ArticleAdvances in nutrition (Bethesda, Md.)2018
Perspective: Total, Added, or Free? What Kind of Sugars Should We Be Talking About?
Article in Advances in nutrition (Bethesda, Md.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
55 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- The Impact of Sugar Source on the Relationships Between Free Sugars Intake and Health: A Secondary Analysis.Nutrients · 2026Pooled it
- A Systematic Review of Evidence on the Role of Ready-to-Eat Cereals in Diet and Non-Communicable Disease Prevention.Nutrients · 2025Pooled it
- Associations of overweight and gestational diabetes mellitus with free sugars from solid and liquid sources: cross-sectional and nested case-control analyses.BMC public health · 2021Pooled it
- A Systematic Review and Activation Likelihood Estimation Meta-Analysis of fMRI Studies on Sweet Taste in Humans.The Journal of nutrition · 2020Pooled it
- Dietary Quality Along a Plant-Based Continuum: The Role of Added Salt, Oil, and Sugar in Chronic Disease Risk.Nutrients · 2026Review
- Estimating added sugars intake among South Koreans: results from the 2023 Korea National Health and Nutrition Examination Survey.Clinical nutrition research · 2026Article
- Interrelationships between Refined Carbohydrates, Periodontal Diseases, and Cognitive Decline: A Narrative Review.Advances in nutrition (Bethesda, Md.) · 2026Review
- Early Life Added Sugars and Associated Appetite, Satiety, Growth and Adiposity in the First 2 Years of Life.Nutrients · 2026Article
- Free Sugars Consumption and Type 2 Diabetes: What Are the Concerns and How Strong is the Evidence?Current nutrition reports · 2026Review
- Usual nutrient intake and adherence to dietary reference values among 3-6-year-old Finnish preschoolers.Food & nutrition research · 2026Article
- Sensitive electrochemical detection of total sugars in food using NiFe alloy nanowires.Mikrochimica acta · 2025Article
- Predicting carbohydrate quality in a global database of packaged foods.Frontiers in nutrition · 2025Article
- Health assessment of snacks and desserts in Guizhou Province: Analysis of fatty acids and sugar content.PloS one · 2025Article
- Article
- Association between added sugars intake and Parkinson's disease status in U.S. adults: a cross-sectional study from NHANES 1990-2020.Archives of public health = Archives belges de sante publique · 2024Article
- Factors Driving Individuals' Attitudes toward Sugar and Sweet-Tasting Foods: An Analysis within the Scope of Theory of Planned Behavior.Foods (Basel, Switzerland) · 2024Article
- Article
- Associations between Dietary Sugar and Fiber with Infant Gut Microbiome Colonization at 6 Mo of Age.The Journal of nutrition · 2024Article
- Comparisons of Different Carbohydrate Quality Indices for Risk of Type 2 Diabetes in the Malmö Diet and Cancer Study.Nutrients · 2023Article
- Stevioside reduces inflammation in periodontitis by changing the oral bacterial composition and inhibiting P. gingivalis in mice.BMC oral health · 2023Article
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
There is consistent public guidance to limit sugars intakes. However, WHO recommendations are for "free" sugars, whereas some other guidance documents and public discussion focus on "added" sugars, and globally most food labeling states "total" sugars. Total sugars comprise all mono- and disaccharides, regardless of source, whereas both added and free sugars exclude the sugars that naturally occur in dairy products and intact fruit and vegetables. Definitions of added and free sugars differ mainly in their respective exclusion or inclusion of sugars in juiced or pureed fruit and vegetables. To date, there has been little evidence-based analysis of the scientific basis for these different sugar classifications or implications of their adoption for consumer communication and nutrition labeling. Evidence of discriminating relations of total compared with added or free sugars with weight gain or energy intake, type 2 diabetes, and dental caries was identified from recent systematic reviews and meta-analyses. The relations were weakest for total sugars and most consistent for dietary sources corresponding to free sugars (including sugars added to and in fruit juices). Consideration of these health outcomes suggests that the emphasis for intake monitoring, public health guidance, and consumer communication should be on free sugars. However, at present, the adoption of free sugars for these purposes would also carry challenges related to implementation, including consumer understanding, consensus on specifications, and current (labeling) regulations.
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