, high-fructose corn syrup.