This review synthesizes current evidence on free sugar intake among European children and adolescents, emphasizing recent trends in consumption, key determinants, associated health outcomes, and implications for preventive strategies. Despite modest reductions in some countries, sugar consumption in youth continues to exceed international recommendations, particularly during adolescence. Longitudinal studies highlight persistent high intakes, with sugar-sweetened beverages (SSBs) and confectionery as primary contributors. Socioeconomic disparities, parental behaviours, screen exposure, and individual traits significantly influence consumption. High sugar intake is linked to increased risk of adiposity, cardiometabolic disturbances, and dental caries, with early exposure potentially impacting long-term disease risk. Recent policy efforts, such as taxation and reformulation, show promise but remain inconsistently implemented across Europe. Free sugar intake in childhood remains a critical nutritional concern in Europe. Evidence supports the need for multilevel approaches, including early-life interventions, updated guidelines, and policy measures targeting the broader food environment. Healthcare professionals play a key role in supporting families through nutrition education and consistent messaging. Coordinated action is essential to reduce sugar intake and prevent chronic diseases across the life course.

Reformulation without substitution as a strategy to reduce children's free sugar intake in Uruguay: A simulation study.

IntroductionA previous culturally adapted oral health intervention was deemed ineffective in improving immigrant parents' oral health-related knowledge and attitudes. This qualitative study aimed to explore the perceived barriers to benefiting from the intervention and the perspectives of immigrant parents regarding their children's oral health behaviors, and use of dental health services.Materials and methodsForty-five immigrant parents who previously received the intervention were invited; 12 consented to participate and were interviewed using semi-structured individual interviews. The interviews were recorded and transcribed verbatim. Data was analyzed using thematic analysis.ResultsThe participants were all women aged 28–44, from Africa, Asia, Eastern Europe and South America. Most were college or university-educated and were employed. Four main themes were identified: Intervention Implementation: Parents appreciated the use of pamphlets in their native languages, but highlighted the need to receive dental information from the public health nurses at the local health centers. Parental perspectives on children's oral hygiene habits: Parents demonstrated high oral health knowledge and highlighted the differences in oral hygiene habits between their home countries and Norway. Parental perspectives on children's feeding practices: Participants noted that sugar intake is deeply rooted in cultural and social practices, making it difficult for them to control their children's sugar intake. Dental Health Systems for Children: Parents expressed the need for more frequent follow-ups starting earlier than 3 years of age. They also emphasized the importance of cultural and linguistic competence and sensitivity during dental appointments.ConclusionsThis study highlights the influence of immigrant parents' cultural backgrounds, daily challenges, and interactions with the Norwegian dental health system on their children's oral health practices and perceptions of the oral health intervention. The findings suggest that oral health interventions should be comprehensive, easy to remember, and delivered by credible professionals. Furthermore, to promote positive behavioral change, it is advisable to provide continuous support, repeat oral health care guidance, provide clear communication, and utilize native languages.Clinical Trial RegistrationClinicalTrials.gov Identifier: [NCT05758454].

Alec Hilton emphasises the importance of combating sugar in children's diets.

Perceptions of Nonsugar Sweeteners and Nonsugar Sweetener Front-of-Package Labels Among Parents in the United States: A Qualitative Study.

The significance of performing tongue brushing is uncertain and lacks sufficient clinical evidence. This study was conducted to assess the existing practices on tongue brushing among school children and their parents and its effect on optimal levels of salt and sugar concentration, the development of dental caries and body mass index among children. Of 191 students (52.9% male), 178 responded; 134 (57.3%) reported tongue brushing. Among 313 parents, 54.5% were female and 283 (91.6%) brushed. Initiation was mainly maternal (68.4%) or paternal (12.0%); only 3.3% of parents cited professional advice. Salt taste thresholds were identical between groups (median 1.5g/200 mL); means were slightly higher in brushers (3.14 vs. 3.00; p = 0.389). Sugar thresholds were also equivalent (means 3.25 vs. 3.09; NS). BMI correlated weakly with brushing score (r = 0.143, p > 0.05). Sugar taste concentration showed a negative, non-significant correlation (r = - 0.112, p = 0.150). CPITN scores were higher in non-brushers, without significance. Tongue brushing is a widely practiced habit, primarily adopted through parental influence rather than clinical advice. However, no significant associations were observed with sugar/salt taste thresholds, BMI, dental caries, or periodontal health. While tongue brushing may reduce halitosis and contribute to oral comfort. It should be promoted as an adjunctive, not primary, oral hygiene practice. Further longitudinal and interventional studies are warranted.

BackgroundUndiagnosed and poorly managed high blood sugar levels can result in short- and long-term complications in children. Following worldwide introduction of dolutegravir based antiretroviral treatment in 2018, several studies in adult people living with HIV have reported high prevalence of hyperglycemia. Little is known about hyperglycemia in children living with HIV on dolutegravir treatment combinations in Uganda.ObjectivesTo determine the prevalence and factors associated with hyperglycemia in children living with HIV on dolutegravir in Kabale district, southwestern Uganda.MethodsIn a cross-sectional study, 271 HIV infected children on dolutegravir (DTG) were recruited using proportional to size and simple random sampling methods from 18 health facilities that provide Anti-retroviral therapy (ART) services in Kabale district. HIV infected children aged below 18 years were considered eligible to participate in the study. Data was collected using structured questionnaires. Blood samples were taken for random blood sugar and HbA1C. Data was analyzed using STATA 17.0 for both descriptive and inferential statistics. Logistic regression analysis was done, crude and adjusted odds ratios obtained.ResultsThe prevalence of hyperglycemia was 20.3% (95% CI; 15.9–25.5): Of the children with hyperglycemia, 76% (42/55) had prediabetes and 24% (13/55) had diabetes mellitus.Red meat consumption (AOR:3.52; 95% CI: 1.4–9.0, p = 0.009) and being above 13 years of age (AOR:2.61; 95% CI 1.4–4.87, p = 0.003) were independently associated with hyperglycemia.ConclusionOne in every five children with HIV on DTG had hyperglycemia. Among those with hyperglycemia, 24% had diabetes mellitus. Hyperglycemia was more likely to be present in adolescents and those who consumed red meat. Regular monitoring of blood sugar in children living with HIV on DTG is recommended.

Formative Research to Develop DC-SIPS: A Multilevel Intervention to Reduce Sugary Drink Intake and Promote Water Intake Among Black Youth in Washington, DC.

Dental cavities are a common chronic disease among US children. Sugar-sweetened beverages (SSBs) are the leading contributor of added sugars in children's diets. We assessed the prevalence and adjusted odds of a caregiver-reported cavity in the past 12 months by SSB consumption among children aged 1 to 5 years. We used data from the 2021-2022 National Survey of Children's Health. Our sample comprised children aged 1 to 5 years who had seen an oral health provider in the past 12 months. An adult caregiver reported whether the child had a cavity in the past 12 months and how frequently they consumed SSBs in the past 7 days. Models were adjusted for age, sex, race and ethnicity, highest level of education among adults in the household, and household federal poverty level. We used multivariable logistic regression to examine the relationship between cavities and SSB consumption. Among 23,023 US children in our sample, 11.6% had a caregiver-reported cavity in the past 12 months. Approximately 37.3% of children were reported to drink no SSBs, 39.5% drank SSBs 1 to 3 times in the past week, and 23.3% drank SSBs 4 or more times in the past week. Compared with children who drank no SSBs, those who drank SSBs 1 to 3 times in the past week or 4 or more times in the past week had 1.7 (95% CI, 1.4-2.2) times and 2.8 (95% CI, 2.1-3.6) times higher adjusted odds, respectively, to have a caregiver-reported cavity. Frequent SSB consumption is common among children aged 1 to 5 years and is associated with higher odds of having a cavity. These findings highlight the need for public health and dental professionals to promote the reduction of SSB intake and encourage healthier choices among very young children and their caregivers to help mitigate oral health issues.

Excessive calorie, sugar and salt intake in children’s diets is a public health concern(1). The UK government introduced voluntary salt(2) and sugar(3) reduction programmes to improve the nutritional content of key food categories. Breakfast cereals are an important breakfast choice in children’s diet and are frequently marketed using child-appealing packages(4). This study aims to assess the impact of these initiatives on improving breakfast cereals with child-appealing packaging from 2020 to 2023.We conducted repeated cross-sectional surveys yearly from 2020 to 2023, collecting data on energy, total sugars, fibre, and salt content per 100g from the nutrition information panel of breakfast cereals available in nine major UK retailers and meeting the child-appealing packaging (e.g. cartoons) criteria(5). Statistical analysis, including the Friedman test and χ2 tests, was performed to assess changes in nutritional content over time and compliance with the salt and sugar reduction programmes.Total number of breakfast cereals surveyed each year were n=119, n=126, n=138, and n=133, respectively, with 80 products consistently surveyed (matched) across all four years. Matched breakfast cereals (n=80) showed statistically significant reductions in median total sugars and salt content in 2023 compared to 2020: median (Interquartile Range) total sugars reduced from 22g/100g (15.6-25.9) in 2020 to 19.9g/100g (15.5-22.6) in 2023 (P<0.001), and median (IQR) salt reduced from 0.50g/100g (0.28-0.70) in 2020 to 0.43g/100g (0.24-0.65) in 2023, (P=0.037). No significant changes were observed in energy or fibre contents, (p>0.05). Despite the modest reductions, 81% of breakfast cereals (n=133) collected in 2023 continued to exceed the recommended sugar reduction guideline (12.3g/100g), while only 6% exceeded the maximum salt target (0.90g/100g). Additionally, around 40% of breakfast cereals cereals in 2023 contained a third (per 30g) of a 4-6-year-old’s maximum daily recommendation of free sugars (19 g/d). There were significant variations in sugar, fibre and salt content between and across different retailers and manufacturers (P<0.05).Our findings show modest yet ongoing reductions in sugar and salt content since 2020, demonstrating the potential feasibility of reformulating breakfast cereals. However, breakfast cereals with child-appealing packaging continue to be a major source of sugar in children’s diets. These findings demonstrate the urgent need for mandatory and comprehensive sugar reduction policies to effectively reduce children’s sugar consumption. Additionally, regulatory measures should be introduced to ensure companies use child-appealing tactics on their healthiest breakfast cereals to improve children’s food preferences, and diet. These steps are essential, building on the potential impact of the UK voluntary reduction programmes to improve children’s health and help reduce childhood obesity.

Purpose: To investigate the association between parental psychological aspects, particularly locus of control and parenting style, and children's dietary and oral hygiene behaviors. Methods: This cross-sectional study was conducted with parents (parent, caregiver) of children aged three to six years who were residents in the municipality of Goianá, Minas Gerais, Brazil. Parents answered a questionnaire containing sociodemographic information and information about their children's diet and oral hygiene. In addition, parents responded to the Parental Health Locus of Control Scale (PHLCS) and the Parenting Style and Dimensions Questionnaire. Data analysis included descriptive analysis and binary logistic regression to identify associations between psychological aspects and children's habits. Results: A total of 98 parents responded to the questionnaires, 93.9 percent of whom were mothers. The average age of children was 62.0 (±11.3) months and the majority were female (55.6 percent). An increase in parents' "powerful others" locus of control score was associated with a higher likelihood (odds ratio [OR] equals 1.215; 95 percent confidence interval equals 1.036 to 1.424) of children consuming sugar three or more times per day, though no significant associations were found with toothbrushing frequency. There was no association between daily toothbrushing frequency and sociodemographic criteria and psychological aspects (P>0.05). Conclusions: The "powerful others" domain of the Parental Health Locus of Control Scale of parents was associated with the frequency of their children's sugar intake but other parental psychological aspects were not associated with children's brushing frequency.

The purpose of the study is to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence (AI)-powered smartphone app, Sugar Smart, to be used by children's parents/caregivers for the maintenance of dietary records and oral hygiene habits of children in Maharashtra, India, through a single-arm parallel randomized control trial. The app, developed based on validated research on local dietary habits, was utilized by 100 children. To evaluate the app, two validated questionnaires and a 7-day diet diary format were employed. The first questionnaire assessed ease of use and compliance using a Chi-squared test, while the second examined improvements in dietary awareness before and after app usage through a paired t-test. The findings indicate that a significant majority of users positively perceived the mobile app. The first questionnaire showed high ease of use and positive feedback (87% found it easy to use, 99% reported it helped regulate sugar intake). The Chi-squared test confirmed the statistical significance (p < 0.05). The second questionnaire revealed significant improvements in oral health awareness and diet (correct brushing: 64-98%, reduced sugar usage: 28-91%). The paired t-test confirmed these improvements (p < 0.05), validating the app's effectiveness in enhancing dietary habits and oral health awareness. The study provides strong evidence for the effectiveness of the digital app in improving parental awareness and management of children's sugar intake. The significant improvements observed underscore the app's potential as a valuable tool in pediatric dentistry and public health. This app demonstrates the potential to revolutionize dietary monitoring and behavior change in pediatric populations, promoting healthier dietary behaviors and thus being an effective digital tool in the reduction of caries burden. Agrawal PV, Rathi N, Sinnarkar SE, et al. Assessment of Compliance and Validity of Digital Application-based Diet Diary with Suggestive Local Food Habits for Prevention of Dental Caries in Children. Int J Clin Pediatr Dent 2025;18(2):191-197.

Quantitative relationship between free sugars intake and early childhood caries among preschoolers in Sri Lanka

Responding to rising concerns about obesity and health issues among children, the UKGovernment has advised manufacturers to reduce the added sugar content in key product ranges that have been identified to be the major sources of sugar in children’s diets: baked products (cakes, cereal bars, biscuits, pastries), yoghurt, chocolate, and sweet spreads(1). Soft drinks were excluded in this review due to significant progress in this area(2). This study aimed to review the total sugar content in these key food products, in major supermarkets, popular children’s cookbooks, and website resources used by parents of children aged 6 months–5 years in the UK.This cross-sectional market analysis study was conducted between January 2023 and March 2024.1.Reviewed the total sugar content in these key product ranges from five major UK supermarketsand compared these findings with data from previous research(3).2.Analysed the same products from a website resource and 10 children’s cookbooks, eithermentioned by previously interviewed parents6 or UK bestsellers on Amazon7, as cooking is important in combating obesity but relies on ensuring popular recipes fit within healthy eating guidelines(4).Supermarket product total sugar content was determined by back-of-pack labelling(3). Nutritics software was utilised for total sugar analysis of the selected recipes(5).A total of 440 products were analysed from the supermarkets, 115 recipes from children’s cookbooks and 50 recipes from the BBC Good Food site. Supermarket chocolate and cake products contained the most total sugar per 100g ranging from 14-68g/100g (mean 51.79 ± 10.06g/100g) for chocolate and 27-71g/100g (mean 37.41 ± 8.50/100g) for cake. Yoghurt contained the lowest amounts of sugar (1.9-19g/100g mean 9.11 ± 3.88g/100g). Cereal bars, often believed to be healthy were found to be medium to high in sugar 7.3-45g/100g (mean 25.99 ± 7.28g/100g).These preliminary findings indicate a slight reduction in the average total sugar content of the reviewed supermarket products compared to 2016 levels3. However, a significant proportion of supermarket products (57.5%) and recipes still exceed the government’s high sugar threshold of 22.5g/100g1. More than 85% of cakes in children’s cookbooks and 60% of cakes on BBC Good Food website have high sugar. Overall products and recipes classified as low in sugar (5g or less per 100g) remain limited, with the majority out of the 605 combined products and recipes, 55%, contained high sugar, 38% medium sugar and 7% low sugar content.Many key food products and recipes intended for children remain high in sugar, highlighting a need for further reformulation/healthier recipe modifications. The persistence of high sugar content in children’s diets highlights the complexity of addressing UK childhood obesity levels.

Healthy home food environment is associated with usual consumption of free sugar in children

Background and Objectives: Dental caries, a prevalent chronic disease, significantly affects children worldwide, leading to discomfort and impacting their quality of life. This study attempts to look at the link children's dental cavities and sugar intake aged 5-12 years visiting a hospital in the Peshawar district, Pakistan. Methodology: This observational cross-sectional study included 200 children from the dental outpatient department of a major hospital in Peshawar. Clinical examinations assessed dental caries using standardized WHO diagnostic criteria. Data on sugar consumption and other variables were collected through dietary surveys and structured questionnaires. Statistical analysis was performed to look at the association between sugar intake and dental caries, controlling for potential confounding factors. Results: The study found a high prevalence of dental caries (68%) among the participants, with an average daily sugar intake of 50 grams, significantly higher than WHO recommendations. There was a notable positive association found between the severity of dental caries and sugar consumption (p &lt; 0.001). An increased incidence of dental caries was shown to be independently correlated with higher sugar consumption (OR = 2.5, 95% CI: 1.8-3.4). Conclusion: The findings highlight the critical role of dietary sugars in initiating dental caries among children in Peshawar. Public health interventions are urgently needed to reduce sugar intake, promote better oral hygiene practices, and improve access to preventive dental care services. These measures are essential for lowering the burden of dental caries and improving the overall well-being of children in the region.

Low fluid intake and the consumption of sugar-sweetened beverages are among the risk behaviours in children that promote the development of non-communicable diseases. The aim of this study was to determine the beverage consumption of school-aged children and its contribution to daily energy and added sugars intake. Dietary intake was observed from dietary records, on three non-consecutive days, of 195 primary school children (52% boys; median 8.8 years) from the city of Zagreb. Total fluid intake included fluid from foods and beverages and was compared with Dietary Reference Values for the EU. The average daily fluid intake of children was 1168 mL (859 – 1563), of which 59.6% was from beverages. Only 14.4% of children reached the reference value for total daily fluid intake. Of the beverages, water (34.7%) contributes the most to daily fluid intake, followed by soft drinks (6.3%) and milk (6.1%). Milk and soft drinks contribute the most to the daily energy intake from beverages. Added sugars account for about 7.7% (5.5% – 10.4%) of children’s daily energy intake. Beverage consumption contributes to 26.5% of daily intake of added sugars, mainly soft drinks. In conclusion, children do not consume enough fluids, especially water. Although food is the main source of energy and added sugars in children’s diets, it is necessary to reduce the consumption of soft drinks.

Introduction: The consumption of sugary drinks has been identified as one of the main factors contributing to the appearance of cavities in children. Objective: to describe the excessive consumption of sugar in children's diets and its influence on the development of caries. Methodology: this is an Integrative Literature Review, carried out in the following databases: PubMed, LILACS, MEDLINE and BBO, using descriptors available in the Health Science Descriptors (DeCS), Medical Subject Headings and some synonymous terms, connected using the Boolean operators "AND" and "OR". In addition, the following inclusion criteria were adopted: full-length articles, in Portuguese, English and Spanish, from the last 10 years and which answered the study question. Results: The study sample included eight articles. All were published in the last five years, most of them in international journals and on PubMed, involving around 9,298 children. Among the main findings, we identified the relationship between excessive sugar consumption in children's diets and the onset of caries, associated factors and their prevalence, excessive consumption of processed foods, passive attitudes of caregivers in relation to children's dental appointments, the relationship between the presence of caries and malnutrition and caries prevention measures. Final considerations: The study made it possible to understand a little more about the excessive consumption of sugar in children's diets and its relationship with the development of caries, as well as other aspects related to the subject and means of preservation.

In the Netherlands, 4–8-year-old children consume proportionally the highest amounts of free sugars among all age groups, and in European countries, children’s sugar intake exceeds the World Health Organization’s recommendation. Restricting children’s access to sugary products could help reduce this consumption. However, it is unclear whether and how restriction is linked to children’s sugar intake and sweet taste preference. This study investigated the relationship between parental restriction of sugary products, children’s free sugar and fruit intake, as well as their sweet taste preference. Parents (N = 243) of 4–7-year-old children were asked to complete a survey that asked for their child’s consumption of fruits and free-sugar-containing products via a three-day food recall (three specified, non-consecutive days). Parental restriction was assessed via the Restricted Access Questionnaire. In a subset of children (N = 60), psycho-hedonic functions were mapped using the Monell two-series forced-choice paired comparison tracking test to estimate children’s optimal sweet taste preference. Regression analyses showed that more restricted children consumed less free sugars but more fruits than less restricted children as reported by the parents (p < 0.05). Parental restriction was unrelated to children’s sweet taste preference. In conclusion, our results imply that restriction is negatively linked to free sugar intake, positively linked to fruit consumption, and unrelated to sweet taste preference in 4–8-year-olds. Future research is needed to determine the causal and long-term effects of parental restrictions on children's sugar intake and sweet taste preference.

Attention-deficit and hyperactivity disorder (ADHD) is a neurodevelopmental disorder that occurs in 5–12% of children in the world. ADHD has the characteristics of difficulty concentrating (focusing), being easily distracted, not being easily tired, excessive activity, impulsiveness, decreased executive function, fidgeting, excessive talking, difficulty waiting for one's turn, and often disturbing others. External factors that play an important role in the treatment of ADHD are nutrition and diet. Various nutrition experts have stated that nutrition plays an important role in neurodevelopment. Increased consumption of sugar calories is associated with decreased activity in areas associated with dopamine (posterior midbrain, dorsolateral/orbitofrontal cortices) and taste processing areas (postcentral gyrus) during sugar consumption. The method used in this study uses study literature collected from various reference journal articles from 2007–2023 and international journal articles that are interconnected. All the articles obtained state that sugar can disrupt the balance of neurotransmitters in the body of people with ADHD, namely dopamine and norepinephrine, which will increase the symptoms of ADHD. The significance value obtained is below p 0.05, which means that there is an effect of sugar on the symptoms of ADHD. Based on several sources of journal articles, it can be concluded that consuming sugar in children with ADHD will increase the symptoms of ADHD, such as inattentiveness and impulsivity. However, sugar consumption in normal children does not cause ADHD, but it is possible to experience other diseases.