How strong is the evidence behind WHO’s sugars advice?

By Joyeeta Basu

- Last updated on GMT

The WHO says its recommendations were based on "systematic reviews of the latest available scientific evidence"
The WHO says its recommendations were based on "systematic reviews of the latest available scientific evidence"

Related tags: Nutrition, Sugar

The food industry has criticised the WHO’s recommendation to reduce the intake of added sugar for being backed by ‘moderate’ and ‘very low quality’ evidence.

But the World Health Organisation (WHO) said that its experts had considered various factors while determining the strength of the recommendations.

In a statement to FoodNavigator it said experts had studied not only the “overall quality of evidence​…but also the desirable and undesirable effects of the recommendations…and the feasibility and cost of options available to public health authorities in implementing the recommendations in different settings.​”

The new guideline from WHO last week strongly recommended adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. In a conditional recommendation it said a further reduction to below 5% per day “would provide additional health benefits​”, calling on governments to make policy changes to support its recommendations.

But the sugar industry felt the evidence backing the recommendations was not strong enough and slammed it for being “misleading​” and backed by “low evidence​”.

According to the WHO: “A strong recommendation is one where the desirable effects of adhering to the recommendation outweigh the undesirable effects. A conditional recommendation is one where the desirable effects of adhering to the recommendation probably outweigh the undesirable effects but these trade-offs were not clear.”

It urges governments to adopt its strong recommendations but suggests further discussion at a national level to decide whether its conditional recommendations should form part of public policy.

WHO said the recommendations were developed based on “systematic reviews of the latest available scientific evidence​”. It said its recommendation is based on systematic reviews of a large number of studies in adults and children and meta-analyses that include over 1300 adults and 10000 children for obesity and almost 3000 for dental caries.

The evidence base for each recommendation is clearly noted in the Guideline,​” it said.

Cutting sugar is key for health

Gaël Bassetto, communication officer at International Diabetes Federation European Region said cutting excessive sugar intake was key to tackling diabetes and other non-communicable diseases. “We hope that these guidelines will push the industry to cut down on the sugar in their products and will encourage governments to take bolder measure to tackle obesity and overweight and reduce the burden of non-communicable diseases.​”

WHO has now proposed to review the guideline in five years to evaluate any new, updated scientific and medical knowledge in the related areas.

Industry welcomes debate

European Committee of Sugar Manufacturers senior adviser, scientific and regulatory affairs, Emilie Majster said, “We are glad that WHO has called for a debate and discussion before the recommendations are turned into policy. Keeping added sugars to 5% of daily calories is unrealistic​.”

The final guideline was prepared taking into account comments received from the public consultation and expert peer review.

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