Added sugar intake in South Africa: findings from the Adult Prospective Urban and Rural Epidemiology cohort study

Am J Clin Nutr. 2014 Jun;99(6):1479-86. doi: 10.3945/ajcn.113.069005. Epub 2014 Apr 16.


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 [-0.08 mmol/L (-0.14, 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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Body Mass Index
  • Cholesterol, HDL / blood
  • Cohort Studies
  • Diet / adverse effects*
  • Diet / ethnology
  • Dietary Sucrose / administration & dosage
  • Dietary Sucrose / adverse effects*
  • Female
  • Follow-Up Studies
  • Health Transition*
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Obesity / blood
  • Obesity / epidemiology
  • Obesity / ethnology
  • Obesity / etiology*
  • Overweight / blood
  • Overweight / epidemiology
  • Overweight / ethnology
  • Overweight / etiology*
  • Prospective Studies
  • Risk Factors
  • Rural Health* / ethnology
  • South Africa / epidemiology
  • Urban Health* / ethnology
  • Waist Circumference / ethnology
  • Young Adult


  • Cholesterol, HDL
  • Dietary Sucrose