PUBLIC HEALTH
SUGAR AND SALT UPDATE Carrie Ruxton PhD, Freelance Dietitian, Cupar, Scotland
Dr Carrie Ruxton is a freelance dietitian who writes regularly for academic and media publications. A contributor to TV and radio, Carrie works on a wide range of projects relating to product development, claims, PR and research. Her specialist areas are child nutrition, obesity and functional foods.
For full article references please email info@ networkhealth group.co.uk
Since dietary guidelines were first published in the UK, there has been a drive to reduce levels of sugar and salt in foods and beverages. Now, a levy will be introduced from April 2018, applying for the first time a direct tax on the sugar content of soft drinks. This article provides an update on recent activities to lower the sugar and salt content of our diet. Until recently, government action has involved direct messaging to consumers, as well as voluntary targets for industry reformulation, mainly directed at salt. Controls on advertising of so-called ‘high fat salt and sugar’ (HFSS) foods to children have also been implemented. In 2015, the Scientific Advisory Committee on Nutrition (SACN)1 set a new target for free sugars of 5% of daily energy; the previous target being 10% energy. Free sugars include all mono- and disaccharides added during processing or cooking, plus those sugars naturally present in honey and fruit juices. Current intakes are far higher than this at around 11% energy in adults and 13-15% energy in children. Maximum recommended salt levels have not changed since 1994 and are 6g per day for adults, with lower amounts advised for children.2 Current intakes in adults are estimated to be around 8g per day,3 but have reduced by 15% in recent years in part due to reformulation. Table 1 presents current recommendations for salt and free sugars. JUSTIFICATION
The 2015 SACN report1 set out the evidence for supporting a sugars reduction, including links between higher intakes of added/free sugars and a greater risk of dental caries in children, as well as higher energy intakes in adults. Consumption of sugar-sweetened soft drinks was associated with dietary energy, body mass index, risk of weight gain and risk 8
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of Type 2 diabetes. SACN estimated that lowering free sugars to 5% energy would reduce daily energy intake by around 100kcal. The main justification for salt reduction is to prevent cardiovascular mortality and morbidity. In 2003, a report by SACN4 highlighted strong associations between high salt intake and high blood pressure, concluding that a reduction in the average salt intake of the population, from 9.5g to 6g daily would lower blood pressure levels and confer significant public health benefits by reducing the risk of cardiovascular disease. HISTORIC ACTION AND PROGRESS
Action to lower sugar consumption has mainly been targeted via dietary advice (e.g. dietary reference values, Eatwell Plate/Guide), a ban on advertising HFSS foods and drinks during children’s TV programming, and a push for manufacturers to adopt front-ofpack (FOP) labelling which displays the macronutrient content in a standardised colour-coded format. Although progress has been slow, there is a trend towards reduced sugar intakes over the past few decades. For example, in the 2000 National Diet and Nutrition Survey (NDNS), the mean percentage energy from non-milk extrinsic sugars was 13.6% in men and 11.9% in women.5 In the most recent NDNS,6 intakes were 12% in men and 11.3% in women. Children’s intakes have also reduced from around 17% in