Protocol for the scientific opinion on the Tolerable Upper Intake Level of dietary sugars

Abstract

In June 2016, EFSA received a mandate from the national food competent authorities of five European countries (Denmark, Finland, Iceland, Norway and Sweden) to provide a dietary reference value (DRV) for sugars, with particular attention to added sugars. A draft protocol was developed with the aim of defining as much as possible beforehand the strategy that will be applied for collecting data, appraising the relevant evidence, and analysing and integrating the evidence in order to draw conclusions that will form the basis for the Scientific Opinion on sugars. As EFSA wished to seek advice from stakeholders on this draft protocol, the NDA Panel endorsed it for public consultation on 12 December 2017. The consultation was open from 9 January to 4 March 2018. A technical meeting with stakeholders was held in Brussels on 13 February 2018, during the consultation period. After consultation with stakeholders and the mandate requestors, EFSA interprets this mandate as a request to provide scientific advice on an Tolerable Upper Intake Level (UL) for (total/added/free) sugars, i.e. the maximum level of total chronic daily intake of sugars (from all sources) judged to be unlikely to pose a risk of adverse health effects to humans. The assessment concerns the main types of sugars (mono‐ and disaccharides) found in mixed diets (i.e. glucose, fructose, galactose, sucrose, lactose, maltose and trehalose) taken through the oral route. The health outcomes of interest relate to the development of metabolic diseases and dental caries. The final version of the protocol was endorsed by the EFSA Panel on Dietetic Products, Nutrition and Allergies on 28 June 2018.

Tolerable upper intake level for dietary sugars

“…The six assessment subquestions defined in the Protocol (EFSA NDA Panel, 2018) for this Scientific Opinion on the UL of dietary sugars, the methods used and the sections of the opinion in which they are addressed, are as follows: The Handbook for Conducting a Literature-Based Health Assessment Using the Office of Health Assessment and Translation (OHAT) from the US National Toxicology Program Approach for Systematic Review and Evidence Integration (NTP, 2019) has been used as reference to conduct the systematic reviews on metabolic diseases and dental caries. The OHAT/NTP tool has been adapted to appraise the internal validity of human intervention and observational studies (Section 7.4).…”

“…The draft protocol was amended in view of the comments received. All comments received were addressed and published in a technical report (EFSA NDA Panel, 2018), and a final version of the protocol was published (EFSA NDA Panel, 2018).…”

Procedure to Estimate Added and Free Sugars in Food Items from the Swedish Food Composition Database Used in the National Dietary Survey Riksmaten Adolescents 2016–17

“…Another problematic aspect is that sugars are being defined differently. In Europe, Nordic countries included, added sugars are commonly equated with refined sugars [7,9]. Even within the Nordic countries, however, it is possible to identify differences in definitions of added sugars.…”

“…Added sugars were defined in accordance to the Nordic Nutrition Recommendations 2012 (NNR 2012) and European Food Safety Authority (EFSA) [7,9] as being sugars from all food items where refined sugars is added during cooking or manufacturing, not including honey or unsweetened fruit juices. Free sugars were defined according to WHO’s definition [8]; sugars from all food items containing added sugars, as well as sugars naturally present in honey, syrups, fruit juice and fruit juice concentrate.…”

“…Several subdivisions of sugars exist with varying definitions, most frequently known as “added sugars” and “free sugars”. In Europe, added sugars are commonly equated with refined sugars or isolated sugar preparations that are added during cooking or manufacturing [7,9]. Free sugars are all added sugars as well as sugars in honey, syrup, fruit juice and fruit juice concentrate [8].…”