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SUGAR: what’s going on? An update

There is growing evidence showing that sugars may have an addictive effect in humans, and it has been proved that added sugar is linked with several diseases, such as diabetes, cardiovascular diseases, obesity, as well as dental cavities. Not surprisingly, sugar remains an issue high on the international nutrition agenda, with many ongoing initiatives and debates.

Here is a selection of updates, with links to reports, news and scientific articles. I hope our readers find it useful.

Box 1. Current sugar recommendations

According to WHO, sugar must not represent more than 10% of the total daily caloric intake. These recommendations also suggest that reducing sugar intake to below 5% (25 grams, equivalent to around 6 teaspoons) of the total caloric intake might have extra health benefits.The guideline limits refers to all monosaccharides (glucose, fructose) and dissacharides (sucrose or better known as table sugar and all added sugar, honey, syrups, fruit juices and fruit concentrates). Most of consumed sugars are hidden in processed foods that are not necessarily sweet. For example, 1 tablespoon of ketchup has approximately 1 teaspoon of sugars (4 grams), and a can of sugar-sweetened soda has up to 40 grams (10 teaspoons) of sugar.
Sources:Human energy requirements, WHO 2004; andWHO website.


In March 2014, the World Health Organization (WHO) launched a public consultation for a new draft guideline on sugars consumption (see here). This consultation was open from the 5 – 31 March for anyone who wished to comment. A declaration of interest needed to be completed, which is a positive step in having more transparent and unbiased processes. The idea is to provide recommendations for countries on how to limit the

consumption of free sugars, and to help reduce the risk of NCDs in adults and children, with a particular focus on the prevention and control of weight gain and dental caries. In parallel with the consultation on the draft guidelines, an expert peer-review process also took place. When both processed are completed, the final version of the guidelines will be revised by WHO’s Guidelines Review Committee and then published. We will share news about the new version once it is finalized.

In the last World Health Assembly (WHA), in May 2014, WHO Director-General Margaret Chan announced a new initiative on obesity: the creation of High-Level Commission on Ending Childhood Obesity. The Commission will produce a consensus report with the most effective approaches to tackle child obesity in different contexts around the world, to be released at next year’s WHA (see more). Dr Chan has also been openly concerned about strategies used by transnational food corporations to promote the consumption of unhealthy foods. “Public health must also contend with Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics. Research has documented these tactics well. They include front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that confuses the evidence and keeps the public in doubt”, said Dr. Chan in her address to the World Health Assembly in 2013 (full speech transcript available here).

Also during WHA, on 19 May, there was an NCD Child Round-table organized by UNICEF, the International Pediatric Association and the American Academy of Pediatrics. The session featured the release of the new NCD Child, DOHaD, NCDA, and PMNCH policy brief and brought together NGOs, ministries of health and private donors focused on global and country advocacy for NCD prevention and treatment for children and youth. WPHNA was among the panelists, represented by Association President Barrie Margetts, who presented the NCD Chapter in the upcoming publication UNICEF Facts for Life. The programme for the Round-table is available here.

On 4 May 2014, the most senior UK public health advisor and chief medical officer, Sally Davies, said at a parliamentary committee that relevant studies have shown that sugar as is likely to be identified with addictive qualities, and warned that taxes on sugar may be a possible way to control sugar intake (read more on BBC). Dr Davis based her argument on previous research conducted in the United States by a team headed by Dr Nora Volkow.

The media has also been publishing various articles on sugar, for example:

The Guardian ( in more than one occasion)
The Huffington Post
USA Today (see via Yale Ruud Center)


(in more than one occasion)
The Telegraph
The BBC (also in more than one occasion)
Sky News

There was also the release of the movie Fed Up, on global obesity and the role of Big Food and Big Sugar (see trailer below).

Sugar on the Association’s work

coverfeb2014The Association has published a series of commentaries and updates on sugar on its journal, World Nutrition.

In January 2014, we published a World Nutrition Update on research on sugar funded by industry, and on discussions on NUGAG about top limit for added sugars.

February 2014 was the first of a series of WN issues focused on sugar, with a special Editorial and Update entitled What sugar does to you: the indictment”. In March 2014, a new Update was published, on the work of sugar pioneers Weston Price, TL Cleave and John Yudkin.

In the April edition, the Commentary “Big Sugar and the corridors of power” was published. It highlighted that WHO is under pressure from Big Sugar and its associated and representative organisations to cancel any restrictions on sugar or even to discard NUGAG. The coalition of Big Sugar corporations and their front organisations, member states whose economies depend on sugar production, and policy-makers including scientists linked with industry, has twice sabotaged WHO recommendations on sugar, in 1990-1992 and 2003-2004. This could happen again.

In the May edition, we published a new Commentary entitled “How much is too much?”, with a shortened version of the submission by the UK-based organisation Action on Sugar to WHO on the topic of added sugars. It urges for targets to be set so that reductions can be made to the amounts of sugar that are added to food products.

On June 2014, a new Commentary entitled “Fed Up: The Clinton clincher” discusses the movie Fed Up and the role of influential people such as Bill Clinton, who also participated in the Stockholm EAT Forum. And on the last issue, July-August 2014, a new piece on the history of sugar was published.

Box 2. Recent studies on sugar

June 2014: A paper published on Public Health Nutrition concluded that the recommendation that sugar intakes should be ?10 % of energy intake is no longer acceptable, and supports a much lower intake throughout life (e.g. 2-3 % of energy intake) to promote dental health.
Sheiham A, James WP (2014) A new understanding of the relationship between sugars, dental caries and fluoride use: implications for limits on sugars consumption. Public Health Nutr. 3:1-9. See online on PubMed.

June 2014: a Swedish study assessed the association between high intake of sweetened beverages and the risk of stroke. More than 70 000 adults free of cardiovascular disease, cancer, diabetes were followed up for over 10 years, and the results concluded that sweetened beverage consumption was significantly positively associated with risk of total stroke and cerebral infarction.
Larsson SC, Akesson A, Wolk A (2014) Sweetened beverage consumption is associated with increased risk of stroke in women and men. J Nutr. ;144(6):856-60. See online on PubMed.

April 2014: a study performed in Africa showed a dramatic increase sugar intake and its link with an increased prevalence of noncommunicable diseases, even in remote areas of South Africa.
Vorster HH, Kruger A, Wentzel-Viljoen E, Kruger HS, Margetts BM (2014) Added sugar intake in South Africa: findings from the Adult Prospective Urban and Rural Epidemiology cohort study. Am J Clin Nutr, 99:1479–86. See online on PubMed.

November 2013: a cross-national study of 75 countries showed that soft drink intake is significantly associated with obesity and diabetes in high- and low and middle-income countries. This study showed that a 1% increase in soft drinks was link with 4.8 overweight adults per 100.
Basu S, McKee M, Galea G, Stuckler D (2013) Relationship of soft drink consumption of global overweight, obesity, and diabetes: a cross-national analysis of 75

countries. Am J Public Health, 103(11):2071-7. See online on PubMed.

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