Perspective: Total, Added, or Free? What Kind of Sugars Should We Be Talking About?

Abstract

There is consistent public guidance to limit sugars intakes. However, WHO recommendations are for “free” sugars, whereas some other guidance documents and public discussion focus on “added” sugars, and globally most food labeling states “total” sugars. Total sugars comprise all mono- and disaccharides, regardless of source, whereas both added and free sugars exclude the sugars that naturally occur in dairy products and intact fruit and vegetables. Definitions of added and free sugars differ mainly in their respective exclusion or inclusion of sugars in juiced or pureed fruit and vegetables. To date, there has been little evidence-based analysis of the scientific basis for these different sugar classifications or implications of their adoption for consumer communication and nutrition labeling. Evidence of discriminating relations of total compared with added or free sugars with weight gain or energy intake, type 2 diabetes, and dental caries was identified from recent systematic reviews and meta-analyses. The relations were weakest for total sugars and most consistent for dietary sources corresponding to free sugars (including sugars added to and in fruit juices). Consideration of these health outcomes suggests that the emphasis for intake monitoring, public health guidance, and consumer communication should be on free sugars. However, at present, the adoption of free sugars for these purposes would also carry challenges related to implementation, including consumer understanding, consensus on specifications, and current (labeling) regulations.

Sugar Reduction in Yogurt Products Sold in the UK between 2016 and 2019

“…Relatedly, because we did not analytically measure the sugar contents of the 893 products surveyed, it was not possible to assess the free sugar contents separately from lactose, the intrinsic milk sugar excluded from the definition of free sugar. Although there is consensus that in relation to health risks associated with dietary sugar, public guidance and intake monitoring should focus on free sugars [40]; in the UK and most countries globally, only total sugar is reported on nutrition labels and the UK's sugar reduction guidelines accordingly focus on total sugars. While the reporting of added sugars (under total sugars) on food labels has been recently mandated in the US [13], notably the US Food and Drug Administration's definition of added sugars excludes fruit puree, a common reason for a high free sugar content in children's yogurts and fromage frais.…”

Evaluation of the nutrient content of yogurts: a comprehensive survey of yogurt products in the major UK supermarkets

“…46 Notably, added sugars in the USA do not include the sugars in juiced or pureed fruits and vegetables that are defined as free sugars by the UK and WHO. It has been argued for public health purposes, the emphasis in communication should be free sugars, 47 and it will be interesting to see how food product companies and consumers navigate these changes. Our study highlighted other potential challenges and mixed messages for consumers, arising from marketing and packaging.…”

Empfehlungen zur Zuckeraufnahme

“…Alle Mono-und Disaccharide, Sirup und andere isolierte Zuckerzubereitungen, die während der Zubereitung und Produktion zugesetzt werden [11].…”