GENEVA - A new guideline from the World Health Organization recommends adults and children reduce their daily intake of free sugars to less than 10 per cent of their total energy intake to cut tooth decay and excess weight.

A further reduction to below 5 per cent or roughly 25 grams (6 teaspoons) a day would provide additional health benefits.

An average bowl of breakfast cereal has four teaspoons of sugar and it is very easy to exceed the healthy limit.

In the United States "a can of soda" contains 10 teaspoons of free sugar and the world's biggest global consumer of free sugar is South America, said Dr. Francesco Branca, director of WHO's Department of Nutrition for Health and Development on March 4.

Free sugars refer to monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the cook or manufacturers and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

"We are not talking about sugars in fruit and vegetables and those naturally present in milk," said Dr. Branca.

There is no reported evidence of adverse effects of consuming these sugars.

"We have solid evidence that keeping intake of free sugars to less than 10 percent of total energy intake reduces the risk of overweight, obesity and tooth decay," he said.

"Making policy changes to support this will be key if countries are to live up to their commitments to reduce the burden of noncommunicable diseases (NCDs)."

'FREE SUGARS'

Free sugars refer to monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

"We have solid evidence that keeping intake of free sugars to less than 10 per cent of total energy intake reduces the risk of overweight, obesity and tooth decay," says Dr. Branca.

"Making policy changes to support this will be key if countries are to live up to their commitments to reduce the burden of noncommunicable diseases."

The WHO guideline does not refer to the sugars in fresh fruits and vegetables, and sugars naturally present in milk, because there is no reported evidence of adverse effects of consuming these sugars.

Much of the sugars consumed today are "hidden" in processed foods that are not usually seen as sweets. For example, 1 tablespoon of ketchup contains around 4 grams (around 1 teaspoon) of free sugars.

A single can of sugar-sweetened soda contains up to 40 grams (around 10 teaspoons) of free sugars.

Worldwide intake of free sugars varies by age, setting and country. In Europe, intake in adults ranges from about 7-8 per cent of total energy intake in countries like Hungary and Norway, to 16-17 per cent in countries like Spain and the United Kingdom.

Intake is much higher among children, ranging from about 12 per cent in countries like Denmark, Slovenia and Sweden, to nearly 25 per cent in Portugal.

URBAN-RURAL DIFFERENCES

There are also rural urban differences in some countries. In rural communities in South Africa intake is 7.5 per cent, while in the urban population it is 10.3 per cent, although southern Africa is below the global average of free sugar consumption.

Reducing sugars intake to less than 10 per cent of total energy: a strong recommendation

The recommendations are based on analysis of the latest scientific evidence.

This evidence shows, first, that adults who consume less sugars have lower body weight and, second, that increasing the amount of sugars in the diet is associated with a weight increase.

In addition, research shows that children with the highest intakes of sugar-sweetened drinks are more likely to be overweight or obese than children with a low intake of sugar-sweetened drinks.

The recommendation is further supported by evidence showing higher rates of dental caries (commonly referred to as tooth decay) when the intake of free sugars is above 10 per cent of total energy intake compared with an intake of free sugars below 10 per cent of total energy intake.

Based on the quality of supporting evidence, these recommendations are ranked by WHO as "strong". This means they can be adopted as policy in most situations.

Further reduction to less than 5 per cent of total energy intake: a conditional recommendation

Given the nature of existing studies, the recommendation of reducing intake of free sugars to below 5 per cent of total energy is presented as "conditional" in the WHO system for issuing evidence-based guidance.

Few epidemiological studies have been undertaken in populations with a low sugars intake. Only three national population-wide studies allow a comparison of dental caries with sugars intakes of less than 5 per cent of total energy intake versus more than 5 per cent but less than 10 per cent of total energy intake.

These population-based ecological studies were conducted during a period when sugars availability dropped dramatically from 15kg a person per year before the Second World War to a low of 0.2kg a person per year in 1946.

This "natural experiment", which demonstrated a reduction in dental caries, provides the basis for the recommendation that reducing the intake of free sugars below 5 per cent of total energy intake would provide additional health benefits in the form of reduced dental caries.

WHO issues conditional recommendations even when the quality of evidence may not be strong on issues of public health importance.

A conditional recommendation is one where the desirable effects of adhering to the recommendation probably outweigh the undesirable effects but these trade-offs need to be clarified; therefore, stakeholder dialogue and consultations are needed before the recommendation is implemented as policy.

Updating the guideline on free sugars intake is part of WHO's on-going efforts to update existing dietary goals to prevent NCDs. The sugars guidelines should be used in conjunction with other nutrient guidelines and dietary goals, in particular those related to fats and fatty acids, including saturated fat and trans-fat.