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  Moynihan; Luc Tappi; Laura Ciccolallo Ciccolallo; Agnes de Sesmaisons-Lecarre; Lucia Fabiani; Zsuzsanna   Horvath; Laura Martino; Irene   Munoz Guajardo; Silvia  Valtuena Martınez; Marco Vinceti

doi:10.2903/j.efsa.2022.7074

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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Abstract

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 language	English
Article number	e07074
Pages (from-to)	e07074
Number of pages	337
Journal	EFSA Journal
Volume	20
Issue number	2
Early online date	28 Feb 2022
DOIs	https://doi.org/10.2903/j.efsa.2022.7074
Publication status	Published (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.

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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EFSA Journal - 2022 - - Tolerable upper intake level for dietary sugarsFinal published version, 67.2 MBLicence: CC BY

Cite this

Pentieva, K., Turck, D., Bohn, T., Castenmiller, J., de Henauw, S., Hirsch-Ernst, K. I., Knutsen, H. K., Maciuk, A., Mangelsdorf, I., McArdle, H. J., Naska, A., Pelaez, C., Siani, A., Thies , F., Tsabouri, S., Adan, R., Emmett, P., Galli, C., Kersting, M., ... Vinceti, M. (2022). Tolerable upper intake level for dietary sugars. EFSA Journal, 20(2), e07074. Article e07074. https://doi.org/10.2903/j.efsa.2022.7074

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abstract = "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.",

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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 Ba{\`u}, Janusz Ciok, Ionut Craciun, Valeria Ercolano, Ana Garc{\'i}a, 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 Sj{\"o}din, Martin Stern, Daniel Tom{\'e}, 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: {\textcopyright} 2022 Wiley-VCH Verlag GmbH & Co. KgaA on behalf of the European Food Safety Authority.",

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Pentieva, K, Turck, D, Bohn, T, Castenmiller, J, de Henauw, S, Hirsch-Ernst, KI, Knutsen, HK, Maciuk, A, Mangelsdorf, I, McArdle, HJ, Naska, A, Pelaez, C, Siani, A, Thies , F, Tsabouri, S, Adan, R, Emmett, P, Galli, C, Kersting, M, Moynihan, P, Tappi, L, Ciccolallo, LC, de Sesmaisons-Lecarre, A, Fabiani, L, Horvath, Z, Martino, L, Munoz Guajardo, I, Valtuena Martınez, S & Vinceti, M 2022, 'Tolerable upper intake level for dietary sugars', EFSA Journal, vol. 20, no. 2, e07074, pp. e07074. https://doi.org/10.2903/j.efsa.2022.7074

TY - JOUR

T1 - Tolerable upper intake level for dietary sugars

AU - Pentieva, K.

AU - Turck, Dominique

AU - Bohn, Torsten

AU - Castenmiller, Jacqueline

AU - de Henauw, Stefaan

AU - Hirsch-Ernst, Karen Ildico

AU - Knutsen, Helle Katrine

AU - Maciuk, Alexander

AU - Mangelsdorf, Inge

AU - McArdle, Harry J

AU - Naska, Androniki

AU - Pelaez, Carmen

AU - Siani, Alfonso

AU - Thies , Frank

AU - Tsabouri, Sophia

AU - Adan, Roger

AU - Emmett, Pauline

AU - Galli, Carlo

AU - Kersting, Mathilde

AU - Moynihan, Paula

AU - Tappi, Luc

AU - Ciccolallo, Laura Ciccolallo

AU - de Sesmaisons-Lecarre, Agnes

AU - Fabiani, Lucia

AU - Horvath, Zsuzsanna

AU - Martino, Laura

AU - Munoz Guajardo, Irene

AU - Valtuena Martınez, Silvia

AU - Vinceti, Marco

N1 - 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.

PY - 2022/2/28

Y1 - 2022/2/28

N2 - 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.

AB - 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.

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KW - free sugars

KW - chronic metabolic diseases

KW - pregnancy-related endpoints

KW - dental caries

KW - Tolerable upper intake level

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ER -

Tolerable upper intake level for dietary sugars

Abstract

Bibliographical note

Keywords

UN SDGs

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