Scimex: The World Health Organization (WHO) has today released their final
guidelines on sugar intake in both adults and children. The guidelines
recommend adults and children reduce their daily intake of sugars,
excluding sugar in fruits, vegetables and milk, to less than 10% of
their total energy intake. A further reduction to below 5% or roughly 25
grams (6 teaspoons) per day would provide additional health benefits.
A new guideline from the
World Health Organization recommends adults and children reduce their daily
intake of free sugars to less than 10% of their total energy intake. A further
reduction to below 5% or roughly 25 grams (6 teaspoons) per day would provide
additional health benefits.
Free sugars refer to monosaccharides (such as glucose, fructose) and
disaccharides (such as sucrose or table sugar) added to foods and drinks by the
manufacturer, cook or consumer, and sugars naturally present in honey, syrups,
fruit juices and fruit juice concentrates.
“We have solid evidence that keeping intake of free sugars to less than 10% of
total energy intake reduces the risk of overweight, obesity and tooth decay,”
says Dr Francesco Branca, Director of WHO’s Department of Nutrition for Health
and Development. “Making policy changes to support this will be key if
countries are to live up to their commitments to reduce the burden of
noncommunicable diseases.”
The WHO guideline does not refer to the sugars in fresh fruits and vegetables,
and sugars naturally present in milk, because there is no reported evidence of
adverse effects of consuming these sugars.
Much of the sugars consumed today are “hidden” in processed foods that are not
usually seen as sweets. For example, 1 tablespoon of ketchup contains around 4
grams (around 1 teaspoon) of free sugars. A single can of sugar-sweetened soda
contains up to 40 grams (around 10 teaspoons) of free sugars.
Worldwide intake of free sugars varies by age, setting and country. In Europe,
intake in adults ranges from about 7-8% of total energy intake in countries
like Hungary and Norway, to 16-17% in countries like Spain and the United
Kingdom. Intake is much higher among children, ranging from about 12% in
countries like Denmark, Slovenia and Sweden, to nearly 25% in Portugal. There
are also rural/urban differences. In rural communities in South Africa intake
is 7.5%, while in the urban population it is 10.3%.
Reducing sugars intake to less than 10% of total energy: a strong
recommendation
The recommendations are based on analysis of the latest scientific evidence.
This evidence shows, first, that adults who consume less sugars have lower body
weight and, second, that increasing the amount of sugars in the diet is
associated with a weight increase. In addition,
research shows that children with the highest intakes of sugar-sweetened drinks
are more likely to be overweight or obese than children with a low intake of
sugar-sweetened drinks.
The recommendation is further supported by evidence showing higher rates of
dental caries (commonly referred to as tooth decay) when the intake of free
sugars is above 10% of total energy intake compared with an intake of free
sugars below 10% of total energy intake.
Based on the quality of supporting evidence, these recommendations are ranked
by WHO as “strong”. This means they can be adopted as policy in most
situations.
Further reduction to less than 5% of total energy intake: a conditional
recommendation
Given the nature of existing studies, the recommendation of reducing intake of
free sugars to below 5% of total energy is presented as “conditional” in the
WHO system for issuing evidence-based guidance.
Few epidemiological studies have been undertaken in populations with a low
sugars intake. Only three national population-wide studies allow a comparison
of dental caries with sugars intakes of less than 5% of total energy intake
versus more than 5% but less than 10% of total energy intake.
These population-based ecological studies were conducted during a period when
sugars availability dropped dramatically from 15kg per person per year before
the Second World War to a low of 0.2kg per person per year in 1946. This
“natural experiment”, which demonstrated a reduction in dental caries, provides
the basis for the recommendation that reducing the intake of free sugars below
5% of total energy intake would provide additional health benefits in the form
of reduced dental caries.
WHO issues conditional recommendations even when the quality of evidence may
not be strong on issues of public health importance. A conditional
recommendation is one where the desirable effects of adhering to the
recommendation probably outweigh the undesirable effects but these trade-offs
need to be clarified; therefore, stakeholder dialogue and consultations are
needed before the recommendation is implemented as policy.
Updating the guideline on free sugars intake is part of WHO's on-going efforts
to update existing dietary goals to prevent NCDs. The sugars guidelines should
be used in conjunction with other nutrient guidelines and dietary goals, in
particular those related to fats and fatty acids, including saturated fat and
trans-fat.
In March 2014, WHO opened a public consultation on the then draft sugars
guideline to seek inputs from all stakeholders. More than 170 comments were
received from representatives of government agencies, United Nations agencies,
nongovernmental organizations, industries and academic institutions as well as
other interested individuals. An expert peer review process was also undertaken
in 2014. The final guideline was prepared taking into account comments received
from the public consultation and expert peer review.
Countries can translate the recommendations into food-based dietary guidelines
that consider locally available food and customs. Additionally, some countries
are implementing other public health interventions to reduce free sugars
intake. These include nutrition labelling of food products, restricting
marketing to children of food and non-alcoholic drinks that are high in free
sugars, fiscal policies targeting foods and beverages high in free sugars, and
dialogue with food manufacturers to reduce free sugars in processed foods.
Note to editors
Reducing free sugars intake to less than 10% of total daily energy intake was
recommended by the WHO Study Group for the first time in 1989 and was further
elaborated by a joint WHO/FAO Expert Consultation in 2002. This new updated WHO
guideline calls for further reduction of free sugars intake to less than 5% of
total energy intake if possible.
Promoting healthy diet was a key theme of the Second International Conference
on Nutrition (ICN2) convened jointly by the Food and Agriculture Organization
of the United Nations (FAO) and WHO in November 2014. At ICN2, more than 170
countries adopted the Rome Declaration on Nutrition, and a Framework for
Action, which highlight the need for global action to end all forms of
malnutrition, including obesity and diet-related NCDs.
The sugars guideline is also part of WHO’s effort to reach targets set by the
Global Action Plan for NCDs 2013-2020 to halt the rise in diabetes and obesity
and reduce the burden of premature deaths due to NCDs by 25% by 2025.
Similarly, the sugars guideline contributes to the work of WHO’s Commission on
Ending Childhood Obesity, which aims to raise awareness and build momentum for
action to address childhood obesity.