Understanding the Link between Sugar and Cancer: An Examination of the Preclinical and Clinical Evidence

Abstract

Per capita sugar consumption has increased in the United States to over 45 kg per year. The average person in the US currently consumes significantly more added sugar in their diet than the World Health Organization's, the American Cancer Society's, and the American Heart Association's recommendations for daily sugar consumption. Evidence from epidemiologic and preclinical studies demonstrates that excess sugar consumption can lead to development of cancer and progression of disease for those with cancer independent of the association between sugar and obesity. Human epidemiologic studies and mechanistic preclinical studies in multiple cancers support a causal link between excess sugar and cancer. Preclinical studies show that high-sucrose or high-fructose diets activate several mechanistic pathways, including inflammation, glucose, and lipid metabolic pathways. Although human studies are limited, compelling human and primate studies have explored the link between added sugar and metabolic syndrome (MetS), a risk factor for cancer. Substantial evidence suggests a causal link between MetS and added sugar, indicating important implications in the association between excess sugar consumption and cancer. Human clinical trials are needed to determine whether sugar increases cancer development and progression independently of its established role in causing obesity as well as for further exploration of the mechanisms involved.

Keywords: cancer; cancer metabolism; fructose; inflammation; sucrose; sugar.

Figure 1

Average daily per capita calories from added sugars in the United States from 1970 through 2016. Food Availability (Per Capita) Data System; Loss-Adjusted Food Availability [5,8].

Figure 2

Proposed model whereby dietary sugar influences multiple cancer-specific pathways, including energy metabolism, lipid metabolism, inflammation, and immune function.