Table 2.
Overview of recommendations or guidelines for dietary intakes of sugar and their justification
| Country | Sugar intake recommendation/guideline | Justification (s) | Reference |
|---|---|---|---|
| Australia | Limit intake of foods and drinks containing added sugars | Probable association of SSB with weight gain | Australian National Health and Medical Research Council (NHMRC) 2013 [4] |
| Suggestive association of added sugars with caries and of soft drinks with caries and bone strength | |||
| Europe (EFSA) | Insufficient data to set an upper limit for (added) sugar intake | Based on narrative review (not systematic or comprehensive) | EFSA 2010 [12] |
| Canada | Maximal intake level of added sugar ≤25 %En | There are insufficient data to set an upper level for added sugars intake. The maximum level is suggested ‘to prevent the displacement of foods that are major sources of essential micronutrients’ | IoM Dietary Reference Intakes, 2005 [17] |
| Germany, Austria, Switzerland | • SSB consumption should be reduced• No specific target for dietary sugar intakea• ‘Only occasionally consume sugar and food or beverages containing various kinds of sugar (e.g., glucose syrup)’ | SSB associated with increased risk of obesity and type 2 diabetes | D-A-CH Reference values 2011 [11] |
| Otherwise no significant associations or effectsa | German Nutrition Society (DGE) 2012 [7] | ||
| Ireland | Excessive consumption of sugar should be avoided | No evidence cited and no specific justification given | Food Safety Authority of Ireland (FSAI) 2011 [25] |
| Netherlands | “Minimize consumption of sugar-containing beverages”. The Dutch Voedingscentrum (Nutrition Center) implements the guidance into more specific targets related to specific food groups | Risk of weight gain and type 2 diabetes | Health Council of the Netherlands. Dutch dietary guidelines 2015 [5] |
| Gezonheidsraad. Verteerbare koolhydraten | |||
| Achtergronddocument bij Richtlijnen goede voeding 2015 [19] | |||
| Health Council of the Netherlands. Background Document Methodology for the evaluation of the evidence for the Dutch dietary guidelines 2015 [18] | |||
| Nordic countries (Denmark, Iceland, Finland, Norway, Sweden) | • Recommended intake of added sugar <10 %En | • High consumption of beverages with added sugars is linked to increased risk of type-2 diabetes in both epidemiological and randomized controlled trials• A restriction in the intake of added refined sugars is important to ensure adequate intakes of micronutrients and dietary fibre (nutrient density) as well as to support a healthy dietary pattern. This is especially important for children and persons with a low energy intake• Consumption of sugar-sweetened beverages has been associated with an increased risk of type-2 diabetes and excess weight gain• Frequent consumption of sugar-containing foods should be avoided to reduce the risk of dental caries• The recommended upper threshold for added sugar is also compatible with the food-based recommendation to limit the intake of sugar-rich beverages and foods | Nordic Nutrition Recommendations (NNR) 2012 [8] |
| Spain | • Moderate (occasional consumption recommended)• Sweets <4 times per day | No specific evidence cited, but justified on the basis of risks of caries and micronutrient density | Nutritional objectives for the Spanish population 2001 [23] |
| Dietary guidelines for the Spanish Population 2001 [24] | |||
| UK | • Average population intake of free sugars 5 %En• SSBs should be minimized | • Increased sugars increased energy intake in adults in RCTs• Increased SSB intake associated with risk of type 2 diabetes, and increased BMI in children in RCTs• Increased intake SSBs and sugars-containing foods associated with increased dental caries• The quantitative recommendation for free sugars was derived from calculations of potential contributions toward reduced energy intake | Scientific Advisory Committee on Nutrition SACN (UK) 2015 [9] |
| USA | Added sugars ≤10 %En | Concluded added sugars and/or SSBs have adverse relationships with body weight, type 2 diabetes, hypertension, stroke, CHD, and dental caries; evidence graded moderate or strong | DGAC Report 2015 [13] |
| • 10% value derived from energy available for added sugars after meeting food group and nutrient recommendations, based on analyses of three healthy eating patterns | Dietary Guidelines for Americans 2015 [16] | ||
| WHO | • Strong recommendation: Reduce intake of free sugars to <10 %En• Conditional recommendation: Reduce intake of free sugars to <5 %Enb | • Recommendation is based entirely on the dental caries evidence although the ad lib diet/BMI link of higher sugars intake could have been included• The <10% is said to reflect the evidence available (predominantly from cohort studies)• Weaker evidence to support the 5% recommendation | WHO 2015 [2] |
SSB sugar-sweetened beverages
This review uses the term “nutritional recommendation” (NR) for documents providing a numerical recommendation and “food-based guideline” (FBG) for documents providing (qualitative) food-specific guidance only. This terminology may deviate from that used in the original documents
aThe recent NR published by the Swiss nutrition society states that added sugar intake should be limited to ≤10 %En. Such a limitation would also entail a limitation of the fructose intake [37]
bFor conditional recommendations (CR) the following explanation is given “CR are made when there is less certainty“ about the balance between the benefits and harms or disadvantages of implementing a recommendation”