Sugar-sweetened soft drinks raise the risk of coronary heart disease, cardiovascular death and early death (e.g., two or more daily servings: +35% coronary heart disease in women; +31% cardiovascular and +21% total mortality).
Original statement
متابعة 88 ألف ممرضة لمدة 24 عاماً ... أظهرت أن شرب علبتين أو أكثر يومياً يرفع خطر أمراض القلب التاجية لدى النساء بنسبة 35%. والأخطر دراسة Circulation عام 2019 على أكثر من 118 ألف بالغ تابعتهم 34 عاماً: علبتان يومياً ترفعان الوفاة بأمراض القلب 31% والوفاة الكلية 21%.
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
Sugar-sweetened soft drinks raise the risk of coronary heart disease, cardiovascular death and early death (e.g., two or more daily servings: +35% coronary heart disease in women; +31% cardiovascular and +21% total mortality).
Origin
- Source status
- Archive editors
- Attribution
- Archive editors (study selection and narrative are the archive's, not necessarily Elawady's)
- Origin
- https://eltayebat.com/rule/soda/
- Attribution uncertainty
- The archive homepage states that the forbidden-food section is supported by research 'independently of Dr. Diaa's words'. No evidence was found that Elawady himself cited these studies.
- Claimed mechanism
Weight gain, dyslipidaemia, inflammation, blood pressure.
- Claimed health effect
Coronary heart disease, stroke, cardiovascular and total mortality.
- Population concerned
Adults
- Geographic restriction by Elawady
none found
Scientific assessment
Mostly true – Correct at its core, but with limitations or minor inaccuracies.
Certainty of evidence: moderate – Further research may still affect the assessment.
1. What was claimed?
Sugary sodas raise heart disease, stroke and premature death.
2. What is demonstrably correct?
The figures are reported correctly: Fung 2009 (A-SOD-15) RR 1.35 (1.07-1.69) for >=2 servings/day; Malik 2019 (A-SOD-05) HR 1.21 total and 1.31 CVD mortality; de Koning 2012 (A-SOD-14) RR 1.20 for CHD; Chen 2010 (A-SOD-18): 1 serving/day less was associated with 1.8 mmHg lower systolic BP; Yang 2014 (A-SOD-16): higher added-sugar intake associated with CVD mortality. A dose-response meta-analysis (Zhang 2021, I-SOD-120) confirms higher all-cause and CVD mortality (HR 1.08 per daily serving).
3. What is wrong or exaggerated?
Causal language ('raises') is somewhat stronger than the observational evidence allows. The highlighted single-cohort figures (+31%, +35%) are larger than the pooled estimate (about +8% per daily serving, roughly +17% at two servings). The European EPIC estimate is smaller: in EPIC (A-SOD-17), SSB were associated with all-cause mortality (HR 1.08, 1.01-1.16) and digestive-disease deaths, but not with circulatory-disease deaths (>=2 glasses/day HR 1.11, 0.95-1.30); the circulatory signal in EPIC came from artificially sweetened drinks. The AHA statement (A-SOD-11) concerns children and cardiovascular risk factors, not heart disease or death in adults.
4. What remains unclear?
How much of the association is causal and independent of overall diet and lifestyle.
5. Which studies support it?
I-SOD-120 (dose-response meta-analysis, NutriGrade high), A-SOD-05, A-SOD-14, A-SOD-15, A-SOD-16, A-SOD-18, A-SOD-23, I-SUG-02; EFSA 2022 (I-SUG-03) rates the certainty of a positive causal relationship between SSB intake and CVD as high (>75-100% probability), with the caveat that attribution to the sugar fraction is more questionable for CVD; A-SOD-11 (indirect: children, risk factors); A-SOD-17 (all-cause mortality only).
6. Which studies contradict it?
No contradicting cohort evidence found; limitations are confounding and self-reported intake.
7. What applies to Germany and Europe?
The WHO guideline (2015) on free sugars and EFSA's 2022 opinion (intake of added and free sugars 'as low as possible') apply in Germany and the EU; the European EPIC cohort (A-SOD-17) found associations in 10 European countries including Germany.
8. What is known about Egypt?
Sugar-sweetened soft drinks are widely sold in Egypt. No Egypt-specific study was reviewed for this claim; the physiological mechanisms and cohort findings are not known to differ by country, but absolute risks depend on local consumption and disease rates.
9. What practical conclusion is appropriate?
Limiting sugary drinks is a reasonable part of cardiovascular prevention; it does not replace treatment of established risk factors.
Assessment details
- Rationale for certainty of evidence
Prospective cohorts show consistent, dose-related associations; a dose-response meta-analysis of about 0.9-1 million participants (I-SOD-120) found 8% higher all-cause and cardiovascular mortality per daily serving and rated this evidence high (NutriGrade); EFSA 2022 (I-SUG-03) judged a causal SSB-CVD relationship highly likely; RCTs show effects of SSB on the mediating risk factors (weight, blood pressure). GRADE starts low for observational data and is upgraded for dose-response; residual confounding remains and there are no RCTs with hard endpoints.
- Source quality
Numbers cited by the archive match the abstracts. Causal verbs ('raises') overstate observational evidence.
- Regional transferability
High; EPIC (10 European countries) found a weaker but positive association for sugar-sweetened soft drinks (HR 1.08 for >=2 glasses/day).
- Individual exceptions
Absolute risk differences are modest; e.g., cohort HRs of 1.2-1.35 for daily drinkers.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Scientifically well supported – The claim agrees with consistent, high-quality evidence.
Research question: Do sugar-sweetened soft drinks increase the risk of coronary heart disease, cardiovascular death and total mortality, and are the archive's figures accurate?
Research question in detail (PECO)
- Population
- Adults
- Intervention or exposure
- SSB
- Comparison
- Low or no intake
- Geographic scope
- universal; magnitude varies (smaller in EPIC)
- Outcomes
- CHD
- CVD mortality
- All-cause mortality
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Sugary and diet drinks linked to higher death rates
Zhang YB et al.. Adv Nutr 2021 · PMID 33786594 · DOI 10.1093/advances/nmaa110 Meta-analysisabstract checkednewly addedDose-response meta-analysis (~0.9-1 million participants): each daily SSB serving associated with 8% higher all-cause and CVD mortality; NutriGrade high.
- Actual result
- HR 1.08 (1.04-1.12) for both.
- Methodological quality
- high
- Relevance
- direct
- Limitations
- Observational.
Sugary and diet drinks and death in 118,000 US adults
Malik VS et al.. Circulation 2019 · PMID 30882235 · DOI 10.1161/CIRCULATIONAHA.118.037401 Cohort studyfull text, structured risk-of-bias assessmentMalik 2019 (NHS/HPFS): >=2 SSB/day CVD mortality HR 1.31 (1.15-1.50).
- Actual result
- HR 1.31.
- Methodological quality
- high
- Relevance
- direct
- Limitations
- US health professionals.
EFSA: how much sugar is safe?
EFSA NDA Panel et al.. EFSA J 2022 · PMID 35251356 · DOI 10.2903/j.efsa.2022.7074 Risk assessmentfull text, structured risk-of-bias assessmentEFSA 2022: high certainty of causal SSB-CVD relationship.
- Actual result
- Causal certainty high (>75-100%).
- Methodological quality
- high
- Relevance
- direct
- Limitations
- Sugar-fraction attribution less certain.
What speaks against the claim?
Soft drinks and death in 10 European countries
Mullee A et al.. JAMA Intern Med 2019 · PMID 31479109 · DOI 10.1001/jamainternmed.2019.2478 Cohort studyfull text, structured risk-of-bias assessmentEPIC (10 European countries): SSB not significantly associated with circulatory deaths.
- Actual result
- SSB >=2/day circulatory HR 1.11 (0.95-1.30).
- Methodological quality
- high
- Relevance
- direct
- Limitations
- Mixed; ASB associated.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
SSB are consistently associated with more CHD and earlier death; pooled effect sizes are smaller than the single-cohort figures the archive quotes.
Why some studies weigh more
Dose-response meta-analysis and EFSA's causal assessment outweigh the null circulatory result in EPIC.
Is a causal relationship established? Probable Dose-response; mediation through weight, blood pressure and diabetes shown in RCTs on risk factors.
Remaining uncertainty
Magnitude; residual confounding.
Justified conclusion
Well supported in direction; magnitude modest.
Why do studies seem to disagree?
EPIC found no significant SSB-circulatory death association while US cohorts did; lower SSB intakes in Europe, different adjustment and beverage definitions may explain it.
Does this depend on the country?
- General biological effects
- Universal.
- Actual monitoring data
- Modelled MENA SSB-attributable CVD incidence was the highest of all regions (815 per million adults, I-SOD-127).
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- Log-symmetry; extrapolation to 2 servings – HR 1.08 symmetric; ~1.17 at 2/day vs archive's 1.31-1.35 recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- CVD mortality with SSB
- Starting level
- low (observational studies)
- Reasons for downgrading
- risk of bias (residual confounding)
- Reasons for upgrading
- dose-response
- Result
- moderate
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- WHO: Guideline: sugars intake for adults and children (2015), publication page and news release (I-SUG-05) (2015) · Original publication
Reduce free sugars to <10% of energy (strong); further reduction to <5% (~25 g) conditional. Free sugars include sugars added by manufacturer, cook or consumer and sugars naturally present in honey, syrups, fruit juices and concentrates (news release https://www.who.int/news/item/04-03-2015-who-calls-on-countries-to-reduce-sugars-intake-among-adults-and-children, fetched 2026-10-26). - ADA: 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2026 (Diabetes Care 2026;49 Suppl 1:S89-S131; I-INTC-03) (2026) · Original publication
Rec. 5.14: minimise sugar-sweetened beverages, sweets, refined grains, processed and ultra-processed foods. Rec. 5.21: encourage water over other beverages (A). Rec. 5.22: nonnutritive sweeteners can replace sugar-sweetened products if consumed in moderation and for the short term (B). Rec. 5.25: replace sugar-sweetened beverages (including any juices) with water or low/no-calorie beverages and minimise foods with added sugar (B).
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| Europe PMC | 26 October 2026 | ("sugar-sweetened beverages") AND ("cardiovascular disease" OR "coronary heart disease") AND ("meta-analysis") AND ("prospective cohort") AND PUB_YEAR:[2020 TO 2026] | both directions | 927 | |
| PubMed | 26 October 2026 | (sugar-sweetened beverages[ti]) AND (cardiovascular[ti] OR coronary[ti] OR mortality[ti]) AND meta-analysis[pt] | both directions | 4 |
Open questions
Causal effect size.
How deeply was this checked?
11 linked studies: 6 checked in full text (6 of them with a structured risk-of-bias assessment), 5 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Mostly true (low)
- 26 October 2026 · Phase 4 (systematic evidence review) · Verdict changed: Mostly true (low) → Mostly true (moderate)
Certainty raised to moderate: a dose-response meta-analysis rated the SSB-mortality evidence high (NutriGrade), EFSA judged the SSB-CVD causal relationship highly likely, and RCTs show effects on the mediating risk factors; GRADE upgrade for dose-response from a low start.
New sources: I-SOD-120
In plain language
People who drink sugary drinks every day had more heart disease and died earlier in many large long-term studies. The archive quotes these numbers correctly, although pooled results across studies show a smaller increase (about 8% higher risk of death per daily drink). Because these studies observe people rather than assign drinks at random, other habits may explain part of the link. Still, the findings are consistent, increase with the amount consumed, and fit with known effects of sugary drinks on weight and blood pressure.
Studies on this claim
Studies supporting the claim (10)
-
Sugary and diet drinks and death in 118,000 US adults
Malik VS et al.. Circulation 2019 · PMID 30882235 · DOI 10.1161/CIRCULATIONAHA.118.037401Cohort studycited by the Tayebat archivefull text, structured risk-of-bias assessment★ key studyTwo or more sugary drinks a day: 21% higher death risk; diet drinks linked only at the highest intake and only in women.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Are SSB and ASB associated with total and cause-specific mortality?
- How was the study done?
Two prospective cohorts (HPFS 1986-2014; NHS 1980-2014); repeated FFQs; Cox models.
- How many people, animals or samples were studied?
118,363 (37,716 men; 80,647 women); 36,436 deaths; Health professionals and nurses free of chronic disease at baseline
- What was actually found?
SSB >=2/d vs <1/mo: total mortality HR 1.21 (1.13-1.28); CVD mortality 1.31 (1.15-1.50); cancer mortality 1.16 (1.04-1.29). ASB: only highest category, total 1.04 (1.02-1.12), CVD 1.13 (1.02-1.25); association in NHS but not HPFS (P interaction 0.01); not with cancer mortality.
- How large was the observed effect?
HR 1.21 total, 1.31 CVD (SSB)
- What do the results mean in everyday life?
Regular sugary drinks are linked with earlier death.
- What are the study's limitations?
Health professionals (limited generalisability); Observational design; residual confounding possible; Self-reported dietary intake
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
That diet drinks are as harmful as sugary ones; causality
-
Added sugar and children's heart health
Vos MB et al.. Circulation 2017 · PMID 27550974 · DOI 10.1161/CIR.0000000000000439Guideline / position statementcited by the Tayebat archivefull text, structured risk-of-bias assessmentThe AHA recommends no more than about 6 teaspoons of added sugar a day for children and none under age 2.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
What are the cardiovascular effects of added sugars in children?
- How was the study done?
Scientific statement reviewing and grading evidence.
- How many people, animals or samples were studied?
Not applicable; Children
- What was actually found?
Strong evidence supports association of added sugars with increased CVD risk in children via energy intake, adiposity and dyslipidaemia; recommended <=25 g/day (~6 teaspoons) and avoidance under age 2.
- How large was the observed effect?
<=25 g/day recommended
- What do the results mean in everyday life?
Applies to all added sugars, including honey and sweets.
- What are the study's limitations?
Narrative expert review, not a systematic review; children and risk factors only; the 25 g/day limit is based on low-level evidence (Level C, expert extrapolation); evidence for insulin resistance and fatty liver is inconclusive.
- What does it say about Elawady's specific claim?
Supports C-SOD-03 and contradicts C-SUG-01 (unlimited sugar).
- Do the results apply to Germany and Europe?
Moderate (US guidance; WHO similar).
- What can explicitly not be concluded from this study?
It cannot show how much added sugar is safe, nor that added sugar causes heart attacks or strokes in children; it concerns risk factors such as weight and blood lipids.
-
Sweetened drinks and heart disease in men
de Koning L et al.. Circulation 2012 · PMID 22412070 · DOI 10.1161/CIRCULATIONAHA.111.067017Cohort studycited by the Tayebat archiveabstract checkedMen with highest sugary-drink intake had 20% more heart disease; diet drinks showed no link.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Are SSB and ASB associated with CHD and biomarkers?
- How was the study done?
Prospective cohort (HPFS) 22 years.
- How many people, animals or samples were studied?
42,883; 3,683 CHD cases; Male health professionals
- What was actually found?
Top vs bottom SSB quartile RR 1.20 (1.09-1.33); ASB RR 1.02 (0.93-1.12); SSB associated with higher TG, CRP, IL-6, TNF receptors and lower HDL, Lp(a), leptin.
- How large was the observed effect?
RR 1.20 (SSB); 1.02 (ASB)
- What do the results mean in everyday life?
Sugary, not diet, drinks linked to heart disease.
- What are the study's limitations?
Observational design; residual confounding possible; Self-reported dietary intake
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
Causation.
-
Sugary drinks and heart disease in women
Fung TT et al.. Am J Clin Nutr 2009 · PMID 19211821 · DOI 10.3945/ajcn.2008.27140Cohort studycited by the Tayebat archiveabstract checkedTwo or more sugary drinks a day: 35% higher heart disease risk; diet drinks not linked.
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Is SSB consumption associated with CHD in women?
- How was the study done?
Prospective cohort (NHS) 1980-2004.
- How many people, animals or samples were studied?
88,520; 3,105 CHD cases; Women aged 34-59 without CHD, stroke, diabetes
- What was actually found?
RRs 1.0, 0.96, 1.04, 1.23 (1.06-1.43) for 1/d and 1.35 (1.07-1.69) for >=2/d (P trend <0.001); attenuated but significant after BMI, energy and diabetes adjustment; ASB not associated.
- How large was the observed effect?
RR 1.35 (1.07-1.69)
- What do the results mean in everyday life?
Sugary drinks linked to heart disease.
- What are the study's limitations?
Observational design; residual confounding possible; Self-reported dietary intake
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
Causation.
-
Added sugar and heart deaths in the US
Yang Q et al.. JAMA Intern Med 2014 · PMID 24493081 · DOI 10.1001/jamainternmed.2013.13563Cohort studycited by the Tayebat archivefull text, structured risk-of-bias assessmentPeople getting 25% or more of calories from added sugar had nearly three times the CVD death risk of those under 10%.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Is % energy from added sugar associated with CVD mortality?
- How was the study done?
NHANES trend analysis and NHANES III linked mortality cohort.
- How many people, animals or samples were studied?
31,147 (trends); 11,733 (cohort); 831 CVD deaths; US adults (nationally representative)
- What was actually found?
Fully adjusted HRs across quintiles 1.00, 1.07, 1.18, 1.38, 2.03 (1.26-3.27); 10-24.9% vs <10%: HR 1.30 (1.09-1.55); >=25%: 2.75 (1.40-5.42). Most adults (71.4%) consumed >=10% from added sugar.
- How large was the observed effect?
Highest vs lowest fifth of added-sugar intake: HR 2.03 (1.26-3.27); >=25% vs <10% of calories: HR 2.75 (1.40-5.42); about 1 extra CVD death per 22 people over 15 years in the highest fifth.
- What do the results mean in everyday life?
Total added sugar matters, from any source.
- What are the study's limitations?
Observational; diet measured once by 24-hour recall at baseline; possible residual confounding; no association seen in non-Hispanic black participants; total mortality not significantly raised.
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
Moderate.
- What can explicitly not be concluded from this study?
Causation.
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Cutting sugary drinks and blood pressure
Chen L et al.. Circulation 2010 · PMID 20497980 · DOI 10.1161/CIRCULATIONAHA.109.911164Cohort studycited by the Tayebat archiveabstract checkedOne sugary drink less per day was linked with about 1.8 mmHg lower systolic BP.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Are changes in SSB intake associated with BP changes?
- How was the study done?
Prospective analysis within an 18-month behavioural intervention trial (PREMIER).
- How many people, animals or samples were studied?
810; Adults with elevated BP (mean 134.9/84.8)
- What was actually found?
1 serving/day reduction associated with -1.8 mmHg SBP (1.2-2.4) and -1.1 mmHg DBP (0.7-1.4); significant after weight-change adjustment; no association for diet beverages or caffeine.
- How large was the observed effect?
-1.8 mmHg SBP per serving reduced
- What do the results mean in everyday life?
Fewer sugary drinks may slightly lower BP.
- What are the study's limitations?
Observational analysis within trial; Self-reported intake
- What does it say about Elawady's specific claim?
Supports C-SOD-03.
- Do the results apply to Germany and Europe?
Moderate.
- What can explicitly not be concluded from this study?
Causation.
-
Sweetened drinks dose-response
Qin P et al.. Eur J Epidemiol 2020 · PMID 32529512 · DOI 10.1007/s10654-020-00655-yMeta-analysiscited by the Tayebat archiveabstract checkedEach extra 250 mL/day of sugary drinks was linked with 12-19% higher risks of obesity and diabetes; diet drinks showed similar links.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Dose-response of SSB/ASB with obesity, T2D, hypertension, mortality.
- How was the study done?
Dose-response meta-analysis of prospective cohorts.
- How many people, animals or samples were studied?
39 articles; Adults
- What was actually found?
Per 250 mL/day SSB vs ASB: obesity RR 1.12 vs 1.21; T2D 1.19 vs 1.15; hypertension 1.10 vs 1.08; all-cause mortality 1.04 vs 1.06 (with I2 up to 92.6%).
- How large was the observed effect?
T2D RR 1.19 per 250 mL/d (SSB)
- What do the results mean in everyday life?
More sweetened drinks, more risk in observational data.
- What are the study's limitations?
High heterogeneity; Cohorts only; Reverse causation for ASB
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
Causation, especially for diet drinks.
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Sugar and health: umbrella review
Huang Y et al.. BMJ 2023 · PMID 37019448 · DOI 10.1136/bmj-2022-071609Systematic reviewindependent cross-checkfull text, structured risk-of-bias assessment★ key studyAcross 73 meta-analyses, high sugar intake was linked to 45 adverse outcomes; authors advise under 25 g/day of added sugar.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Quality and validity of evidence on sugar and health outcomes.
- How was the study done?
Umbrella review of 73 meta-analyses.
- How many people, animals or samples were studied?
73 meta-analyses; 83 outcomes; Humans free of acute/chronic disease
- What was actually found?
Significant harmful associations with 45 outcomes; moderate-quality: SSB and body weight, added sugars and ectopic fat; low-quality: +4% gout per SSB serving/week, +17% CHD and +4% all-cause mortality per 250 mL/day SSB; recommends free/added sugars <25 g/day and SSB <1 serving/week.
- How large was the observed effect?
CHD +17% per 250 mL/d SSB
- What do the results mean in everyday life?
High sugar intake is more harmful than beneficial.
- What are the study's limitations?
Most evidence is observational and of low certainty, and concerns sugary drinks rather than sugar in foods; sucrose intake was even linked to slightly lower diabetes risk in some cohorts; recommendations go beyond the strength of the evidence.
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
It cannot show that sugar in any form or small amount is harmful, nor precise effect sizes; it does not cover honey, fruit or sugars eaten in solid foods well.
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EFSA: how much sugar is safe?
EFSA NDA Panel et al.. EFSA J 2022 · PMID 35251356 · DOI 10.2903/j.efsa.2022.7074Risk assessmentindependent cross-checkfull text, structured risk-of-bias assessment★ key studyEFSA found no safe intake level and advises keeping added and free sugars as low as possible.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Can a UL or safe level for dietary sugars be set?
- How was the study done?
Regulatory scientific opinion with systematic reviews.
- How many people, animals or samples were studied?
Not applicable; General population
- What was actually found?
Sugars are a well-established hazard for caries; RCTs on surrogate endpoints show causal positive relationship of added/free sugars with obesity and dyslipidaemia (moderate certainty), NAFLD and T2D (low), hypertension (very low); no safe level identified; intake of added and free sugars should be as low as possible in a nutritionally adequate diet.
- How large was the observed effect?
Not applicable
- What do the results mean in everyday life?
Applies to sugar, honey and syrups alike.
- What are the study's limitations?
Trials looked at markers (weight, liver fat, blood fats) rather than diseases; cohort studies mostly compared sugar with other calories at equal total energy; few data below 10% of energy.
- What does it say about Elawady's specific claim?
Contradicts C-SUG-01, C-SUG-05 (health relevance); supports C-SOD-01.
- Do the results apply to Germany and Europe?
Directly applicable in EU/Germany.
- What can explicitly not be concluded from this study?
It cannot name a safe daily amount of sugar; it does not show that sugar is harmful when it does not add extra calories, except for tooth decay.
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Sugary and diet drinks linked to higher death rates
Zhang YB et al.. Adv Nutr 2021 · PMID 33786594 · DOI 10.1093/advances/nmaa110Meta-analysisindependent cross-checkabstract checked★ key studyPooled cohorts: each daily sugary drink was linked to 8% higher overall and cardiovascular mortality; diet drinks were linked at 1.5 or more per day.
SSB per serving: CVD mortality HR 1.08 (1.04-1.12).
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Pool cohort studies on sweetened drinks and death.
- How was the study done?
Dose-response meta-analysis.
- How many people, animals or samples were studied?
About 0.9-1 million participants.
- What was actually found?
Sugary drinks linked to more deaths; diet drinks at higher doses too.
- How large was the observed effect?
SSB HR 1.08 per serving.
- What do the results mean in everyday life?
Fewer sugary drinks is consistent with longer life; diet drinks are not clearly protective.
- What are the study's limitations?
Observational; reverse causation for diet drinks.
- What does it say about Elawady's specific claim?
Supports the direction of both claims.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot prove causation.
No study in this group is marked as key.
Studies contradicting or limiting the claim (0)
No studies in this group.
Studies with mixed or unclear results (1)
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Soft drinks and death in 10 European countries
Mullee A et al.. JAMA Intern Med 2019 · PMID 31479109 · DOI 10.1001/jamainternmed.2019.2478Cohort studycited by the Tayebat archivefull text, structured risk-of-bias assessment★ key studyTwo or more soft drinks a day were linked with higher death rates; for diet drinks the link was even stronger, which may partly reflect who chooses diet drinks.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Are total, SSB and ASB soft drinks associated with total and cause-specific mortality?
- How was the study done?
Population-based prospective cohort (EPIC), 10 European countries.
- How many people, animals or samples were studied?
451,743; 41,693 deaths; Adults without cancer, heart disease, stroke or diabetes
- What was actually found?
>=2 glasses/day vs <1/month: total soft drinks HR 1.17 (1.11-1.22); SSB 1.08 (1.01-1.16); ASB 1.26 (1.16-1.35); ASB and circulatory deaths 1.52 (1.30-1.78); SSB >=1/day and digestive deaths 1.59 (1.24-2.05).
- How large was the observed effect?
HR 1.17 total; 1.08 SSB; 1.26 ASB
- What do the results mean in everyday life?
Soft drinks are linked with earlier death in Europe.
- What are the study's limitations?
Observational; drink intake asked only once at baseline; residual confounding; diet-drink results may reflect people at risk switching to diet drinks; sugar-sweetened drinks were not linked to heart or circulatory deaths in this cohort.
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High (includes Germany).
- What can explicitly not be concluded from this study?
It cannot prove that soft drinks cause death, nor that sugary soft drinks raise cardiovascular death in Europeans (that association was not significant here).
No study in this group is marked as key.
Regional context
Germany / EU
The WHO guideline (2015) on free sugars and EFSA's 2022 opinion (intake of added and free sugars 'as low as possible') apply in Germany and the EU; the European EPIC cohort (A-SOD-17) found associations in 10 European countries including Germany.
Egypt
Sugar-sweetened soft drinks are widely sold in Egypt. No Egypt-specific study was reviewed for this claim; the physiological mechanisms and cohort findings are not known to differ by country, but absolute risks depend on local consumption and disease rates.
What applies in my country?
General scientific assessment
Mostly true Sugary drinks are consistently linked with more heart disease and earlier death, with moderate certainty; the archive's single-study figures are larger than the pooled estimates.
The following areas of food safety are relevant to this statement:
- Additives and processing
Honey, sugar, sweets
Choose a country to see the checked information for it.
Limits: legal rules describe what is allowed, not what every single food contains. Measurement data come from samples and are meaningful only together with their method details.
Country of residence or purchase Compare with another country
References
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- Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association.. Vos MB et al.. Circulation 2017 · PMID 27550974 · DOI 10.1161/CIR.0000000000000439
- Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men.. de Koning L et al.. Circulation 2012 · PMID 22412070 · DOI 10.1161/CIRCULATIONAHA.111.067017
- Sweetened beverage consumption and risk of coronary heart disease in women.. Fung TT et al.. Am J Clin Nutr 2009 · PMID 19211821 · DOI 10.3945/ajcn.2008.27140
- Added sugar intake and cardiovascular diseases mortality among US adults.. Yang Q et al.. JAMA Intern Med 2014 · PMID 24493081 · DOI 10.1001/jamainternmed.2013.13563
- Reducing consumption of sugar-sweetened beverages is associated with reduced blood pressure: a prospective study among United States adults.. Chen L et al.. Circulation 2010 · PMID 20497980 · DOI 10.1161/CIRCULATIONAHA.109.911164
- Sugar and artificially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose-response meta-analysis of prospective cohort studies.. Qin P et al.. Eur J Epidemiol 2020 · PMID 32529512 · DOI 10.1007/s10654-020-00655-y
- Dietary sugar consumption and health: umbrella review.. Huang Y et al.. BMJ 2023 · PMID 37019448 · DOI 10.1136/bmj-2022-071609
- Tolerable upper intake level for dietary sugars.. EFSA NDA Panel et al.. EFSA J 2022 · PMID 35251356 · DOI 10.2903/j.efsa.2022.7074
- Association of Consumption of Sugar-Sweetened Beverages or Artificially Sweetened Beverages with Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies.. Zhang YB et al.. Adv Nutr 2021 · PMID 33786594 · DOI 10.1093/advances/nmaa110
- Association Between Soft Drink Consumption and Mortality in 10 European Countries.. Mullee A et al.. JAMA Intern Med 2019 · PMID 31479109 · DOI 10.1001/jamainternmed.2019.2478