According to a microsimulation study published in Circulation, removing 20% of sugar from packaged foods and 40% from beverages could prevent 2.48 million cardiovascular disease events (such as strokes, heart attacks, and cardiac arrests), 490,000 cardiovascular deaths, and 750,000 diabetes cases in the United States over the lifetime of the adult population.

A team of researchers from Massachusetts General Hospital (MGH), Tufts University’s Friedman School of Nutrition Science and Policy, Harvard T.H. Chan School of Public Health, and the New York City Department of Health and Mental Hygiene (NYC DOH) developed a model to simulate and quantify the health, economic, and equity consequences of a pragmatic sugar-reduction policy proposed by the United States National Salt Commission (NSSRI). The NSSRI is a collaboration of over 100 local, state, and national health organizations convened by the NYC Department of Health. In 2018, it presented draft sugar reduction targets for packaged foods and beverages in 15 categories. NSSRI finalized the strategy in February, with the purpose of industry voluntarily agreeing to gradually reformulate sugary products.

However, implementing a national policy will require government support to monitor companies’ progress toward targets and to report publicly on their progress. The researchers anticipate that this model will help to foster consensus over the US’s need for a national sugar reformulation policy. “We expect that this study will contribute to the advancement of the reformulation project over the next few years,” says main author Siyi Shangguan, MD, MPH, an attending physician at MGH. “Reducing the sugar content in commercially prepared foods and beverages will have a greater impact on Americans’ health than other sugar-cutting measures such as imposing a sugar tax, labeling added sugar content, or prohibiting sugary beverages in schools.”

According to the model, ten years after the NSSRI policy is implemented, the US may save $4.28 billion in overall net healthcare expenses and $118.04 billion over the lifetime of the present adult population (ages 35 to 79). When the social costs associated with lost productivity due to Americans suffering diseases as a result of excessive sugar consumption are included, the overall cost savings associated with the NSSRI policy reach $160.88 billion over the lifetime of the adult population. These benefits are almost certainly overstated, as the calculations were conservative. Additionally, the study indicated that even partial compliance by industry with the regulation might result in significant health and economic benefits.

The researchers discovered that after six years, the NSSRI strategy became cost-effective and cost-saving. Additionally, the policy has the potential to minimize disparities, with the highest predicted health advantages among Black and Hispanic individuals, as well as lower-income and less-educated Americans – populations that consume the most sugar historically as a result of inequitable institutions.

Other hazardous elements, such as trans fats and sodium, have been successfully reduced through product reformulation efforts. The United States, on the other hand, lags behind other countries in enacting robust sugar-reduction regulations, with the United Kingdom, Norway, and Singapore taking the lead on sugar-reformulation efforts. If the NSSRI’s recommended sugar-reduction targets are met, the US may potentially become a leader in safeguarding its citizens from the hazards of excessive sugar intake. “The NSSRI program is by far the most meticulously developed and comprehensive sugar reform initiative in the world,” Shangguan explains.

Consumption of sugary foods and beverages is highly associated with obesity and diseases such as type 2 diabetes and heart disease, the leading cause of death in the United States. Over two-thirds of American adults are obese, one-in-two have diabetes or prediabetes, and nearly one-in-two have cardiovascular disease, with lower-income groups bearing the brunt of the burden disproportionately.

“Sugar is one of the most obvious food additives to reduce to safe levels,” says Dariush Mozaffarian, MD, DrPH, co-senior author and dean of Tufts University’s Friedman School of Nutrition Science and Policy. “Our findings indicate that it is past time for a nationwide program with voluntary sugar reduction targets, which might result in significant gains in health, health inequities, and healthcare spending in less than a decade.”

The National Institutes of Health contributed significant support for this work.

Shangguan is an attending physician at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. Mozaffarian is the dean of Tufts University’s Friedman School of Nutrition Science and Policy. Thomas Gaziano, MD, MSc, is an assistant professor of medicine at Harvard Medical School and an associate professor of medicine at Brigham and Women’s Hospital. Renata Micha, PhD, is an associate professor of research at Tufts University’s Friedman School of Nutrition Science and Policy and an associate professor at Greece’s University of Thessaly.


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Materials provided by Massachusetts General Hospital


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