Academic journal article Bulletin of the World Health Organization

Evidence to Support a Food-Based Dietary Guideline on Sugar Consumption in South Africa

Academic journal article Bulletin of the World Health Organization

Evidence to Support a Food-Based Dietary Guideline on Sugar Consumption in South Africa

Article excerpt

Voir page 606 le resume en francais. En la pagina 605 figura un resumen en espanol.

Introduction

The argument that people should limit intake of sugar added to food is based on evidence that a high intake of sugar increases the risk of certain chronic diseases, particularly dental caries and obesity. As oral diseases and obesity are widespread in South Africa and affect large numbers of people in terms of physical, economic, and social outcomes, the impact that reductions in sugar intake would have as an important preventative measure needs to be emphasized (1). This paper aims to determine whether a food-based dietary guideline on sugar consumption is a justifiable component of public health policy in the South African context. It reviews the scientific evidence that suggests that sugar is a risk factor for various illnesses. It examines the current patterns of sugar consumption in South African adults and children aged >6 years, and the sugar-related conditions they experience.

The term "added sugar" is used throughout and, unless otherwise stated, this refers to all monosaccharides and disaccharides that are added to foods and drinks during preparation and cooking (2).

The call for a sugar guideline

The development of a dietary guideline for "sugar" has been fraught with conflict and political pressure, both locally and internationally. These conflicts seem to arise primarily from the twin imperatives: the formulation of appropriate public health policy and the protection of commercial sugar interests. Both have fundamentally influenced the content and process of this debate.

In 1997, the Nutrition Society of South Africa established a task group to develop food-based dietary guidelines for South Africa. The objective of this group, the members of which were mostly volunteers, was to develop a core set of food-based dietary guidelines to promote health in South Africans aged >6 years according to WHO's guidelines for the development of food-based dietary guidelines (3). Members of the Food-based Dietary Guidelines Task Group came from a wide range of organizations; many active participants came from the food industry, even though some had a dual role, in that they also represented their professional association. From the start, the South African Sugar Association played a role and also sponsored workshops (4).

In September 2001, preliminary guidelines (that excluded guidance on sugar) and results of a pilot study on consumers were published along with a series of technical papers that supported the guidelines (5). The preliminary guidelines were tested on consumers in order to test their understanding of the messages conveyed. The Department of Health raised concerns about the guidelines and urged the inclusion of a guideline on sugar as a preventative measure against the high prevalence of dental caries in certain population groups in South Africa. Such a guideline would conform to the national oral health goal: "to promote the reduction of risk factors, like sugar intake, tobacco and alcohol abuse" (1) and to the Department of Health's "obesity guidelines", which advocate a sugar intake of less than 45 g per day (Department of Health, personal communication, 2002). The Department of Health provisionally accepted the food-based dietary guidelines (Box 1) with minor revisions, but it insisted that a sugar guideline be developed and included. We were charged with the task of writing a technical support paper for an appropriate sugar guideline aimed at children (aged >6 years) and adults.

Sugar consumption in South Africa

Average intakes and sources of added sugar

The National Food Consumption Survey (NFCS) undertaken in 1999 is a useful source of data on consumption of added sugar in children aged 7-9 years (6). Large differences in sugar intake are seen according to geographical area and dietary assessment method used. …

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