Bulletin of the World Health Organization

Populations with high sugar consumption are at increased risk of chronic disease, South African researchers report

28 August 2003

A new review of the evidence from South Africa confirms that high consumption of added sugars contributes significantly to the incidence of dental caries and obesity. Published in this month’s Bulletin of the World Health Organization, the findings cover both rural and urban populations, and add to the growing body of global evidence on the influence of diet on chronic disease.

The paper examines the effect of added sugars on a population experiencing both under-nutrition and over-nutrition. The information was compiled as part of an effort by the South African Department of Health to advise on sugar consumption in its dietary guidelines. The researchers recommend that added sugars should form no more than 6–10% of total dietary intake. The wording of the guideline, they suggest, should be “Eat and drink food and drinks containing sugar sparingly and not between meals.”

"Countries which have not included a comparable recommendation in their dietary guidelines should consider doing so," comments the accompanying Bulletin Editorial by Jim Mann, Professor of Human Nutrition and Medicine at Otago University, New Zealand.

The article suggests that increasing problems with dental caries and obesity alone justify the new guideline. It reports that total tooth loss in adult populations in South Africa reaches up to 35%, while obesity affects nearly 20% of adults and 30% of black women. Even in children aged 7 to 9, overweight and obesity affect up to 9%.

The research indicated that among adolescents and adults (older than 10 years), the percentage consumption of added sugars is over twice as high in urban populations as it is in rural ones — 12.3% compared to 5.9% of total energy intake. In rural areas the sources are mainly white table sugar and non-carbonated soft drinks, while in town added sugar comes from a greater variety of foods and drinks. Illustrating the contrast in the nutritional transition in urban and rural areas, the authors note that 33% of urban populations consume carbonated soft drinks while only 3% of their rural counterparts do.

The review , by Cape Town-based researchers NP Steyn, NG Myburgh and JH Nel, also compares sugar consumption in malnourished populations of children to that of well-nourished populations. It finds that in many cases sugar displaces protein consumption and significantly dilutes iron, zinc and thiamine intake. This suggests that the diets of undernourished children would not be improved by the addition of sugar-rich foods.

The authors' recommendation is more specific than that of WHO and FAO in their March 2003 report Diet, Nutrition and the Prevention of Chronic Disease, which is for a dietary intake of less than 10% of total energy intake. The more specific range of 6–10% reflects the need to account for the varying availability of fluoridated water in South Africa, Steyn and his colleagues say.

“This paper gives an important perspective on the influence of sugar on diet and nutrition in the developing world, in a country where both under-nutrition and over-nutrition co-exist,” said Dr. Pekka Puska, Director of Noncommnicable Disease Prevention and Health Promotion. “This information strengthens the ability of the public health community to respond to the epidemic of diet-related chronic disease.” Dr. Puska is currently leading WHO’s development of a Global Strategy on Diet, Physical Activity and Health.

For further information please contact Iain Simpson, Communications Officer, Director-General’s Office, WHO, Tel: +41 22 791 3215, mobile: +41 79 475 5534, email: simpsoni@who.int. All WHO Press Releases, Fact Sheets and Features can be obtained on the WHO home page http://www.who.int.