The objective of this chapter is to present the mechanisms and evidence that support the hypothesis that increased consumption of added sugars contributes to the development of metabolic syndrome (MetS). MetS is described along with its formally defined diagnostic criteria and less well-recognized risk factors. The amount and types of sugar consumed in the United States are discussed. The mechanistic scenario by which consumption of fructose or fructose-containing sugar may promote the development of components of MetS and how this scenario differs from the established paradigm are described. We cite the epidemiological studies that demonstrate associations between sugar consumption and all the formally defined, and some of the less well-recognized, risk factors for MetS. Results from dietary intervention studies showing that many of these risk factors are adversely affected when sugar intake is increased and beneficially affected when sugar intake is decreased are presented. We conclude that specific recommendations to reduce consumption of added sugars to the levels recommended by the 2015-2020 Dietary Guidelines for American, or to the even lower levels recommended by the American Heart Association, may be beneficial in the prevention and management of MetS.
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