Total and added sugar intakes, sugar types, and cancer risk: results from the prospective NutriNet-Santé cohort

ABSTRACT Background Excessive sugar intake is now recognized as a key risk factor for obesity, type 2 diabetes, and cardiovascular diseases. In contrast, evidence on the sugar–cancer link is less consistent. Experimental data suggest that sugars could play a role in cancer etiology through obesity but also through inflammatory and oxidative mechanisms and insulin resistance, even in the absence of weight gain. Objective The objective was to study the associations between total and added sugar intake and cancer risk (overall, breast, and prostate), taking into account sugar types and sources. Methods In total, 101,279 participants aged >18 y (median age, 40.8 y) from the French NutriNet-Santé prospective cohort study (2009–2019) were included (median follow-up time, 5.9 y). Sugar intake was assessed using repeated and validated 24-h dietary records, designed to register participants’ usual consumption for >3500 food and beverage items. Associations between sugar intake and cancer risk were assessed by Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). Results Total sugar intake was associated with higher overall cancer risk (n = 2503 cases; HR for quartile 4 compared with quartile 1: 1.17; 95% CI: 1.00, 1.37; Ptrend = 0.02). Breast cancer risks were increased (n = 783 cases; HRQ4vs.Q1 = 1.51; 95% CI: 1.14, 2.00; Ptrend = 0.0007). Results remained significant when weight gain during follow-up was adjusted for. In addition, significant associations with cancer risk were also observed for added sugars, free sugars, sucrose, sugars from milk-based desserts, dairy products, and sugary drinks (Ptrend ≤ 0.01). Conclusions These results suggest that sugars may represent a modifiable risk factor for cancer prevention (breast in particular), contributing to the current debate on the implementation of sugar taxation, marketing regulation, and other sugar-related policies. This trial was registered at clinicaltrials.gov as NCT03335644.

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Total and added sugar intakes, sugar types and cancer risk: results from the NutriNet-Santé cohort

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.572 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C Debras ◽

E Chazelas ◽

B Srour ◽

E Kesse-Guyot ◽

C Julia ◽

...

Keyword(s):

Risk Factor ◽

Cancer Risk ◽

Cancer Prevention ◽

Prospective Cohort ◽

Modifiable Risk Factor ◽

Cardiometabolic Health ◽

Current Debate ◽

Added Sugar ◽

Sugar Intake ◽

Sugary Drinks

Abstract Background Excessive sugar is now recognized as a key risk factor for several cardiometabolic diseases. In contrast, the associations between sugars and cancer risk in cohort studies have been less investigated, and data is lacking regarding differential effect of sugar types and sources. Experimental data suggest that sugars could play a role in cancer etiology, through obesity but also through inflammatory and oxidative mechanisms and insulin resistance. Our objective was to study the associations between total and added sugar intake and cancer risk, accounting for sugar types and sources. Methods 101,279 French adults from the NutriNet-Santé prospective cohort study (2009-2019) were included. Sugar intake was assessed using repeated 24h-dietary records, designed to register participants' usual consumption for more than 3,500 food and beverage items. Associations with cancer risk were assessed by multi-adjusted Cox proportional hazard models. Results Sugar intake was associated with increased cancer risk (2,503 cases, Hazard Ratio Quartile 4 vs 1=1.17, 95% Confidence Interval 1.00-2.37, P trend=0.02). This association was mainly driven by breast cancer (783 cases, HR Q4 vs Q1=1.51 (1.14-2.00); P trend=0.0007) and remained significant even when weight-gain during follow-up was accounted for. Associations were more specifically observed for added sugars (P trend=0.02), free sugars (P trend=0.007), sucrose (P trend=0.01), and sugars from milk-based desserts (P trend=0.02), from sugary drinks (P trend=0.002), and from dairy products (P trend=0.01). Conclusions These results suggest that sugar (especially added sugar), of which intake is increasing in Western countries, may represent a modifiable risk factor for cancer prevention, adding to its well-established effect on dental and cardiometabolic health. These findings provide important and novel insights to the current debate on the implementation of sugar taxation, marketing regulation, and other sugar-related policies. Key messages In this large-scale prospective cohort of French adults, sugar intake (especially added sugar) was associated with higher cancer risk. These results suggest that (added) sugar may represent a modifiable risk factor for cancer prevention, adding novel insights to current debates on implementing sugar-related public health policies.

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Objective Biomarkers for Total Added Sugar Intake – Are We on a Wild Goose Chase?

Advances in Nutrition ◽

10.1093/advances/nmaa093 ◽

2020 ◽

Vol 11 (6) ◽

pp. 1429-1436

Author(s):

Jimmy Chun Yu Louie

Keyword(s):

Human Physiology ◽

Current Knowledge ◽

Dietary Assessment ◽

Added Sugar ◽

Added Sugars ◽

Sugar Intake ◽

Adverse Health Outcomes ◽

Dietary Assessment Methods ◽

Nutritional Sciences ◽

Wild Goose

ABSTRACT Misreporting of added sugar intake has been the major criticism of studies linking high added sugar consumption to adverse health outcomes. Despite the advancement in dietary assessment methodologies, the bias introduced by self-reporting can never be completely eliminated. The search for an objective biomarker for total added sugar intake has therefore been a topic of interest. In this article, the reasons this search may be a wild goose chase will be outlined and discussed. The limitations and inability of the 2 candidate biomarkers, namely urinary sucrose and fructose and δ¹³C isotope, which are based on the 2 only possible ways (i.e., difference in metabolism and plant sources) to identify added sugar based on current knowledge in human physiology and food and nutritional sciences, are discussed in detail. Validation studies have shown that these 2 candidate biomarkers are unlikely to be suitable for use as a predictive or calibration biomarker for total added sugar intake. Unless advancement in our understanding in human physiology and food and nutritional sciences leads to new potential ways to distinguish between naturally occurring and added sugars, it is extremely unlikely that any accurate objective added sugar biomarker could be found. It may be time to stop the futile effort in searching for such a biomarker, and resources may be better spent on further improving and innovating dietary assessment methods to minimize the bias introduced by self-reporting.

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Association Between Added Sugars from Infant Formulas and Rapid Weight Gain in US Infants and Toddlers

Journal of Nutrition ◽

10.1093/jn/nxab044 ◽

2021 ◽

Author(s):

Kai Ling Kong ◽

Brenda Burgess ◽

Katherine S Morris ◽

Tyler Re ◽

Holly R Hull ◽

...

Keyword(s):

Weight Gain ◽

Complementary Feeding ◽

Infants And Toddlers ◽

Rapid Weight Gain ◽

Cross Sectional ◽

Added Sugar ◽

Added Sugars ◽

Solid Foods ◽

Sectional Analysis ◽

Weight For Age

ABSTRACT Background Formulas often contain high amounts of added sugars, though little research has studied their connection to obesity. Objectives This study assessed the contribution of added sugars from formulas during complementary feeding on total added sugar intakes, and the association between these sugars and upward weight-for-age percentile (WFA%) crossing (i.e., participants crossing a higher threshold percentile were considered to have an upward crossing). Methods Data from three 24-hour dietary recalls for infants (n = 97; 9–12 months) and toddlers (n = 44; 13–15 months) were obtained in this cross-sectional analysis. Foods and beverages with added sugars were divided into 17 categories. Pearson's correlations were used to test relations between added sugar intake and upward WFA% crossing, followed by multivariable regressions when significant. ANOVA compared intakes of all, milk-based, and table foods between primarily formula-fed compared with breastfed participants. Multivariable regressions were used to test effects of added sugars and protein from all foods compared with added sugars and protein from milk-based sources on upward WFA% crossing. Results Added sugars from formulas comprised 66% and 7% of added sugars consumed daily by infants and toddlers, respectively. A significant association was observed between upward WFA% crossing and added sugars from milk-based sources after controlling for gestational age, sex, age, introduction to solid foods, mean energy intakes, and maternal pre-pregnancy BMI and education (β = 0.003; 95% CI, 0.000–0.007; P = 0.046). Primarily formula-fed participants consumed nearly twice the energy from added sugars (P = 0.003) and gained weight faster (upward WFA% crossing = 1.1 ± 1.2 compared with 0.3 ± 0.6, respectively; P < 0.001) than their breastfed counterparts. Conclusions Added sugars in formulas predict rapid weight gain in infants and toddlers. Educating mothers on lower-sugar options may enhance childhood obesity prevention.

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Added Sugar Intake and Risk of Falling Among Older People: The Seniors-ENRICA Cohort Study

Gerontology & Geriatrics: Research ◽

10.26420/gerontolgeriatrres.2021.1056 ◽

2021 ◽

Vol 7 (2) ◽

Author(s):

Ballesteros JM ◽

◽

Struijk E ◽

Machado-Fragua MD ◽

Ortolá R ◽

...

Keyword(s):

Older People ◽

Chronic Diseases ◽

Risk Of Falling ◽

Added Sugar ◽

Cox Models ◽

Added Sugars ◽

Sugar Intake ◽

Vitamin Intake ◽

Injurious Falls ◽

Prospective Association

Background: Added sugar intake is a key contributor to the development of several chronic diseases. We aimed to investigate the prospective association between added sugar intake and the risk of falling among older men and women. Methods: We analyzed data from 2,154 Spanish adults aged ≥65 years from the Seniors-ENRICA cohort. Baseline food consumption was collected in 2008-2010 with a validated diet history, in which 155 foods were identified to contain added sugar. The occurrence of falls was ascertained up to 2015. Analyses were conducted with Cox models adjusted for potential confounders, including nutritional status, chronic diseases and sleeping medication. Results: Over 7.2y of follow-up, 605 participants experienced ≥1 fall and 527 suffered injurious falls. The hazard ratios (95% confidence interval) for ≥1 fall across quintiles of added sugar intake were: 1.0, 1.09 (0.83-1.42), 1.07 (0.82-1.40), 1.15 (0.88-1.52), and 1.48 (1.12-1.96); p-trend 0.03. The corresponding figures for injurious falls were: 1.0, 1.17 (0.88-1.56), 1.06 (0.79- 1.41), 1.13 (0.84-1.52), and 1.40 (1.03-1.90); p-trend 0.10. These associations did not vary over strata of age, protein, calcium or vitamin intake, diet quality, physical activity or alcohol consumption. No differences were found when solid and liquid sources of added sugars were examined separately. Conclusions: Intake of added sugars was associated with a higher risk of falling in older people. This adds to the evidence to support interventions to reduce added sugar intake.

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Added sugars: consumption and associated factors among adults and the elderly. São Paulo, Brazil

Revista Brasileira de Epidemiologia ◽

10.1590/s1415-790x2012000200003 ◽

2012 ◽

Vol 15 (2) ◽

pp. 256-264 ◽

Cited By ~ 8

Author(s):

Milena Baptista Bueno ◽

Dirce Maria Lobo Marchioni ◽

Chester Luis Galvão César ◽

Regina Mara Fisberg

Keyword(s):

Soft Drink ◽

Linear Regression Analysis ◽

The Elderly ◽

Sao Paulo ◽

Socioeconomic Level ◽

São Paulo ◽

Added Sugar ◽

Added Sugars ◽

Sugar Intake ◽

Factors Associated

OBJECTIVE: To investigate added sugar intake, main dietary sources and factors associated with excessive intake of added sugar. METHODS: A population-based household survey was carried out in São Paulo, the largest city in Brazil. Cluster sampling was performed and the study sample comprised 689 adults and 622 elderly individuals. Dietary intake was estimated based on a 24-hour food recall. Usual nutrient intake was estimated by correcting for the within-person variance of intake using the Iowa State University (ISU) method. Linear regression analysis was conducted to identify factors associated with added sugar intake. RESULTS: Average of energy intake (EI) from added sugars was 9.1% (95% CI: 8.9%; 9.4%) among adults and 8.4% (95% CI: 8.2%; 8.7%) among the elderly (p < 0.05). Average added sugar intake (% EI) was higher among women than among men (p < 0.05). Soft drink was the main source of added sugar among adults, while table sugar was the main source of added sugar among the elderly. Added sugar intake increased with age among adults. Moreover, higher socioeconomic level was associated with added sugar intake in the same group. CONCLUSIONS: Added sugar intake is higher among younger adults of higher socioeconomic level. Soft drink and table sugar accounted for more than 50% of the sugar consumed.

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Consumption of added sugars and development of metabolic syndrome components among a sample of youth at risk of obesity

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2013-0456 ◽

2014 ◽

Vol 39 (4) ◽

pp. 512-512 ◽

Cited By ~ 12

Author(s):

JiaWei Wang

Keyword(s):

Insulin Resistance ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Glucose Tolerance ◽

Fat Mass ◽

Diet Quality ◽

Healthy Eating Index ◽

Added Sugar ◽

Added Sugars ◽

Sugar Intake

Previous evidence showed controversial links between added sugar intake, diet quality, and increasing prevalence of metabolic syndrome (MetS) components (abdominal adiposity, dysglycemia, elevated blood pressure, reduced high-density lipoprotein cholesterol (HDL-C), and hypertriglyceridemia) in youth, and most studied only its liquid source of sugar-sweetened beverages (SSB). To better understand the extent of the detrimental effects of added sugars from both liquid and solid sources to diets in terms of nutrient and food intake and metabolic consequences in children, 3 studies were undertaken to (i) quantify the associations of added sugar intake with overall diet quality and adiposity indicators; (ii) assess whether excess weight and glucose tolerance status modifies the associations between consumption of added sugars and MetS components; and (iii) evaluate whether consumption of added sugars predicts the development of MetS components over time. Data for these studies were obtained from the Quebec Adiposity and Lifestyle Investigation in Youth cohort. Caucasian children (8 to 10 years at baseline, N = 630) with at least 1 obese biological parent were recruited from 1040 Quebec primary schools and followed-up 2 years later (N = 564). Dietary intake, including added sugars (liquid vs. solid) and Canadian Healthy Eating Index (HEI-C) was assessed in three 24-h recalls at baseline. Adiposity indicators included measured height and weight for body mass index (BMI), BMI z score, waist circumference (WC), and fat mass (by dual-energy X-ray absorptiometry). Plasma glucose and insulin were measured at fasting and by oral glucose tolerance tests to calculate the homeostasis model assessment of insulin resistance (HOMA-IR) and the Matsuda IS index (Matsuda-ISI). Systolic blood pressure (SBP), concentration of triglycerides and HDL-C were measured by standard instruments. Multivariate linear regression models were used, adjusting for age, sex, pubertal status (by Tanner stage), energy intake, fat mass, and physical activity (by 7-day accelerometer). The main findings include the following: (i) Higher consumption of added sugars from SSB or solid sources was associated with lower nutrient density and lower HEI-C. Positive associations with adiposity indicators were observed with consumption of added sugars from liquid sources only. (ii) Higher SSB consumption was associated with higher HOMA-IR and higher SBP among overweight children (≥85th BMI percentile), as well as higher SBP and higher WC among children with impaired glucose tolerance. These associations with metabolic indicators were not observed among children whose BMI was below 85th percentile. (iii) No association with added sugar intake was observed for 2-year changes in adiposity, but higher consumption of added sugars from liquid sources was associated with higher fasting glucose, higher fasting insulin, higher HOMA-IR, and lower Matsuda-ISI. In conclusion, this thesis suggested that consumption of added sugars from both solid and liquid sources was associated with a lower overall diet quality, but only added sugars from liquid sources was associated with adiposity indicators. Cross-sectional links with higher levels of SSB intake and MetS components were more evident among overweight/obese and glucose-intolerant children. Consumption of added sugars from liquid sources was not associated with changes in adiposity over 2 years, but was clearly associated with development of impaired glucose homeostasis and insulin resistance. This thesis presents further evidence on the nutritional and metabolic consequences of consuming added sugar from liquid and solid sources.

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Changes in added sugar intake and its major food sources in older Australians during a 15—year follow-up

Journal of Nutrition & Intermediary Metabolism ◽

10.1016/j.jnim.2014.10.049 ◽

2014 ◽

Vol 1 ◽

pp. 16

Author(s):

H. Moshtaghian ◽

J. Louie ◽

V. Flood ◽

K. Charlton ◽

Y. Probst ◽

...

Keyword(s):

Food Sources ◽

Added Sugar ◽

Sugar Intake ◽

Major Food

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Does vitamin D status predict weight gain or increase in waist circumference? Results from the longitudinal Health 2000/2011 Survey

Public Health Nutrition ◽

10.1017/s1368980019004403 ◽

2020 ◽

Vol 23 (7) ◽

pp. 1266-1272 ◽

Cited By ~ 1

Author(s):

Tuija Jääskeläinen ◽

Satu Männistö ◽

Tommi Härkänen ◽

Katri Sääksjärvi ◽

Seppo Koskinen ◽

...

Keyword(s):

Vitamin D ◽

Risk Factor ◽

Weight Gain ◽

Waist Circumference ◽

Healthy Lifestyle ◽

Adult Population ◽

Population Based ◽

Vitamin D Insufficiency ◽

Vitamin D Status

AbstractObjective:To investigate whether vitamin D status predicts weight gain or increase in waist circumference during the 11-year follow-up in general adult population.Design:A population-based longitudinal study.Setting:The study was conducted using data from the nationally representative Health 2000/2011 Survey. The analyses were based on regression models adjusted for sociodemographic and lifestyle factors.Participants:Weight, waist circumference and vitamin D status (serum 25-hydroxyvitamin D concentration analysed with radioimmunoassay) were measured from 2924 participants aged 30–64 years at baseline.Results:In men, low vitamin D status at baseline predicted ≥10 % increase in waist circumference during the follow-up when adjusted for age only (OR for sufficient v. deficient S-25(OH)D 0·41; 95 % CI 0·25, 0·67; P for trend <0·01), but the association with weight gain was only borderline significant. After adjustment for potential confounders, low vitamin D status remained a significant predictor of increase in waist circumference, but the association with weight gain was further attenuated. In women, vitamin D status at baseline did not predict weight gain or increase in waist circumference.Conclusions:Our results suggest that vitamin D insufficiency may be a risk factor of abdominal obesity among men but not among women. In men, it may also increase the risk of weight gain. Further studies are required to confirm these findings and examine potential mechanisms behind them. There is also a possibility that vitamin D is a biomarker of healthy lifestyle rather than an independent risk factor for obesity.

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Dietary Sugar Intake and Its Association with Obesity in Children and Adolescents

Children ◽

10.3390/children8080676 ◽

2021 ◽

Vol 8 (8) ◽

pp. 676

Author(s):

Emmanuella Magriplis ◽

George Michas ◽

Evgenia Petridi ◽

George P. Chrousos ◽

Eleftheria Roma ◽

...

Keyword(s):

Total Energy ◽

Children And Adolescents ◽

Age Groups ◽

Significant Proportion ◽

Dietary Intakes ◽

Food Groups ◽

Added Sugar ◽

Added Sugars ◽

Sugar Intake ◽

Sweetened Beverages

Sugar intake has been associated with increased prevalence of childhood overweight/obesity; however, results remain controversial. The aim of this study was to examine the probability of overweight/obesity with higher sugar intakes, accounting for other dietary intakes. Data from 1165 children and adolescents aged ≥2–18 years (66.8% males) enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were used; specifically, 781 children aged 2–11 years and 384 adolescents 12–18 years. Total and added sugar intake were assessed using two 24 h recalls (24 hR). Foods were categorized into specific food groups to evaluate the main foods contributing to intakes. A significant proportion of children (18.7%) and adolescents (24.5%) exceeded the recommended cut-off of 10% of total energy intake from added sugars. Sweets (29.8%) and processed/refined grains and cereals (19.1%) were the main sources of added sugars in both age groups, while in adolescents, the third main contributor was sugar-sweetened beverages (20.6%). Being overweight or obese was 2.57 (p = 0.002) and 1.77 (p = 0.047) times more likely for intakes ≥10% of total energy from added sugars compared to less <10%, when accounting for food groups and macronutrient intakes, respectively. The predicted probability of becoming obese was also significant with higher total and added-sugar consumption. We conclude that high consumption of added sugars increased the probability for overweight/obesity among youth, irrespectively of other dietary or macronutrient intakes.

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Analysis of weight trends over time in female survivors with triple negative breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.7_suppl.28 ◽

2018 ◽

Vol 36 (7_suppl) ◽

pp. 28-28 ◽

Cited By ~ 1

Author(s):

Damien Mikael Hansra ◽

Rebecca Rollins ◽

Karen Rados ◽

Anita Johnson ◽

Johnathan Ramey ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factor ◽

Weight Gain ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Stage I ◽

Definitive Treatment ◽

Female Survivors ◽

Worse Prognosis

28 Background: Triple-negative breast cancer (TNBC) is a subtype of breast cancer (BC) with unique clinical-pathological & prognostic characteristics. Studies have shown obesity to be risk factor for TNBC. Furthermore, patients (pts) with BC and overweight/obesity have a worse prognosis. Here we investigate body mass index (BMI) & weight trends among BC survivors. Methods: A retrospective review BC pts at Cancer Treatment Centers of America Atlanta from 2012-10/27/17. Definition of a survivor: pts who have completed definitive therapy with no evidence of disease. Survivor BMI & weight gain (kg) calculated from chart review. Weight gain in kg was recorded post chemotherapy, at 3, 6, 9, 12 month follow up. Inclusion: Pts with ER-PR-HER2- (TNBC), adults > 18 yo, pts who completed chemo (neoadjuvant or adjuvant) & surgery +/- radiation. Exclusion: Pts who died, had relapsed local disease or metastatic disease; missing BMI data; currently on chemotherapy; who did not receive chemotherapy; missing continuous BMI data or pathology report; lost to follow up. Results: 1756 BC pts with stage IA-IIIC identified, 300 pts identified as TNBC. A total of 134 patients met full inclusion/exclusion survivorship criteria. Average age of survivors = 52 (range 25-76). Stage: I = 38%; II = 50%, III = 12%. BMI categories: 0% underweight (BMI < 18.5 kg/m2), 15% normal weight (BMI 18.5 to < 25 kg/m2), 18% overweight (BMI 25 to < 30 kg/m2), 55% obese (BMI ≤30 kg/m2), 12% morbid obesity (BMI ≤ 40 kg/m2). Average BMI for all survivors = 32.23 +/-0.59 kg/m2 (range 19-52 kg/m2); post chemotherapy weight change = 0.53 +/-0.41 kg; at 3 month follow up = -0.16 +/-0.51 kg; at 6 month = -0.02 +/-0.54 kg; at 9 month follow up 1.20 +/-0.59 kg; at 12 month follow up = 2.25 +/-0.61 kg. BMI by stage: I = 32.81 +/- 1.00 kg/m2; II = 32.12 +/- 0.91 kg/m2; III = 32.44 +/- 1.27 kg/m2. Conclusions: In our study, female survivors with TNBC present with obesity and gain weight after chemotherapy. Also, weight gain continues at 9 & 12 months post definitive treatment. Survivors with TNBC should be treated with intensive weight loss interventions given that overweight/obesity is a risk factor for recurrence, worse prognosis, & cardiovascular events.

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