Background: Obesity and other noncommunicable disease (NCD)
risk factors are increasing in low- and middle-income countries.
There are few data on the association between increased added
sugar intake and NCD risk in these countries.
Objective: We assessed the relation between added sugar intake
and NCD risk factors in an African cohort study. Added sugars were
defined as all monosaccharides and disaccharides added to foods
and beverages during processing, cooking, and at the table.
Design: We conducted a 5-y follow-up of a cohort of 2010 urban
and rural men and women aged 30–70 y of age at recruitment in
2005 from the North West Province in South Africa.
Results: Added sugar intake, particularly in rural areas, has increased
rapidly in the past 5 y. In rural areas, the proportion of
adults who consumed sucrose-sweetened beverages approximately
doubled (for men, from 25% to 56%; for women, from 33% to 63%)
in the past 5 y. After adjustment, subjects who consumed more
added sugars ($10% energy from added sugars) compared with
those who consumed less added sugars had a higher waist circumference
[mean difference (95% CI): 1.07 cm (0.35, 1.79 cm)] and
body mass index (in kg/m2
) [0.43 (0.12, 0.74)] and lower HDL
cholesterol [20.08 mmol/L (20.14, 0.002 mmol/L)].
Conclusions: This cohort showed dramatic increases in added
sugars and sucrose-sweetened beverage consumption in both urban
and rural areas. Increased consumption was associated with increased
NCD risk factors. In addition, the study showed that the
nutrition transition has reached a remote rural area in South Africa.
Urgent action is needed to address these trends