The issue of sugar consumption in Sudan is a growing concern, particularly its relationship with weight management and overall health. This article delves into the effects of sugar intake on the Sudanese population, exploring its connection to conditions like diabetes, obesity, and metabolic syndrome, while also examining potential interventions and recommendations for healthier lifestyles.
Sugar Intake and Associated Health Risks in Sudan
A cross-sectional study involving 323 participants in Sudan revealed that a significant portion of the population consumes high amounts of added sugars. Specifically, 74.6% of participants had a sugar intake exceeding 200 calories per day. This high sugar intake was significantly associated with several health issues:
- Weight Status: High sugar consumption was prevalent among individuals with normal weight, overweight, and obesity (p<0.015).
- Chronic Diseases: It was also linked to diabetes and hypertension (p <0.000 and 0.038, respectively).
- Abdominal Obesity: A statistically significant association was found between high sugar intake and abdominal obesity (p<0.016).
- Demographics: The study also noted a correlation with a mean age of 33 years (p<0.00) and marital status (married and single, p<0.003).
Stepwise logistic regression identified diabetes and a BMI less than 25 as significant predictors of sugar consumption, with p-values of 0.001 and 0.039, respectively. These findings emphasize the need to address high sugar intake within the Sudanese population to mitigate the risk of related health complications.
Diabetes Mellitus: A Growing Concern in Sudan
Diabetes mellitus (DM), characterized by elevated blood glucose levels due to impaired β-cell function and insulin action, poses a significant health challenge in Sudan. This chronic disease can lead to long-term damage and dysfunction in various organs, including the eyes, kidneys, nerves, heart, and blood vessels. The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), with Sudan estimated to have a diabetes prevalence of 16%, which translates to approximately 3,526,600 cases.
The Role of Lifestyle Modification:
Adopting a healthy lifestyle is crucial in preventing or delaying complications associated with type 2 diabetes mellitus (T2DM). Studies have demonstrated that lifestyle modifications can reduce the risk of type 2 diabetes by approximately 50% in high-risk populations. A healthy lifestyle encompasses:
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- Maintaining a nutritious diet
- Engaging in regular physical activity
- Maintaining a healthy body weight
- Avoiding tobacco use
Health education plays a vital role in diabetes management by empowering individuals to make informed decisions about their lifestyle and treatment, as well as developing self-care skills. This includes planning nutritious meals, making lifestyle changes, engaging in physical activity, and developing healthy habits. Adherence to medication, regular monitoring, and treatment are also essential for managing diabetes and preventing complications. Poor diabetes control can lead to a lower quality of life, increased healthcare costs, and a burden on individuals, communities, and the healthcare system.
Diabetes Self-Management Education (DSME) as an Intervention:
The long-term prognosis of diabetes mellitus heavily relies on the self-care behavior of affected individuals. Research has consistently demonstrated that educational interventions positively influence knowledge, physical activity, food intake, self-efficacy, and health literacy. Diabetes self-management education (DSME) is a process that equips patients with the knowledge, attitudes, and abilities necessary for self-management, enabling them to engage in and sustain lifestyle modifications that improve health outcomes.
A study conducted in Sudan assessed the impact of a DSME intervention on medication adherence and diabetes control. The quasi-experimental research involved a single-group, pretest-posttest design, with primary outcomes focusing on changes in HbA1c values, fasting blood glucose, and body mass index. The study population consisted of T2DM patients attending primary health care centers in six different cities in Sudan between September 2022 and March 2023.
The DSME program was tailored to be socio-demographically and culturally appropriate. Implementing doctors underwent online training sessions to ensure consistent delivery of education across different cities. The program involved biweekly two-hour lessons for eight weeks, covering healthy eating, physical activity, monitoring, medication management, problem-solving, risk reduction, and healthy coping. Participants received visual and written materials, including a full-color book containing explanatory materials about diabetes and treatment goals. Blood tests (fasting blood sugar and HbA1c) and examinations of height and weight were conducted before and three months after the program's completion.
The results of the study indicated that the DSME intervention led to improved medication adherence and diabetes control. There was a decrease in poor, low, and partial adherence to medication, coupled with an increase in good and high adherence. Furthermore, statistically significant reductions in BMI, FBS, and HbA1c were observed. These findings underscore the significance of patient education in enhancing glycemic control and promoting self-management behaviors.
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Physical Activity and Metabolic Syndrome in Sudanese Adolescents
The growing prevalence of overweight and obesity among adolescents highlights the significance of studying metabolic syndrome (MetS) in this population. A cross-sectional study conducted in Sudan aimed to assess the association between MetS and physical activity (PA) among Sudanese early adolescents.
The study involved 921 primary school students from Khartoum State, with MetS defined according to the International Diabetes Federation criteria. A standardized questionnaire was used to assess PA, and metabolic equivalents of task were calculated to identify levels of different intensities of PA.
The results revealed that the prevalence of MetS was significantly higher in subjects in the lowest PA tertile (least active) compared to the more active tertiles. After adjusting for other factors, the odds of MetS among adolescents in the lowest PA tertile were seven times higher than those in the highest PA tertile. This indicates that a physically inactive lifestyle is associated with higher odds of MetS and its components, especially waist circumference and triglyceride levels, in Sudanese early adolescents.
These findings emphasize the importance of promoting PA and exercise among all children and adolescents, regardless of their weight status, to prevent excessive weight gain and reduce the potential health risks associated with a sedentary lifestyle.
WHO Recommendations on Sugar Intake and Non-Sugar Sweeteners
The World Health Organization (WHO) recommends that adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. Free sugars include monosaccharides and disaccharides added to foods and drinks, as well as sugars naturally present in honey, syrups, fruit juices, and fruit juice concentrates.
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The WHO guideline does not apply to sugars in fresh fruits and vegetables or sugars naturally present in milk, as there is no reported evidence of adverse effects from consuming these sugars. Much of the sugars consumed today are "hidden" in processed foods that are not typically seen as sweets.
Furthermore, the WHO has issued a guideline recommending against the use of non-sugar sweeteners (NSS) to control body weight or reduce the risk of noncommunicable diseases (NCDs). The recommendation is based on evidence suggesting that NSS do not provide long-term benefits in reducing body fat and may have potential undesirable effects, such as an increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults.
The WHO emphasizes that replacing free sugars with NSS does not aid in long-term weight control and encourages individuals to consider alternative ways to reduce free sugar intake, such as consuming foods with naturally occurring sugars or unsweetened foods and beverages.
Benefits of Reducing or Eliminating Sugar Intake
Avoiding sugar completely can have several health benefits, as excessive sugar intake has been linked to various health issues.
Here are some potential benefits:
- Weight Management: Reducing calorie consumption.
- Reduced Risk of Obesity: Preventing weight gain and reducing the risk of obesity-related health problems.
- Improved Blood Sugar Control: Stabilising blood sugar levels and reducing the risk of insulin resistance.
- Lower Risk of Heart Disease: Improving lipid profiles and reducing cardiovascular risk factors.
- Better Dental Health: Reducing the risk of dental caries and promoting better oral hygiene.
- Improved Skin Health: Reducing inflammation and slowing down aging.
- Enhanced Mental Clarity: Promoting mental clarity, focus, and cognitive function.
- Balanced Mood: Stabilising mood and preventing mood swings.
- Reduced Risk of Chronic Inflammation: Lowering inflammatory markers and reducing the risk of chronic inflammation-related diseases.
- Enhanced Immune Function: Supporting immune health by reducing inflammation and promoting optimal immune function.
By reducing sugar intake and focusing on a balanced diet rich in whole foods, individuals can experience improved well-being and a reduced risk of chronic diseases.