Dentists and sugary drinks
2015; Elsevier BV; Volume: 146; Issue: 2 Linguagem: Inglês
10.1016/j.adaj.2014.11.023
ISSN1943-4723
Autores Tópico(s)Gastroesophageal reflux and treatments
ResumoInhabitants of the United States consume sugar, particularly in the form of sugar-sweetened beverages (SSBs), at an alarming rate. SSBs are a leading cause of dental cavities,1Moynihan P.J. Kelly S.A. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines.J Dent Res. 2014; 93: 8-18Crossref PubMed Scopus (607) Google Scholar obesity, and type II diabetes.2Basu S. McKee M. Galea G. Stuckler D. Relationship of soft drink consumption to global overweight, obesity, and diabetes: a cross-national analysis of 75 countries.Am J Public Health. 2013; 103: 2071-2077Crossref PubMed Scopus (263) Google Scholar SSBs include soft drinks, sports drinks, energy drinks, fruit drinks, flavored milk, and other beverages that contain added caloric sweeteners. In the United States, SSB consumption has reached epidemic proportions, with the average American now consuming a whopping 50 gallons per person per year,3Zmuda N. Bottom’s up! A look at America’s drinking habits.Advertising Age. June 27, 2011; (Available at:) (Accessed December 2, 2014)http://adage.com/article/news/consumers-drink-soft-drinks-water-beer/228422/Google Scholar the second highest consumption rate in the world (after Mexico), equivalent to approximately 1.5 cans of soda per person per day. SSBs are the leading source of added sugar in the American diet.4Welsh J.A. Sharma A.J. Grellinger L. Vos M.B. Consumption of added sugars is decreasing in the United States.Am J Clin Nutr. 2011; 94: 726-734Crossref PubMed Scopus (339) Google Scholar Besides having no nutritional value, SSBs displace healthier beverage options. They are cheap and readily available, and they are one of the most widely advertised products, particularly to children, adolescents, and low-income groups. The last thing they offer is “happiness and choice.” The United States is in the midst of an obesity epidemic. Americans are among the most overweight and obese population in the world. Today, over two-thirds (69%) of all Americans older than 20 years are overweight, and just over one-third (35%) are obese.5Ogden C.L. Carroll M.D. Kit B.K. Flegal K.M. Prevalence of childhood and adult obesity in the United States, 2011–2012.JAMA. 2014; 311: 806-814Crossref PubMed Scopus (6477) Google Scholar It is the duty of all health professionals to act to reduce these frightening rates. SSBs have a damaging impact on a population’s health, particularly for children and adolescents, and especially their teeth. Dental cavities are the most prevalent chronic disease in the United States and are a significant cause of health inequalities. There is a strong link between the amount and frequency of sugar consumed and dental cavities. The primary cause of dental cavities is a diet high in sugar, and the primary source of sugar in children’s diets is sugary drinks. These are products that we should prevent our children and youth from drinking. The World Health Organization (WHO) recently released a draft guideline recommending that daily sugar intake should ideally be just 5% of total energy intake, and at the most less than 10% of total energy intake.6Sanchez N. World Health Organization: new public guidelines on sugar intake.Liberty Voice. March 6, 2014; (Available at:) (Accessed December 2, 2014)http://guardianlv.com/2014/03/world-health-organization-new-public-guidelines-on-sugar-intake/Google Scholar This effectively cuts their earlier recommended amount in half and was based on the totality of the evidence linking sugar to tooth decay and obesity. Others have called for an even lower maximum sugar intake, noting that the burden of dental cavities can be eliminated if sugar intakes are limited to less than 3% of energy intake.7Sheiham A. James P.T. 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: 863Crossref PubMed Scopus (122) Google Scholar For adults, the WHO recommendation equates to a maximum of 6 teaspoons of sugar per day, and for children just 3 teaspoons. Consuming just 1 can of soda (which contains 9 teaspoons of sugar) will tip an adult over the limit for the day. Shockingly, a can of soda contains 3 days’ worth of sugar for a child. A 20-ounce bottle of soda contains approximately 16 teaspoons of sugar—more than 5 days’ worth of sugar for a child. For each extra can of SSB consumed per day, the likelihood of a child becoming obese increases by 60%.8Ludwig D.S. Peterson K.E. Gortmaker S.L. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1802) Google Scholar Just one can. The number 1 selling item in US supermarkets is soda.9Bean-Mellinger B. The top 10 grocery store items in America. eHow. Available at: http://www.ehow.com/info_8446468_top-grocery-store-items-america.html. Accessed December 2, 2014.Google Scholar It is vital that members of the dental professional do not succumb to the influence of the sugar industry. It is unfortunate that in 2003 the American Academy of Pediatric Dentistry received $1 million from the Coca-Cola Company.10Kanner AD, Golin J. Does Coke money corrupt kids’ dentistry? Mothering. March/April 2005. Available at: http://www.massglobalaction.org/home/pdf/Does%20Coke%20Money%20Corrupt%20Kids.pdf. Accessed December 2, 2014.Google Scholar A few months later, the academy stated that “scientific evidence is not clear on the exact role that soft drinks play in terms of children’s oral disease.” This contradicts their previous statement that “consumption of sugars in any beverage can be a significant factor that contributes to dental caries.”11Thomas C. “Heads we win, tails they lose”: the corruption of science.Ethical Nag. February 14, 2013; (Available at:) (Accessed December 2, 2014)http://ethicalnag.org/2013/02/14/heads-they-win-tails-we-lose-how-corporations-corrupt-science/Google Scholar Fortunately, the academy now states that “frequent ingestion of sugars and other carbohydrates (eg, fruit juices, acidic beverages) and prolonged contact of these substances with teeth are particular risk factors in the development of caries.”12American Academy of Pediatric Dentistry; Clinical Affairs Commmittee. Policy on dietary recommendations for infants, children, and adolescents. Revised 2012. Available at: http://www.aapd.org/media/Policies_Guidelines/P_DietaryRec.pdf. Accessed December 2, 2014.Google Scholar As oral health professionals, we see the damage that SSBs cause our patients on a daily basis, and we are thus in an ideal position to advocate for change, both to our patients and to policy makers. It is our duty to do all that we can to raise awareness of the dangers of these drinks. At the local level, we can discuss the dangers of SSBs with our patients and place sugar chart posters in the waiting room. When prescribing oral liquid medications, we can specify sugar-free varieties, as highlighted by Donaldson and colleagues in this issue of The Journal.13Donaldson M. Goodchild J.H. Epstein J.B. Sugar content, cariogenicity, and dental concerns with commonly used medications.JADA. 2015; 146: 129-133Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar We can also take a keen interest in what our patients' current sugar intake is and to advise them on reducing their overall sugar consumption.14Marshall T.A. Nomenclature, characteristics, and dietary intakes of sugars.JADA. 2015; 146: 61-64Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar On the policy front, we can lobby for the adoption of SSB-free hospitals,15Dunn S. Hospitals ban sugary drinks.Nelson Mail. February 21, 2014; (Available at:) (Accessed December 2, 2014)http://www.stuff.co.nz/nelson-mail/news/9748877/Hospitals-ban-sugary-drinksGoogle Scholar city councils,16Davidson K. NCC bans sugary drinks.Nelson Mail. July 21, 2014; (Available at:) (Accessed December 2, 2014)http://www.stuff.co.nz/nelson-mail/news/10291300/NCC-bans-sugary-drinksGoogle Scholar schools, and sports facilities. Local activism can make a difference, community by community. Importantly, we and our professional organizations can target politicians to encourage them to implement taxation measures on SSBs, advertisement bans, sponsorship bans, and measures to limit availability of SSBs, particularly in schools and child care facilities.17Thow A.M. Hawkes C. Global sugar guidelines: an opportunity to strengthen nutrition policy.Public Health Nutr. 2014; 17: 2151-2155Crossref PubMed Scopus (12) Google Scholar A fine example occurred recently. Voters in the city of Berkeley, CA, overwhelmingly voted for a 1-cent-an-ounce tax on sugary drinks. This was despite the soda industry’s spending an unprecedented $2.4 million trying to defeat the proposal.18Dinkelspiel F. A record $3.6 million spent in Berkeley campaigns.Berkeleyside. November 3, 2014; (Available at:) (Accessed December 2, 2014)http://www.berkeleyside.com/2014/11/03/a-record-3-6-million-spent-in-berkeley-campaigns/Google Scholar The Berkeley Dental Society should be congratulated for backing the proposal, which ensured that Berkeley became the first US city to pass a law taxing sugary drinks. Now it is up to all of us to follow their excellent lead. Consumption of SSBs is out of control. Children and adolescents in particular are being harmed, and we need to implement measures to safeguard their health. In the interests of children everywhere, all nations need to treat the issue seriously. It is a leadership issue. The response to SSBs needs to follow that of tobacco and alcohol, where legislation and regulation are vital policies to curb their use. Dentists must act. Dr. Beaglehole is the principal dental officer, Nelson Marlborough District Health Board, Nelson, New Zealand, and spokesman on water fluoridation for the New Zealand Dental Association. Nomenclature, characteristics, and dietary intakes of sugarsThe Journal of the American Dental AssociationVol. 146Issue 1PreviewThe World Health Organization has recommended a reduction in free sugars intake throughout one’s life span to decrease the burden of noncommunicable diseases, including caries and obesity. The author defines sugars’ nomenclature, describes sugars’ roles in food, and identifies current sugars intake. Full-Text PDF Sugar content, cariogenicity, and dental concerns with commonly used medicationsThe Journal of the American Dental AssociationVol. 146Issue 2PreviewOral adverse events such as cariogenicity are often overlooked as drug-associated effects because the sugar content of many medications may be negligible compared with the patients’ overall dietary intake of sugar. There are, however, several liquid formulations of medications with significantly high sugar content that are commonly used in patients with swallowing difficulties. These medications may be associated with negative oral health sequelae and should be considered part of the oral health care providers’ differential diagnosis of oral pathologies. Full-Text PDF Responsibility and sugary drinksThe Journal of the American Dental AssociationVol. 146Issue 6PreviewI write in response to Dr. Rob H. Beaglehole’s February JADA guest editorial, “Dentists and Sugary Drinks: A Call to Action” (JADA. 2015;145[2]:73-74). Full-Text PDF
Referência(s)