In the JournalsPerspective

Adding sugar content to food labels may reduce CVD, diabetes by 2037

The timely implementation of an FDA policy to update food and beverage labels to include information on added sugar content has the potential to significantly reduce CVD and diabetes in the U.S. from 2018 to 2037, according to a study published in Circulation.

In 2016, the FDA implemented an update to food and beverage labels to include information on added sugar content, according to the study.

“The purpose of our study was to estimate the impact of the FDA’s added sugars label on reducing sugar intake and preventing diabetes and cardiovascular disease,” Renata Micha, RD, PhD, associate research professor at Tufts University Friedman School of Nutrition Science and Policy in Boston, said in a press release. “Our results indicate that timely implementation of the added sugars label could reduce consumption of foods and beverages with added sugars, which could then lead to an improvement in health and a reduction in health care spending.”

Prediction models

Yue Huang, MS, research scholar at Tufts University Friedman School of Nutrition Science and Policy at the time of the study and is now a research associate with the Massachusetts Health Policy Commission, and colleagues used the U.S. IMPACT Food Policy Model to estimate the cost-effectiveness of this policy, in addition to the number of type 2 diabetes and CVD cases that were prevented, policy costs, quality-adjusted life-years, informal care, health care and lost productivity savings.

Two scenarios were modeled in the study: updates to food and beverage labels according to the FDA policy without a change in industry formulations (sugar label) and updates to the labels with industry reformulation (sugar label with reformulation).

The timely implementation of an FDA policy to update food and beverage labels to include information on added sugar content has the potential to significantly reduce CVD and diabetes in the U.S. from 2018 to 2037, according to a study published in Circulation.
Source: Adobe Stock

Information from National Health and Nutrition Examination Survey 2011-2014 was used to generate a synthetic population representative of U.S. patients aged 30 to 84 years. Data assessed included BMI, demographic information and added sugar intakes.

From 2018 to 2037, researchers predicted that the sugar label scenario would either prevent or postpone 599,300 new cases of type 2 diabetes (95% uncertainty interval, 302,400-957,400) and 354,400 new cases of CVD (95% uncertainty interval, 167,000-673,500). This would contribute to a gain of 727,000 QALYs (95% uncertainty interval, 401,300-1,138,000).

When industry reformulation was added to the scenario, 708,800 cases of CVD (95% uncertainty interval, 369,200-1,252,000) and 1,184,000 cases of type 2 diabetes (95% uncertainty interval, 666,000-1,703,000) would be prevented, with an overall gain of 1.3 million QALYs (95% uncertainty interval, 0.8-1.9).

Savings over time

The sugar label scenario would save $61.9 billion in societal costs (95% uncertainty interval, 33.1-103.2) and $31 billion in net health care costs (95% uncertainty interval, 15.7-54.5). In contrast, the sugar label and reformulation scenario would lead to savings of $113.2 billion in societal costs (95% uncertainty interval, 67.3-175.2) and $57.6 billion in net health care costs (95% CI uncertainty interval, 31.9-92.4).

Both scenarios have a greater than 80% probability of being cost-effective by 2022 and cost-saving by 2023.

“Our findings support more proximal implementation of the FDA’s policy, considering the opportunity costs in preventable cardiometabolic events not prevented,” Huang and colleagues wrote. “In addition, we demonstrate that the health care and societal savings as a result of the added sugar label significantly outweigh policy costs, even when an estimated $2.5 billion of industry reformulation costs were considered.” – by Darlene Dobkowski

Disclosures: Micha reports she received research funding from Unilever and personal fees from Bunge and the World Bank. Huang reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

The timely implementation of an FDA policy to update food and beverage labels to include information on added sugar content has the potential to significantly reduce CVD and diabetes in the U.S. from 2018 to 2037, according to a study published in Circulation.

In 2016, the FDA implemented an update to food and beverage labels to include information on added sugar content, according to the study.

“The purpose of our study was to estimate the impact of the FDA’s added sugars label on reducing sugar intake and preventing diabetes and cardiovascular disease,” Renata Micha, RD, PhD, associate research professor at Tufts University Friedman School of Nutrition Science and Policy in Boston, said in a press release. “Our results indicate that timely implementation of the added sugars label could reduce consumption of foods and beverages with added sugars, which could then lead to an improvement in health and a reduction in health care spending.”

Prediction models

Yue Huang, MS, research scholar at Tufts University Friedman School of Nutrition Science and Policy at the time of the study and is now a research associate with the Massachusetts Health Policy Commission, and colleagues used the U.S. IMPACT Food Policy Model to estimate the cost-effectiveness of this policy, in addition to the number of type 2 diabetes and CVD cases that were prevented, policy costs, quality-adjusted life-years, informal care, health care and lost productivity savings.

Two scenarios were modeled in the study: updates to food and beverage labels according to the FDA policy without a change in industry formulations (sugar label) and updates to the labels with industry reformulation (sugar label with reformulation).

The timely implementation of an FDA policy to update food and beverage labels to include information on added sugar content has the potential to significantly reduce CVD and diabetes in the U.S. from 2018 to 2037, according to a study published in Circulation.
Source: Adobe Stock

Information from National Health and Nutrition Examination Survey 2011-2014 was used to generate a synthetic population representative of U.S. patients aged 30 to 84 years. Data assessed included BMI, demographic information and added sugar intakes.

From 2018 to 2037, researchers predicted that the sugar label scenario would either prevent or postpone 599,300 new cases of type 2 diabetes (95% uncertainty interval, 302,400-957,400) and 354,400 new cases of CVD (95% uncertainty interval, 167,000-673,500). This would contribute to a gain of 727,000 QALYs (95% uncertainty interval, 401,300-1,138,000).

When industry reformulation was added to the scenario, 708,800 cases of CVD (95% uncertainty interval, 369,200-1,252,000) and 1,184,000 cases of type 2 diabetes (95% uncertainty interval, 666,000-1,703,000) would be prevented, with an overall gain of 1.3 million QALYs (95% uncertainty interval, 0.8-1.9).

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Savings over time

The sugar label scenario would save $61.9 billion in societal costs (95% uncertainty interval, 33.1-103.2) and $31 billion in net health care costs (95% uncertainty interval, 15.7-54.5). In contrast, the sugar label and reformulation scenario would lead to savings of $113.2 billion in societal costs (95% uncertainty interval, 67.3-175.2) and $57.6 billion in net health care costs (95% CI uncertainty interval, 31.9-92.4).

Both scenarios have a greater than 80% probability of being cost-effective by 2022 and cost-saving by 2023.

“Our findings support more proximal implementation of the FDA’s policy, considering the opportunity costs in preventable cardiometabolic events not prevented,” Huang and colleagues wrote. “In addition, we demonstrate that the health care and societal savings as a result of the added sugar label significantly outweigh policy costs, even when an estimated $2.5 billion of industry reformulation costs were considered.” – by Darlene Dobkowski

Disclosures: Micha reports she received research funding from Unilever and personal fees from Bunge and the World Bank. Huang reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

    Perspective
    Kim Allan Williams Sr.

    Kim Allan Williams Sr.

    The authors wrote that “Implementation of the FDA’s added sugar labeling policy may lead to cost savings and substantial health gains for patients in the U.S.,” but note the emphasis on the “may.”

    This study models the public’s response and an industry response reducing sugar intake by about 8% with a very large impact on health and costs. However, there are no prospective data to support the 8%, so this is hypothesis-generating.

    This simulation study should be promoted to all patients to resonate with their concern for their own health and the health of our Medicare system. We need the help of everyone to invest in lowering the burden of health care costs that are preventing our country from rebuilding infrastructure and educating our youth.

    An 8% decrease in sugar intake would allow government funds to be redirected toward free college tuition for every student from a household falling below the median U.S. income.

    It does not stop with sugar. People should recognize that sugar, refined carbohydrates, sodium, saturated fat, trans fats and cholesterol all should be reduced, minimized, avoided or eliminated from the diet in the U.S. and around the world.

    This would reduce unnecessary costs, morbidity and mortality. Recommendations like this are politically charged.

    We have AMA policy and American College of Cardiology/American Heart Association 2019 Prevention Guidelines that support reducing sugar intake, but they are largely ignored by hospitals, medical societies, schools, restaurants and legislatures. 

    We legislate seatbelt use and hands-free driving.

    These have far less impact than nutrition interventions such as the one modeled here, yet, we allow the health of our U.S. population and our health care financing to be subservient to corporate profits.

    The response to the sugar-sweetened beverage tax in Chicago recently, strongly opposed by the beverage industry association and quickly overturned, is a good example of how little we value preventive health in the U.S. 

    When will we stop mopping up the floor and start turning off the faucets?

    • Kim Allan Williams Sr., MD, MACC, FAHA, MASNC
    • Cardiology Today Editorial Board Member
      Rush University Medical Center, Chicago
      Past President, American College of Cardiology

    Disclosures: Williams reports no relevant financial disclosures.