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CME / ABIM MOC / CE

What Is the Effect of Sugar Consumption on Common Health Issues?

  • Authors: News Author: Lisa O’Mary; CME Author: Charles P. Vega, MD 
  • CME / ABIM MOC / CE Released: 5/12/2023
  • Valid for credit through: 5/12/2024
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

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    • Letter of Completion
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Target Audience and Goal Statement

This activity is intended for primary care clinicians, nurses, pharmacists, physician assistants, and other clinicians who treat and manage patients who might consume excessive amounts of sugar.

The goal of this activity is for learners to be better able to assess how the consumption of sugar affects the risk for multiple disease outcomes.

Upon completion of this activity, participants will:

  • Assess how the consumption of sugar affects the risk for metabolic outcomes
  • Assess how the consumption of sugar affects the risk for cancer outcomes
  • Outline implications for the healthcare team


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News Author

  • Lisa O’Mary

    Freelance writer, Medscape

    Disclosures

    Lisa O’Mary has no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine

    Disclosures

    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: Boehringer Ingelheim; GlaxoSmithKline; Johnson & Johnson

Editor/Nurse Planner

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.


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CME / ABIM MOC / CE

What Is the Effect of Sugar Consumption on Common Health Issues?

Authors: News Author: Lisa O’Mary; CME Author: Charles P. Vega, MD Faculty and Disclosures

CME / ABIM MOC / CE Released: 5/12/2023

Valid for credit through: 5/12/2024

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Clinical Context

Sugar-sweetened beverages are associated with multiple poor health outcomes among children and adults, and the authors of the current study provide a review of trends in the consumption of sugar-sweetened beverages. Reductions in the consumption of sugar-sweetened beverages in wealthier countries has been offset by increased consumption in less developed countries. Globally, sugar-sweetened beverage consumption is highest in the Caribbean and lowest in East Asia and Oceania. Still, a 2018 report found that sugar-sweetened beverages made up 10% to 15% of total daily caloric intake among school-aged children in China. National surveys in the US found that sugar-sweetened beverages accounted for 8% and 6.9% of total daily calories among children and adults, respectively. Overall, one study found that sugar-sweetened beverages were associated with an additional 180,000 adiposity-related deaths globally in 2010.

The current study provides a broad review of the health consequences of not just sugar-sweetened beverages, but overall sugar consumption as well.

Study Synopsis and Perspective

A new compilation of nearly all research to date on the health effects of sugar offers dozens of reasons to cut back now.

Researchers from China and the United States rounded up 8,601 scientific studies on sugar and combined them to evaluate its effects on 83 health outcomes. The studies accounted for decades of research on the topic, stretching back to the beginning of the largest electronic databases for scientific papers. 

The result is a list that cites the world’s most common health problems, such as heart disease, diabetes, obesity, high blood pressure, heart attack, high cholesterol, cancer, and depression. The findings were published this week in BMJ. Researchers looked at studies that evaluated the effects of consuming free sugars, which means any food that contains processed or naturally occurring sugars, such as table sugar, honey, or maple syrup. Sugar found in whole fruits and vegetables and in milk is not free sugar.

Simple Sugar Swaps

Sugar hides in some surprising foods. Try these simple changes to avoid excess sweet stuff.

US dietary guidelines recommend getting no more than 10% of daily calories from added sugars. For a typical 2,000-calorie-per-day diet, that equals no more than 200 calories, or about 12 teaspoons. The CDC reports that the average person consumes 17 teaspoons per day, with the largest sources being sugar-sweetened beverages, desserts, and snacks.

The new analysis also found links between sugary beverage consumption and other diet and lifestyle characteristics that may contribute to health problems.

“People who consumed sugar sweetened beverages more frequently were likely to ingest more total and saturated fat, carbohydrate, and sodium and less fruit, fibre, dairy products, and wholegrain foods,” the authors write. “This dietary pattern was also associated with more frequent smoking and drinking, lower physical activity levels, and more time spent watching television. Therefore, the role of these confounding factors should be taken into consideration when explaining the association between sugar consumption and burden of disease.”

Recommendations for limiting sugar consumption are in place worldwide, the authors note. They conclude that more needs to be done, given the known health dangers of sugar.

“To change sugar consumption patterns, especially for children and adolescents, a combination of widespread public health education and policies worldwide is urgently needed,” they said. 

BMJ. 2023;381:e071609.[1]

Study Highlights

  • Researchers assessed published systematic reviews and meta-analyses that assessed the health outcomes of dietary sugar consumption. Studies published before January 2022 were eligible for review.
  • Researchers focused on total sugar consumption, as well as the intake of sugar-sweetened beverages specifically, as most included studies focused on sugar-sweetened beverages.
  • The current research excluded analyses of total dietary carbohydrates and nonnutritive sweeteners.
  • Researchers included 67 meta-analyses of observational studies, along with 6 meta-analyses of randomized controlled trials in their analysis. The most common outcomes of the included research were endocrine/metabolic disease, followed by cancer and cardiovascular disease.
  • Sugar-sweetened beverages were the primary variable in 58 studies, whereas total sugars served this role in just 4 studies.
  • Overall, sugar consumption was associated with 45 significant negative health outcomes and 4 beneficial outcomes. There were 34 outcomes without a significant association.
  • The majority of outcomes were based on low or very low quality of evidence. No high-quality evidence was found for any study outcome, and only 5% of outcomes were judged to have moderate evidence of quality.
  • Increased sugar consumption was associated with higher rates of obesity and fat deposition in the liver and muscle.
  • Each additional serving of sugar-sweetened beverages per week was associated with a relative 4% increase in the risk for gout among adults and an increase of body mass index of 0.07 units among children.
  • Sugar-sweetened beverage consumption was associated with lower levels of high-density lipoprotein cholesterol, higher levels of low-density lipoprotein cholesterol, and lower levels of total cholesterol.
  • Each 355 mL/day increase in consumption of sugar-sweetened beverages was associated with a 14% increased relative risk for metabolic syndrome. Each 250 mL/day increase in consumption of sugar-sweetened beverages was associated with a 12% increased relative risk for obesity.
  • Each additional serving of sugar-sweetened beverages per day was associated with a relative increased risk for type 2 diabetes of 27%.
  • However, sugar-sweetened beverages consumption among adults did not significantly affect body mass index, serum triglyceride levels, or waist circumference.
  • Each 250 mL/day increase in consumption of sugar-sweetened beverages was associated with a 17% increase in the risk for coronary heart disease and a 7% increase in the risk for stroke. Each 355 mL/day increase in sugar-sweetened beverages consumption was associated with an 11% increase in the risk for hypertension.
  • Sugar-sweetened beverages consumption was not associated with a higher risk for heart failure.
  • Low-quality evidence found that sugar-sweetened beverage consumption at the highest levels was associated with a 2-fold increase in the risk for hepatocellular carcinoma. Fructose consumption was associated with a positive linear relationship with the risk for pancreatic cancer.
  • Sugar-sweetened beverages were not associated with a higher risk for other forms of gastrointestinal cancer or hematologic cancer.
  • Very low quality evidence suggested a positive association between sugar-sweetened beverage consumption and the risks for any cancer, and breast cancer specifically.
  • Each additional 250 mL/day of sugar-sweetened beverages was associated with a 4% increase in all-cause mortality.
  • Sugar-sweetened beverage consumption was also associated with a significant increase in the risk for depression.
  • In very low quality evidence, sugar-sweetened beverages were also associated with higher risks for fatty infiltration of the liver and reduced bone density. However, sugar-sweetened beverages did not promote a higher risk for kidney disease.

Implications for the healthcare team

  • In the current study, sugar-sweetened beverages were associated with higher rates of metabolic syndrome, obesity, and type 2 diabetes, but there was no significant association between sugar-sweetened beverages and waist circumference.
  • Sugar-sweetened beverages were associated with higher risks for hepatocellular and pancreatic cancer, and possibly breast cancer as well. Sugar-sweetened beverages were not found to promote a significantly higher risk for colorectal cancer.
  • The healthcare team should counsel patients to restrict their consumption of sugar, particularly sugar-sweetened beverages.

 

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