The lowering of dietary recommendations for the consumption of free or added sugar from 25% to 10% of daily calories has been criticized as being based on low-quality scientific evidence, ill-informed opinions and over-extrapolation of results from studies on sugar-sweetened beverages. This Comment rebuts these criticisms.
This is a preview of subscription content, access via your institution
Subscribe to Nature+
Get immediate online access to the entire Nature family of 50+ journals
Subscribe to Journal
Get full journal access for 1 year
only $8.25 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Erickson, J., Sadeghirad, B., Lytvyn, L., Slavin, J. & Johnston, B. C. The scientific basis of guideline recommendations on sugar intake: a systematic review. Ann. Intern. Med. 166, 257–267 (2017).
Archer, E. & Arjmandi, B. Falsehoods and facts about dietary sugars: a call for evidence-based policy. Crit. Rev. Food Sci. Nutr. 61, 3725–3739 (2021).
Yan, R. R., Chan, C. B. & Louie, J. C. Y. Current WHO recommendation to reduce free sugar intake from all sources to below 10% of daily energy intake for supporting overall health is not well supported by available evidence. Am. J. Clin. Nutr. 116, 15–39 (2022).
Kroeger, C. M. et al. Scientific rigor and credibility in the nutrition research landscape. Am. J. Clin. Nutr. 107, 484–494 (2018).
Miller, V. et al. Evaluation of the quality of evidence of the association of foods and nutrients with cardiovascular disease and diabetes: a systematic review. JAMA Netw. Open 5, e2146705 (2022).
Chen, H. et al. Consumption of sugar-sweetened beverages has a dose-dependent effect on the risk of non-alcoholic fatty liver disease: an updated systematic review and dose-response meta-analysis. Int. J. Environ. Res. Public Health 16, 2192 (2019).
Kazierad, D. J. et al. Inhibition of ketohexokinase in adults with NAFLD reduces liver fat and inflammatory markers: a randomized phase 2 trial. Med. (N. Y.) 2, 800–813.e3 (2021).
Sigala, D. M. & Stanhope, K. L. An exploration of the role of sugar-sweetened beverage in promoting obesity and health disparities. Curr. Obes. Rep. 10, 39–52 (2021).
Sheiham, A. & James, W. P. Diet and dental caries: the pivotal role of free sugars reemphasized. J. Dent. Res. 94, 1341–1347 (2015).
Reiser, S. Effect of dietary sugars on metabolic risk factors associated with heart disease. Nutr. Health 3, 203–216 (1985).
K.L.S. has received honoraria for speaking from numerous organizations (since 2016: American Diabetes Association, Columbia University, Harvard School of Medicine, Swedish Medical Center and University of Missouri) and from CrossFit for serving as academic organizer of a 2017 conference and lead author of the conference summary report.
About this article
Cite this article
Stanhope, K.L. Guidelines to lower intake of added sugar are necessary and justified. Nat Rev Cardiol 19, 569–570 (2022). https://doi.org/10.1038/s41569-022-00750-5