Impact of Measures Aiming to Reduce Sugars Intake in the General Population and Their Implementation in Europe: A Scoping Review

Objectives: Implementing public health measures is necessary to decrease sugars intake, which is associated with increased risk of noncommunicable diseases. Our scoping review aimed to identify the types of measures implemented and evaluated to decrease sugars intake in the population and to assess their impact.Methods: Following a review of systematic reviews (SRs) published in 2018, we systematically searched new SR (May 2017–October 2020) in electronic databases. We also searched the measures implemented in Europe in the NOURISHING database. Two researchers selected the reviews, extracted and analysed the data.Results: We included 15 SRs assessing economic tools (n = 5), product reformulation and labels/claims (n = 5), and educational/environmental interventions (n = 7). Economic tools, product reformulation and environmental measures were effective to reduce sugar intake or weight outcomes, while labels, education and interventions combining educational and environmental measures found mixed effects. The most frequently implemented measures in Europe were public awareness, nutritional education, and labels.Conclusion: Among measures to reduce sugar intake in the population, economic tools, product reformulation, and environmental interventions were the most effective, but not the more frequently implemented in Europe.

Assessment and Evaluation of the Intake of Sugars in European Countries

The intake of sugars is a trending topic in nutrition and health. For an evaluation of the sugar intake (comparison with existing guidelines), up-to-date information on the guidelines, dietary intake and trends in the intake is needed. The available information for European countries is presented in this review. The existing guidelines on the intake show that there is currently no consensus among the experts from different organizations. The differences are mainly due to the selection of the adverse health outcomes for which there is sufficient evidence. Data from national European surveys show that the mean proportion of energy coming from added sugars for most European population groups is below 10%, and that the trend in the intake seems to be downwards. There are, however, many serious uncertainties and assumptions needed for the assessment of the intake of sugars. For instance, the assessment reflects a short period of the lives of the respondents, the data collection in several surveys was conducted more than 10 years ago, and recent reformulations of the industry are not considered in the food composition tables. Due to the uncertainties regarding the assessment of the sugar intake in Europe, the information should be used prudently and with care.

Ultra-processed food consumption in adults across Europe

Purpose The purpose of this study is to describe ultra-processed food and drinks (UPFDs) consumption, and associations with intake of total sugar and dietary fibre, and high BMI in adults across Europe. Methods Using food consumption data collected by food records or 24-h dietary recalls available from the European Food Safety Authority (EFSA) Comprehensive European Food Consumption Database, the foods consumed were classified by the level of processing using the NOVA classification. Diet quality was assessed by data linkage to the Dutch food composition tables (NEVO) and years lived with disability for high BMI from the Global Burden of Disease Study 2019. Bivariate groupings were carried out to explore associations of UPFDs consumption with population intake of sugar and dietary fibre, and BMI burden, visualised by scatterplots. Results The energy share from UPFDs varied markedly across the 22 European countries included, ranging from 14 to 44%, being the lowest in Italy and Romania, while the highest in the UK and Sweden. An overall modest decrease (2–15%) in UPFDs consumption is observed over time, except for Finland, Spain and the UK reporting increases (3–9%). Fine bakery wares and soft drinks were most frequently ranked as the main contributor. Countries with a higher sugar intake reported also a higher energy share from UPFDs, as most clearly observed for UPF (r = 0.57, p value = 0.032 for men; and r = 0.53, p value = 0.061 for women). No associations with fibre intake or high BMI were observed. Conclusion Population-level UPFDs consumption substantially varied across Europe, although main contributors are similar. UPFDs consumption was not observed to be associated with country-level burden of high BMI, despite being related to a higher total sugar intake.

Association between added sugar intake and overall diet quality in the Finnish adult population

Added sugar intake has been associated with several health issues, but few studies have examined its association with overall diet quality. We aimed at examining the association between added sugar intake and overall diet quality in Finnish adults. Associations between added sugar intake and sociodemographic factors, lifestyle factors, and BMI were also explored. Our data comprised 5094 adults residing in Finland who participated in the National FinHealth 2017 Study. Dietary intake was assessed by a validated food frequency questionnaire. Food consumption and nutrient intakes were calculated using the Finnish national food composition database. Added sugar intake was estimated based on food categorization and identifying naturally occurring sugar sources. Overall diet quality was assessed by the modified Baltic Sea Diet Score. The average added sugar intake was 7.6E% in women and 8.3E% in men in this study population. Added sugar intake was inversely associated with education (P=0.03 women; P=0.001 men), physical activity (P<0.0001), and BMI in men (P=0.003), and directly with smoking (P=0.002 women; P<0.0001 men). Added sugar intake was inversely associated with overall diet quality in both sexes (P<0.0001). No interactions were found except for men’s physical activity subgroups, the inverse association being stronger among active men than moderately active or inactive men (P for interaction=0.005). Our findings suggest that high added sugar intake is associated with several unhealthy dietary and lifestyle habits, including poor-quality diets, smoking, and leisure-time inactivity in Finnish adults. Efforts to improve diet quality should consider added sugar intake equally in the whole population.

Sugar Content of Market Beverages and Children’s Sugar Intake from Beverages in Beijing, China

(1) Background: This study aims to find the sugar content of market beverages and estimate the sugar intake from beverages among students in Beijing. (2) Methods: Using snapshotting, we collected the sugar content of beverages through their packages or nutrition labels. Combined with the statistic of student beverage consumption, we estimated students’ sugar intake. (3) Results: The median sugar content of total beverages was 9.0 g/100 mL, among which the fruits/vegetable juices and beverages had the highest sugar content (10.0 g/100 mL). Sugar content in most beverages in Beijing was generally higher than the recommendations, and fruit/vegetable juices and beverages exceeded the most. The median of sugar intake from beverages among students was 5.3 g/d, and the main sources were fruit/vegetable juices and beverages, protein beverages and carbonated beverages. Sugar intake from beverages differed according to gender, age and living area. Higher sugar intake was found among boys, older students and rural students. (4) Conclusions: Sugar content in market beverages in Beijing were high. Gender, age and residence were the influencing factors of sugar intake. Targeted measures should be taken to decrease the sugar content in beverages, especially the fruit/vegetable juices and beverages and the sugar intake among students.

Sugar Intake and Cancer: A Literature Review

ABSTRACTBackground: Cancer is the second leading cause of death after heart disease globally (total death 9.6 million). Cancer prevalence is increasing in Indonesia from 1.4 per 1000 people in 2013 to 1.79 per 1000 people in 2018. Diet is linked with cancer prognosis, particularly carbohydrate intake which stimulates insulin signals that can be potent mitogens.Purpose: This literature review aims to examine sugar intake and cancer incidence.Method: This literature review (traditional review) using the keywords “cancer”,” sugar”, “carbohydrate”, “insulin” and “hyperinsulinemia” in the Sciencedirect database and Google search engine. The inclusion criteria were peer-review articles or documents from credible national and international institutions, the literature uses English or Bahasa (Indonesian Language). The exclusion criteria were that the literature had similar content or redundant with other literature.Result: Sugar increases insulin resistance which enhances the levels of bioactive IGF-I that contribute to raising the risk of cancer. Prolonged hyperinsulinemia reduces the production of growth-promoting factors such as IGFBP-1 and IGFBP-2 which normally bind to and inhibit the action of IGF-I with resultant increases in the levels of free, bio-active IGF-I, and concomitant changes in the cellular environment that favor cancer development, proliferation, and metastatic cancer cells.Conclusion: The mechanism of insulin and IGF-1 stimulate and accelerate cancer cell proliferation may explain the relationship between sugar intake and cancer incidence. Adopting a balanced diet, changing or decreasing sugar intake with healthier food coupled with increased physical activity reduces the risk of cancer.