Tolerable upper intake level for dietary sugars

K. Pentieva, Dominique Turck, Torsten Bohn, Jacqueline Castenmiller, Stefaan de Henauw, Karen Ildico Hirsch-Ernst, Helle Katrine Knutsen, Alexander Maciuk, Inge Mangelsdorf, Harry J McArdle, Androniki Naska, Carmen Pelaez, Alfonso Siani, Frank Thies , Sophia Tsabouri, Roger Adan, Pauline Emmett, Carlo Galli, Mathilde Kersting, Paula MoynihanLuc Tappi, Laura Ciccolallo Ciccolallo, Agnes de Sesmaisons-Lecarre, Lucia Fabiani, Zsuzsanna Horvath, Laura Martino, Irene Munoz Guajardo, Silvia Valtuena Martınez, Marco Vinceti

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Following a request from five European Nordic countries, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL)or a safe level of intake for dietary (total/added/free) sugars based on available data on chronic metabolic diseases, pregnancy-related endpoints and dental caries. Specific sugar types (fructose) and sources of sugars were also addressed. The intake of dietary sugars is a well-established hazard in relation to dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic metabolic diseases or pregnancy-related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free sugars and risk of some chronic metabolic diseases: The level of certainty is moderate for obesity and dyslipidaemia (>50–75% probability), low for non-alcoholic fatty liver disease and type 2 diabetes (>15–50% probability) and very low for hypertension (0–15% probability). Health effects of added vs. free sugars could not be compared. A level of sugars intake at which the risk of dental caries/chronic metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free sugars would decrease the intake of total sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations.
Original languageEnglish
Article numbere07074
Pages (from-to)e07074
Number of pages337
JournalEFSA Journal
Issue number2
Early online date28 Feb 2022
Publication statusPublished (in print/issue) - 28 Feb 2022

Bibliographical note

Funding Information:
The Panel wishes to thank the following EFSA staff members for the support provided to this scientific output: Mathias Amundsen, Davide Arcella, Ester Artau Cortacans, Elisa Aiassa, Andrea Baù, Janusz Ciok, Ionut Craciun, Valeria Ercolano, Ana García, Andrea Germini, Federico Morreale and Charlotte Salgaard Nielsen. The Panel also wishes to thank Monty Duggal for the support provided to the Working Group on Sugars until May 2018, Jean-Louis Bresson, Barbara Burlingame, Tara Dean, Susan Fairwheather-Tait, Marina Heinonen, John Kearney, Monika Nauhaeuser-Berthold, Grazyna Nowicka, Yolanda Sanz, Anders Mikael Sjödin, Martin Stern, Daniel Tomé, Hendrik van Loveren and Peter Willatts as members of the 5th NDA Panel for their contribution to the protocol; Julia Wanselius for the development of the food composition databases on added and free sugars on behalf of the mandate requestor, the authors of published papers on dietary sugars who provided individual data or additional information upon request, the national institutions of European countries which answered the questionnaire specifically developed for this scientific opinion and to those that provided food consumption data for the Comprehensive European Food Consumption Database used in this opinion.

Publisher Copyright:
© 2022 Wiley-VCH Verlag GmbH & Co. KgaA on behalf of the European Food Safety Authority.


  • added sugars
  • free sugars
  • chronic metabolic diseases
  • pregnancy-related endpoints
  • dental caries
  • Tolerable upper intake level


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