title: What is the appropriate upper limit for added sugars consumption?
abstract: Dramatic increases in obesity and diabetes have occurred worldwide over the past 30 years. Some investigators have suggested that these increases may be due, in part, to increased added sugars consumption. Several scientific organizations, including the World Health Organization, the Scientific Advisory Council on Nutrition, the Dietary Guidelines Advisory Committee 2015, and the American Heart Association, have recommended significant restrictions on upper limits of sugars consumption. In this review, the scientific evidence related to sugars consumption and its putative link to various chronic conditions such as obesity, diabetes, heart disease, nonalcoholic fatty liver disease, and the metabolic syndrome is examined. While it appears prudent to avoid excessive calories from sugars, the scientific basis for restrictive guidelines is far from settled.
authors.affiliation: J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA. jrippe@rippelifestyle.com.
authors.forename: James M
authors.initials: JM
authors.lastname: Rippe
authors.affiliation: J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Sievenpiper
authors.affiliation: J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA.
authors.forename: Kim-Anne
authors.initials: KA
authors.lastname: Lê
authors.affiliation: J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: White
authors.affiliation: J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Clemens
authors.affiliation: J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Angelopoulos
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000209:etiology; D006331:Heart Diseases / Q000097:blood / Q000209:etiology; D006801:Humans; D007333:Insulin Resistance; D015201:Meta-Analysis as Topic; D024821:Metabolic Syndrome / Q000097:blood / Q000209:etiology; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000209:etiology; D018673:Nutrition Policy; D064427:Nutritive Sweeteners / Q000008:administration & dosage* / Q000009:adverse effects*; D009765:Obesity / Q000097:blood / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D014481:United States
chemical_list: D064427:Nutritive Sweeteners
keywords: added sugars; diabetes; fructose; heart disease; high fructose corn syrup; obesity; sucrose