Members of the sugar industry are decrying The European Food Safety Authority (EFSA)’s

recommendation to keep added and free sugars as low as possible, calling it “misleading” 

for consumers’ sense of sugar safety.  

EFSA’s conclusion – which is in line with current recommendations – is the result of a multi-year safety assessment. It was ultimately unable to set a tolerable upper intake level (UL) 

for dietary sugars.

“EFSA’s scientific opinion will support national public health authorities and nutrition 

professionals in updating nutrition goals and specific recommendations for different  

consumers in their countries,” an EFSA spokesperson tells NutritionInsight.  

In contrast, the supplier Cosun Beet Company anticipates this advice may stimulate the increased use of artificial sweeteners in traditional products replacing sugar with no free 

choice for those consumers who prefer foods without artificial sweeteners. 

“Furthermore, it will trigger an enormous reformulation effort in various solid foods to 

replace added natural sugars with flour, starches, fats and oils, thickeners and artificial 

sweeteners – with no target for calorie reduction. Thus it will have no effect on the calories 

we eat,” the sugar beet processor argues.

Forming future decisions
EFSA’s opinion also contains several recommendations for further research to inform the 

possible setting of an UL for dietary sugars in the future.

The request for an assessment of dietary sugars’ health risks was originally made by 

Denmark, Finland, Iceland, Norway and Sweden in 2017. 

“This safety assessment of dietary sugars provides us with important knowledge,” says 

Anna Karin Lindroos, nutritionist and PhD at the Swedish Food Agency.

“It will, together with other relevant science-based reports, be a useful source when 

reviewing recommendations for sugar intake and food-based dietary guidelines in the 

Nordic countries,” she states. 

Opening the floor for input
EFSA released its draft opinion last July, noting that a threshold is not possible because 

all the “dose-response” relationships (between intake of sugars and risk of adverse health 

effects) were positive and linear. This refers to the clear indication that risk of adverse 

effects rises in line with higher sugar intake.

Since then, the authority has “refined and clarified” important aspects of its work, thanks 

to public consultation.  

During this period, 723 comments were received from 15 countries. The spokesperson 

emphasizes that EFSA applied a structured and transparent framework to appraise the 

validity of the included studies and to weigh the evidence, including a thorough and 

systematic analysis of the uncertainties. 

Assessing disease risk
Ultimately, EFSA underlined uncertainties about chronic disease risk for people whose 

consumption of added and free sugars is below 10% of their total energy intake. 

“This is due to the scarcity of studies at doses in this range,” says professor Dominique 

Turck, chair of EFSA’s panel of nutrition experts who carried out the assessment. 

Nonetheless, the review found evidence for a positive and causal relationship between 

the intake of added or free sugars and risk of some chronic metabolic diseases.

Specifically, there is moderate (more than 50 to 75%) certainty for connections with 

obesity and dyslipidemia. Meanwhile, there is low (15 to 50%) certainty for non‐alcoholic 

fatty liver disease and Type 2 diabetes and very low (0 to 15%) certainty for hypertension. 

Part of a healthy diet?
The European Association of Sugar Manufacturers (CEFS), has responded to the scientific 

opinion with an emphasis on sugar’s safety, noting it has been used for many centuries.  

“The opinion confirms that sugar is a safe product that can be enjoyed as part of a healthy, 

sustainable and balanced diet. Healthy diets are crucial in the fight against obesity, which 

is a root cause of diet-rated non-communicable diseases,” says Marie-Christine Ribera, 

CEFS director general. 

Meanwhile, Kenniscentrum Suiker & Voeding – an information resource funded by Cosun – 

adds that these recommendations could mislead consumers, creating an impression that the 

ingestion of a very small amount of sugar can already be harmful to health.

“With one-sided advice regarding free and added sugars, there is a risk of unforeseen, 

negative health side effects,” it argues.

Onward research potential
As EFSA’s review was so wide-ranging, its scientists will be able to prioritize the data gaps 

and research needed to set a tolerable upper intake level for dietary sugars in the future.

Notably, it has screened over 30,000 publications to identify several areas to target.

“The pooling and reuse of individual human data from research studies would be a valuable 

source of information. Research should focus both on the health effects of dietary sugars 

and on the impact of clinical and community interventions designed to reduce sugar intakes,” 

says Turck. 

“Finally, we need validated methods for assessing intakes and the standardization of 

reporting guidelines and definitions for dietary sugars and their sources,” he continues. 

Taking food categories into account
EFSA notes that human diets include different categories and sources of sugars, which 

can be naturally occurring or added. 

However, data limitations meant it was not possible to compare the effects of sugars 

classified as added or free.

Additionally, limited data means that some foods could not be assessed, such as sweets, 

cakes and desserts, other sweetened beverages such as sweetened milk and milkshakes, 

and yogurts.

“Although we could not assess their contributions, the impact of other important 

contributors to sugar intake should be considered by national authorities when setting 

food-based dietary guidelines,” Turck concludes. 

By Katherine Durrell