EFSA opinion draft on the tolerable upper intake level for dietary sugars: Towards an alignment of dietary sugar classification and recommendations?

Oct 13, 2021
Sébastien Bouley

The new draft, at the center of a recent technical meeting between the EFSA and stakeholders, aligns to the WHO definition of free sugars.

 

On September 21st, an online technical meeting presenting the EFSA’s draft scientific opinion on a tolerable upper level for dietary sugars was held.

The opinion: aims and timetable

The opinion addresses and evaluates the body of evidence concerning sugar consumption and the risk of developing chronic metabolic conditions (obesity, non-alcoholic fatty liver disease, type 2 diabetes mellitus, dyslipidaemia, hypertension, cardiovascular diseases, and gout), pregnancy-related conditions (as gestational diabetes mellitus and birthweight-related endpoints), or caries. A public consultation phase on the draft closed on September 30th; the publication of the final version of the document should be in February 2022.

The conclusions of the draft opinion

Although the primary objective of the project was to establish a tolerable upper level for dietary sugars intake, the collected data were insufficient to do so. Nevertheless, a few relationships interpreted as causal, characterized by a very low to a high degree of certainty, were identified. They led the authors to suggest dietary sugar intakes to remain “as low as possible”, as long as within the framework of a nutritionally adequate diet.

The online technical meeting with stakeholders

The structure of the meeting followed that of the document; it involved more than 10 speakers (see list at the bottom of the article) that described the EFSA’s approach, the protocol that was followed (identified food composition and food consumption sources, hazard identification, data collection, statistical analysis) and the conclusions that were drawn. A lively debate with participants followed.

Dietary sugar classification: towards an alignment?

This draft addresses total, added and free sugars considering that sugars are mono and di-saccharides. It is noteworthy that, in the opinion draft, the EFSA has aligned with the WHO definition of free sugars, intended as added sugars to food, and sugars naturally present in honey, sirups, fruit juices and fruit juice concentrates. This understanding of the term was not contemplated in a former EFSA opinion on dietary reference values for carbohydrates and dietary fibre. The draft opinion also defines total sugars, seen as free sugars (including added sugars), plus sugars naturally occurring in all kinds of food (except, obviously, for those in honey, sirups, fruit juices and fruit juice concentrates). These definitions are not universally shared; the FDA, for example, has a different understanding of them.

Dietary sugar recommendations: towards an alignment?

It is very important to remember that the EFSA focuses only on risk assessment tasks, and is not meant to deal with considerations and applications belonging to public health policies. The opinion is not meant to directly reach the general public, and its content will need to be processed by the public-health-competent institutions.

In this regard, it is useful to point out that, in France, two orders of recommendations on sugar intake exist at the present moment. One of them has been issued by the ANSES (the French agency for food, environmental and occupational health & safety) and recommends a maximal daily intake of 100 g of total sugars (understood as added sugars and naturally present sugars, with the exception of lactose and galactose) per day, for the adult population. The second one is from the WHO: in the 2015 guidelines on the matter, the organization establishes a cut-off value of free sugars at a contribution of 10% of total daily energy intake; for an adult ingesting 2000 kcal per day, this would correspond to 50 g of free sugars. The two recommendations do not contradict each other. It remains to be seen whether the publication of the definitive EFSA opinion will lead to a review of current references.

To know more, you can consult:

  • the list of key speakers at the EFSA online technical meeting with stakeholders, in order of appearance:

CURTUI Valeriu, TURCK Dominique, HORVATH Zsuzsanna, WANSELIUS Julia, FABIANI Lucia, DE SESMAISONS-LECARRE Agnès, VINCETI Marco, TAPPY Luc, KERSTING Mathilde, MOYNIHAN Paula, MARTINO Laura, CICCOLALLO Laura, VALTUENA MARTINEZ Silvia.

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