Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review

Abstract

This systematic review aims to identify and characterize existing national sugar reduction initiatives and strategies in the Eastern Mediterranean Region. For this purpose, a systematic review of published and grey literature was performed. A comprehensive list of search terms in the title/abstract/keyword fields was used to cover the four following concepts (1) sugar, (2) reduction OR intake, (3) policy and (4) EMR countries. A total of 162 peer-reviewed documents were identified, until the 2nd of August 2022. The key characteristics of the identified national strategies/initiatives included the average sugar intake of each country’s population; sugar levels in food products/beverages; implementation strategies (taxation; elimination of subsidies; marketing regulation; reformulation; consumer education; labeling; interventions in public institution settings), as well as monitoring and evaluation of program impact. Twenty-one countries (95%) implemented at least one type of sugar reduction initiatives, the most common of which was consumer education (71%). The implemented fiscal policies included sugar subsidies’ elimination (fourteen countries; 67%) and taxation (thirteen countries 62%). Thirteen countries (62%) have implemented interventions in public institution settings, compared to twelve and ten countries that implemented food product reformulation and marketing regulation initiatives, respectively. Food labeling was the least implemented sugar reduction initiative (nine countries). Monitoring activities were conducted by four countries only and impact evaluations were identified in only Iran and Kingdom of Saudi Arabia (KSA). Further action is needed to ensure that countries of the region strengthen their regulatory capacities and compliance monitoring of sugar reduction policy actions.

Multisectoral action to address noncommunicable diseases: lessons from three country case studies

“…Recognizing the significant carcinogenic effects of palm oil derivatives that arise from the refining process, the Iranian Food and Drug Administration worked with the oil industry to substitute palm oil with other vegetable-based oils. The main strategy was setting a mandatory maximum permitted limit of palm oil content in the most commonly used household frying oils and industrial frying oils ( 35 , 36 ). The following factors were key to the successful implementation of the mandatory limit:…”

The Impact of Excessive Fructose Intake on Adipose Tissue and the Development of Childhood Obesity

“…Among those initiatives, campaigns for consumer education and awareness, led mainly by governmental entities, were the most common (71%). Additional strategies involved sugar subsidies' elimination (67%), taxation (62%), food product reformulation, marketing regulation, and food labeling [154]. In fact, many approaches might be helpful for reducing fructose and/or free sugar consumption if they consider the socioeconomic characteristics and food culture of the population.…”

Influence of Sugar-Sweetened Beverages Intake on Sarcopenic Obesity, Visceral Obesity, and Sarcopenia in Lebanese Patients with MASLD: A Case-Control Study

“…The marked nutrition transition is characterized by a shift in dietary intake and food consumption behaviors leaning towards more highly processed, ‘westernized’ dietary patterns along with increased sedentary behaviors [ 15 ]. Notably, Lebanon has witnessed a concerning trend in the increased consumption of sugar-sweetened beverages especially amongst children and adolescents [ 15 , 16 ]. These trends have been contributing to the development and progression of overweight and obesity in the country, reaching 65% and 27%, respectively, among Lebanese aged 18–69 years in 2020 [ 17 ], reflecting these shifting dietary habits and lifestyle change, which is leading to metabolic and health consequences threatening the health of the population in the short and long run.…”

“…There is a lack of research on the association of the overarching risk factors of MASLD among the MENA population. With the rise of obesity, sarcopenia, and sarcopenic obesity in Lebanon [ 15 , 16 ], it has become critical to study the risk factors related to the development and progression of MASLD. Thus, this study aimed to explore the association between dietary, medical, clinical, and anthropometric characteristics with MASLD and the factors affecting visceral obesity, sarcopenia, and sarcopenic obesity among the Lebanese population through a case-control design.…”