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WHO says halving sugar target has extra benefit

“Halve sugar intake, say health experts,” The Daily Telegraph reports, while The Guardian tells us that “a can of coke a day is too much sugar”.

The widespread media reports follow new draft international guidelines looking at the healthy maximum recommended levels of sugars in the diet.

Currently, people are advised to have less than 10% of their total energy intake from sugars. However, the new draft guidelines from the World Health Organization (WHO), state that a reduction to below 5% of total energy intake would have “additional benefits”.

An intake of 5% is equivalent to around 25 grams (six teaspoons) of sugar a day for a healthy adult. The WHO’s suggested limits apply to all sugars, including “hidden” sugars added to foods by manufacturers, as well as sugars that are naturally present in fruit juices and honey.

Why has the WHO published new draft guidelines on sugar?

The WHO has produced its draft guideline on recommended daily sugar intake to get feedback from the public and experts, before it finalises its advice.

The new consultation is needed because the existing WHO guideline was published 12 years ago. This advice, based on the best evidence available in 2002 says that sugars should make up less than 10% of total energy intake.

Why has a new draft guideline on sugar been produced?

The WHO says there is growing concern that consumption of sugars – particularly in the form of sugar-sweetened drinks – may result in:

  • reduced intake of foods containing more nutritionally adequate calories 
  • an increase in total calorie intake, leading to an unhealthy diet and weight gain

These may in turn increase the risk of conditions such as cardiovascular disease and diabetes.

The WHO points out that much of the sugars we eat and drink are “hidden” in processed foods that are not usually seen as sweets. For example, a tablespoon of ketchup contains around 4 grams (around a teaspoon) of sugars. A single can of sugar-sweetened fizzy drink contains up to 40 grams (around 10 teaspoons) of sugar.

The WHO also highlights the role sugars play in dental disease (tooth decay). This, the WHO argues, is globally the most common non-infectious disease in the world today.

The new guidelines on sugar intake aim to help both children and adults to reduce their risk of unhealthy weight gain and dental decay, the WHO says. The WHO’s recommendations, once agreed, can act as a benchmark for health policy officials to assess people’s current sugar intake and to help them develop measures to reduce sugar intake.

What does the new draft WHO sugar guideline say?

There is no change in the WHO’s new draft guideline from the existing target of having less than 10% of your total energy intake per day from sugars. However, the new guideline does suggest that a reduction to below 5% of total energy intake per day would have “additional benefits”. This target of 5% of your total energy intake is equivalent to around 25 grams (around six teaspoons) of sugar per day for an adult of normal BMI.

Tell the WHO what you think about its sugar advice

Comments on the new draft guideline can be made via the WHO website until March 31 2014. Anyone who wishes to submit a comment must submit a declaration of interest.

The suggested limits on intake of sugars in the draft guideline apply to all sugars that are added to food by manufacturers, cooks or consumers. It also applies to sugars naturally present in honey, syrups, fruit juices and fruit concentrates. These sugars include glucose, fructose, sucrose and table sugar.

Dr Francesco Branca, WHO’s nutrition director, reportedly told a news conference that the 10% target was a “strong recommendation” while the 5% target was “conditional”, based on current evidence. “We should aim for 5% if we can,” said Dr Branca.

What evidence is the new draft guideline based on?

WHO commissioned two systematic reviews that it says informed the development of the draft guideline. One is a study from the University of Otago in New Zealand which looked at sugar intake and body weight. This review, which included 68 studies, found that in adults:

  • advice to reduce free sugars was associated with an average 0.80kg reduction in weight
  • advice to increase intake was associated with a corresponding 0.75kg increase

However, the evidence was less consistent in children than in adults. The researchers say the effect seems to be due to an altered type of energy intake, as replacing sugars with other carbohydrates did not result in any change in body weight.

A second review, from the University of Newcastle, looked at the effect of restricting sugar intake on dental caries. It included 55 studies and found “moderate quality” evidence showing that the incidence of caries is lower when free-sugars intake is less than 10%. With a 5% cut-off, a “significant relationship” was observed, although this evidence was judged to be of very low quality.

Was media coverage of the WHO draft sugar guidelines accurate?

The media’s reporting of the new guidelines was factually accurate. Some papers chose to include comments critical of the WHO’s “lack of clarity”. According to BBC News, UK campaigners say it is a “tragedy” that the WHO has taken 10 years to think about changing its advice and are in favour of 5% becoming the firm recommendation.

The Independent reports one expert saying he suspected “dirty work” on the part of food and drinks companies might lie behind the WHO’s “less than resounding” message. However, The Independent also reports other experts who have pointed out that a limit of less than 5% would be “ambitious and challenging” and “untried and untested”.

The news follows a post-Christmas surge in stories about the harms from sugar, including the launch in January this year of the new campaign group Action on Sugar. The news also comes after Dame Sally Davies, England’s Chief Medical Officer, reportedly suggested a tax on sugar to help combat growing levels of obesity.

Should I cut down on sugar?

Most adults and children in the UK eat too much sugar. According to Public Health England, surveys show that the average intake for adults is 11.6% and for children intake is 15.2%. This is well above the current recommendation of less than 10% of energy intake from sugar.

Sugars are added to a wide range of foods, such as sweets, cakes, biscuits, chocolate, and some fizzy drinks and juice drinks. These are the sugary foods that you should cut down on. Fruit and vegetables also contain naturally occurring sugars, but these foods also have a range of other nutrients that make them a much better option.

You can find out more information about the relative proportions of food we should be eating in the Eatwell Plate

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

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