Emphasising sugar reduction, and fructose reduction in particular, would have greater benefits for heart health than salt reduction strategies, claim the paper’s authors, James DiNicolantonio from Saint Luke's Mid America Heart Institute and Sean Lucan from Montefiore Medical Center in the United States.
They also suggest that salt reduction policies are misguided, and that people may even eat more processed foods when salt levels are reduced.
However, other researchers have called the paper’s premise ‘disingenuous’ and ‘exaggerated’, saying that both sugar and salt should be reduced.
Professor Francesco Cappuccio at the University of Warwick said: “I would agree with the authors on some important points: that high-sugar diets may contribute substantially to cardiovascular disease, and that added sugars are the problem.
“However the emphasis on reducing sugar, and not salt, is disingenuous. Both should be targeted at population level for an effective approach to cardiovascular prevention.”
The US researchers, who reviewed a selection of evidence to come to their conclusions, said that reducing consumption of added sugars would help cut high blood pressure rates, and could also “help address broader problems related to cardiometabolic disease”.
Professor Tom Sanders at King’s College London said: “In my opinion the effects of added sugars are exaggerated in this article. Cutting salt intake and losing weight will lower blood pressure, but the evidence for a direct effect of added sugar is tenuous.”
The paper’s authors argue that added sugars should be addressed more directly in dietary guidelines.
“High-sugar diets may contribute substantially to cardiometabolic disease. While naturally occurring sugars in the form of whole foods like fruit are of no concern, epidemiological and experimental evidence suggest that added sugars (particularly those engineered to be high in fructose) are a problem and should be targeted more explicitly in dietary guidelines to support cardiometabolic and general health,” they wrote.
The World Health Organisation (WHO) recommends that no more than 10% of a person’s total calories should come from added sugars, but earlier this year it said that halving that recommendation, to 5% of calories, “would have additional benefits”.