SUGAR IN INFANTS, CHILDREN AND ADOLESCENTS:

A POSITION PAPER OF THE EUROPEAN SOCIETY FOR

PAEDIATRIC GASTROENTEROLOGY, HEPATOLOGY

AND NUTRITION

COMMITTEE ON NUTRITION

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DEFINITIONS,

RECOMMENDATIONS,

INTAKE

HEALTH

EFFECTS

INNATE &

PROGRAMMED

PREFERENCES FOR TASTES

•Free/added sugars,

s.-containing beverages

• WHO, SACN, AHA

•Infants, children, adolescents

•Body wt. / adiposity

• Dental caries

• T2D &

cardiometabolic risk

•Innate preferences /rejections

• Mismatch of taste preferences

• Ability to learn

HEALTH EFFECTS OF

FREE/ADDED

SUGARS

Monosaccharides & disaccharides added to foods & beverages by

manufacturer, cook / consumer &

s. naturally present in honey, syrups, fruit juice & fruit juice concentrate.

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FREE SUGARS1, 2

ADDED SUGARS3, 4, 5

1WHO, Guideline, 2015 2SACN, Carbohydrates & Health, 2015 3EFSA J; 1008:1–14, 2009 4IOM: DRI, 2005 5Vos et al.: AHA, Circulation, 134:00–00, 2016

SUGARS-CONTAINING BEVERAGES

Sweetened

ice teas (5-10 % sugar)

Tea with

sugar Fruit syrups

Sweetened

carbonated bev. (9-13 % sugar)

Friut nectars

(5-16 % sugar)

Flavoured

water drinks (1-4% sugar)

Energy drinks (11-13% sugar)

Sports drinks (4-6% sugar)

Fruit juice (5-17% sugar)

SSBs: Sugar Sweetened Beverages : added caloric sweeteners

(sucrose, high-fructose corn syrup, fruit-juice concentrates) Non SSB

•SUGARS-CONTAINING BEVERAGES Europe (9 countries; 12-17 y):

SSBs: 228 ml/day

Sweetened tea: 63 ml/day

Fruit juice: 133 ml/day1

• ADDED SUGARS:

Europe (2-9 y) : 14% E2

US (2-18 y) : 14% E3

1Duffey et al, Eur J Clin Nutr 66, 244–52, 2012 2Svensson et al, Eur J Clin Nutr 68, 822–8, 2014 3Poti, et al, Am J Prev Med 45, 551–9, 2013

INTAKES OF SUGARS

WHO • Reducing the intake:

<10% E in children & adults (strong r.).

• A further reduction of the intake:

< 5% E would have additional benefits in reducing the risk of

dental caries in children & adults (conditional r.)

SACN • Average population intake:

• < 5% of total E

≥ 2 y

SACN, Scientific Advisory Committee on Nutrition, London, 2015

WHO, Guideline: Sugars Intake for adults and children, 2015

SACN, Scientific Advisory Committee on Nutrition, London, 2015

FREE SUGARS

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AHA

• Children < 2 y:

avoid

≥ 2 y:

≤ 25 g/day

≤ 100 kcal/day

≈ 6 TS/day

Vos et al, AHA, Circulation, 134:00–00, 2016

ADDED SUGARS

355 ml

39 g sugar

140 kcal

10 TS sugar

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• WHO definition of free sugars

should be used uniformly in dietary

recommendations, studies, regulations

and foods labelling.

• Intakes of free sugars should be reduced and minimised with a

desirable upper limit of <5% energy intake in children and

adolescents aged > 2–18 years. Intakes should be even lower in

infants and toddlers <2 years.

• Intake of sugars (SSBs!) among children far exceeds

recommended levels. National Authorities should

adopt policies aimed at reducing the intake of free

sugars in infants, children and adolescents.

CONCLUSIONS & RECOMMENDATIONS

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• Sugar should be consumed

in its natural form.

• Replacing all

free sugars in liquid form:

- SSBs, fruit juices, smoothies &

- sweetened milk drinks/products

with water & milk.

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