The E.U. Table 10: Examples of implemented policies to address sugars intake. 103, FDA (2017) U.S. Food and Drug Administration webpage, Changes to the Nutrition Facts Label, FDA, U.S. Food and Drug Administration webpage for high-intensity sweeteners, Fidler Mis et al (2017) Sugar in Infants, Children and Adolescents: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition, Fitch C. & Keim K.S. Enable or guide choice by changing default, Table 11: Examples of implemented policies to address sweeteners intake, Health Promotion and Disease Prevention Knowledge Gateway, Physical activity and sedentary behaviour, Food and non-alcoholic beverage marketing to children and adolescents, EU burden from non-communicable diseases and key risk factors, Health inequalities: dietary and physical activity-related determinants, Cost of Non-Communicable Diseases in the EU, 2. Adequate evidence for an association between the amount and frequency of SSBs and detriment to deciduous dentition. (EC) 1333/2008 and Reg. e. Reg. ', 'The evidence regarding the relevance of monosaccharides for the risk of obesity is insufficient'. These monosaccharides occur naturally in small amounts in fruits, vegetables and plant juices. Annex II is meant as a tool for the benefit and voluntary use of the MS, and can support them in designing, implementing and evaluating reformulation strategies in the context of their public health policies on nutrition-related NCDs. Sugars and sweeteners intake across European countries, 7. soft drinks, sweetened milks and juices (including 100%) will be taxed on content of sugar and sweeteners. However, these potential benefits will not be fully realized if there is a compensatory increase in energy intake from other sources'. 'A higher than recommended intake of free sugars, particularly SSBs in children and adolescents, is associated with increased incidence of dental caries…'. '…evidence suggests that added sugars are a source of excess fructose and that reduction of fructose from added sugars is likely to decrease uric acid, possibly improving blood pressure in children. As described in Table 4, high intake of added sugars can be a risk factor for ill health, especially in the case of intake of sugar sweetened beverages. 'The preponderance of evidence […] weighs in favour of improved triglycerides and HDL in children with low consumption of added sugars'. Following the above definition, for the purposes of this Brief, the term 'sweeteners' will refer to those non-nutritive (or low caloric) food additives that are approved for use as sugar replacers in the EU and are reported in Table 3. 'children and adolescents who have high intakes of dietary sugars (specifically from SSBs and added sugars) tend to have higher daily energy intakes compared with similar populations with lower intakes of dietary sugars'. Official Journal of the European Union L135/1, European Commission Scientific Committee for Food, Revised Opinion on Cyclamic Acid and its sodium and calcium salts. 'The DGAC concurs with the World Health Organization's commissioned systematic review that moderate consistent evidence supports a relationship between the amount of free sugars intake and the development of dental caries among children and adults. There's Glyphosate in Our Food System — So Now What? 'Observational studies, show that SSB intake during infancy and early childhood is associated with SSB intake in childhood and adolescence', but cannot demonstrate causality. Our scientific work supports a whole host of EU policies in a variety of areas from agriculture and food security, to environment and climate change, as well as nuclear safety and security and innovation and growth. 'The effect of sugars containing fructose (sucrose, HFCS), the respective roles of excess energy or sugar intake per se, and the effect of co-ingestion of glucose and fructose, are still poorly understood. In most cases, the use of intense sweeteners as sugar substitutes 'results in a decrease in short-term energy intake due to their low calorie content and the lack of compensation. l. There is no universal definition of a 'cup'. 'the consumption of sugar-sweetened beverages should be limited, because they increase the risk of obesity and diabetes'. Wiley-Blackwell, SACN (2015) Scientific Advisory Committee on Nutrition - Public Health England, Carbohydrates and health report, UKDH (2013) U.K. Department of Health, Food Standards Agency, Welsh Government, Scottish Government, Guide to creating a front of pack nutrition label for pre-packaged products sold through retail outlets, USDA (2016) U.S. Department of Agriculture, A guide to smart snacks in schools, WHO (2003) World Health Organization, Food based dietary guidelines in the WHO European Region. traffic light/ colour coding systems in Ecuador and South Korea for total sugars, Heart Check in Nigeria for added sugars. Suggestive evidence that frequent consumption of SSBs has an unfavourable effect on blood pressure. The sources of these are described in Table 2 and include plants, especially fruits and vegetables where most mono- and disaccharides are intrinsically occurring. Since January 2017, prohibition of unlimited supply, for free or for a fixed price, of drinks with added sugars or synthetic sweeteners in all catering establishments open to the public, including hotels, holiday clubs, reception establishments, establishments training and housing minors (e.g. Evidence on the relationship of sugar-sweetened beverages and body weight should be considered when developing food-based dietary guidelines'. has banned phthalates in toys, both phthalates and bisphenol-A remain approved for food contact uses -- subject to strict regulations on their use. The Healthy, Hunger Free Kids Act set standards for the national school lunch and breakfast programmes, which included limits on added sugars in foods and beverages. Sugars and sweeteners intake: effects on health, Joint FAO/WHO Expert Consultation report (1998), WHO handbook for guideline development (2014) 2, AAP (2004) American Academy of Paediatrics, Soft Drinks in Schools - Policy Statement Pediatrics, 2004 :113:152-154, Reaffirmed in 2008, AAP (2015) American Academy of Paediatrics, Snacks, Sweetened Beverages, Added Sugars, and Schools – Policy Statement, ADA (2016) American Diabetes Association, Standards of Medical Care in Diabetes, Diabetes Care Volume 39, Supplement 1, AHA & ADA (2012) American Heart Association and American Diabetes Association Scientific Statement, Nonnutritive Sweeteners: Current Use and Health Perspectives, AHA (2005) American Heart Association Scientific Statement, Dietary Recommendations for Children and Adolescents, A guide for Practitioners: Consensus Statement From the American Heart Association. The available evidence is insufficient to set an upper limit for sugars based on their effects on body weight. However, the available data cover insufficient time periods to guarantee the maintenance of this effect over the medium or long term'. In the EU (EC 2008, EU 2011) sweeteners are referred to as food additive substances used to 'impart a sweet taste to foods or in table-top sweeteners'. A number of national or international institutions have recently examined the potential impact of sugars consumption on health, focusing mainly on effects on body weight management, Type 2 Diabetes mellitus (T2DM), cardiovascular parameters such as blood glucose, pressure, lipids, cholesterol and dental health. In the late 1960s cyclamate was banned in the United Kingdom but was approved after being re-evaluated by the European Union in 1996. Intakes represent total intake from all sources, except where otherwise stated. There are few actions in place specific for sweeteners; most of these tackle the use of intense sweeteners in SSBs in school environments and are summarised in Table 11. a In this table the terminology used to refer to sweeteners is as given in the literature source (e.g. Based on moderate evidence, an association was found between greater sugars-sweetened beverage (SSB) soft-drink consumption and higher incidence of type 2 diabetes mellitus, while there was insufficient that included fruit juices. Sugar Sweetened Beverages (SSBs) consumption is high in many parts of the world and is considered to significantly contribute to added sugar intake (WHO 2018, CDC website, EC 2018). Products containing limited quantities of sugars may be allowed if authorised by the relevant national health/nutrition authorities (. Sucrose and fructose were also individually examined with same findings. '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. labelling of sugar content in foods, restrictions of marketing practices for foods high in sugars content, encouraging healthy behaviours such as drinking water, ii) making the healthy option available by improving the 'food environment', e.g. ) After artificial sweeteners were banned in Japan more than 40 years ago, the Japanese began to sweeten their foods with stevia. 'Randomised controlled trials conducted in adults indicate that increasing or decreasing the percentage of total dietary energy as sugars when consuming an ad libitum diet, either through the substitution of other macronutrient components or by replacing sugars with non-caloric sweeteners, leads to corresponding relative increases or decreases in energy intake'. 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