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Global sugar consumption

How much sugar are different countries around the world consuming, and how does Australia and New Zealand compare?

This article is based on the published work of researchers Janette Walton, Haley Bell, Roberta Re and Anne Nugent in their paper Current perspectives on global sugars consumption: definitions, recommendations, population intakes, challenges and future directions in Nutrition Research Reviews, 2021.

The big picture

Despite sugar intake reduction being a goal of many countries, data is not collected in a consistent and regular way which makes comparisons difficult. Overall, it appears intakes are above recommendations, however more specific conclusions are hampered by lack of detailed high-quality data.

Classification and definition

There are three main definitions used in dietary recommendations and food labelling, issued by various bodies such as the World Health Organisation (WHO) and European Food Safety Authority (EFSA).

TOTAL SUGARS: Glycemic carbohydrates made up of 1-2 monomers found in food. Includes monosaccharides (glucose, fructose, galactose) and disaccharides (sucrose, lactose, maltose, trehalose). Includes natural sugars in fruit and milk.

ADDED SUGARS: Sugars (mono- and di-saccharides) used as ingredients in processed and prepared foods and sugars eaten separately or added to foods at the table.

FREE SUGARS: Includes monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer plus sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

Editor’s note: There is debate as to whether 100% fruit juices should be classified as free sugars due to their nutrient density, status as a core food included in Dietary Guidelines, and lack of direct evidence of harm.

Term mismatch

In dietary advice, the terms ‘added’ and ‘free sugars’ are used, whereas ‘total sugars’ is used on food labels. This is because there is no accepted method for measuring added and free sugars. Food composition data on food labels are used by researchers to estimate dietary sugars intake, however for most countries (including Australia and New Zealand), there is no mandatory labelling of added or free sugars and only total sugars is required to be declared on the label.

Editor’s note: Several groups have developed methods for estimating added and free sugars in food and/or diets. Sydney University developed a 10-step method for added sugars in foods (Read more here), and a UK group developed a 5-step method. (Read more here.)

International sugar intake recommendations

Most organisations have chosen to us the World Health Organisation (WHO) recommendations, with some differences.

Table 1. International organisation’s sugar intake recommendations

Organisation

Population Group

Year

Recommendation

German Nutrition Society

Children and adults

2019

No more than 10% energy from free sugars

(European) ESPGHAN* Committee on Nutrition

Children

2017

Desirable upper limit of 5% energy from free sugars (and lower in those <2 years)

American Heart Association (AHA)

Children

2017

≥ 25g (100cal or ~6 teaspoons) added sugars per day.

Avoid added sugars in children <2 years

(French)

ANSES

Adults

2016

100g/d upper limit for total sugars (excluding sugars naturally present in dairy)

World Health Organisation (WHO)

Children and adults

2015

Free sugars not to exceed 10%E (strong recommendation), and less than 5% (conditional recommendation)

U.S Departments of Health and Agriculture

General

2020

< 10%E per day from added sugars

(UK) SACN

2 yrs and over

2015

Average population intake of free sugars not more than 5%E

Nordic Nutrition Recommendations (NNR)

General

2012

Limit added sugars <10%E

European Food Safety Authority (EFSA)

General

2010

Insufficient data to set an upper limit for added sugars intake

U.S. Institute of Medicine (IOM)

General

2005

Maximum intake ≥ 25%E

Abbreviation Key

ESPGHAN: European Society for Paediatric Gastroenterology, Hepatology and Nutrition.

SACN: Scientific Advisory Committee on Nutrition.

ANSES: French Agency for Food, Environmental and Occupational Health & Safety.

The WHO conditional recommendation of 5%E from free sugars is rarely achieved in dietary surveys.

“Of the 27 surveys that provided an estimate for free sugars, only one survey reported an estimate of mean intake below 5%E (Spain, where older male adults reported sugars intakes of 4.8%E)”

While the AHA have listed an Upper Limit for children, this was not reflected in the US national dietary guidelines due to a lack of evidence. The Institute of Medicine (IOM) used a 25%E maximum due to the nutrient displacement effect of foods high in added sugars. They were unable to set an Upper Limit (UL).

International sugars intakes

“Globally free sugars intake as a percentage of total energy are highest for children and adolescents (13-14%E) and lowest for older adults (8%E)”

Children <4 years

  • Data for 16 countries, including Australia
  • Total sugars intake ranged from 18.8%E (Israel, girls) to 31.4% (The Netherlands)
  • Added sugars ranged from 1.5% (USA, girls) to 14.1% (The Netherlands, girls)
  • Free sugars ranged from 9% (Ireland) to 17.4% (The Netherlands, girls)

Children 4-12 years

  • Data available for 25 countries, including A&NZ.
  • Total sugars intake ranged from 8% (China, girls) to 28.6% (The Netherlands, girls)
  • Added sugars ranged from 3% (China) to 17% (The Netherlands, girls).
  • Free sugars ranged from 9.1% (Portugal) to 19.5% (The Netherlands)

Adolescents 13-18 years

  • Data available for 24 countries, including A&NZ
  • Total sugars ranged from 15.4% (Italy) to 30% (Slovenia)
  • Added sugars ranged from 9.1% (Portugal, girls) to 16.2% (USA)
    (A&NZ av. added sugar intake in this age group is 12%)
  • Free sugars ranged from 9.1% (Portugal, boys) to 17.9% (The Netherlands, boys)

Adults 19-64 years

  • Data available for 29 countries, including A&NZ
  • Total sugars intake ranged from 12.7%E (Lithuania) to 26% (The Netherlands, women)
  • Added sugars intake ranged from 6.3% (Norway, men) to 14% (Brazil, women)
  • Free sugars intake ranged from 6.9% (Portugal, men) to 18.1% (Austria, women)

Adults >65 years

  • Data for 26 countries, including A&NZ.
  • Total sugars ranged from 13.2%E (Lithuania) to 23.3% (New Zealand women)
  • Added sugars ranged from 4% (Portuguese men) to 12% (Brazil, women)
  • Free sugars ranged from 4.4% (Portugal) to 12.5% (UK men)

Table 2. Sugars Intake in Australia and New Zealand

Australia

Assessment year

Total sugars %E

Added sugars

%E

Free sugars %E

2-3 yrs

2011-12

24%

8.4% (Male)

8.1% (Female)

11%

4-8 yrs

23%

10% (M)

12%

9-13 yrs

21% (M)

23% (F)

11% (M)

12% (F)

12% (M)

13% (F)

14-18 yrs

21%

13% (M)

12% (F)

14% (M)

13% (F)

19-30 yrs

19% (M)

20% (F)

10%

12%

31-50 yrs

18% (M)

19% (F)

9.4% (M)

8.9% (F)

10%

51-70 yrs

17% (M)

19% (F)

7.8% (M)

7.7% (F)

9% (M)

8.8% (F)

New Zealand

Assessment year

Total sugars %E

Added sugars

%E

Free sugars %E

11-14 yrs

2008-9

22% (M)

24% (F)

N/A

N/A

15-18 yrs

20% (M)

23% (F)

11% (M)

12% (F)

13% (M)

15% (F)

19-30 yrs

20% (M)

23% (F)

10% (M)

12% (F)

12% (M)

14% (F)

31-50 yrs

19% (M)

21% (F)

9.5% (M)

9.1% (F)

10%

51-70 yrs

19% (M)

21% (F)

8.4% (M)

8.6% (F)

10% (M)

9.7% (F)

 Evidence base

  • The relationship between consumption of foods containing sugars and dental caries is well established.
  • There is debate on the relationship between dietary sugars and obesity, type 2 diabetes and cardiovascular disease.
  • Despite systematic reviews and critical analysis of the evidence, there is no firm conclusion that dietary sugars are directly related to diet-related diseases other than as a source of dietary energy, particularly implicated as a contributor towards positive energy balance. (In other words, any harm is due to overconsumption of energy and not sugars per se)
  • While fructose has been identified as having potential to adversely impact metabolic health, there is no agreed conclusion yet.
  • The strongest available evidence of a link with dietary sugars is for sugar-sweetened beverages (SSB) and body weight, rather than sugar or sugars per se.
  • The European Food Safety Authority (EFSA) has produced a draft review of the evidence to derive a tolerable upper intake level (UL) (See our summary here)

Conclusions and recommendations

The researchers suggest that for quantitative dietary sugars recommendations, more explicit quantification, justifications and communication of uncertainty factors, together with greater international harmonisation for both exposures and outcomes, would help to minimise variation in international recommendations.

 

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