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Guidelines to lower intake of added sugar are necessary and justified

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.

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  1. 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).

    Article  PubMed  Google Scholar 

  2. 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).

    Article  CAS  PubMed  Google Scholar 

  3. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kroeger, C. M. et al. Scientific rigor and credibility in the nutrition research landscape. Am. J. Clin. Nutr. 107, 484–494 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  5. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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).

    Article  CAS  PubMed Central  Google Scholar 

  7. 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).

    CAS  Google Scholar 

  8. 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).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sheiham, A. & James, W. P. Diet and dental caries: the pivotal role of free sugars reemphasized. J. Dent. Res. 94, 1341–1347 (2015).

    Article  CAS  PubMed  Google Scholar 

  10. Reiser, S. Effect of dietary sugars on metabolic risk factors associated with heart disease. Nutr. Health 3, 203–216 (1985).

    CAS  PubMed  Google Scholar 

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Correspondence to Kimber L. Stanhope.

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Competing interests

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.

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Stanhope, K.L. Guidelines to lower intake of added sugar are necessary and justified. Nat Rev Cardiol 19, 569–570 (2022).

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