A ‘Tolerable Upper Intake Level’ impossible to set.

The expert panel on nutrition of the European Food Safety Authority (EFSA) have released their draft scientific opinion on the safety of dietary sugars.

One of the requests to the panel was to, if possible, set an evidence-based ‘tolerable upper intake level’ (UL) below which consumption would not cause health problems. The group of scientists concluded based on the body of evidence it was not possible to set such a threshold as the relationship between intake of sugars and adverse outcomes was positive and linear.

EFSA’s scientists consider that based on dental caries risk intake of total sugars should be as low as possible, and intake of added and free sugars should be as low as possible, noting that below 10% energy there is high uncertainty about the shape and direction of relationships between intake and chronic disease. The opinion confirms links between intake of different categories of sugars and the risk of developing chronic metabolic diseases and dental caries, albeit with varying degrees of certainty. In isocaloric exchange with other macronutrients, the available evidence did not support a positive relationship between the intake of total, added or free sugars and any of the chronic metabolic diseases or pregnancy-related endpoints considered.

The EFSA panel noted exploring the relationship between the intake of dietary sugars, an energy-containing macronutrient, and health is challenging. A notable limitation in the body of evidence is that the energy and non-energy contribution (i.e. the molecule-specific effect) of dietary sugars to metabolic disease risk could not be systematically addressed across studies and endpoints.

The EFSA panel recommend further research be prioritised to assist in the development of a UL including:

• Develop and validate reliable methods and (bio)markers of intake of dietary sugars.
• Use standardised definitions for the characterisation of dietary sugars, their fractions (added and free sugars) and their sources (food groups in which they are contained).
• Measure the impact of interventions to reduce the amount of added and free sugars from all sources (especially to below 10 E%) in controlled settings on the development of chronic metabolic diseases and surrogate endpoints in all age groups. The impact of potential effect modifiers and the mechanisms involved should be further investigated.
• Use reliable methods to measure possible mediators and confounders of the relationship between the intake of dietary sugars and incidence of chronic metabolic diseases, particularly energy intake, measures of body fatness, diet quality and physical activity, and report on their validity.
• Measure the impact of interventions in clinical and community settings to reduce the amount of dietary sugars (as E% and in g/day) on the development of dental caries in all age groups.

The opinion is purely an assessment of the scientific evidence. EFSA says public health policy and guidelines are the responsibility of public health authorities.

You can read the draft opinion here and make comments until Sept 30.