Textual analysis of sugar industry influence on the World Health Organization's 2015 sugars intake guideline

Objective To determine whether sugar industry-related organizations influenced.textual changes between the draft and final versions of the World Health Organization's (WHO's) 2015 guideline Sugars intake for adults and children. Methods Stakeholder consultation submissions on the draft guideline from seven sugar industry-related and 10 public health organizations were assessed using the Wordscores program. Document scores were rescaled using the Martin Vanberg transformation to improve comparability. Draft and final guidelines were compared to identify changes influenced bythe sugar industry and public health organizations. Findings There was a small shift in transformed Wordscores score between the draft and final guidelines, from 0.25 to 0.24, towards the industry positionjhe change was linked to increased use ofthe word lowto describe the quality of the evidence, consistent with industry arguments. There was also a shift from.use of the word consumption to intake; irrespective of policy position. Scores for World Sugar Research Organisation and Sugar Nutrition UK submissions (0.11 and 0.1-8, respectively) represented strong pro-industry positions and scores for European Public Health Alliance and Wemos submissions (1.00 and 0.88, respectively) represented the strongest public health positions. Industry tacticsIncluded challenging the quality of the evidence, distinguishing-between different types of sugar and advocating-harm reduction. Conclusion There was little change between draft and final versions ofthe WHO sugars intake guideline 2015, following industry consultation. The main change was linked to emphasizing the low quality of the evidence on sugar's adverse effects. Guideline development appeared relatively resistant to industry influence at the stakeholder consultation stage.