Abstract
AbstractThere is consistent public guidance to limit sugars intakes. However, WHO recommendations are for “free” sugars, whereas some other guidance documents and public discussion focus on “added” sugars, and globally most food labeling states “total” sugars. Total sugars comprise all mono- and disaccharides, regardless of source, whereas both added and free sugars exclude the sugars that naturally occur in dairy products and intact fruit and vegetables. Definitions of added and free sugars differ mainly in their respective exclusion or inclusion of sugars in juiced or pureed fruit and vegetables. To date, there has been little evidence-based analysis of the scientific basis for these different sugar classifications or implications of their adoption for consumer communication and nutrition labeling. Evidence of discriminating relations of total compared with added or free sugars with weight gain or energy intake, type 2 diabetes, and dental caries was identified from recent systematic reviews and meta-analyses. The relations were weakest for total sugars and most consistent for dietary sources corresponding to free sugars (including sugars added to and in fruit juices). Consideration of these health outcomes suggests that the emphasis for intake monitoring, public health guidance, and consumer communication should be on free sugars. However, at present, the adoption of free sugars for these purposes would also carry challenges related to implementation, including consumer understanding, consensus on specifications, and current (labeling) regulations.
Highlights
There is consistent guidance to the public to reduce or limit intakes of sugars, which has been accompanied by public health policies and commercial action intended to help achieve this goal
Because the differences between total, added, and free sugars mainly pertain to the inclusion or exclusion of sugars naturally occurring in dairy products and fruit, evidence relating to sugars from these sources is critical to determine whether and how the different classifications of sugars might be relevant for public health
Possible to look at health relations with the main food and beverage components that largely account for distinctions among total compared with added or free sugars, intact fruit compared with fruit juice, and dairy products. By focusing on these and drawing primarily on evidence from recent systematic reviews and meta-analyses, it is possible to evaluate whether the distinction between total, added, and free sugars is likely to be relevant, and which term most consistently aligns with relations with health outcomes
Summary
There is consistent guidance to the public to reduce or limit intakes of sugars, which has been accompanied by public health policies and commercial action (e.g., product reformulations) intended to help achieve this goal. Because the differences between total, added, and free sugars mainly pertain to the inclusion or exclusion of sugars naturally occurring in dairy products and fruit (intact or juiced), evidence relating to sugars from these sources is critical to determine whether and how the different classifications of sugars might be relevant for public health.
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