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image66% of adults exceed the World Health Organisation (WHO) free sugar recommendation solely from fluid consumption.


A WHO study of 16,276 participants across 13 countries published in 2015 found that 66% adults exceeded the free sugar recommendation (free sugars <10% of total energy intake) from beverages alone without taking into account their food consumption.

Exceeding WHO recommendations for free sugar is associated with higher risks of

  • Weight gain image
  • Obesity
  • Metabolic syndromes
  • Type 2 diabetes and
  • other health problems

WHO estimates that by the year 2030 diabetes will be the seventh leading cause of death worldwide. Diabetes is associated with complications affecting the kidneys, eyes, feet, and cardiovascular system.

In Australia it is estimated that over 13% people with diabetes have lower limb nerve damage and 15% experience retinopathy. Diabetes is now considered the leading cause of end-stage kidney disease.

In people with diabetes, cardiovascular disease (CVD) is the primary cause of death, with around 65% of all CVD deaths in Australia occurring in people with diabetes or pre-diabetes. Furthermore, 41% of people with diabetes also report poor psychological well-being with reports of anxiety, stress, depression and feeling ‘burned-out ‘ from coping with their diabetes. Moreover, diabetes is ranked in the top 10 leading causes of death in Australia.


National Diabetes Strategy Advisory Group Consultation Paper

Risk of chronic kidney disease has already been demonstrated to be linked to the types of beverages consumed. Kidney Health Australia has adopted the viewpoint that there is

  • lack of evidence to suggest that drinking water in excess of thirst is beneficial
  • water is the preferred option to satisfy thirst
  • recommended fluid intake is proportional to thirst and individual circumstances
  • from the kidney perspective all fluids consumed counts towards the daily fluid intake and
  • drinking fluids when first sensation of thirst registers (thirst is a sign of dehydration)

Daily fluid intake is influenced by many factors. Fluid intake requirements are increased if

  • living in hot or tropical environments
  • increased activity and exercise
  • medical conditions causing excess obligatory fluid loss ie diabetes insipidus or conditions requiring increased urine flow ie renal calculi.

Fluid intake requirements are decreased in patients with end stage kidney disease and also those patients with certain cardiac and respiratory conditions ie cardiac heart failure.

Dehydration signs and symptoms include some of the following

  • headachesimage
  • fatigue and lethargy
  • slow reaction times
  • dark coloured urine
  • dry cracked lips.

Unfortunately fruit juice is still perceived as a healthy option despite the low water, high sugar content. Public health education programs encouraging adults to increase water consumption in preference to sweetened fluids so as to decrease their risk of chronic disease (ie CKD, T2DM, obesity) is required.

Nurses continue to play a significant role in educating patients and reinforcing health information. To be successful in effecting health change the message must be consistent, evidence based and current.

References :

Guelinck I, Ferreira‐Pêgo C, Moreno L A, Kavouras S A, Gandy J, Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, Ma G, Carmuega E, Babio N, Salas‐Salvadó J 2015 Intake of water and different beverages in adults across 13 countries Eur J Nutr 54 Suppl (2):S45-S55 DOI:10.1007/soo394-015-0952-8