title: Potential link between excess added sugar intake and ectopic fat: a systematic review of randomized controlled trials.
abstract: BACKGROUND
  The effect of added sugar intake on ectopic fat accumulation is a subject of debate.
  
  
  OBJECTIVE
  A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to examine the potential effect of added sugar intake on ectopic fat depots.
  
  
  METHODS
  MEDLINE, CAB Abstracts, CAB Global Health, and EBM (Evidence-Based Medicine) Reviews - Cochrane Central Register of Controlled Trials databases were searched for studies published from 1973 to September 2014.
  
  
  METHODS
  RCTs with a minimum of 6 days' duration of added sugar exposure in the intervention group were selected. The dosage of added sugar intake as a percentage of total energy was extracted or calculated. Means and standard deviations of pre- and post-test measurements or changes in ectopic fat depots were collected.
  
  
  RESULTS
  Fourteen RCTs were included. Most of the studies had a medium to high risk of bias. Meta-analysis showed that, compared with eucaloric controls, subjects who consumed added sugar under hypercaloric conditions likely increased ectopic fat, particularly in the liver (pooled standardized mean difference = 0.9 [95%CI, 0.6-1.2], n = 6) and muscles (pooled SMD = 0.6 [95%CI, 0.2-1.0], n = 4). No significant difference was observed in liver fat, visceral adipose tissue, or muscle fat when isocaloric intakes of different sources of added sugars were compared.
  
  
  CONCLUSIONS
  Data from a limited number of RCTs suggest that excess added sugar intake under hypercaloric diet conditions likely increases ectopic fat depots, particularly in the liver and in muscle fat. There are insufficient data to compare the effect of different sources of added sugars on ectopic fat deposition or to compare intake of added sugar with intakes of other macronutrients. Future well-designed RCTs with sufficient power and duration are needed to address the role of sugars on ectopic fat deposition.
authors.affiliation: J. Ma, M.C. Karlsen, P.F. Jacques, E. Saltzman, C.E. Smith, and N.M. McKeown are with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University, Boston, Massachusetts, USA. M. Chung is with the Nutrition/Infection Unit, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA. C.S. Fox is with the NHLBI's Framingham Heart Study, Framingham, Massachusetts, USA. C.S. Fox is with Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jiantao
authors.initials: J
authors.lastname: Ma
authors.affiliation: J. Ma, M.C. Karlsen, P.F. Jacques, E. Saltzman, C.E. Smith, and N.M. McKeown are with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University, Boston, Massachusetts, USA. M. Chung is with the Nutrition/Infection Unit, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA. C.S. Fox is with the NHLBI's Framingham Heart Study, Framingham, Massachusetts, USA. C.S. Fox is with Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Micaela C
authors.initials: MC
authors.lastname: Karlsen
authors.affiliation: J. Ma, M.C. Karlsen, P.F. Jacques, E. Saltzman, C.E. Smith, and N.M. McKeown are with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University, Boston, Massachusetts, USA. M. Chung is with the Nutrition/Infection Unit, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA. C.S. Fox is with the NHLBI's Framingham Heart Study, Framingham, Massachusetts, USA. C.S. Fox is with Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Mei
authors.initials: M
authors.lastname: Chung
authors.affiliation: J. Ma, M.C. Karlsen, P.F. Jacques, E. Saltzman, C.E. Smith, and N.M. McKeown are with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University, Boston, Massachusetts, USA. M. Chung is with the Nutrition/Infection Unit, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA. C.S. Fox is with the NHLBI's Framingham Heart Study, Framingham, Massachusetts, USA. C.S. Fox is with Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Jacques
authors.affiliation: J. Ma, M.C. Karlsen, P.F. Jacques, E. Saltzman, C.E. Smith, and N.M. McKeown are with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University, Boston, Massachusetts, USA. M. Chung is with the Nutrition/Infection Unit, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA. C.S. Fox is with the NHLBI's Framingham Heart Study, Framingham, Massachusetts, USA. C.S. Fox is with Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Saltzman
authors.affiliation: J. Ma, M.C. Karlsen, P.F. Jacques, E. Saltzman, C.E. Smith, and N.M. McKeown are with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University, Boston, Massachusetts, USA. M. Chung is with the Nutrition/Infection Unit, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA. C.S. Fox is with the NHLBI's Framingham Heart Study, Framingham, Massachusetts, USA. C.S. Fox is with Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Caren E
authors.initials: CE
authors.lastname: Smith
authors.affiliation: J. Ma, M.C. Karlsen, P.F. Jacques, E. Saltzman, C.E. Smith, and N.M. McKeown are with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University, Boston, Massachusetts, USA. M. Chung is with the Nutrition/Infection Unit, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA. C.S. Fox is with the NHLBI's Framingham Heart Study, Framingham, Massachusetts, USA. C.S. Fox is with Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
authors.affiliation: J. Ma, M.C. Karlsen, P.F. Jacques, E. Saltzman, C.E. Smith, and N.M. McKeown are with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University, Boston, Massachusetts, USA. M. Chung is with the Nutrition/Infection Unit, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA. C.S. Fox is with the NHLBI's Framingham Heart Study, Framingham, Massachusetts, USA. C.S. Fox is with Harvard Medical School, Boston, Massachusetts, USA. nicola.mckeown@tufts.edu.
authors.forename: Nicola M
authors.initials: NM
authors.lastname: McKeown
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism*; D002828:Choristoma / Q000378:metabolism*; D004032:Diet; D019422:Dietary Sucrose / Q000008:administration & dosage / Q000494:pharmacology*; D002149:Energy Intake; D005247:Feeding Behavior; D006801:Humans; D008099:Liver / Q000378:metabolism*; D009005:Monosaccharides / Q000008:administration & dosage / Q000494:pharmacology; D009132:Muscles / Q000378:metabolism*
chemical_list: D019422:Dietary Sucrose; D009005:Monosaccharides
keywords: added sugar; ectopic fat depots; liver fat; muscle fat; visceral adipose tissue