Health Hazards of Sugar

Tooth Decay

The most recent National Oral Health Survey of Adults conducted by the Ministry of Health Malaysia(MOH) reported that 85.1% of Malaysian adults have experienced a dental cavity.[1] And that 6 in 10 adults required dental care due to tooth decay.[1] As excessive sugar consumption is one of the primary factors that contribute to dental cavities, both the World Health Organization(WHO) and the MOH have listed reducing added sugar as a primary step of preventing tooth decay. [2][3] 

Obesity

Obesity is a complex issue with numerous contributing factors. Diet, activity, genetics, medication, etc. can all play a role in how our bodies are shaped. However, at the base level, weight gain is due to an excess number of calories consumed as compared to what our bodies are burning. Therefore, diet inevitably is a vital consideration when looking at unwanted weight gain. 

The most recent National Health & Morbidity Survey(NHMS) by the MOH reported that over half of Malaysians are either overweight or obese.[4] And many sources are now pointing towards added sugar as a main culprit in the rising incidence of obesity, worldwide. While your overall calorie intake is the main dietary factor in determining your body mass index, sugar rich foods & drinks tend to be amongst the most commonly consumed products, as they are very palatable but not satiating.[5] Furthermore, they have been found to trigger certain neurochemical pathways that can lead to addiction.[6] This means that on average, we have a higher tendency to "accidentally" consume extra calories from sugar rich foods, leading to weight gain.[7]

As obesity is strongly correlated with all cause mortality, it's one of the first things we should try to avoid when we are thinking of bettering our health.[8] Both the WHO & our MoH recommend a reduction in added sugar intake to reduce one's risk of obesity.[9][10]

Cardiovascular Health

The most recent Statistics on Causes of Death report by the Department of Statistics Malaysia(DOSM), show that cardiovascular diseases remain the leading cause of mortality in Malaysia.[13] And while there are many risk factors of heart & circulatory diseases, recent studies have shown a strong link between excessive sugar consumption and an elevated incidence of such diseases.[11][12][17] Even in diets where total calorie intake and the proportion of carbohydrates, proteins and fats were comparable, a higher sugar diet resulted in worse outcomes for heart health indicators.[14]

Due to these concerning correlations, several health authorities including the WHO and our own MoH have suggested limiting sugar consumption in the battle against heart disease. [9][10] 

Type 2 Diabetes

Lifestyle variables play a large role in type 2 diabetes(adult onset diabetes), with many studies and associations agreeing that lifestyle changes are the most effective form of intervention to prevent, delay or manage the disease.[15][16] The NHMS reported that 1 in 6 adult Malaysians have diabetes, and that 2 in 5 adults with the condition are unaware of it.[4] Therefore, we think it’s important for Malaysians to begin considering a healthier lifestyle, and there is no better place to start than with your diet. 

One of the biggest dietary contributors to type 2 diabetes is excessive sugar consumption. Maintaining a healthy weight is known to be highly effective at preventing developing diabetes.[15][16] And as mentioned above, added sugars may play a very big role in unwanted weight gain. Furthermore, frequent intake of sugar-sweetened foods and beverages can lead to insulin resistance, a key factor in the development of the disease.[17] 

Given the growing prevalence of diabetes in Malaysia, reducing added sugar intake is a crucial step in preventing and managing the disease. Public health bodies, including the WHO and the American Diabetes Association, strongly advocate for lowering sugar consumption to curb the rising rates of type 2 diabetes and its related complications.[15][18] By making mindful dietary choices—such as opting for natural, low-glycemic sweeteners like stevia—it is possible to enjoy sweetness without the negative metabolic consequences of sugar.

Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)

Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD), previously known as Non-Alcoholic Fatty Liver Disease, is a growing health concern, characterized by excess fat accumulation in the liver due to metabolic dysfunction rather than alcohol consumption. The prevalence of this condition is estimated to have increased significantly in Malaysia, being estimated at 22.7% of the population affected in 2013, compared to 28.2% in 2023.[19][20] It is strongly associated with conditions such as obesity, insulin resistance, and type 2 diabetes.[21] 

One of the key dietary contributors to MAFLD is excessive sugar intake, particularly in the form of fructose, which makes up half of the composition of table sugar..[22] With MAFLD now recognized as one of the leading causes of liver disease worldwide, and numerous studies linking dietary sugar with the disease, reducing added sugar intake is a crucial step toward better liver health.[21][22] 

References

1. 1. National Health and Morbidity Survey (NHMS) 2020: MINISTRY OF HEALTH MALAYSIA National Oral Health Survey of Adults (NOHSA) 2020. - Master Fact Sheet - Key Findings

   2. World Health Organization. Oral Health [Internet]. WHO;2024 [cited 2025] Available from: https://www.who.int/news-room/fact-sheets/detail/oral-health

   3. Oral Health Programme, Ministry of Health Malaysia. Standard Operation Procedure, Prevention of Dental Caries for Lifelong Smiles. 2024. Available from: https://hq.moh.gov.my/ohp/images/pdf/xtvtnsop/sop_prevention_dental_caries.pdf

   4. Ministry of Health Malaysia. National Health & Morbidity Survey 2023: Key Findings. Institute for Public Health, Ministry of Health Malaysia; 2024. Available from: https://iku.nih.gov.my/images/nhms2023/key-findings-nhms-2023.pdf

   5. May CE, Rosander J, Gottfried J, Dennis E, Dus M. Dietary sugar inhibits satiation by decreasing the central processing of sweet taste. Elife. 2020 Jun 16;9:e54530. doi: 10.7554/eLife.54530. PMID: 32539934; PMCID: PMC7297538.

   6. DiNicolantonio JJ, O’Keefe JH, Wilson WL. Sugar addiction: is it real? A narrative review. British Journal of Sports Medicine 2018;52:910-913.

   7. Malik VS, Popkin BM, Bray GA, Després JP, Hu FB. Sugar-Sweetened Beverages, Obesity, Type 2 Diabetes Mellitus, and Cardiovascular Disease Risk. Circulation. 2010 Mar 23;121(11):1356-64. doi:10.1161/CIRCULATIONAHA.109.876185
      Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.109.876185

   8. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013 Jan 2;309(1):71-82. doi: 10.1001/jama.2012.113905. PMID: 23280227; PMCID: PMC4855514.

   9. World Health Organization. Free sugars and NCDs in adults. ELENA; 2024 [cited January 2025]. Available from: https://www.who.int/tools/elena/interventions/free-sugars-adults-ncds

   10. Ministry of Health Malaysia. Malaysian Dietary Guidelines - Key Message 10 - Consume foods and beverages low in sugar. MoH. Available from: https://www.moh.gov.my/moh/images/gallery/Garispanduan/diet/km10.pdf

   11. Temple NJ. Fat, Sugar, Whole Grains and Heart Disease: 50 Years of Confusion. Nutrients. 2018 Jan 4;10(1):39. doi: 10.3390/nu10010039. PMID: 29300309; PMCID: PMC5793267. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5793267/#sec7-nutrients-10-00039

   12. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults. JAMA Intern Med. 2014;174(4):516–524. doi:10.1001/jamainternmed.2013.13563. Available from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1819573

   13. Department of Statistics Malaysia. Statistics on causes of death, Malaysia, 2024. Putrajaya: DOSM; 2024. Available from: https://www.dosm.gov.my/uploads/release-content/file_20241029115211.pdf

   14. Ahmad A, Isherwood C, Umpleby M, Griffin B. Effects of High and Low Sugar Diets on Cardiovascular Disease Risk Factors. J Nutr Sci Vitaminol (Tokyo). 2020;66(Supplement):S18-S24. doi: 10.3177/jnsv.66.S18. PMID: 33612591.

   15. World Health Organization. Diabetes. 2024 November. https://www.who.int/en/news-room/fact-sheets/detail/diabetes. Accessed 2025 Jan.

   16. Galaviz KI, Narayan KMV, Lobelo F, Weber MB. Lifestyle and the Prevention of Type 2 Diabetes: A Status Report. Am J Lifestyle Med. 2015 Nov 24;12(1):4-20. doi: 10.1177/1559827615619159. PMID: 30202378; PMCID: PMC6125024.

   17. DiNicolantonio JJ, O'Keefe JH. Added Sugars Drive Insulin Resistance, Hyperinsulinemia, Hypertension, Type 2 Diabetes and Coronary Heart Disease. Mo Med. 2022 Nov-Dec;119(6):519-523. PMID: 36588634; PMCID: PMC9762218.

   18. American Diabetes Association; 5. Lifestyle Management: Standards of Medical Care in Diabetes—2019. Diabetes Care 1 January 2019; 42 (Supplement_1): S46–S60. https://doi.org/10.2337/dc19-S005

   19. Goh SC, Ho EL, Goh KL. Prevalence and risk factors of non-alcoholic fatty liver disease in a multiracial suburban Asian population in Malaysia. Hepatol Int. 2013 Jun;7(2):548-54. doi: 10.1007/s12072-012-9359-2. Epub 2012 Mar 23. PMID: 26201786.

   20. Wan KS, Mat Rifin H, Yoga Ratnam KK, Mohd Yusoff MF, Ganapathy SS, Rahim NR, Ayob NS, Ahmad NA. Research highlight. Liver matters: the high burden of metabolic dysfunction-associated fatty liver disease (MAFLD) in Malaysia. The prevalence of metabolic syndrome and metabolic dysfunction-associated fatty liver disease in Malaysia 2023. Institute for Public Health (IKU); 2024. Available from:https://iku.nih.gov.my/images/metsmafld/rh-mafld.pdf

   21. Huneault HE, Ramirez Tovar A, Sanchez-Torres C, Welsh JA, Vos MB. The Impact and Burden of Dietary Sugars on the Liver. Hepatol Commun. 2023 Nov 6;7(11):e0297. doi: 10.1097/HC9.0000000000000297. PMID: 37930128; PMCID: PMC10629746.

   22.  Jensen T, Abdelmalek MF, Sullivan S, Nadeau KJ, Green M, Roncal C, Nakagawa T, Kuwabara M, Sato Y, Kang DH, Tolan DR, Sanchez-Lozada LG, Rosen HR, Lanaspa MA, Diehl AM, Johnson RJ. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018 May;68(5):1063-1075. doi: 10.1016/j.jhep.2018.01.019. Epub 2018 Feb 2. PMID: 29408694; PMCID: PMC5893377.