The World Health Organization (WHO) published last week their long awaited recommendations on sugar intake for adults and children. These guidelines are based on a careful analysis of more than 120 scientific studies by international public health experts. The objectives of the guidelines were to provide recommendations on the intake of added sugars to reduce the risk of chronic disease in adults and children, with a particular focus on the prevention and control of unhealthy weight gain and dental caries. Added sugars include monosaccharides and disaccharides added to food and beverages that do not include them in the first place. They also include sugars naturally present in honey, syrup, fruit juices and fruit juices concentrates.

For both adults and children, WHO recommends reducing the intake of added sugars to less than 10% of total daily energy intake. They also recommend that the ideal target would be less than 5% of total daily energy intake (although this recommendation was based on lower quality evidence). WHO hopes that these guidelines will be translated in the communities and implemented to guide public health nutrition policies, for instance, by encouraging food manufacturers to reduce the amount of added sugars in processed foods, guiding food an nutrition labelling or increasing consumer awareness about added sugars, all of which could be targeted to reverse the obesity and associated chronic diseases epidemics.

Between 2003 and 2013, the consumption of added sugars increased 10% around the world, with the highest increment observed in Asia (21%), according to the International Sugar Organization. Several epidemiological studies have shown that added sugars are associated with poor diet quality and contribute to a very good extent to a positive energy balance. In the presence of a positive energy balance, added sugars consumption leads to fat accumulation in the liver and drives the secretion of fat molecules called triglycerides from the liver. Triglyceride levels have been shown to represent a causal risk factor for cardiovascular disease and type 2 diabetes risk. Intervention studies have also documented that added sugars consumption is linked to a preferential accumulation of intra-abdominal obesity and the development of insulin resistance.

Higher intake of added sugars threatens nutrient quality of diets by providing a significant amount of energy to the body without specific nutrients. As the bulk of added sugars are often consumed under the form of sugar-sweetened beverages such as soft drinks and fruit juices (especially in children), this increment in energy intake comes without a satiating effect, further contributing to a positive energy balance. Contrary to sugar-sweetened beverages, fresh fruits consumption does provide a satiating effect and also brings along high-quality nutrients such as fibres. Consequently, while sugar-sweetened beverages do associate with obesity and type 2 diabetes risk, fresh fruit consumption has been associated with the maintenance of a healthy body weight and a reduced risk of developing chronic diseases.

These new WHO guidelines are obviously welcomed by health professionals, as they provide a great support to public health campaigns aiming at reducing added sugars consumption. It should be kept in mind however that positive messages about healthy eating and healthy drinking have a much better impact on consumer behaviour, compared to negative, often paternalistic, messages encouraging the population to cut specific nutrients from their diets. Therefore, to counter the rise in the consumption of sugar-sweetened beverages, positive public health messages aiming at encouraging the population to adopt healthy drinking habits such as drinking more water for instance could have a tangible and lasting impact on consumer behaviour and public health.

Benoit Arsenault, PhD, Professeur adjoint/Assistant Professor, Département de médecine, Faculté de médecine, Université Laval.