Advocating for Reduced Sugar Consumption to Reduce the Prevalence of Non-communicable Diseases

Over the recent decades, non-communicable diseases (NCDs) have emerged as the leading killer worldwide. The recent estimates released by the World Health Organization suggested that on an annual basis close to 40 million people succumb to the NCDs and their associated complications. The World Health Organization (WHO), strongly advocates that all adults and children should reduce their daily intake of free sugars to less than 10% of their total energy intake. As heterogeneous settings are prevalent across the world, the primary challenge is to combine these recommendations with the existing nutrient guidelines and dietary goals, in such a manner that these healthy practices percolate till the remote sections of community. In conclusion, it is the need of the hour to not only seriously consider but even incorporate the recommendations of the World Health Organization in policies so that the future epidemic of non-communicable diseases can be prevented.


Introduction
Over the recent decades, non-communicable diseases (NCDs) have emerged as the leading killer worldwide [1]. These NCDs have been broadly categorized into four main conditions, namely diabetes mellitus, cardiovascular diseases (like myocardial infarctions and stroke), malignancies, chronic respiratory diseases (like bronchial asthma, etc.) [1]. The recent estimates released by the World Health Organization suggested that on an annual basis close to 40 million people succumb to the NCDs and their associated complications [1]. Of these deaths, almost three-fourth of these fatalities (28 million) was reported in low and middle income nations alone, and this estimate actually came as a shock to the policy makers [1,2]. On further stratification, the cardiovascular diseases emerged as leading cause for deaths (17.5 million), followed by malignancy, respiratory diseases, and diabetes mellitus [1,2].

Scope of Lifestyle Modifications
Although, the trend of the non-communicable disease is indirectly dependant on parameters like ageing and unplanned urbanization, nevertheless, the role played by adoption of unhealthy lifestyles by individuals cannot be ignored [2]. In-fact, a major proportion of the premature fatalities attributed to NCDs can be prevented (or significantly delayed) by adhering to lifestyle modifications like consumption of a healthy and balanced diet, involvement in regular physical activity (viz. walking, running, cycling, aerobic exercise, swimming, etc.), periodic health checkup, not consuming tobacco or alcohol, etc. [1,2]. However, at the same time, the need of a timely and effective response from the program managers / health professionals is also indispensable [1,2]. Furthermore, various international agencies, medical practitioners, researchers, other stakeholders have repeatedly emphasized that by consuming a healthy diet over a period of time, not only various forms of malnutrition, but even origin or progression of various forms of NCDs can be prevented [1,3].

Recommendations Pertaining to Sugars' Consumption
The most recent guideline pertaining to sugars' consumption has been released by the World Health Organization (WHO), and it strongly advocates that all adults and children should reduce their daily intake of free sugars to less than 10% of their total energy intake [4,5]. Free sugar generally comprises of monosaccharides (like glucose or fructose)/ disaccharides (like sucrose) added to foods and drinks, and natural sugar present in honey, fruit juices, etc [4]. However, free sugar does not include that sugar which is naturally present in fruits or vegetables or even milk [5]. In-fact, even the Global Action Plan for NCDs 2013-2020, which targets to achieve 25% decrease in the burden of premature deaths by the year 2025, has advocated for adhering to these guidelines worldwide [2].
In order to effectively respond to the ever-rising load of NCDs and to maximize the benefit of these revised guidelines on sugars' intake, the World Health Organization, is working in close approximation with different policy makers of various nations to ensure that these sugar guidelines are incorporated in the national policies of various nations at the earliest [5]. The appeal of the WHO is not without any scientific evidence, and in-fact, findings from different systematic review and meta-analysis has clearly indicated (and even supported) that intake of free sugars (to less than 10%) can remarkably minimize the potential risk of overweight, obesity and even dental decay [4,6,7].

Recommendations
As heterogeneous settings are prevalent across the world (viz. rural or urban settings or preference to food items based on the age-groups), the primary challenge is to combine these recommendations with the existing nutrient guidelines and dietary goals, in such a manner that these healthy practices percolate till the remote sections of community [2,4,5]. In-fact, the scientific community has come with scientific and practical suggestions to ensure consumption of a healthy diet (with regard to each element of a healthy diet -sugars, fruits, vegetables, fats, salt) for both adults and children [3].
Furthermore, a wide gamut of interventions such as ensuring restriction in consumption of those foods and drinks which are rich in sugars (by increasing their price); developing the practice of eating fresh fruits/raw vegetables as snacks; encouraging demand of consumers for healthy foods; strengthening primary health care (viz. arrangement for dietary counseling); ensuring coordination between trade, food and agricultural policies; mandatory labeling of food products especially referring to nutrient constituents; instructing food manufacturers to reduce the amount of free sugars in processed foods; building standards to promote healthy, safe and affordable food in government institutions like schools; providing incentives to those who engage themselves in growing/using/selling fresh fruits and vegetables; and providing subsidies to encourage food manufacturers to produce healthy food; have been either proposed or practiced [2][3][4][5]7].

Conclusion
In conclusion, it is the need of the hour to not only seriously consider but even incorporate the recommendations of the World Health Organization in policies so that the future epidemic of noncommunicable diseases can be prevented.