Cross-cultural associations:

Average sucrose intake and 50-year coronary heart disease mortality rates in 16 cohorts

Dietary sugars consist of mono-and disaccharides and can be divided into naturally occurring sugars present in fruit (glucose and fructose), milk (lactose and galactose), grains (bread and pasta) (maltose) and added sugar (sucrose). In the 1960s traditional Western diets were high in sucrose, while the traditional Mediterranean and Japanese diets were low. The average intake of sucrose was related to 50-year CHD mortality rates (R = 0.71) but the naturally occurring sugars were not thus associated. In addition, the sucrose intake was positively associated with saturated fat intake (R=0.63).

Relationship of average population sucrose intake at baseline with 50-year CHD death rates.

Relationship of average population sucrose intake at baseline with 50-year CHD death rates. US: US railroad; EF: East Finland; WF: West Finland, ZU: Zutphen, the Netherlands; CR: Crevalcore, Italy; MO: Montegiorgio, Italy; RR: Rome railroad, Italy; DA: Dalmatia, Croatia; SL: Slavonia, Croatia; VK: Velika Krsna, Serbia; ZR: Zrenjanin, Serbia; BE: Belgrade, Serbia; KT: Crete, Greece; CO: Corfu, Greece; TA: Tanushimaru, Japan; UB: Ushibuka, Japan

Application

In 2015, the WHO endorsed an added sugar (sucrose) recommendation of <50 g/day and suggested a further reduction to 25 g/day. This accords with the low CHD risk associated with the traditional Mediterranean and Japanese dietary patterns that contained <25 g of added sugar per day.

References

More cohort findings with 25 or 50-year follow-up in the 16 cohorts

The original cross-cultural associations from the 1960s were later repeated using 25 and 50-year CHD mortality data for serum cholesterol and saturated fat intake and extended with associations on flavonoids and dietary patterns.

25-year follow-up study findings

50-year follow-up study findings

Are these cross-cultural associations causal?

Ecological or cross-cultural associations are frequently viewed as the lowest level of evidence about causality. However, to demean ecological associations is to fail to recognize the powerful indication they provide about the population burden of disease. They can be useful for prevention when correlations among populations are congruent with sound clinical evidence, with significant correlations at the level of individuals within populations, and with known mechanisms.

Read more about cross-cultural findings

Search study findings on the individual level:

Alcohol (6) All-cause mortality (16) Blood pressure (8) Body mass index (7) Cardiovascular disease (30) Cholesterol (8) Cohort (12) CVD risk factors (31) Depression & Optimism (11) Diabetes (6) Diet (23) Dietary patterns (4) Disease outcomes (13) ECG predictors (2) Fatty acids (5) Flavonoids & lignans (5) Foods (7) Functional outcomes (10) Healthy aging (38) Lifestyle (25) Mental health (11) Nutrients (8) Physical activity (9) Self-rated health (2) Smoking (11)