This 2019 review traces the dramatic rise in sugar consumption beginning with the Industrial Revolution, when sugar became cheaper and processed foods and sweetened drinks became increasingly available. Rates of obesity, type 2 diabetes, and cardiovascular disease rose alongside that consumption, while sugar shortages during periods such as World War I coincided with declines in metabolic disease. The authors review evidence linking excess sugar consumption to insulin resistance, fatty liver, diabetes, cardiovascular disease, and obesity.

The article also examines how the sugar industry helped shape the scientific debate that followed. Beginning in the 1950s and ’60s, the Sugar Research Foundation funded research that downplayed sugar’s role in cardiovascular disease and redirected attention toward saturated fat and cholesterol; one industry-funded researcher, Mark Hegsted, later helped draft the precursor to the federal Dietary Guidelines. The authors argue that this history of industry influence helped distort nutrition science and dietary policy while the metabolic consequences of excessive sugar consumption continued to accumulate.

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