Reducing free sugars intake in children and adults
WHO recommends a reduced intake of free sugars throughout the lifecourse.
In both adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake.**
WHO suggests a further reduction of the intake of free sugars to below 5% of total energy intake.
- Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.
- For countries with a low intake of free sugars, levels should not be increased. Higher intakes of free sugars threaten the nutrient quality of diets by providing significant energy without specific nutrients (1).
- These recommendations were based on the totality of evidence reviewed regarding the relationship between free sugars intake and body weight (low and moderate quality evidence) and dental caries (very low and moderate quality evidence).
- Increasing or decreasing free sugars is associated with parallel changes in body weight, and the relationship is present regardless of the level of intake of free sugars. The excess body weight associated with free sugars intake results from excess energy intake.
- The recommendation to limit free sugars intake to less than 10% of total energy intake is based on moderate quality evidence from observational studies of dental caries.
- The recommendation to further limit free sugars intake to less than 5% of total energy intake is based on very low quality evidence from ecological studies in which a positive dose–response relationship between free sugars intake and dental caries was observed at free sugars intake of less than 5% of total energy intake.
- The recommendation to further limit free sugars intake to less than 5% of total energy intake, which is also supported by other recent analyses (2,3), is based on the recognition that the negative health effects of dental caries are cumulative, tracking from childhood to adulthood (4,5). Because dental caries is the result of lifelong exposure to a dietary risk factor (i.e. free sugars), even a small reduction in the risk of dental caries in childhood is of significance in later life; therefore, to minimize lifelong risk of dental caries, the free sugars intake should be as low as possible.
- No evidence for harm associated with reducing the intake of free sugars to less than 5% of total energy intake was identified.
- Although exposure to fluoride reduces dental caries at a given age, and delays the onset of the cavitation process, it does not completely prevent dental caries, and dental caries still progresses in populations exposed to fluoride (6-18).
- Intake of free sugars is not considered an appropriate strategy for increasing caloric intake in individuals with inadequate energy intake if other options are available.
- These recommendations do not apply to individuals in need of therapeutic diets, including for the management of severe and moderate acute malnutrition. Specific guidelines for the management of severe and moderate acute malnutrition are being developed separately.
* This is an extract from the relevant guideline (19). Additional guidance information can be found in this document.
** Total energy intake is the sum of all daily calories/kilojoules consumed from food and drink. Energy comes from macronutrients, such as fat (9 kcal/37.7 kJ per gram), carbohydrate (4 kcal/16.7 kJ per gram) including total sugars (free sugars + intrinsic sugars + milk sugars) and dietary fibre, protein (4 kcal/16.7 kJ per gram) and ethanol (i.e. alcohol) (7 kcal/29.3 kJ per gram). Total energy intake is calculated by multiplying these energy factors by the number of grams of each type of food and drink consumed and then adding all values together. A percentage of total energy intake is therefore a percentage of total calories/kilojoules consumed per day.
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