March 4, 2015

expert reaction to final guideline from the World Health Organization on daily intake of free sugars

The World Health Organization has published guidelines for the intake of sugar for adults and children, with the aim of reducing the risk of non-communicable diseases and dental problems.

Dr Nita Forouhi, MRC Programme Leader, MRC Epidemiology Unit, University of Cambridge, said:

“We have a win-win situation with the WHO’s tiered guidance on sugars intake being under 10% of energy intake as a ‘strong recommendation’ with immediate policy implications, and under 5% as a ‘conditional recommendation’, sending a clear message that ‘less is better’ but allowing room for stakeholder and policymaker consultation and weighing up of trade-offs for the lower cut-off.

“The strengths of the WHO guidance include its evidence-based approach, a transparent process, a clear definition of free sugars which is helpful, the identification of current research gaps and future initiatives required, the acknowledgement that the sugars guidelines should not be used in isolation but alongside other nutrient guidelines and dietary goals, and the recognition that individual countries should translate the recommendations into food-based guidelines that consider locally available food and customs rather than a one-size-fits-all approach.

“The challenge is to move from guidelines to action, which will depend both on how people might change their dietary behaviours, i.e. individual behaviour change, and on how the foods and drinks available to them in the overall food landscape help them achieve these goals, i.e. public health and policy interventions.

“To achieve behaviour change by individuals, people need more information and health education, and programmes like the Change4Life ‘sugar swaps’ are a step in the right direction which should go hand-in-hand with better nutrition labelling that clarifies added and ‘hidden’ sugars to enable consumer choice. For changing the currently universally sweetened food environment we need joined up engagement from the food industry, governments and policymakers, including the use of food reformulations, and incentives and disincentives that promote healthier eating.  The WHO acknowledge that free sugars particularly in the form of sugar-sweetened beverages increase overall energy intake and may reduce the intake of foods containing more nutritionally adequate calories, and promote weight gain and increased chronic disease risk. This provides support for the notion that sugar-sweetened beverages may represent the “low hanging fruit” for the first wave of public health and policy action.”

Prof. Tom Sanders, Professor emeritus of Nutrition and Dietetics, King’s College London, said:

“The strong recommendation is made to reduce free sugar intake to below 10% energy which is about 50 g/d in a female on 2000 kcal/d. This is based on evidence showing higher intakes to be linked to obesity and its related disorders. There is currently no evidence supporting a recommended intake lower than 10% for obesity prevention, either from observational studies or randomised control trials (RCTs).

“In the UK average intakes of free sugars are about 11-12% of the energy (58g /d) in adults but higher in teenagers where they are closer to 18% of the energy. The target of 10% can easily met be avoiding sugar sweetened beverages and getting fluid intakes preferably from water or sugar-free beverages. The conditional recommendation of 5% is to prevent dental caries (that is an intake of 25 g/d or four heaped teaspoons of sugar) – this target is much harder to meet because it would involve not eating cakes, biscuits, confectionary and all sugar sweetened beverages including fruit juice.”

http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf

Declared interests

Prof. Tom Sanders is a Scientific Governor of the charity British Nutrition Foundation and honorary Nutritional Director of the charity HEART UK.  Prof Tom Sanders is now emeritus but when he was doing research at King’ College London, the following applied: Tom does not hold any grants or have any consultancies with companies involved in the production or marketing of sugar-sweetened drinks.  In reference to previous funding to Tom’s institution: £4.5 million was donated to King’s College London by Tate & Lyle in 2006; this funding finished in 2011. This money was given to the College and was in recognition of the discovery of sucralose by Prof Hough at the Queen Elizabeth College (QEC), which merged with King’s College London. The Tate & Lyle grant paid for the Clinical Research Centre at St Thomas’ that is run by the Guy’s & St Thomas’ Trust, it was not used to fund research on sugar. Tate & Lyle sold their sugar interests to American Sugar so the brand Tate & Lyle still exists but it is no longer linked to the company Tate & Lyle PLC, which gave the money to King’s College London in 2006.