The study, published in the open-access journal BMC Public Health, used public health records from countries across the world to compare dental health and diet over time across large populations.
The researchers found that the incidence of tooth decay increased dramatically with any sugar consumption above 0% of energy. Even in children, an increase from near-zero sugar to 5% of energy intake doubles the prevalence of decay and continues to rise as sugar intake increases.
Free sugars are monosaccharides and disaccharides added to foods and those naturally present in fruit, honey and syrups. According to current guidelines from the World Health Organisation, the maximum total energy intake from free sugars should be 10%, with 5% as a ‘target’. However, this latest research suggests that 5% should be the absolute maximum, with a target of less than 3%.
Co-author Professor Philip James, Honorary Professor of Nutrition at the London School of Hygiene & Tropical Medicine and past President of the World Obesity Federation, said: “Our top priority is not to allow the idea of a magic single bullet to solve the problem to be developed. A fundamental aspect of public health planning is to develop society wide measures which impact on the health of the whole community. There now needs to be an explicit revision of population dietary goals as it relates to every aspect of government policy.”
Tooth decay is the most common non-communicable disease in the world, affecting 60-90% of school-age children and the vast majority of adults. In the USA, 92% of adults aged 20-64 have experienced decay in at least one of their permanent teeth.
In order to address the issue of tooth decay, Professor Philip James recommends a series of radical policy changes to reduce sugar consumption. These include:
The use of fruit juices and the concept of sugar-containing treats for children no longer being promoted.
Food provided at nurseries and schools having a maximum of free sugars amounting to no more than 2.5% of energy.
The removal of vending machines offering confectionary and sugary drinks in areas controlled or supported financially by local or central government.
The food industry being told that they should progressively reformulate their products to reduce or preferably remove all the sugars.
New food labels labelling anything above 2.5% sugars as ‘high’.
Phasing out sugar beet production in the EU, and curtailing sugar production in the US.
A sugars tax to increase the cost of sugar-rich food and drinks.
Aubrey Sheiham and Philip T James. A reappraisal of the quantitative relationship between sugar intake and dental caries: the need for new criteria for developing goals for sugar intake. BMC Public Health 2014, 14:863.
London School of Hygiene & Tropical Medicine