Sugar: The Facts

A public health concern?

• The World Health Organization (WHO) reported that each year, cardiovascular and respiratory diseases, cancers, and diabetes cause 71% of deaths worldwide. A poor diet, obesity and lack of physical activity are some of the most common causes for these noncommunicable diseases (NCDs)¹.
   
• Poor diet quality, rapidly increasing obesity rates, and the risk of NCDs are associated with high free sugars intakes².
   
• Therefore, in order to reduce the risk of NCDs in children and adults, the WHO is encouraging actions to lower free sugars intakes²

What is sugar?

Sugars is a term referring to all mono- and disaccharides in foods, while sugar refers only to sucrose³. The main types of sugars and their food sources are:

Table 1. Types of sugars and their common sources

What is the difference between total, free and added sugars?

Figure 1. Total, free and naturally occurring sugars definition

What are the main food sources of sugars?

• Milk and dairy products are the only source of lactose in the diet; they also provide beneficial nutrients, such as proteins, vitamins and minerals, especially calcium⁵.
   
• Fruits contain naturally occurring sugars (mainly fructose, glucose, and to a lesser extent sucrose) along with fibers, minerals and vitamins⁶. Compared to whole raw fruits, many of these beneficial nutrients are lost in fruit juices during processing. Whole fruits should therefore be favored over fruit juices.
   
• Sweetened baked goods and sugar-sweetened beverages are the common sources of added sugars (mainly sucrose, fructose, and glucose)⁷.

What role do sugars play?

• Sugars, and more generally carbohydrates, are a natural source of energy in our foods and a major source of fuel for the body⁸.
   
• Taste is the most obvious quality that sugars bring to food and beverages, but it is not the only one.
   
• Beyond sweetness, sugars also contribute to some important functional qualities of food, such as food preservation, volume of baked goods and browning⁹.

What are the recommendations for sugars intakes?

International organizations have not reached a common consensus on recommendations for dietary sugars intakes, due to insufficient scientific evidence.

• World Health Organization (WHO) strongly recommends limiting free sugars intakes to <10% of total energy requirements (strict recommendation). As a further recommendation (conditional recommendation), free sugars should be reduced to <5% of total energy requirements².
   
• American Heart Association (AHA) recommends that added sugars consumption should not exceed 6% and 7% of daily energy requirements for women and men respectively¹⁰.
   
• Scientific Advisory Committee on Nutrition (SACN) recommends that average intakes of free sugars should not exceed 5% of total dietary energy for age groups from 2 years and older. The consumption of sugar-sweetened beverages should be minimized in both children and adults¹¹.

How much is consumed globally?

• Across various geographical regions, intakes of added sugars are the highest in adolescents with mean values ranging from 12.4% to 18.6% of total daily energy intake12, therefore exceeding WHO’s recommendations of 10%.
   
• In the US, mean intakes of added sugars in adults correspond to 15% of daily energy intake13, while in the UK, they correspond to 12% of daily energy intake¹⁴.
   
• The major sources of added sugars in the diet across all age groups (>2 years) are sugar-sweetened beverages in US¹⁵ and Mexico¹⁶. In Europe, added sugars come from sweet foods (e.g. confectionery and pastries) followed by beverages¹⁴. Among 4 to 13-year-old Chinese children, added sugars are mainly provided by bakery products¹⁷.
   
• In the Philippines, the total sugars intake is within WHO’s recommendation of 10%. The mean usual intake of total sugar of 6-9 years old is 27.1 g/day (6.8%E) and of 19-49 years old adults is 26.3g/day (4.3%E)^{18, 19}.​​​​

What are health impacts of excess sugars consumption?

Obesity, diabetes and cardiovascular diseases risk:

• High sugars consumption may lead to excess energy intakes, which are associated with increased body weight and risk of obesity. Such metabolic changes lead to alteration of glucose and fat metabolism, which are risk factors for many non-communicable diseases¹¹.
   
• A high consumption of added sugars is also an indicator of poorer diet quality20, which may result in increased risk for metabolic disorders.
   
• Glucose and maltose are high glycemic sugars. A diet with a higher glycemic index (GI) is associated with a greater risk of type 2 diabetes⁵. Fructose and sucrose have a lower GI but may increase blood lipid levels²¹.
   

Dental caries:

• Higher consumption of sugars is associated with greater risk of dental caries¹¹. Dental caries occur when orally fermentable carbohydrates from sugary foods and beverages interact with dental plaque bacteria⁵.
   
• Unlike other sugars, lactose (found in milk and dairy) has little impact on development of dental caries⁵.

What are the different characteristics of individual sugars?

Glucose, fructose, sucrose and lactose present the same caloric content. However, they have different expected impact on glycemic, lipidemia and dental caries, as well as varying sweetening power.
 

Figure 2. Characteristics of individual sugars
 

What are the regulations limiting sugars consumption?

Many governments around the world are developing or implementing some regulations to limit sugars consumption, including:

• Soda/sugar taxes: the French soda tax, Mexico’s sugary drinks tax, Philippines’ sugar-sweetened beverage tax²²
   
• Labelling guidelines: warning labels in Chile, nutrition traffic light system in Ecuador²²
   
• Advertising restrictions: ban on advertisement of foods high in fat, sugar and salt (HFSS) to children in UK²³
   
• ^​​​​Education campaigns: the Norwegian School Fruit Programme, Hungarian Aqua Promoting Programme in the Young (HAPPY)²⁴