March 5, 2014

expert reaction to new WHO sugars guideline to undergo public consultation

The World Health Organization (WHO) launched a public consultation on its draft guideline on sugars intake, which aims to reduce public health problems like obesity and dental caries.

Professor Susan Jebb, Department of Primary Care Health Sciences, University of Oxford said:

“The WHO consultation on dietary recommendations to limit sugar intake send a clear message to consumers about the risks, but it does not necessarily follow that lowering the dietary recommendations will be sufficient to drive the changes in intake to improve health.  The main challenge we face with sugar is how to help people change their diet. As WHO acknowledge, reducing sugar is an important element in curbing energy intake to tackle obesity. Reformulation is likely to be an important  strategy to help reduce sugar and hence energy intake but we also need to consider other interventions to help consumers change their dietary habits and reduce their overall intake of sugar-rich foods – especially those which add calories but few essential nutrients.

“Within the Responsibility Deal in England, companies are urged to reduce the sugar content of foods and drinks as part of the calorie reduction pledge.  It would add considerably to these efforts if this action was replicated by other governments around the world. Many of the key players are international food and drink companies and it would make good sense if action was coordinated globally.  I hope that alongside developing the new dietary recommendations on sugar that WHO will also seek to galvanise this international cooperation.”

Prof Tom Sanders, Head of Diabetes and Nutritional Sciences Division, School of Medicine, King’s College London, said:

“The scientific evidence is based mainly on the association of high intakes of sugar sweetened beverage consumption with obesity and the well-known causal association between sugar intake and dental caries.

“The proposal aims to restrict the intake of added sugars to 10% energy – this is about 60g/day which is not much different from current UK guidelines of <11% for non-milk extrinsic sugars. Current intakes of non-milk extrinsic sugars in the UK are 11-12% so meeting the reduction to 10% on average is not difficult by not adding sugar to tea and coffee and restricting the intake of sugary drinks to one small glass of fruit juice a day. However, there is a skewed distribution of intake with some people consuming huge amounts of sugar, usually as soft drinks.  In terms of dental caries it is frequency of consumption that matters more than total intake and of course oral hygiene: in this respect sweets are a bigger problem because even five 2g sweeties consumed through the day would promote caries. I think the recommendation of a limit of 5% added sugar would be very tough to meet and there are no trials to my knowledge to demonstrate that this is a feasible target.  5% is untried and untested; 10% we can live with.

“Our own research finds that healthy adults consuming a traditional British diet get about 25% of their total energy from sugar, with about 11% from non-milk extrinsic sugars. We have found that the UK recommendation (<11%) is easily met by following UK dietary guidelines and restricting intake to no more than one serving per day of sugar sweetened beverages including fruit juice; non-milk extrinsic sugar fall to about 7% energy but total sugar intake remains unaffected at 25% energy.

“What will be confusing for consumers are the different terms used to describe sugar because the new recommendations are for ‘free sugars’ which cover not only added sugars but also includes honey and sugar in fruit juices and concentrates. Sugar in fruit or that in milk does not appear to count – so if you can eat for example a banana, an apple and a satsuma and half a pint of milk you will get about 60g of sugar. The European Nutritional Directive only allows for a declaration for total sugar content. For foods like muesli it is very confusing because the sugar content is the same for ‘no added sugar’ varieties vs added sugar versions.  Fizzy drinks and fruit juice are easy targets for sugar reduction and there are low calorie alternatives as well as water. However, it is perhaps time to stop Sports drinks being promoted as being ‘energy’ drinks because they packed with much greater amounts of sugar than even standard fizzy drinks.”

Dr Nita Forouhi, Programme Leader, Medical Research Council Epidemiology Unit, University of Cambridge, said:

“It is appropriate and welcome that the WHO has retained its past recommendation that ‘free sugars’ should contribute less than 10% of total calorie intake per day. Their recommendation to reduce this further down to under 5% of total calorie intake for benefits for obesity and dental caries is ambitious, and challenging.

“Aiming for added free sugars contributing under 10% of total daily calories is a more realistic goal for a whole population approach for effects of added sugars for a range of health outcomes, including caries, obesity, and type 2 diabetes.

“In tangible terms for the public, it is easier to grasp what they can cut out rather than work out what is 10% of their total calorie intake. Important messages should include at that (1) sugary drinks such as fizzy drinks and fruit juices with added sugars count up to a lot of sugar and are an easy sugar source to replace; and (2) sweet snacks and desserts should be considered ‘discretionary calories’ as occasional treats rather than for daily habitual consumption. This should go hand-in-hand with clear front of pack labelling to make any hidden sugars, added and total, clearly visible. Specifically labels should include information on what proportion of the average recommended daily added sugar intake is contained in products.  Re-formulations of foods by food manufacturers to cut down the added sugars is clearly another important action that is much needed.

“There is a growing and consistent body of evidence that added sugars have an adverse effect on many health conditions in addition to dental caries and obesity, such as type 2 diabetes and heart disease. There is also evidence that added sugars can have effects both through their contribution to calories, and also independently.

“We should remember that sugar is one part, among many components of diet, and while it is absolutely right to target reducing consumption of added and hidden sugars, we should promote this message alongside advice to continue overall healthy diets and lifestyles that include consumption of a variety of foods, including fruits, vegetables, nuts, and others that contain natural sugars.”

http://www.who.int/mediacentre/news/notes/2014/consultation-sugar-guideline/en/