Tolerable upper intake level for dietary sugars

Turck, Dominique; Bohn, Torsten; Castenmiller, Jacqueline; Henauw, Stefaan De; Hirsch‐Ernst, Karen Ildico; Knutsen, Helle Katrine; Maciuk, Alexander; Mangelsdorf, Inge; McArdle, Harry J; Naska, Androniki; Peláez, Carmen; Pentieva, Kristina; Siani, Alfonso; Thiès, Frank; Tsabouri, Sophia; Adan, Roger A.H.; Emmett, Pauline M; Galli, Carlo; Kersting, Mathilde; Moynihan, Paula; Tappy, Luc; Ciccolallo, Laura; Sesmaisons‐Lecarré, Agnès de; Fabiani, Lucia; Horváth, Zsuzsanna; Martino, Laura; Guajardo, Irene Muñoz; Martínez, Silvia Valtueña

doi:10.2903/j.efsa.2022.7074

Cited by 40 publications

(38 citation statements)

References 333 publications

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“…The 4–6% of the energy in a recommended diet that may be used on EDNP food and drinks is consistent with the WHO’s recommendation and the EFSA’s opinion on dietary sugars, emphasizing the additional health benefits of reducing the intake of free sugar to less than 5% or as low as possible of the total energy intake [ 31 , 32 ]. Recently, the 2020 Dietary Guidelines Advisory Committee has suggested that less than 6% energy from added sugars is more compatible with a dietary pattern that is nutritionally adequate [ 3 ].…”

Section: Discussionsupporting

confidence: 57%

Defining Energy-Dense, Nutrient-Poor Food and Drinks and Estimating the Amount of Discretionary Energy

et al. 2022

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Overconsumption of energy provided by energy-dense, nutrient-poor (EDNP) food and drinks increases the risk of unhealthy weight gain and of obesity-related health outcomes. The aim of this study was to develop a nutrient profiling model for classifying EDNP food and drinks and to estimate the amount of discretionary energy for EDNP food and drinks in a recommended diet. A stepwise approach was used first to develop a nutrient profiling model for classifying EDNP food and drinks and then to estimate the amount of discretionary energy in a recommended diet using diet modeling. The nutrition profiling model comprised 24 macro- and micronutrients and energy density. The model classified 67% of 1482 foods and 73% of 161 drinks correctly as EDNP food and drinks compared with an expert-adjusted model. Sweets, chocolate, cake, cookies and biscuits, sweet and salty snacks, sugar-sweetened and artificially sweetened drinks, and alcoholic drinks were classified as EDNP food and drinks. The estimated amount of discretionary energy for EDNP food and drinks was 4–6% of the energy requirements for 4–75-year-old Danes. It seems prudent to have special attention on EDNP food and drinks in dietary guidelines and future public health initiatives to avoid overconsumption of energy.

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Section: Discussionsupporting

confidence: 57%

Defining Energy-Dense, Nutrient-Poor Food and Drinks and Estimating the Amount of Discretionary Energy

et al. 2022

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“…Furthermore, for some age classes, the proposed SPSs could be deemed very small, limiting the acceptance of recommendations by parents. In addition to that, the strong restriction of sweet products following the recommendations limit of added sugars ( 24 , 83 , 84 ) exacerbated the monotony of food choices, especially for breakfast and snacks that in some cases could appear as difficult application and even with the inclusion of “discretionary foods” for children more than that was recommended for adults ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Considerations for the translation of nutrient recommendations as dietary plans for infants, children, and adolescents as reported in Italian Guidelines for healthy eating

et al. 2022

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Healthy eating in childhood and adolescence is important for proper growth and development and to establish a healthy foundation for future dietary habits. This paper aims to describe the elaboration of dietary plans for pediatric ages highlighting critical points related to the application of the Italian nutrient recommendations. National databases on food composition data were used to compile the dietary plans. Starting from the definition of serving size for adults, the suggested portion size for pediatric ages was shaped to produce appropriate dietary plans according to the different classes of age. Items from “cereals and derivatives,” “milk,” “fruit,” “vegetables,” “olive oil,” and “water” groups were included daily. Pizza was included once a week. Sweets and snacks were gradually introduced, once a week in infants and up to five times a week in adolescents. Legumes were provided three times a week, as a source of vegetable and sustainable proteins. The main critical aspect of the dietary plans was related to the monotony, especially for snacks and breakfasts. This work demonstrated the limits of the translation of Italian nutrient recommendations into dietary plans for pediatric age groups. Keeping the protein intake in the recommended range of 8–12% of daily energy resulted in inadequate provision of calcium and iron. Other critical points were the reference values for body weight and physical activity. The proposed dietary plans are adequate with regard to food composition, the intake of energy and several nutrients, and in terms of food selection. However, their implementations require action, information, and advocacy.

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“…In 2015, the WHO updated dietary guidelines pertinent to sugar intake and recommended decreasing the intake of FS to less than 10% EI as a ‘strong recommendation’ [ 7 ], and to less than 5% as a conditional recommendation [ 7 ]. The Scientific Advisory Council on Nutrition in England adopted a relatively similar approach, providing a recommendation of 10% of calories from AS, with the ultimate goal of achieving an even lower intake of 5% [ 23 ]. The American Heart Association has called for even stricter restrictions on calories from AS, with a proposed upper limit of no more than 150 kcal per day for the average adult man and no more than 100 kcal of AS per day for the average adult woman [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review

et al. 2022

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This systematic review aims to identify and characterize existing national sugar reduction initiatives and strategies in the Eastern Mediterranean Region. For this purpose, a systematic review of published and grey literature was performed. A comprehensive list of search terms in the title/abstract/keyword fields was used to cover the four following concepts (1) sugar, (2) reduction OR intake, (3) policy and (4) EMR countries. A total of 162 peer-reviewed documents were identified, until the 2nd of August 2022. The key characteristics of the identified national strategies/initiatives included the average sugar intake of each country’s population; sugar levels in food products/beverages; implementation strategies (taxation; elimination of subsidies; marketing regulation; reformulation; consumer education; labeling; interventions in public institution settings), as well as monitoring and evaluation of program impact. Twenty-one countries (95%) implemented at least one type of sugar reduction initiatives, the most common of which was consumer education (71%). The implemented fiscal policies included sugar subsidies’ elimination (fourteen countries; 67%) and taxation (thirteen countries 62%). Thirteen countries (62%) have implemented interventions in public institution settings, compared to twelve and ten countries that implemented food product reformulation and marketing regulation initiatives, respectively. Food labeling was the least implemented sugar reduction initiative (nine countries). Monitoring activities were conducted by four countries only and impact evaluations were identified in only Iran and Kingdom of Saudi Arabia (KSA). Further action is needed to ensure that countries of the region strengthen their regulatory capacities and compliance monitoring of sugar reduction policy actions.

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Tolerable upper intake level for dietary sugars

Cited by 40 publications

References 333 publications

Defining Energy-Dense, Nutrient-Poor Food and Drinks and Estimating the Amount of Discretionary Energy

Defining Energy-Dense, Nutrient-Poor Food and Drinks and Estimating the Amount of Discretionary Energy

Considerations for the translation of nutrient recommendations as dietary plans for infants, children, and adolescents as reported in Italian Guidelines for healthy eating

Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review

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