Added sugars: Definitions, classifications, metabolism and health implications
Palabras clave:
Chronic disease, Food consumption, Food label, SugarResumen
The sugars added to foods have been featured in recent scientific research, including the publication of the World Health Organization recommendation to limit consumption of added sugars, based on studies on weight gain and dental caries. However, it is possible that there is evidence of an association between excessive consumption and other pathologies, but scientific studies have yet to investigate these associations. Moreover, there is no consensus on the descriptions and definitions of these sugars, with several terms and components used to designate them. In Brazil, there are few studies investigating added sugars, identifying a
lack of discussion on this subject. This paper presents a literature review of sugars added to foods, from their definitions and classifications to the metabolism and health effects. The search was performed without limiting dates in the following databases: Web of Science, Scopus, PubMed and SciELO, as well as in national and international official sites. Keywords in Portuguese and English related to sugars added to foods were used, in combination with terms related to systematic review and meta-analysis studies, in order to find research linking added sugars consumption with health damage. The literature indicates that there is a relationship between excessive consumption of added sugars and various health outcomes, including weight gain, type 2 diabetes
Mellitus, cancer, and cardiovascular diseases. The different descriptions of sugars in foods may confuse both food consumers and researchers, since each term includes different components. Thus, it is suggested to use the standardized term “added sugar” as the most suitable term for the broader population to understand, because it indicates that those sugars are not natural food components.
Citas
World Health Organization. Carbohydrates in human nutrition. Geneva: WHO; 1998.
Slavin J. Whole grains and human health. Nutr Res Rev. 2004;17(1):99-110.
Institute of Medicine. Dietary Reference Intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino Acids. Washington (DC): National Academy of Sciences; 2002.
World Health Organization. Guideline: Sugars intake for adults and children. Geneva: WHO; 2015.
Office of Disease Prevention and Health Promotion. 2015-2020 Dietary Guidelines for Americans. Washington (DC): Office of Disease Prevention and Health Promotion; 2015.
Pomeranz JL. The bittersweet truth about sugar labeling regulations: They are achievable and overdue. Am J Public Health. 2012;102(7):14-20. https://doi.org/10.2105/AJPH.2012.300732
Food and Drug Administration. Food labeling: Revision of the nutrition and supplement facts labels. Washington (DC): Food and Drug Administration; 2016.8. Canada Gazette. Regulations amending the food and drug regulations (nutrition labelling, other labelling provisions and food colours). Canada Gazette. 2016 [cited 2016 Jan 12];150(25). Available from: http://www.gazette.gc.ca/rp-pr/p2/2016/2016-12-14/html/sor-dors305-eng.php
Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: Systematic review and metaanalyses of randomised controlled trials and cohort studies. BMJ. 2012;346:e7492. https://doi.org/10.1136/bmj.e7492
Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: Systematic review to inform WHO guidelines. J Dent Res. 2014;93(1):8-18. https://doi.org/10.1177/0022034513508954
Food and Agriculture Organization of the United Nations. Food and nutrition in numbers. Roma: Food and Agriculture Organization of the United Nations; 2014.
Newens KJ, Walton J. A review of sugar consumption from nationally representative dietary surveys across the world. J Hum Nutr Diet. 2016;29(2):225-40. https://doi.org/10.1111/jhn.12338
Cummings JH, Stephen AM. Carbohydrate terminology and classification. Eur J Clin Nutr. 2007;61(Suppl.1):S5-18. https://doi.org/10.1038/sj.ejcn.1602936
Englyst HN, Hudson GJ. The classification and measurement of dietary carbohydrates. Food Chem. 1996;57(1):15-21. https://doi.org/10.1016/0308-8146(96)00056-8
Salmerón J, Ascherio A, Rimm EB, Colditz GA, Spiegelman D, Jenkins DJ, et al. Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care. 1997;20(4):545.
Livesey G. Health potential of polyols as sugar replacers, with emphasis on low glycaemic properties. Nutr Res Rev. 2003;16(2):163-91. https://doi.org/10.1079/nrr200371
Sigman-Grant M, Morita J. Defining and interpreting intakes of sugars. Am J Clin Nutr. 2003;78(4):815s-26s.
World Health Organization. Diet, nutrition and the prevention of chronic diseases. Geneva: WHO; 2003.
Van Horn L, Johnson RK, Flickinger BD, Vafiadis DK, Yin-Piazza S. Translation and implementation of added sugars consumption recommendations: A conference report from the American Heart Association Added Sugars Conference 2010. Circulation. 2010;122(23):2470-90. https://doi.org/10.1161/CIR.0b013e3181ffdcb0
Agência Nacional de Vigilância Sanitária. Resolução nº 12 de 1978: aprova normas técnicas especiais, do Estado de São Paulo, revistas pela CNNPA, relativas a alimentos (e bebidas), para efeito em todo território brasileiro. Diário Oficial [da] União; 1978 24 jul.
Barclay A, Sandall P, Shwide-Slavin C. The ultimate guide to sugars and sweeteners. New York: The Experiment; 2014.
United States Department of Agriculture. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2000. Washington (DC): United States Department of Agriculture; 2000.
Guyton AC, Hall JE. Tratado de fisiologia médica. Guanabara Koogan; 2011.
The Stationery Office. Carbohydrates and health. London: The Stationery Office; 2015.
Erickson J, Slavin J. Total, added, and free sugars: Are restrictive guidelines science-based or achievable? Nutrients. 2015;7(4):2866-78. https://doi.org/10.3390/nu7042866
National Health and Medical Research Council. Australian Dietary Guidelines. Canberra: National Health and Medical Research Council; 2013.
Ministry of Health (New Zealand). Food and nutrition guidelines for healthy older people: A background paper. Wellington: Ministry of Health; 2013.
Vorster HH, Badham JB, Venter CS. An introduction to the revised food-based dietary guidelines for South Africa. S Afr J Clin Nutr. 2013;26(3Suppl.):S1-S164. 2013;26(3):1-16.
Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, et al. Nutrition recommendations and interventions for diabetes: A position statement of the American Diabetes Association. Diabetes Care. 2008;31(Suppl.1):S61-78. https://doi.org/10.
/dc08-S061
European Food Safety Authority. Scientific opinion on dietary reference values for carbohydrates and dietary fibre. EFSA J. 2010;8(3):1462.
Ministério da Saúde (Brasil). Guia alimentar para a população brasileira. 2ª ed. Brasília: Ministério da Saúde; 2014.
Ministério da Saúde (Brasil) Guia alimentar para a população brasileira: promovendo a alimentação saudável. Brasília: Ministério da Saúde; 2006.
Popkin BM, Hawkes C. Sweetening of the global diet, particularly beverages: Patterns, trends, and policy responses. Lancet Diabetes Endocrinol. 2015;4(2):174-86. https://doi.org/10.1016/S2213-8587(15)00419-2
Scapin T. Notificação dos açúcares de adição em rótulos de alimentos industrializados comer-cializados no Brasil [dissertação]. Florianópolis: Universidade Federal de Santa Catarina; 2016.
Smith C, Marks AD, Lieberman M. Basic medical biochemistry: A clinical approach. Philadelphia: Lippincott Williams & Williams; 2005.
Barreiros RC, Bossolan G, Trindade CEP. Frutose em humanos: efeitos metabólicos, utilização clínica e erros inatos associados. Rev Nutr. 2005;18:377-89. https://doi.org/10.1590/S1415-52732005000300010
Stanhope KL, Havel PJ. Fructose consumption: Considerations for future research on its effects on adipose distribution, lipid metabolism, and insulin sensitivity in humans. J Nutr. 2009;139(6):1236s-41s. https://doi.org/10.3945/jn.109.106641
Malik VS, Schulze MB, Hu FB. Intake of sugarsweetened beverages and weight gain: A systematic review. Am J Clin Nutr. 2006;84(2):274-88.
Stanhope KL, Havel PJ. Fructose consumption: Potential mechanisms for its effects to increase visceral adiposity and induce dyslipidemia and insulin resistance. Curr Opin Lipidol. 2008;19(1):16-24. https://doi.org/10.1097/MOL.0b013e3282f2b24a
DiNicolantonio JJ, O’Keefe JH, Lucan SC. Added fructose: A principal driver of type 2 diabetes Mellitus and its consequences. Mayo Clin Proc. 2015;90(3):372-81. https://doi.org/10.1016/j.mayocp.2014.12.019
Greenwood DC, Threapleton DE, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, et al. Association between sugar-sweetened and artificially sweetened soft drinks and type 2 diabetes: Systematic review and dose-response meta-analysis of prospective studies. Br J Nutr. 2014;112(5):725-34. https://doi.org/10.1017/s0007114514001329
Xi B, Li S, Liu Z, Tian H, Yin X, Huai P, et al. Intake of fruit juice and incidence of type 2 diabetes: A systematic review and meta-analysis. PLoS ONE. 2014;9(3):93471. https://doi.org/10.1371/journal.pone.0093471
Aune D, Chan DS, Vieira AR, Navarro Rosenblatt DA, Vieira R, Greenwood DC, et al. Dietary fructose, carbohydrates, glycemic indices and pancreatic cancer risk: A systematic review and meta-analysis of cohort studies. ESMO. 2012;23(10):2536-46. https://doi.org/10.1093/annonc/ mds076
Kaaks R, Lukanova A. Energy balance and cancer: The role of insulin and insulin-like growth factor-I. Proc Nutr Soc. 2001;60(1):91-106.
Michaud DS, Fuchs CS, Liu S, Willett WC, Colditz GA, Giovannucci E. Dietary glycemic load, carbohydrate, sugar, and colorectal cancer risk in men and women. Cancer Epidemiol Biomarkers Prev. 2005;14(1):138.
Galeone C, Pelucchi C, La Vecchia C. Added sugar, glycemic index and load in colon cancer risk. Curr Opin Clin Nutr Metab Care. 2012;15(4):368-73. https://doi.org/10.1097/MCO.0b013e 3283 539f81
Reiner Z, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, et al. Guidelines for the management of dyslipidaemias: The task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Atherosclerosis. 2011;217(1):3-46.
Welsh JA, Sharma A, Abramson JL, Vaccarino V, Gillespie C, Vos MB. Caloric sweetener consumption and dyslipidemia among us adults. JAMA. 2010;303(15):1490-7. https://doi.org/10.1001/jama.2010.449
Te Morenga LA, Howatson AJ, Jones RM, Mann J. Dietary sugars and cardiometabolic risk: Systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr. 2014;100(1):65-79. https://doi.org/10.3945/ajcn.113.081521
Huang C, Huang J, Tian Y, Yang X, Gu D. Sugar sweetened beverages consumption and risk of coronary heart disease: A meta-analysis of prospective studies. Atherosclerosis. 2014;234(1):11-6. https://doi.org/10.1016/j.atherosclerosis. 2014.01.037
Wang DD, Sievenpiper JL, de Souza RJ, Cozma AI, Chiavaroli L, Ha V, et al. Effect of fructose on postprandial triglycerides: A systematic review and meta-analysis of controlled feeding trials. Atherosclerosis. 2014;232(1):125-33.
Zhang YH, An T, Zhang RC, Zhou Q, Huang Y, Zhang J. Very high fructose intake increases serum LDL-cholesterol and total cholesterol: A meta-analysis of controlled feeding trials. J Nutr. 2013;143:1391-8.
Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: Prospective cohort study. BMJ. 2008;336(7639):309-12. https://doi.org/10.1136/bmj.3944 9.819271.BE
Johnson RJ, Segal MS, Sautin Y, Nakagawa T, Feig DI, Kang D-H, et al. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am J Clin Nutr. 2007;86(4):899-906.
Madero M, Perez-Pozo SE, Jalal D, Johnson RJ, Sanchez-Lozada LG. Dietary fructose and hypertension. Curr Hypertens Rep. 2011;13(1):29-35. https://doi.org/10.1007/s11906-010-0163-x
Johnson RJ, Sanchez-Lozada Lg, Nakagawa T. The effect of fructose on renal biology and disease. J Am Soc Nephrol. 2010;21:2036-9.
Ha V, SievenpiperJl, de Souza RJ, Chiavaroli L, Wang DD, Cozma AI, et al. Effect of fructose on blood pressure: A systematic review and metaanalysis of controlled feeding trials. Hypertension. 2012;59(4):787-95.
Malik AH, Akram Y, Shetty S, Malik SS, Yanchou Njike V. Impact of sugar-sweetened beverages on blood pressure. Am J Cardiol. 2014;113(9):1574-80. https://doi.org/10.1016/j.amjcard.2014.01.437
Goldfein KR, Slavin JL. Why sugar is added to food: Food science 101. Compr Rev Food Sci Food Saf. 2015;14(5):644-56. https://doi.org/10.1111/1541-4337.12151
Fitch C, Keim KS. Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners. J Acad Nutr Diet. 2012;112(5):739-58. https://doi.org/10.1016/j.jand.2012.03.009
Miller PE, Perez V. Low-calorie sweeteners and body weight and composition: A meta-analysis of randomized controlled trials and prospective cohort studies. Am J Clin Nutr. 2014;100(3):765-
https://doi.org/10.3945/ajcn.113.082826
Rogers PJ, Hogenkamp PS, de Graaf C, Higgs S, Lluch A, Ness AR, et al. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Int J Obes (Lond). 2016;40(3):381-94. https://doi.org/10.1038/ijo.2015.177
Swithers SE. Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements. Trends Endocrinol Metab. 2013;24(9):431-41. https://doi.org/10.1016/j.tem.2013. 05.005
Pepino MY. Metabolic effects of non-nutritive sweeteners. Physiol Behav. 2015;152:450-5. https://doi.org/10.1016/j.physbeh.2015.06.024
Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: Effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr. 2009;89(1):1-14. https://doi.org/10. 3945/ajcn.2008.26792
Shankar P, Ahuja S, Sriram K. Non-nutritive sweeteners: Review and update. Nutrition. 2013;29(11-12):1293-9. https://doi.org/10.1016/j.nut.2013.03.024
Gardner C. Non-nutritive sweeteners: Evidence for benefit vs. risk. Curr Opin Lipidol. 2014;25(1):80-4. https://doi.org/10.1097/mol.0000000000000034
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