Cut the sugar, warns WHO report

People should get no more than 10 per cent of their calories from sugar - including sugar from honey, syrups and fruit juices - experts say in a major new report published yesterday from two United Nations agencies on how to stem the global epidemic of obesity-linked diseases. But their findings, far from inspiring a collective solution, ignited a swift response from the sugar and food industry.

A diet low in energy-dense foods that are high in saturated fats and sugars, and abundant in fruit and vegetables, together with an active lifestyle are among the key measures to combat chronic disease recommended in an independent Expert Report prepared and commissioned by the World Health Organisation (WHO) and the Food and Agriculture Organisation (FAO).

The report from a team of global experts aims to identify new recommendations for governments on diet and exercise to tackle the ever increasing number of people who die each year from chronic diseases - approximately 59% of the 56.5 million total reported deaths in the world.

"This Expert Report is highly significant because it contains the best currently available scientific evidence on the relationship of diet, nutrition and physical activity to chronic diseases, based on the collective judgement of a group of experts with a global perspective,"​ said Dr Ricardo Uauy, Head of the University of Chile's Institute of Nutrition and Food Technology, and Professor of Public Health Nutrition at the London School of Hygiene & Tropical Medicine, who chaired the Expert Group.

But far from being a problem for only the Western world, the report highlights the fact that more and more people in the developing world are suffering from chronic disease, a seismic shift from a few decades ago when chronic disease was associated with the rich, developed world. Increased urbanisation - as rural people abandon their land and move towards the cities - plays a large part in this change, according to the report.

City-dwellers are more likely to consume energy-dense diets - high in saturated fat and in refined carbohydrates. This sudden change in diet, combined with a sedentary lifestyle, is having a drastic effect on the urban poor, adds the report.

"Not all fats or all carbohydrates are the same; it pays to know the difference,"​ said Dr Uauy, adding, "People should eat less high-calorie foods, especially foods high in saturated fat and sugar, be physically active, prefer unsaturated for saturated fat and use less salt; enjoy fruits, vegetables and legumes and prefer foods of plant and marine origin."​

A diet rich in fruit and vegetables containing immune-system boosting micronutrients could also help the body's natural defences against infectious diseases, Uauy said.

Carbohydrates, the report suggests, should provide the bulk of energy requirements - between 55 and 75 per cent of daily intake and free sugars should remain beneath 10 per cent.

But the president and CEO of the US trade organisation The Sugar Association, Richard Keelor, yesterday raised strong objections to the emphasis on sugar in the report, calling it misguided and misleading. Denouncing the report's aim at sugar as unfair, Keelor said : "The preponderance of the recent scientific evidence exonerating sugar (sucrose) as a causative factor in obesity, diabetes, heart disease, hyperactivity and dental caries has all but been ignored."​

Providing support to the Sugar Association's position is the US National Academy of Sciences, Food Nutrition Board's (FNB) September 2002 recommendations on Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. After nearly three years of work and a review of 279 research studies, NAS suggests that "not more than 25 per cent of total calories should come from added sugars."​

Charles W. Baker, chief science officer for the Sugar Association, and who presented scientific comments to WHO on the draft report in June 2002, commented : "The [WHO] report conflicts with conclusions of a number of other major expert committees with a broader emit to review all aspects of diet and health that have been reported in the last few years."​

So, while medical experts around the world may disagree on the exact amount of sugar that should be in an individual's daily diet, there is the common agreement that sugar intake should be limited - suggesting that the debate surrounding sugar should concentrate on the exact percentage that is acceptable for a daily dietary regime.

The Grocery Manufacturers of America, the world's largest association of food, beverage and consumer product companies, also objected to the targeting of sugar. It maintained that all foods can be part of a healthy diet when eaten in moderation and combined with the right amount of physical activity.

In addition to a reduction in sugar consumption the report suggested that protein should make up a further 10-15 per cent of calorie intake and salt should be restricted to less than 5 grammes a day. Intake of fruit and vegetables should be plumped up to reach at least 400 grammes a day.

WHO and FAO hope the report's findings will provide member states with solid evidence to prepare national health strategies. The Expert Report urges national governments to aim for dietary guidelines that are simple, realistic and food-based. Finland and Japan, countries that have actively intervened in the diet and nutritional behaviour of their populations, have witnessed dramatic decreases in risk factors and plunging rates of chronic disease, emphasised the report.

Recognising that chronic diseases are preventable, addressing the issues and creating an environment which supports health, the report highlights, is the key to reducing rates of deaths and disability from chronic diseases.

Clearly evident from the report findings is the fact that this is not a debate about self-interest, but one that should be reaching a higher moral plane. It is not about persecuting the food industry for using sugar and salt but about reducing the heavy burden of chronic disease that is rapidly increasing worldwide.

According to the WHO figures, in 2001, chronic diseases contributed to approximately 59 per cent of the 56.5 million total reported deaths in the world and 46 per cent of the global burden of disease. These are not figures to be taken lightly. It is up to national and international governments, the global food industry, and health bodies to work together to tackle this very serious problem. The way forward is collective, not individualistic. How can progress be made if each different party stands in its own defensive corner and dismisses the wider, real problem - that of a global epidemic of obesity-linked diseases ? We have entered an era where globalisation is a fact - progress can only occur if we work together.

The extreme seriousness of the problem highlighted by the WHO report demands unity on all sides. Defensive words do little to develop the debate and carry it forward towards finding solutions. Until all parties concerned show a willingness to bring the debate to a higher moral level it is inevitable that the chronic diseases linked to poor dietary habits will continue to soar in both the developing and Western worlds.