Sucrose: Dietary Importance

J Plaza-Diaz and A Gil, University of Granada, Granada, Spain

ã 2016 Elsevier Ltd. All rights reserved.

Definition glucose between 65 and 75, depending on the conditions

(e.g., acidity, pH, and temperature). The specific gravity of a
Carbohydrates are the world’s primary source of food energy. single sucrose crystal is 1.5879 g ml1.
The Food and Agriculture Organization of the United Nations Sucrose melts and decomposes at 186–188
C to form cara-
(FAO) and, more recently, the European Food Safety Authority mel and, when combusted, it produces carbon, carbon dioxide,
(EFSA) have advised that carbohydrate intake should range and water. The heat of combustion is 1351.3 kcal mol1 or
from 45% to 60% for both adults and healthy children older 3.95 kcal g1. Sucrose is, therefore, less caloric than fat
than 1 year of age. (9.3 kcal g1) and protein (4.1 kcal g1).
Dietary carbohydrates can be in the form of complex The International Commission for Uniform Methods of
molecules (polymers or polysaccharides) or more simple Sugar Analysis (ICUMSA) is an international standards body,
molecules, monomers (monosaccharides) or dimers (disaccha- founded in 1897, which publishes detailed laboratory proce-
rides), commonly referred to as sugars. Sucrose is a disaccharide dures for the analysis of sugar. Sucrose is extremely soluble in
composed of the monosaccharides glucose and fructose. water and alcohol and other polar solvents. Solubility is one of
Sucrose is the organic compound commonly known as table the most studied properties of sucrose because it is such an
sugar, cane sugar, or beet sugar. Sucrose is an odorless, white, important factor in production and use. Numerous tables are
crystalline powder with a sweet taste. It is a nonreducing sugar, available to determine the saturation point of sucrose (maxi-
which is soluble in water and crystallizes easily. It is used to mum solubility) under various conditions.
sweeten foods, improve the sour and bitter taste of many foods, Because the amount of sucrose dissolved in water is impor-
and preserve foods by increasing osmotic pressure, which pre- tant industrially, a series of measuring indexes have been
vents the growth of many microorganisms. developed to indicate the relative proportions of the two mate-
Sucrose is hydrolyzed in the small intestine via the action of rials. The most important of these is the Brix scale, which
the sucrase–isomaltase enzyme complex, and the resulting provides the percentage of sucrose (by weight) in a water
monosaccharides are later metabolized, rendering energy or solution. For example, 65
Brix would represent a solution
serving as a carbon skeleton for other biological compounds, that is 65% sucrose and 35% water. Thus, a Brix reading can
primarily glycogen, fatty acids, and cholesterol. be used to obtain the corresponding specific gravity or refrac-
tive index of a solution that, in practice, corresponds to a
solution of pure sucrose at a set reference temperature, usually
Chemical and Physical Characteristics 20
C. This index is very useful for estimating the sucrose
content in many foods containing relatively high amounts of
Chemical Characteristics sucrose, namely, fruit juices.
Sucrose (a-D-glucopyranosyl-b-D-fructofuranoside) is a disaccha- Other properties that are commonly measured include vis-
ride with the general molecular formula C12H22O11, and it has a cosity, osmotic pressure, boiling point elevation, and equilib-
molecular weight of 342.30. In solution, it is present primarily in rium relative humidity, because these physical properties are
the cyclic form, which can be represented in various ways (e.g., a very useful in the food technology field.
Fischer projection or as a Haworth-type structure; Figure 1). All
sugars are fairly reactive but, in sucrose, the reactive sites of Sources and Production
glucose and fructose are bonded together. Sucrose is a non-
reducing sugar and is stable when heated. Fructose will decom- Table sugar (sucrose) comes from plant sources. Two important
pose at temperatures above 103
C, and both glucose and sugar crops predominate: sugarcane (Saccharum officinarum L.)
fructose are unstable in alkaline solutions. In acidic solutions, and sugar beet (Beta vulgaris L. var. rapa). Sugar can account for
sucrose will invert or break down to its component monosaccha- between 12% and 20% of dry weight. Minor commercial sugar
rides. This reaction is accelerated with increasing acidity or tem- crops include the date palm (Phoenix dactylifera), sorghum (Sor-
perature. In solution (including in human metabolism), most ghum vulgare), and the sugar maple (Acer saccharum).
sucrose reactions begin with the inversion reaction. Sucrose is present naturally in many fruits and fruit juices,
but it can also be found as added sugar in baby foods, baked
products, beverages, breakfast cereals, cereal grains and pasta,
Physical Properties
dairy and egg products, ethnic foods, fast foods, fat and oil
Sucrose is normally used as a solid because it is extremely products, finfish and shellfish products, legumes and legume
stable in its crystalline form. Pure sucrose is a colorless, odo- products, meals, entrées and side dishes, nut and seed prod-
rless crystalline powder with a pleasing sweet taste without any ucts, poultry products, pork products, sauces, gravies and
other flavor or aftertaste; it is the standard reference for sweet- soups, sausages and luncheon meats, snacks, spices and
ness. If sucrose is given a sweetness rating of 100, the relative herbs, sweets, and vegetables and vegetable products (see
sweetness of fructose is between 105 and 125, and that of Table 1).

Encyclopedia of Food and Health http://dx.doi.org/10.1016/B978-0-12-384947-2.00668-1 199

200 Sucrose: Dietary Importance

HC a O CH2OH

HCOH b C
O CH2OH
HOCH HOCH
H O H HOCH2 O H
HCOH HCOH H
OH H H OH
HC HC OH CH2OH
O
CH2OH CH2OH H OH OH H
(a) (b)

Figure 1 The chemical structure of sucrose. Macrae, R., Robinson, R. K., and Sadler, M. J. (eds) (1993). Encyclopaedia of food science, food
technology and nutrition. Academic Press.

Table 1 The sucrose content of foodsa processing requires two stages: mills extract the raw sugar
from the freshly harvested cane and ‘mill-white’ sugar, which
Range in mg per 100 g serving is intended for local consumption, is sometimes produced
immediately afterward. Sugar crystals appear naturally white
Baby foods 40–9340
in color during the crystallization process. Sulfur dioxide is
Baked products 160–44 528
Beverages 50–59 896 added to inhibit the formation of color-inducing molecules
Breakfast cereals 30–44 357 and to stabilize the sugar juices during evaporation.
Cereal grains and pasta 20–1700
Dairy and egg products 10–10 000
Ethnic foods 10–20 081 Sugar Beets
Fast foods 10–32 098 Sugar beets come from regions with cooler climates, including
Fat and oil products 290–6399
northwest and eastern Europe and America; the Russian Fed-
Finfish and shellfish products 30–2950
Legumes and legume products 340–8680
eration produced more than 39 million tons in 2013, France
Meals, entrées, and side dishes 320–3501 33 million tons, Germany 22 million tons, and the United
Nut and seed products 340–51 503 States over 29 million tons.
Poultry products 20–600 White beet sugar is made from beets, which are harvested in
Pork products 40–780 the autumn and early winter by digging them out of the
Sauces, gravies, and soups 240–1100 ground. The processing begins by slicing the beets into thin
Sausages and luncheon meats 80–1300 chips, which increases the surface area, making it easier to
Snacks 120–16 508 extract the sugar.
Spices and herbs 20–4089 The extraction takes place in a diffuser, where the beet is
Sweets 700–94 546
kept in contact with hot water for about an hour before being
Vegetables and vegetable products 10–5250
squeezed in screw presses to extract as much juice as possible.
a
Detailed information for specific products can be found at http://nutritiondata.self.com/ The juice is cleaned up before it can be used for sugar produc-
foods-000009000000000000000-w.html. tion by carbonatation, where small clumps of chalk are grown
in the juice. As the clumps form, they collect many nonsugars;
filtering out the chalk also removes any nonsugar molecules.
Sugarcane The juice is evaporated in a multistage evaporator, and the
Most sugarcane comes from countries with warm climates syrup placed in a large pan, typically holding 60 tons or more
because sugarcane does not tolerate frost. Approximately 80% of sugar syrup. In the pan, water is boiled off until the condi-
of the world’s sucrose is derived from sugarcane; the remainder tions are right for sugar crystals to grow. Once the crystals have
is almost entirely from sugar beets. grown, the resulting mixture of crystals and mother liquor is
In 2013, Brazil, India, China, Thailand, and the United States spun in a centrifuge to separate the two, similar to how laundry
were the major sugarcane-producing countries in the world. is spin-dried. The crystals are dried with hot air before being
Brazil produced approximately 739 million tons of sugarcane packed and/or stored for dispatch.
in 2013, whereas India produced 341 million tons, China 125
million tons, Thailand more than 100 million tons, and the
United States more than 27 million tons. Viewed by region, Patterns of Consumption
South America predominates in sugarcane production, provid-
Global Scenario
ing 44.7% of the global production in 2013. Asia comes in the
second place with 39.7% of the global production; Africa and At the present time, cane sugar and beet sugar are produced in
Central America produce 11.2% and Oceania produces 1.5%. more than 130 countries. As far as the consumption per coun-
Since the sixth century BC, sugarcane producers have try is concerned, India, China, Brazil, the United States, and
crushed the harvested vegetable material from sugarcane to Russia stand out, as they represent 45.2% of global consump-
collect and filter the juice containing the sugar. Sugarcane tion for the 2010–11 sugar cycle. India and Russia showed the
 Sucrose: Dietary Importance 201

greatest increases in demand at 8.5% and 3.3%, respectively, þ9.8%) and in middle-aged women aged 35–54 years
for the same cycle. ( 10 g day1, þ12.7%) between 1998–99 and 2006–07.
There are six sugar-consuming regions in the world. The In Denmark, between 1999 and 2007, added sugar intake
first is found in Asia (composed of 36 countries) with a deficit fell by 47% in 2-year-old children and by 62% in 12-month-
(between production and consumption) of 6.3 million tons old children.
and an annual consumption of 14.9 kg per capita. The region In Sweden, the levels of sucrose intake between reports
with the second highest consumption is composed of the 12 (1989 and 1997–98) increased by 6 g day1 in men but were
countries of the former Soviet Union, with a deficit of 4.8 unchanged in women. The percentage of energy from sucrose
million tons. In the third place is North Africa with a sugar between the reports increased marginally in men but was
consumption deficit of 3.9 million tons. In the fourth and fifth essentially unchanged in women.
places are North America and Europe with a deficit of 2.8 and In Spain, the daily sugar intake per capita is 111.2 g, accord-
2.4 million tons, respectively. In North America, the deficit ing to the 2011 ENRICA study. China’s per capita daily sugar
region is composed of two countries, Mexico and the United consumption is less than 31 g and lower still in rural areas
States, which have a population of 422 million inhabitants (5.5 g day1), which is much lower than levels consumed in
who maintain a high sugar intake compared with production medium- and high-income countries. In India, the per capita
levels; in per capita terms, the sugar consumption deficit in this daily sugar consumption is greater than 58 g.
region is 2.8 million tons. In Australia, the total sugar intake increased significantly
between 1983 and 1995 by 14 and 5 g in men and women,
respectively. In terms of the percentage of energy contribution,
in men, the proportion of energy from total sugars increased
Sucrose Intake by Country
between 1983 and 1995 from 18% to 20%. In women, it
Although overall energy intake has steadily increased globally, stayed relatively constant at 21% Figure 2 shows the sugar
worldwide trend data do not support the widely held view that daily energy intake (kcal day1) in the world.
refined sugar, as available for consumption, has increased
dramatically over the last 40–50 years.
The most comprehensive trend analysis for the National
Health and Nutrition Examination Survey (NHANES) Digestion, Absorption, and Metabolism of Sucrose
1999–2000 through 2007–08 revealed a decrease in total
energy intake (from 2145 to 2070 kcal day1) for the US pop- The human body is able to capture some of the chemical
ulation. The absolute intake of added sugars decreased from energy from carbohydrates through cellular metabolism,
100 g in 1999–2000 NHANES to 77 g in 2007–08 (24%). In resulting in the generation of an intermediate chemical form,
addition, the percentage of total energy, via added sugar intake, adenosine triphosphate, which acts as an energy source for
fell from 18.1% to 14.6%. cellular processes. Adenosine triphosphate is regenerated
In the United Kingdom, there were significant reductions from adenosine diphosphate using energy from food. The
for male children in total sugars ( 9%) and nonmilk extrinsic brain, nervous system, and red blood cells have an obligatory
sugars (NMES) ( 22%) between 1997 and 2008–09, but there requirement for glucose as an energy source.
was no reduction in the overall total food energy. In female The intestinal digestion of sucrose requires hydrolysis of its
children, the only significant difference was a reduction in the a(1,20 )b-linkage, which involves the anomeric carbon of both
percentage of food energy from NMES, which fell from 16.8% hexoses, to yield fructose and glucose. In mammalian species,
to 14.6%, with no other differences. the hydrolysis of sucrose is performed via the sucrase activity of
In France (INCA surveys), sugar intake only increased sig- the sucrase–isomaltase complex in the enterocytes of the small
nificantly in younger men aged 18–34 years ( 10 g day1, intestine.

∗
700 ∗ ∗
600
500
400
300
200
100
0
a

ld

ld

pe

lia

il

es
as
n

ric

di

ic

ad

ic
or

or

ra

at
hi

ro

er

ex
In

Br
Af

an
w

st
C

St
Eu

Am

Au
g

d
n

te
pi

tin

ni
lo

La

U
ve
De

Daily energy from sugar (kcal day–1) (∗including calories from high-fructose corn syrup)
Figure 2 The world caloric intake of sugar. Adapted from USDA-ERS, Conadesuca, OECD, Credit Suisse Research, 2013.
202 Sucrose: Dietary Importance

Following absorption, glucose and fructose are transported Sucrose as a Sweetener

to the liver by specific transporters, SLGT1 and GLUT-5, respec-
Sweeteners can be categorized as nutritive and nonnutritive.
tively. Glucose is phosphorylated to glucose-6-phosphate in
Nutritive sweeteners (NSs) contain carbohydrates and provide
the liver by glucokinase, which functions in glycogen synthesis
energy (4 kcal g1 and an average of 2 kcal g1 for sugar alco-
or lipogenesis via the glycolytic pathway, or it reaches the
hols). Nonnutritive sweeteners (NNSs) offer little or no energy
systemic circulation. The plasma concentration of insulin
when ingested. They are referred to as high-intensity sweet-
increases immediately after the ingestion of glycemic carbohy-
eners because, as sweetening ingredients, they are many times
drates. A family of glucose transporters mediates the cellular
sweeter than sucrose. NNSs can replace the sweetness of sugar
uptake of glucose, while in some tissues (e.g., adipose tissue
or energy-containing sweeteners. However, they do not have
and skeletal muscle), it is insulin-dependent (GLUT-4).
the same functional properties, such as browning,
Fructose is metabolized by conversion to glycolytic pathway
crystallization, and microbial inhibition.
intermediates. In the liver, it is phosphorylated to produce
Enjoying a sweet taste is innate, but the perception of
fructose-1-phosphate in a reaction catalyzed by ketohexoki-
sweetness and the preferred level of sweetness vary among
nase or fructokinase. Fructose-1-phosphate is cleaved by the
individuals. Taste perception begins on the tongue and soft
action of aldolase B to form dihydroxy-acetaldehyde-
palate, where taste receptors interact with food or beverages.
phosphate (DHAP) and glyceraldehyde. To metabolize glycer-
Taste receptor cells are organized into taste buds, which are
aldehyde, it has to be phosphorylated by triose kinase, creating
distributed throughout the tongue and on specialized struc-
glyceraldehyde-3-phosphate, which enters the glycolytic path-
tures called papillae. A sweet taste is elicited by interaction with
way, along with DHAP, at the triose-phosphate level. Under
a sweet receptor, which is a dimeric G protein-coupled receptor
postprandial conditions, fructose is primarily converted to
composed of T1R2 and T1R3 subunits with multiple active
acetyl-coenzyme A and later to fatty acids and cholesterol.
sites. T1R2 and T1R3 receptors respond to sugars (e.g., sucrose,
Glucose is made available to body tissues via the blood-
fructose, galactose, glucose, lactose, and maltose) and NNSs
stream, and it is the primary carbohydrate used for energy. The
(e.g., acesulfame K, aspartame, cyclamate, dulcin, neotame,
balance between oxidation, biosynthesis, and glucose storage
saccharin, and sucralose), although their specific preferential
depends on the hormonal and nutritional state of the cells,
binding sites may vary.
tissues, and organism. The predominant metabolic pathways
Sucrose is an important part of both groups of sweeteners.
of glucose vary indifferent cells depending on the physiological
In the NS group, which includes sucrose, glucose, and fructose,
demand. Thus, the liver has a fundamental role in glucose
the carbohydrate adds texture, flavor, and color to baked
homeostasis in the body.
goods; supports the growth of yeast for leavening or
Glucose can be completely oxidized by hepatocytes to
fermentation; contributes to volume in ice cream, baked
obtain energy, and it can be stored in the form of glycogen,
goods, and jams; enhances the creamy consistency of frozen
or it can be used to supply carbons for fatty acid and amino
desserts; enhances the crystallization of confectionary
acid synthesis. Heart and skeletal muscles can completely oxi-
products; balances acidity in salad dressings, sauces, and
dize glucose or store it in the form of glycogen. Glucose can be
condiments; and helps to maintain the natural color, texture,
partially broken down in fatty tissues to provide glycerol,
and shape of preserved fruits. In the NNS group, the carbohy-
which is necessary for triacylglycerol synthesis, or oxidized
drate is present in a modified form, such as sucralose.
completely to supply two units of carbon (acetyl-CoA) for
The chlorination of three hydroxyl groups on sucrose pro-
fatty acid synthesis.
duces a modified sucrose that is approximately 600 times
The brain depends on the continuous supply of glucose,
sweeter than sucrose (sucralose). Sucralose is used as a sugar
which can oxidize completely to form CO2 and water. Con-
substitute in numerous food products, including beverages,
versely, erythrocytes, which have a limited capacity for oxidizing
baked goods, dairy products, canned fruits, syrups, and condi-
glucose because they do not have mitochondria, depend entirely
ments, and it is sold direct to consumers as an NS sugar
on metabolic fuels for energy production, partially oxidizing
replacement (e.g., Splenda™).
glucose to lactate via glycolysis. Other specialized cells such as
corneal cells, lens and retina cells, leukocytes, testicular cells, and
renal medulla cells are predominantly glycolytic.
Health Effects

Nutritional Aspects of Sucrose In the last several decades, numerous epidemiological studies
have associated a high intake of sugar with higher prevalence of
Although at first glance, the sole function of carbohydrates noncommunicable chronic diseases, primarily dental caries,
appears to be an energy source for human and animal metab- being overweight or obese, diabetes, and cardiovascular
olism, sugars have other significant structural functions in disease (CVD). However, recent reviews and meta-analyses
living organisms, such as important components of membrane do not always support this hypothesis, particularly when the
antigens and proteins that are secreted by many cells. results are adjusted to the energy intake.
The release of insulin, in response to sucrose ingestion,
maintains blood glucose within a closely regulated range,
Dental Caries
which is essential for normal functioning of the central ner-
vous system. Sugar does not cause abnormal insulin and blood There is consistent evidence of moderate quality supporting a
glucose responses. relationship between the amount of total sugars consumed and
 Sucrose: Dietary Importance 203

the development of dental caries. Dental caries progress with sugar, including sugars in drinks, is specifically responsible for
age, and the effects of sugar on dentition are lifelong. Even low obesity.
levels of caries in childhood are significant to the amount of In addition, there is no convincing evidence that sugar is
caries throughout an individual’s lifetime. Nevertheless, dental addictive or stimulates overconsumption. Until scientists
caries, regardless of sugar consumption, has decreased dramat- develop valid and reliable methods for measuring energy
ically in developed countries due to increased buccodental intake in individuals and can balance this against energy
hygiene and the use of fluoridated toothpaste and/or water expenditure, more precise causes of weight gain will remain
supplies. elusive. Although obesity may be related to morbidity and
Population studies support the dose–response effect mortality rates, whether this is predominately a reflection of
between sugar intake and dental caries with 18 of 20 studies inadequate physical activity and low physical fitness beyond
showing a positive association, one showing a neutral associ- high energy and dietary sugar intake requires further
ation and one showing a negative association between sugar examination.
intake and the presence of dental caries. Additionally, nine
population studies provide evidence of positive correlations
Diabetes
between sugar intake and caries levels. There is also evidence
of moderate quality showing that dental caries are lower when Diabetes mellitus (DM) is one of the most prevalent endocrine
free sugar intake equates to less than 10% of the total food diseases in the general population. A number of expert reports
energy. Indeed, countries with estimated sugar intakes are less have considered the possible role of sugar in the causation of
than 10% – or even 5% – of the total food energy that do not DM. In the 1980s, the US Food and Drug Administration Sugar
have lower prevalence of caries. Changes in the sugar supply do Task Force and UK Committee on the Medical Aspects of Food
not reliably predict the magnitude or trends in the prevalence (and Nutrition) both dismissed the notion that sugar causes
of caries. Most developed countries have a lower prevalence of DM directly. The EFSA has indicated, “available evidence is
caries than many countries with lower sugar intake, despite insufficient to set an upper limit for sugars based on their
intakes being greater than 10% of the total food energy. How- effects on type 2 DM risk.”
ever, the majority of data are for children meaning the situa- Likewise, the UK recommendations do not consider it
tion in regard to adult dental health is unclear. appropriate to make specific recommendations for single
nutrients, including added sugars. Moreover, the American
Diabetes Association suggests minimizing the substitution of
Obesity
sucrose-containing foods for isocaloric amounts of other car-
Obesity occurs when energy intake from food and drink con- bohydrates. Nevertheless, there is moderate evidence that high
sumption is greater than energy expenditure through the consumption of sugar-sweetened beverages (SSBs) contributes
body’s metabolism and physical activities over a prolonged to an increased risk for type 2 DM. The direction of the asso-
period, resulting in the accumulation of body fat. Changes in ciation indicates that greater consumption of SSBs is detrimen-
body weight would be expected from any change in macronu- tal to health and the association is biologically relevant.
trient intake that leads to an overall excess or deficit in food However, recent recommendations to prevent DM are focussed
energy compared with the requirements for weight stability. An on the restriction of total carbohydrate and energy intake and
earlier World Health Organization (WHO)-sponsored expert increasing physical activity to allow for weight control, partic-
review stated, “excess energy in any form will promote body fat ularly in those who are obese.
accumulation.”
A recent review and meta-analysis reported that isocaloric
Cardiovascular Diseases
substitution of sugars for other carbohydrates does not lead to
weight gain. Therefore, there is no consistent or reliable evi- There is some concern that increased consumption of carbo-
dence that sugars affect obesity more than any other hydrates (particularly sugars and especially fructose), as may
macronutrient. occur on a low-fat high-carbohydrate (LFHC) diet, could result
Currently, there is no clear evidence of a dose–response in increased plasma triacylglycerols and reduced High density
gradient for the amount of sugar consumed and body weight. lipoproteins (HDLs) cholesterol (HDL-c), which are both
There are a number of short-term intervention studies that independent risk factors for CVD. A number of in-depth
focus on increasing or decreasing intakes of sugars and sugar- reviews have examined the effects of carbohydrates on triglyc-
containing foods, but the majority are unreliable as evidence of erides and factors that may influence any effect on CVD.
the effect of ‘free sugars’ on obesity because of confounding These reviews have shown that in controlled isocaloric
information on the caloric intake from other macronutrients. feeding studies, LFHC diets are associated with marginally
Conversely, there are no randomized controlled trials in reduced HDL-c (although it often results in an improved total
children to evaluate the potential effects of sugar on body cholesterol: HDL ratio) and slightly increased triacylglycerols.
weight. Therefore, some authoritative reviews have concluded The authors found no adverse effects on cardiovascular risk
that there is no consistent or reliable body of evidence to factors (i.e., blood lipids, glucose, and insulin) when sucrose
support any specific sugar intake level for the avoidance of replaced starchy foods at the levels of at least 25% of total
obesity in childhood. energy intake.
The overconsumption of food energy, whatever its macro- Hypocaloric diets (not ad libitum), which can be low or
nutrient composition, will lead to weight gain. However, there high in sucrose, have been shown to reduce serum triacylgly-
is no convincing evidence to support the widely held view that cerol levels. Consumption of fructose within the range
204 Sucrose: Dietary Importance

observed across the US population is not associated with Pennington NL and Baker CW (1990) Sugar: user’s guide to sucrose. New York:
hyperlipidemia in normal, overweight, or obese individuals, Springer.
Plaza-Diaz J, Martı́nez-Augustin O, and Gil A (2013) Foods as sources of mono and
although high consumption may result in nonalcoholic fatty
disaccharides: biochemical and metabolic aspects. Nutrición Hospitalaria 28: 5–16.
liver disease. Quiles IIJ (2013) Consumption patterns and recommended intakes of sugar. Nutrición
A low-fat (particularly low in saturated fat) high- Hospitalaria 28: 32–39.
carbohydrate diet, adequate physical activity/cardiorespiratory Research Institute Thought leadership from Credit Suisse Research and the world’s
fitness, and abstinence from tobacco use are the current rec- foremost experts (2013). Sugar consumption at a crossroads. http://www.
international-adviser.com/ia/media/Media/Credit-Suisse-Global-Wealth-Databook-
ommendations to reduce the risk of CVD. Although changing 2013.pdf.
to a high-carbohydrate diet may increase blood triacylglycer- Scientific Advisory Committee on Nutrition (2014). Draft carbohydrates and health
ols, the implications for CVD risk are unknown, and outcomes report scientific consultation.
are moderated by many factors that require further study. Thus, Stipanuk MH and Caudill MA (2013) Biochemical, physiological, and molecular aspects
of human nutrition. St. Louis, MO: Saunders.
currently, there is insufficient evidence to conclude that sugar
Te Morenga L, Mallard S, and Mann J (2012) Dietary sugars and body weight:
directly or indirectly increases the risk of CVD. systematic review and meta-analyses of randomised controlled trials and cohort
studies. BMJ 346: e7492.
Welsh JA, Sharma AJ, Grellinger L, and Vos MB (2011) Consumption of added sugars
See also: Candies and Sweets: Sugar and Chocolate Confectionery; is decreasing in the United States. American Journal of Clinical Nutrition
94: 726–734.
Carbohydrate: Digestion, Absorption and Metabolism; Obesity: Causes
Wittekind A and Walton J (2014) Worldwide trends in dietary sugars intake. Nutrition
and Prevalence; Sweeteners: Classification, Sensory and Health Effects. Research Reviews 27: 330–345.
WHO (2015) Guideline: sugars intake for adults and children. Geneva: World Health
Organization.

Further Reading
EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) (2010) Scientific
opinion on dietary reference values for carbohydrates and dietary fibre. EFSA Relevant Websites
Journal 8: 1462.
Fitch C, Keim KS, and Academy of Nutrition and Dietetics (2012) Position of the http://faostat.fao.org/ – Food and Agriculture Organization of the United Nations,
academy of nutrition and dietetics: use of nutritive and nonnutritive sweeteners. FAOSTAT.
Journal of the Academy of Nutrition and Dietetics 112: 739–758. http://www.icumsa.org/ – International Commission for Uniform Methods of Sugar
Gil A (2010) Tratado de nutrición (Nutrition treatise). Madrid: Editorial Medica Analysis.
Panamericana. http://nutritiondata.self.com/foods-000009000000000000000-w.html –
Moynihan PJ and Kelly SAM (2014) Effect on caries of restricting sugars intake: SELFNutritionData Foods highest in sucrose.
systematic review to inform WHO guidelines. Journal of Dental Research 93: 8. http://www.wsro.org/ – The World Sugar Research Organisation.