{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T03:39:18Z","timestamp":1789011558181,"version":"build-2803163510"},"reference-count":58,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"World Sugar Research Organisation"},{"id":[{"id":"https:\/\/ror.org\/02hj84f21","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: This secondary and exploratory meta-analysis re-evaluated 30 randomized controlled trials on free and added sugars (FS) detailed in the European Food Safety Authority\u2019s (EFSA) report on the tolerable upper intake level for dietary sugars, focusing on the influence of food source (beverages, foods, or mixed) on cardiometabolic and anthropometric health. Methods: The EFSA\u2019s method of analyzing the relative FS intake (difference between treatment and comparator arms, \u0394%Efs) was used, with further adjustment for the reported intake of all sources of FS and energy. The EFSA\u2019s \u201chigh vs. low\u201d random-effects meta-analysis comparing groups with the highest and lowest FS intake was replicated, and additional exploratory dose\u2013response meta-regressions (linear and non-linear) were performed, stratified by food source. Given the secondary and observational nature of the analysis, all source-stratified findings should be interpreted as hypothesis-generating, rather than causal. Results: There were no interactions between \u0394%Efs and food source for any outcome, and within a source there were linearly positive and statistically significant regressions for body weight (mixed), low-density lipoprotein cholesterol (LDL-C, foods), and uric acid (beverages). Across 13 outcomes, \u0394%Efs was positively and linearly related to greater fasting glucose, high-density lipoprotein cholesterol (HDL-C), and LDL-C, and non-linearly to body weight. However, the data were limited in their representation of FS intake at typical population levels, and there were insufficient data to investigate the effect of FS from foods on most anthropometric outcomes. Conclusions: Meta-regressive dose\u2013responses revealed little relationship between \u0394%Efs from specific food sources and health outcomes, but such effects might be masked by confounding factors. Future trials that test realistic intakes of FS across diverse food matrices and account for dietary compensation would help to overcome limitations in the body of evidence.<\/jats:p>","DOI":"10.3390\/nu18091323","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T14:29:03Z","timestamp":1776868143000},"page":"1323","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Impact of Sugar Source on the Relationships Between Free Sugars Intake and Health: A Secondary Analysis"],"prefix":"10.3390","volume":"18","author":[{"given":"Jennifer A.","family":"Peregoy","sequence":"first","affiliation":[{"name":"Traverse Science, Inc., Mundelein, IL 60060, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8900-6366","authenticated-orcid":false,"given":"Laura","family":"Chiavaroli","sequence":"additional","affiliation":[{"name":"Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada"},{"name":"Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael\u2019s Hospital, Toronto, ON M5B 1W8, Canada"},{"name":"Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, ON M5B 1W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L.","family":"Sievenpiper","sequence":"additional","affiliation":[{"name":"Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada"},{"name":"Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael\u2019s Hospital, Toronto, ON M5B 1W8, Canada"},{"name":"Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, ON M5B 1W8, Canada"},{"name":"Division of Endocrinology and Metabolism, Department of Medicine, St. Michael\u2019s Hospital, Toronto, ON M5B 1W8, Canada"},{"name":"Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5499-3464","authenticated-orcid":false,"given":"Stephen A.","family":"Fleming","sequence":"additional","affiliation":[{"name":"Traverse Science, Inc., Mundelein, IL 60060, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"ref_1","first-page":"CD013320","article-title":"High versus Low-added Sugar Consumption for the Primary Prevention of Cardiovascular Disease","volume":"2022","author":"Bergwall","year":"2022","journal-title":"Cochrane Database Syst. 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