The review, which included 73 meta-analyses from 8,601 articles covering 83 health outcomes in adults and children, the reduction of added (“free”) sugars to around six teaspoons a day as well as limiting sugar-sweetened drinks to less than one serving a week.

According to current US dietary guidelines, no more than 200 calories should come from added sugars in a 2,000-calorie diet, which is about 12 teaspoons.

“This umbrella review shows that high dietary sugar consumption, especially intake of sugars that contain fructose, is harmfully associated with large numbers of health outcomes,” the researchers concluded.

“Evidence for the harmful associations between dietary sugar consumption and changes in body weight, ectopic fat accumulation, obesity in children, coronary heart disease, and depression seems to be more reliable than that for other outcomes.

“To change sugar consumption patterns, especially for children and adolescents, a combination of widespread public health education and policies worldwide is urgently needed.”

Sugar Association: ‘This is a red flag’

In a scathing response to the evidence review featured in the British Medical Journal (BMJ), the Sugar Association called into the question the methodology of the studies used as well as the timing of the publication.

“This is a review of existing evidence, and even a well-executed systematic review is only as good as the studies that are inputted. Essentially, garbage in equals garbage out,” said Courtney Gaine, president and CEO of the Sugar Association.

“Whenever conclusion statements are stronger than the actual findings and, even worse, don’t reflect the aim of the study or what the study was designed to find, it is a red flag.

“Clearly there is something fishy here, but the timing of a paper like this in the midst of the 2025 to 2030 Dietary Guidelines for Americans process is not a surprise,” she added.

The review’s release comes as the US Dietary Guidelines Advisory Committee revisits the country’s Dietary Guidelines for 2025 to 2030 in which current guidelines recommend those two years and older keep an added sugar intake of less than 10% of their total daily calories.

For example, in a 2,000-calorie diet, no more than 200 calories should come from added sugars, which is about 12 teaspoons.

Reviewers highlight use of observational and low-quality studies

The BMJ researchers, from China’s Sichuan University and the UC Davis School of Medicine in Sacramento in the US acknowledged that existing evidence was mostly observational and of low quality – an observation picked up by the Sugar Association.

“It is known that added sugars literature suffers from significant variability when it comes to definitions, intake measurements and control of energy and other diet and lifestyle variables,” they wrote.

“The studies included in this review are primarily focused on sugar sweetened beverages, and not all sources of added sugars.

“It is clear the outcomes of studies do depend on source, which is why there is now recognition that food and beverage sources of added sugars should be viewed differently in scientific analyses.”

Sugar intake has dropped but obesity has rocketed, says Sugar Association

Generally, sugar-sweetened beverages are the largest source of added sugars, including carbonated and noncarbonated soft drinks, fruit drinks, and sports and energy drinks, the review cited.

Previous surveys have shown that consumption of sugar sweetened beverages is declining in many developed countries, although consumption levels remain high.

“While popular amongst some to proclaim that reducing added sugars (to such levels as never before seen in over the 100 years of USDA’s record-keeping) will improve health, the real-world data suggest otherwise,” Gaines highlighted.

“We’ve seen sugar consumption dro 30% since 2000 while obesity rates in adults have tripled and in children, quadrupled.”