sugars to control dental caries have not been widely implemented . In 2003, a joint committee of the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) recommended limiting “free” or added sugars, defined as “monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit concentrates” to 10% of total calories . The World Sugar Research Organisation (WSRO), a trade organization representing more than 30 international members with economic interests in the cane and beet sugar industry, including the Sugar Association (SA) in the US and Coca-Cola , successfully blocked the 2003 WHO/FAO joint committee recommendation from becoming WHO policy . The WHO/FAO joint committee quantitative recommendation to limit free sugars  was replaced with the nonspecific recommendation to “limit the intake of free sugars” . In 2014, based largely on the global burden of dental disease, the WHO Nutrition Guidance Expert Advisory Group issued draft guidelines with strong quantitative recommendations to limit daily consumption of free sugars to 10% of total calories, with a further suggestion to limit free sugars to less than 5% of total calories . As with the 2003 WHO recommendation, WSRO and its members have submitted comments in opposition to the 2014 WHO draft recommendation [9,10] and have signaled willingness to contest the 2014 recommendations with equal force as in 2003 [11,12]. WSRO argued that dental public health interventions should focus on reducing the harm of sugar consumption with methods such as the “regular use of fluoride toothpaste” rather than restricting sugar intake [9,13].
Publications about food industry influence on public health policy are growing [14–21], but analyses of food industry documents are rare . Historical analyses of internal tobacco industry documents have proven key to informing policy and litigation successes in tobacco control [23–27]. There are similar historical internal documents related to WSRO that could inform public health efforts by illuminating sugar industry activities designed to undermine or subvert policies to restrict sugar consumption .
We analyzed previously unexplored sugar industry documents to trace industry interactions with the US National Institute of Dental Research (NIDR, which changed its name to the National Institute of Dental and Craniofacial Research [NIDCR] in 1998) between 1966 and 1971, a critical period for dental caries control policy when the NIDR planned the launch of the National Caries Program (NCP) with the goal of eradicating dental caries within one decade . Reflecting the research priorities of the sugar industry, the 1971 NCP research priorities ignored strategies to limit sugar consumption and focused instead on fluoride delivery, reducing the virulence of oral bacteria, and modifying food products with additives to counter sugar’s harmful effects . Ultimately, the NCP, which drove the US dental caries research agenda for more than a decade, failed to significantly reduce the burden of dental caries , a preventable disease that remains the leading chronic disease in children and adolescents in the US .
Sugar industry documents.
This study drew substantially on previously unexplored WSRO-related internal documents from between 1959 and 1971 . WSRO was formed from a number of related sugar industry trade organizations including the Sugar Research Foundation (SRF) and the International Sugar Research Foundation (ISRF) (Fig. 1) [6,34–36]. The first author located these documents in 2010 in an inventory of the papers of Roger Adams housed in the University of Illinois Archives through a Google search using the terms “International Sugar Research Foundation” and “archives” . Roger Adams, Emeritus Professor of Organic Chemistry, served on the SRF and then ISRF Scientific Advisory Board  from 1959 until his death in 1971 [38,39]. Adams’s files contain correspondence with sugar industry executives, meeting minutes, and other relevant reports. Afte