Assessment of dietary intake of sugars, whether by some method of recall as used in the trials, or by food frequency questionnaires as in cohort studies, was associated with a considerable degree of measurement error even when using validated methods. This is probably one explanation why a dose-response effect could not be shown between change in dietary intake and magnitude of weight change. Nevertheless, even crude estimates of intake provided assistance in interpreting potentially inconsistent findings. The studies of long term intervention in children27 29 33 40 46 and two studies of interventions reducing dietary sugars in adults28 33 found little difference in intakes between intervention and control groups, and no meaningful change in weight.
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We identified 12 studies that involved isoenergetic exchange of dietary sugars with other macronutrients (table 4⇓).48 49 50 51 52 53 54 55 56 57 58 Interventions ranged from two weeks to six months, and sugars were in the form of either sucrose or fructose used to sweeten foods or liquids. We saw no evidence of difference in weight change as a result of differences in sugars intakes when energy intakes were equivalent (0.04 kg (95% confidence interval −0.04 to 0.13); fig 5⇓).
In view of the public health importance of the issue, the resource implications, and the disagreements in the literature, we reviewed systematically and quantitatively the evidence from randomised trials for the efficacy of individualised counselling for lowering cholesterol concentration.
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