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Revealing the added sugars in packaged foods and beverages would prevent nearly a million cases of type 2 diabetes and cardiovascular disease in the United States and save about $ 62 billion in social costs, according to a new report. study.
"What was quite striking is that when we combine these facts with a possible formulation of the sector to reduce the added sugar content in packaged foods and beverages, the health gains and cost savings would be twice as important, "said author, Renata Micha, PhD, Friedman. School of Nutrition Science and Policy at Tufts University, Boston, stated theheart.org | Medscape Cardiology.
The US Food and Drug Administration (FDA) required labeling of added sugar content in 2016, but in response to industry concerns, late compliance from July 2018 to January 2020 for major manufacturers and until January 2021 for small manufacturers making annual sales of less than $ 10 million. .
"This is a very important study, especially for policy makers, because it shows that a strategy as simple as labeling the added sugars can have a significant impact not only on health outcomes, but also save a lot of money for the health system and the economy in general ", Frank Hu, MD, PhD, director of the Department of Nutrition, Harvard TH School of Public Health Chan, Boston, said in an interview.
"So I think that puts the current delay in the establishment of food labels in a more urgent situation because it has negative effects not only on the products, the food industry, but also on the consumers ", did he declare.
The study is published online on April 15 in circulation and is the first to assess the health impacts and costs of the FDA's added sugar labeling policy.
Modeling in microsimulation
The researchers used a previously validated microsimulation model and created a nationally representative population of adults aged 30 to 84, using demographic and food data from national health and nutrition surveys (NHANES). ) and disease data from the Centers for Disease Control and Prevention Wonder Database. The policy effects were calculated based on recent meta-analyzes and a regulatory impact analysis by the FDA, assuming that the changes to the labeling result in only a limited amount of money. 39, a modest effect on the reduction of calorie intake by 6.8%.
The median added sugar intake of packaged products was 37.3 g / day (mean, 60.6 g / day) at baseline. Between 2018 and 2037, the median sugar intake is expected to decrease by 5.8 g / day without further intervention and by an additional 2.1 g / day with sugar labeling or 4.8 g / day with labeling plus reformulation. product.
Over the 20-year period, researchers estimated that "added sugar" would prevent or delay 354,400 new cases of heart disease and stroke – including 27,830 deaths from cardiovascular disease (CVD) – and 599,300 cases type 2 diabetes, including 16,700 with type 2 diabetes.
This would result in a gain of 727,000 quality-adjusted life years (QALYs) and save $ 31 billion in net health care costs and $ 61.9 billion in societal costs, given the loss of productivity and the costs of informal care.
The addition of the industry's reformulation to the scenario would prevent 708,800 cases of CVD (50,100 deaths), 1.18 million cases of type 2 diabetes (31,540 diabetes deaths) type 2), for an overall gain of 1.3 million QALYs.
This would result in a net savings of $ 57.6 billion in health care costs – nearly 60% due to reduced diabetes costs – and $ 113.2 billion in societal costs .
In both scenarios, health gains were higher for men than for women and for younger adults, aged 30 to 49, reflecting their higher added sugar intake, particularly sugary drinks, note the authors.
"The overall results are not surprising and provide most of the evidence needed to support the change in practice and help US decision makers prioritize options for improving their diet and their health," Micha said.
However, the model may underestimate the overall health and economic impacts because it uses conservative assumptions about potential industry reformulations and the reduction of sugar may have additional benefits over others. health outcomes, such as obesity and tooth decay, "she said.
Labeling vs. taxation
"I am a primary care physician, so I have seen the devastating impact of sugary drinks and the devastating cost of diabetes and heart disease for families, individuals and productivity," said the door. – Spole of the American Heart Association (AHA), Mary Ann Bauman. , MD, said in an interview.
"I agree with the authors that these numbers and benefits can be underestimated," she said. "I was not surprised, I was really happy that someone would put the numbers in dollars."
Food recommendations emphasize the need to reduce sugar intake to less than 10% of total energy, but Americans currently consume more than 15%, with sweetened beverages being the main culprit.
"I think it will give us a way of pressure," said Bauman. "Businesses are generally reluctant to change the way they work, but if we release the information now to the public and can see how it can make a difference, it will speed up reformulation and change the way it works. labeling. "
Additional analyzes suggest that the sugar labeling and reformulation scenarios as well as reformulation would have a probability of more than 80% to be profitable within 4 years and realize cost savings of up to 4%. here 2023, according to the study conducted as part of the project Food- Price Project.
Although the model assumes that the FDA's added sugar labeling policy will prompt Americans to change their sugar consumption behaviors, the biggest benefit could come from reformulating the industry, Hu observed. .
"After the labeling of trans fatty acids, the food industry has gradually eliminated the majority of these," he said. "And even though the changes will not be as dramatic for the added sugar, there are already examples of cases where the food industry has voluntarily reduced the amount of added sugar in its products because of policies such as taxes on sugar and packaging labeling, these types of changes will be much larger and far more important than individual behavioral changes based on information on food labels. "
Hu and Bauman note that efforts to reduce excess sugar exposure with taxes on sodas have met with stiff resistance from the Chicago and Washington State industries. However, the federal government's food labeling changes are more difficult to turn into weapons, especially when accompanied by public health awareness campaigns.
"I think the public health community should take this opportunity to launch public health campaigns on how to use the changes in food labeling and how this information can be translated." in consumer approaches in terms of behaviors and patterns of consumption, "said Hu. "I think this is in itself an excellent opportunity to raise awareness about sugar and the health risks associated with over-consumption."
Bauman commented: "I would really like to continue to focus on the link between sugary drinks, type 2 diabetes and heart disease, because we know that if a man drinks a sweet drink a day, it increases the risk of heart attack or death from heart disease by 20% We know that children who drink more sugary drinks than their peers have an increased risk of diabetes and develop risk factors for heart disease. "
She noted that Americans consume an average of 10 teaspoons of sugar from sugary drinks each day. "There is a lot of room to make the change."
All authors report support from National Institutes of Health grants when conducting the study. In addition, Micha reports Unilever research funds and personal expenses from the World Bank and Bunge. Hu and Bauman do not report any relevant conflict of interest.
circulation. Posted online 15 April 2019. Summary
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