Sugar: Health Risks and Policy Actions for Healthier Consumption

Authors

  • Supat chaiyakul Nutrition Association of Thailand

Keywords:

sugar, Health risk, Policy actions

Abstract

Sugar is a source of energy and a favorite sweet taste for humans. The unsavory effects of excessive sugar consumption was shown to be related to neurochemical changes in the brain and change the eating behavior from fulfilling energy needs or appetite to become a reward. This leads to sugar addiction as individuals lose control over the frequency and quantity of sugar consumption. High sugar consumption leads to health problems, such as, dental caries, obesity, metabolic syndrome, and inflammatory diseases, all of which are major global public health concerns. For healthier consumption, the World Health Organization recommends that the intake of free sugars should be reduced to less than 10% of total energy intake. Specific to lowering the risk of dental caries and obesity, the intake of free sugars should be below 5% of total energy intake. In compliance with the WHO recommendations, the Thai government has launched the policy framework for promoting healthier consumption (reduction of sugar, salt and fat). Actions are taken through collaboration and networking among government agencies, non-government agencies, professional/civil society and private sector. For healthy eating, Thailand has developed and promoted food-based dietary guidelines (FBDGs) for Thai people. Key actions related to reducing sugar consumption are, for example, establishing regulatory requirements on radio/television advertisements of unhealthy foods/snacks for children, front-of-pack labeling using GDA system, sugar tax on sweetened beverages, and provision of funds to support activities among youth groups and general public.

References

World Health Organization. Sugars intake for adults and children Guideline. Geneva: World Health Organization; 2015.

Sirichakwal PP, Sranacharoenpong K. Practical experience in development and promotion of food-based dietary guidelines in Thailand. Asia Pac J Clin Nutr. 2008; 17(S1):63-5.

Jouppila K. Mono- and disaccharides: selected physicochemical and functional aspect. In; Eliasson AC, editor. Carbohydrates in food. 3rd ed. Boca Raton: CRC Press; 2016; 98-135.

Lindhorst TK. Essentials of carbohydrate chemistry and biochemistry, 3rd ed. Weinheim: Wiley-VCH; 2007.

Mitchell H. Sweeteners and sugar alternatives in food technology. Oxford: Wiley-Blackwell Pub; 2006.

Varzakas T, Labropoulos A, Anestis S. Sweeteners: nutritional aspects, applications, and production technology. Boca Raton: CRC Press; 2012.

Serra-Majem L, Raposo A, Aranceta-Bartrina J, Varela-Moreiras G, Logue C, Laviada H, et al. Ibero⁻American Consensus on low- and no-calorie sweeteners: safety, nutritional aspects and benefits in food and beverages. Nutrients. 2018; 10(7):818-23.

Brien-Nabors LO. Alternative sweeteners. 4th ed. Boca Raton: CRC Press; 2012.

Food Chemical Codex (FCC), General Standard for Food Additives (GSFA); 2010.

สำนักอาหาร สำนักงานคณะกรรมการอาหารและยา. ข้อกำหนดในการใช้วัตถุเจือปนอาหารตามมาตรฐานทั่วไปสำหรับวัตถุเจือปนอาหารของโคเด็กซ์ (General Standard for Food Additives: GSFA 2014). นนทบุรี สำนักงานคณะกรรมการอาหารและยา; 2557.

United State Department of Agricultural. Sugar: World Markets and Trade Reports [internet]. Update 2019 Nov 21. [Cited 2018 Dec 18]. Available from https://www.fas.usda.gov/data/sugar-world-markets-and-trade

Neufeld EF, Ginsburg V. Complex carbohydrates. New York: Academic Press; 1966.

Cho S, Prosky L, Dreher ML. Complex carbohydrates in foods. New York: CRC Press; 1999.

Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: A systematic review and meta-analysis. Am J Public Health. 2007; 97(4):667-75.

Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: Systematic review and meta-analyses of randomized controlled trials and cohort studies. BMJ. 2013; 346:e7492.

Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006; 84(2):274-88.

Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes a meta-analysis. Diabetes Care. 2010; 33(11):2477-483.

World Health Organization. The World Oral Health Report 2003. Geneva: World Health Organization; 2003.

Marcenes W, Kassebaum NJ, Bernabe E, Flaxman A, Naghavi M, Lopez A, et al. Global burden of oral conditions in 1990–2010: a systematic analysis. J Dent Res. 2013; 92(7):592–97.

Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull. World Health Organ. 2005; 83(9):661–69.

World Health Organization. Diet, nutrition and the prevention of chronic diseases: report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series, No. 916. Geneva: World Health Organization; 2003.

Moynihan P, Petersen PE. Diet, nutrition and the prevention of dental diseases. Public Health Nutr. 2004; 7(1A):201–26.

Sheiham A, James WP. A new understanding of the relationship between sugars, dental caries and fluoride use: implications for limits on sugars consumption. Public Health Nutr. 2014; 17(10):2176-84.

Freeman CR, Zehra A, Ramirez V, Wiers CE, Volkow ND, Wang GJ. Impact of sugar on the body, brain, and behavior. Front Biosci. 2018; 23:2255-66.

Barnes JN, Joyner MJ. Sugar highs and lows: the impact of diet on cognitive function. J Physiol. 2012; 590(12):2831.

Ochoa M, Lalles JP, Malbert CH, Val-Laillet D. Dietary sugars: their detection by the gut-brain axis and their peripheral and central effects in health and diseases. Eur J Nutr. 2015; 54(1):1–24.

Page KA, Chan O, Arora J, Belfort-Deaguiar R, Dzuira J, Roehmholdt B, et al. Effects of fructose vs glucose on regional cerebral blood flow in brain regions involved with appetite and reward pathways. Jama. 2013; 309(1):63–70.

Luo S, Monterosso JR, Sarpelleh K, Page KA. Differential effects of fructose versus glucose on brain and appetitive responses to food cues and decisions for food rewards. PNAS. 2015; 112(20):6509–14.

Colantuoni C, Schwenker J, McCarthy J, Rada P, Ladenheim B, Cadet JL, et al. Excessive sugar intake alters binding to dopamine and mu-opioid receptors in the brain. Neuro report. 2001; 12(16):3549–52.

Rorabaugh JM, Stratford JM, Zahniser NR. Differences in bingeing behavior and cocaine reward following intermittent access to sucrose, glucose or fructose solutions. Neurosci. 2015; 301:213-20.

Tryon MS, Stanhope KL, Epel ES, Mason AE, Brown R, Medici V, et al. Excessive sugar consumption may be a difficult habit to break: a view from the brain and body. J Clin Endocrinol Metab. 2015; 100(6):2239-47.

Ochoa M, Malbert CH, Meurice P, Val-Laillet D. Effects of chronic consumption of sugar-enriched diets on brain metabolism and insulin sensitivity in adult yucatan minipigs. PLoS ONE. 2016; 11(9): e0161228.

Chan TF, Lin WT, Huang HL, Lee CY, Wu PW, Chiu YW, et al. Consumption of sugar-sweetened beverages is associated with components of the metabolic syndrome in adolescents. Nutrients. 2014; 6:2088-03.

Johnson RJ, Segal MS, Sautin Y, Nakagawa T, Feig DI, Kang DH, et al. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am J Clin Nutr. 2007; 86(4):899–906.

Sobrecases H, Lêa KA, Bortolotti M, Schneiter P, Ith M, Kreis R, et al. Effects of short-term overfeeding with fructose, fat and fructose plus fat on plasma and hepatic lipids in healthy men. Diabetes Metab Syndr. 2010; 36:244–46.

Nobili V, Mosca A, De Vito R, Raponi M, Scorletti E, Byrne CD. Liver zonation in children with non-alcoholic fatty liver disease: associations with dietary fructose and uric acid concentrations. Liver Int. 2018; 38(6):1102-09.

Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009; 119(5):1322–34.

Lírio LM, Forechi L, Zanardo TC, Batista HM, Meira EF, Nogueira BV, Mill JG, Baldo MPJ. Chronic fructose intake accelerates non-alcoholic fatty liver disease in the presence of essential hypertension. J Diabetes Complications. 2016; 30(1):85-92.

Jegatheesan P, De Bandt JP. Fructose and NAFLD: the multifaceted aspects of fructose metabolism. Nutrients. 2017; 9:3.

Nomura K, Yamanouchi T. The role of fructose-enriched diets in mechanisms of nonalcoholic fatty liver disease. J Nutr Biochem. 2012; 23:203–8.

Lírio LM, Forechi L, Zanardo TC, Batista HM, Meira EF, Nogueira BV, et al. Chronic fructose intake accelerates non-alcoholic fatty liver disease in the presence of essential hypertension. J Diabetes Complications. 2016; 30:85–92.

Lê KA, Ith M, Kreis R, Faeh D, Bortolotti M, Tran C, et al. Fructose overconsumption causes dyslipidemia and ectopic lipid deposition in healthy subjects with and without a family history of type 2 diabetes. Am J Clin Nutr. 2009; 89:1760–5.

Teff KL, Elliott SS, Tschop M, Kieffer TJ, Rader D, Heiman M, et al. Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases triglycerides in women. J Clin Endocrinol Metab. 2004; 89(6):2963–72.

Bantle JP. Dietary fructose and metabolic syndrome and diabetes. J Nutr. 2009; 139(6):1263S-8S.

Mai BH, Yan LJ. The negative and detrimental effects of high fructose on the liver, with special reference to metabolic disorders. Diabetes Metab Syndr Obes. 2019; 12:821–6.

Dornas WC, Lima WG, Pedrosa ML, Silva ME. Health implications of high-fructose intake and current research. Adv Nutr. 2015; 6(6):729–7.

Le MT, Frye RF, Rivard CJ, Cheng J, McFannd KK, Segal MS, et al. Effects of high-fructose corn syrup and sucrose on the pharmacokinetics of fructose and acute metabolic and hemodynamic responses in healthy subjects. Metab Clin Exp. 2012; 61(5):641–51.

American Diabetes Association. Diabetes Nutrition Principles and Recommendations in Diabetes. Diabetes Care. 2004; 27(suppl 1):s36.

สำนักนโยบายและยุทธศาสตร์ สำนักงานปลัดกระทรวงสาธารณสุข กระทรวงสาธารณสุข. แผนยุทธศาสตร์ชาติระยะ 20 ปี (ด้านสาธารณสุข) ธันวาคม 2559. [เข้าถึงได้เมื่อวันที่ 28 มีนาคม 2563]. เข้าถึงได้จาก: https://waa.inter.nstda.or.th/stks/pub/2017/20171117-MinistryofPublicHealth.pdf

กระทรวงสาธารณสุข. ประกาศกระทรวงสาธารณสุข ฉบับที่ 182 เรื่อง ฉลากโภชนาการ. พระราชบัญญัติอาหาร พ.ศ. 2522; 2558.

กระทรวงสาธารณสุข. ประกาศกระทรวงสาธารณสุข ฉบับที่ 373 เรื่อง การแสดงสัญลักษณ์โภชนาการบนฉลากอาหาร. พระราชบัญญัติอาหาร พ.ศ. 2522; 2558.

The World Health Organization Regional Office for the Eastern Mediterranean. New WHO policy aims to lower sugar intake to fight obesity and overweight in the Region [Internet]. [Cited 2018 Dec 18]. Available from: http://www.emro.who.int/media/news/who-policy-to-lower-sugar-intake.html

สำนักโภชนาการ กรมอนามัย กระทรวงสาธารณสุข. คุณค่าทางโภชนาการในผลไม้. พิมพ์ครั้งที่ 1 กรุงเทพฯ โรงพิมพ์ชุมนุมสหกรณ์การเกษตรแห่งประเทศไทย จำกัด; 2553.

Sugar: World Markets and Trade Reports. November 21, 2019. Global Agricultural Information Network; [Cited 2019 Dec 18]. Available from

https://www.fas.usda.gov/data/sugar-world-markets-and-trade

สำนักงานสถิติแห่งชาติ กระทรวงดิจิทัลเพื่อเศรษฐกิจและสังคม. รายงาน การสำรวจพฤติกรรมการบริโภคอาหารของประชากร พ.ศ. 2560. กรุงเทพฯ กองสถิติพยากรณ์; 2561.

WHO EMRO. New WHO policy aims to lower sugar intake to fight obesity and overweight in the Region. Updated 2016 Apr 5 [cited 2020 Mar 28]. Avialble from: http://www.emro.who.int/media/news/who-policy-to-lower-sugar-intake.html

กองยุทธศาสตร์และแผนงาน สำนักงานปลัดกระทรวงสาธารณสุข. ทิศทางการขับเคลื่อนการดำเนินงานตามนโยบายเร่งรัดกระทรวงสาธารณสุข ประจำปีงบประมาณพ.ศ.2563. [เข้าถึงเมื่อ 28 สิงหาคม 2562] เข้าถึงได้จาก: http://www.pyomoph.go.th/backoffice/files/3215.pdf.

Downloads

Published

2020-05-08

How to Cite

Chaiyakul, S. (2020). Sugar: Health Risks and Policy Actions for Healthier Consumption. Journal of Nutrition Association of Thailand, 55(1), 95–110. Retrieved from https://he01.tci-thaijo.org/index.php/JNAT/article/view/239842

Issue

Section

Academic article