Posted Nov 1 , 2017 06:07 AM

Conversion of Sugar to Fat: Is Hepatic de Novo Lipogenesis Leading to Metabolic Syndrome and Associated Chronic Diseases?

Schwarz JM, et al., Journal of the American Osteopathic Association. 2017;117:520

What perspective does this review bring (excerpted from the Abstract)?

Epidemiologic studies suggest a link between excess sugar consumption and obesity, fatty liver disease, metabolic syndrome, and type 2 diabetes mellitus. One important pathway that may link these metabolic diseases to sugar consumption is hepatic conversion of sugar to fat, a process known as de novo lipogenesis (DNL). Mechanistic studies have shown that diets high in simple sugars increase both DNL and liver fat. Importantly, removal of sugar from diets of children with obesity for only 9 days consistently reduced DNL and liver fat and improved glucose and lipid metabolism. Although the sugar and beverage industries continue to question the scientific evidence linking high-sugar diets to metabolic diseases, major health organizations now make evidence-based recommendations to limit consumption of simple sugars to no more than 5% to 10% of daily intake. Clear recommendation about moderating sugar intake to people may be an important non-pharmacologic tool to include in clinical practice.

Why is this important?

Sugar is one of the more controversial food substances. From the individual’s standpoint, the sweet taste of things is pleasurable, yet from the public health standpoint sugar intake (especially in sugar-sweetened beverages) is conclusively associated with cardiovascular diseases as well as diabetes (Curr Opin Cardiol. 2017;32(5):572-579). The effects of sugar on a person’s synthesis of fat is also well described. Domestic US sugar production has been protected by government policy for the past 82 years, resulting in elevated domestic prices and an estimated annual (2013) $1.4 billion dollar "tax" on consumers (Nutr Today. 2017;52(3):143-150). Currently, many manufacturers are looking to reduce the sugar content of their products. High fructose corn syrup (HFCS) is also a hot topic as it is a common sweetener used in a multitude of products. HFCS is also subsidized when free trade pacts (such as NAFTA) do away with tariffs, and reported increases in the use of HFCS has followed that agreement (CMAJ. 2017;189:E881) Clearly, more public health measures as well as other policy measures will be needed to curb the negative impact of sugars on America’s health. Do you counsel your patients on lowering sugar and high fructose corn syrup in their diet? If you don’t, will this article’s perspective help to change your counseling practices?

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