Australian paradox

The Australian Paradox is a term coined in 2011 to describe what its proponents say are diverging trends in sugar consumption and obesity rates in Australia. The term was first used in a 2011 study published in Nutrients by Professor Jennie Brand-Miller, in which she and co-author Dr Alan Barclay reported that, in Australia, "a substantial decline in refined sugars intake occurred over the same timeframe that obesity has increased."<ref name=Nutrients>,

 The Australian paradox: a substantial decline in sugars intake over the same timeframe that overweight and obesity have increased, 
 Nutrients, 
 
 Vol. 3(Issue: 4),
 pp. 491–504,
 DOI: 10.3390/nu3040491,
 PMID: 22254107,
 PMC: 3257688,</ref> 

The "paradox" in its name refers to the fact that sugar consumption is often considered (for example by Robert Lustig) to be a significant contributor to rising obesity rates,<ref> Russell, Geoff. Australian paradox(link). {{{website}}}.

26 October 2011.

</ref> and because ecological studies in the United States have found a positive relationship over certain time periods between sugar consumption and obesity prevalence,<ref name=Nutrients/> although added sugars consumption is now also declining in the United States.

Reaction

Some people have criticized Brand-Miller's 2011 study, such as economist Rory Robertson, who argued that "[Brand-Miller's study's] regular claim – "In Australia sugar consumption has dropped 23 per cent since 1980" – is woefully misleading, based as it is on a series that was abandoned by the Australian Bureau of Statistics (ABS) as unreliable a decade ago."<ref> Pascoe, Michael. Economist v nutritionists: big sugar and low-GI brigade lose(link). {{{website}}}.

7 March 2012.

</ref> Robertson has also argued that while the paper claims that consumption of sugary soft drinks in Australia declined by 10% between 1994 and 2006, it actually increased by 30%. He cites these and other data to support calling the research "a menace to public health".<ref>

Is sugar innocent?(link). {{{website}}}. Australian Broadcasting Corporation. 9 February 2014.

</ref>

In February 2014, the Australian Broadcasting Corporation (ABC) aired a program criticizing the 2011 study proposing the existence of the paradox, based in part on Robertson's research. The CEO of the Australian Beverages Council, Geoff Parker, has responded that his industry cites other studies besides Brand-Miller's 2011 study to support their view that sugar is not uniquely linked to obesity.<ref name=Safi> Safi, Michael. Soft-drink industry resists sugar consumption evidence in documentary(link). {{{website}}}.

10 February 2014.

</ref> In response to Robertson's allegations, Sydney University, Brand-Miller's employer, launched an investigation to determine if she is guilty of research misconduct. A spokesperson for the university said there were "...no substantiated claims against the work of any academic at the university, nor indeed has there been any finding that the complaints warrant any further investigation".<ref name=Safi/>

In July 2014, Brand-Miller and Barclay were cleared of misconduct by a six-month investigation conducted by Robert Clark of the University of New South Wales.<ref> Safi, Michael. Researchers cleared of misconduct in row over sugar link to obesity(link). {{{website}}}.

20 July 2014.

</ref> Following an investigation prompted by the Australian economist, two minor arithmetical errors were identified in the original manuscript of The Australian Paradox which were promptly corrected. This was the only allegation out of 8 others that was substantiated.<ref>

News - The University of Sydney(link). sydney.edu.au.

</ref>

Another study on the same topic was published in 2013 by researchers (Rikkers et al.) from the University of Western Australia. The study concluded that "The Australian Paradox assertion is based on incomplete data, as it excludes sugar contained in imported processed foods, which have increased markedly."<ref>,

 Trends in sugar supply and consumption in Australia: is there an Australian Paradox?, 
 BMC Public Health, 
 2013,
 Vol. 13,
 pp. 668,
 DOI: 10.1186/1471-2458-13-668,
 PMID: 23866719,
 PMC: 3726354,</ref> The study argued that the claim that sugar consumption had been declining in Australia relied only on production data, and that Australia gets back much of the raw sugar it exports in the form of processed foods.<ref>

O'Connor, Anahad. Australians Are Getting Fatter(link). {{{website}}}.

25 July 2013.

</ref> Tom McNeill argued that Rikkers et al.'s paper was significantly flawed, writing: "Rikkers et al.'s biggest source of error is the inclusion of incorrect products in the category of "moderate to high sugar content", in violation of their study inclusion criteria. Fruit juices and fruit drinks have been added to the analysis by the authors without consideration of their actual sugar content, or the very definition of these products which must be adhered to by food manufacturers under the control of Food Standards Australia and New Zealand (FSANZ)".<ref>,

 Trends in sugar supply and consumption in Australia: is there an Australian Paradox? (Comments), 
 BMC Public Health, 
 2013,
 
 
 DOI: 10.1186/1471-2458-13-668/comments,
 
 
 
 Full text,</ref> A narrative review of eye disease published the following year argued that the claim of the existence of an Australian paradox "is flawed as it assumes declining sugar intake, without taking into account imported foods containing sugar", quoting Rikkers et al.'s analysis as evidence.<ref>Kearney, Frances M, 
 Review of the role of refined dietary sugars (fructose and glucose) in the genesis of retinal disease, 
 Clinical & Experimental Ophthalmology, 
 
 Vol. 42(Issue: 6),
 pp. 564–573,
 DOI: 10.1111/ceo.12290,</ref> 

Brand-Miller and Barclay have responded that Rikkers et al. are wrong and that, in fact, the sugar consumption data they used (compiled by the United Nations Food and Agriculture Organization, the Australian Bureau of Statistics and Australian beverage industry) "all incorporated data on imported products".<ref>,

 Trends in added sugar supply and consumption in Australia: there is an Australian Paradox, 
 BMC Public Health, 
 2013,
 Vol. 13,
 pp. 898,
 DOI: 10.1186/1471-2458-13-898,
 PMID: 24079329,
 PMC: 3853158,</ref> Recent research by Levy and Shrapnel ("Quenching Australia's thirst: A trend analysis of water-based beverage sales from 1997 to 2011") has concluded that added sugar from soft drinks has continued to decline.<ref>Levy Gina S, 
 Quenching Australia's thirst: A trend analysis of water-based beverage sales from 1997 to 2011, 
 Nutrition & Dietetics, 
 2014,
 Vol. 71(Issue: 3),
 pp. 193–200,
 DOI: 10.1111/1747-0080.12108,</ref>

Brand-Miller's stated that per capita sales of sugar-sweetened beverages had decreased by 10%, in an interview with ABC Radio in 2014, "it might be that a key word came out. It's possible that this should be, 'While nutritively sweetened beverages ... 10 per cent sweetened beverages decreased by 10 per cent.' So I'll double-check it." Barclay, the 2011 study's other author, also said, in an email to the program, that "the 10 per cent decline could not possibly refer to per capita sales of nutritively sweetened soft drinks".<ref> Rollins, Adrian. Attack on controversial sugar study intensifies(link). {{{website}}}. Australian Medical Association. 4 March 2014.

</ref> As mentioned previously, Brand-Miller and Barclay published a correction to their original 2011 study addressing this.<ref>Barclay, Alan,

 Barclay, A.W. and Brand-Miller, J. The Australian Paradox: A Substantial Decline in Sugars Intake over the Same Timeframe that Overweight and Obesity Have Increased. Nutrients 2011, 3, 491-504, 
 Nutrients, 
 
 Vol. 6(Issue: 2),
 pp. 663–664,
 DOI: 10.3390/nu6020663,</ref> According to Esther Han, this correction invalidates the study's claim that soft drink consumption decreased from 1994 to 2006.<ref>

Han, Esther. Rise in sugary drinks is really a fall, says study funded by Beverages Australia(link). {{{website}}}.

17 February 2014.

</ref>

Complaints about the scientific journal Nutrients over its publication of The Australian Paradox paper led to the Open Access Scholarly Publishers Association (OASPA) investigating Nutrients publisher, MDPI. In 2014, OASPA's investigation concluded that MDPI continued to meet its membership criteria.<ref>

Conclusions from OASPA Membership Committee Investigation into MDPI(link). OASPA.

11 April 2014.

</ref>

In April 2017, an update of all available Australian added sugars consumption data titled "Declining consumption of added sugars and sugar-sweetened beverages in Australia: a challenge for obesity prevention" was published in the American Journal Of Clinical Nutrition. The analysis concluded "In Australia, 4 independent data sets confirmed shorter- and longer-term declines in the availability and intake of added sugars, including those contributed by SSBs (Sugar Sweetened Beverages)."<ref>,

 Declining consumption of added sugars and sugar-sweetened beverages in Australia: a challenge for obesity prevention, 
 The American Journal of Clinical Nutrition, 
 2017,
 Vol. 105(Issue: 4),
 pp. 854–863,
 DOI: 10.3945/ajcn.116.145318,
 PMID: 28275129,</ref>

Independent analyses by Australian researchers including Ridoutt and colleagues at the Commonwealth Scientific and Industrial Research Organisation (CSIRO)<ref name="ridoutt">,

 Changes in Food Intake in Australia: Comparing the 1995 and 2011 National Nutrition Survey Results Disaggregated into Basic Foods, 
 Foods (Basel, Switzerland), 
 
 Vol. 5(Issue: 2),
 pp. 40,
 DOI: 10.3390/foods5020040,
 PMID: 28231135,
 PMC: 5302341,</ref> and Lei and colleagues also concluded that Australians consumed less added sugars in the years 2011-12 than they did in 1995.<ref>, 
 Dietary intake and food sources of added sugar in the Australian population, 
 The British Journal of Nutrition, 
 
 Vol. 115(Issue: 5),
 pp. 868–877,
 DOI: 10.1017/S0007114515005255,
 PMID: 26794833,</ref>

In December 2017, the Australian Bureau of Statistics published a comparison of free sugars consumption using Australia's 1995 National Nutrition Survey and 2011/2 Australian Health Survey titled "CONSUMPTION OF ADDED SUGARS - A COMPARISON OF 1995 TO 2011-12". Its main conclusion was "Between 1995 and 2011-12, Australians had a relative decrease in their consumption of free sugars, with the average proportion of dietary energy from free sugars declining from 12.5% to 10.9%."<ref> Statistics, c=AU; o=Commonwealth of Australia; ou=Australian Bureau of. Main Features - Consumption of Added Sugars - A comparison of 1995 to 2011-12(link). abs.gov.au.

13 December 2017.

</ref>

See also

• French paradox

References

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