The UK population on average is eating too much free sugars. These are the sugars added to foods by the manufacturer, cook or consumer at home, plus sugars naturally present in honey, syrups and unsweetened fruit juices. Worryingly, school-aged children and teenagers have the highest intakes, consuming around three times the recommendation (no more than 5% total dietary energy),1 which translates broadly as:
– No more than 19g of free sugars a day (equivalent to 5 cubes) for 4-6 year-olds.
– No more than 24g a day (6 cubes) for 7-10 year-olds.
– No more than 30g a day (7 cubes) for children aged 11 years and over.
We should remember that free sugars do not include lactose (sugars naturally present in milk and dairy products) and sugars within the cellular structure of foods, like in fruit and vegetables. These foods should be encouraged in children and adolescents as they provide important nutrients.
Why worry about the intake of free sugars in children?
Excess weight is a significant issue in children, for example 20% of 4-5 year-olds are either overweight or obese.2 Around a third of free sugars in children’s and teenagers diets come from sugars-sweetened drinks and fruit juice. Research indicates that consumption of sugars-sweetened (compared with calorie free) drinks results in weight gain. Additionally, a high consumption of sugars and sugars-containing foods and drinks is associated with an increased risk of tooth decay, which affects over a quarter of five year-olds in England,3 around a third of 12 year-olds and nearly half of 15 year-olds.4
What advice can healthcare professionals give?
When talking to parents and carers about how they can reduce free sugars in their child’s diet, drinks could be the first place to start. Ideally, sugars-sweetened drinks should be minimised and replaced with water and lower-fat milks. Children that enjoy carbonated drinks could try small amounts of unsweetened fruit juice or no-added-sugar fruit drinks diluted with sparkling water. While unsweetened fruit juice can be a part of a healthy, balanced diet (eg provides vitamin C) it should be limited to a small 150ml glass a day due to its free sugars content. Biscuits, cakes, puddings and sweetened breakfast cereals also contribute free sugars in 4-10 year-olds, so advise around lower sugars snack or treat choices. Choosing reduced/lower-sugars breakfast cereals may also help.
Nutrition labels can also make a change, with red traffic light labelling indicating high sugars content. Perhaps confusingly, the total sugar content of a food or drink is shown on labels, but this may not be equivalent to the free sugars content. The total sugar present may represent sugars added, but it may also be a combination of free sugars, plus sugars naturally present in milk or fruit and vegetables, like in dried fruit added to some cereal products. A simpler method is to check the ingredients list; if words such as cane sugar, honey, high fructose corn syrup, fructose, sucrose or glucose (all free sugars) appear towards the beginning then the product is likely to have more free sugars than one in which any sugars are at the end.
Reducing free sugars in the context of a healthy, balanced diet is an important public health measure that health professionals should encourage.
1. Scientific Advisory Committee on Nutrition. Carbohydrates and Health. gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf (accessed 27 January 2016).
2. Health and Social Care Information Centre National Child Measurement Programme – England, 2014-2015. hscic.gov.uk/catalogue/PUB19109/nati-chil-meas-prog-eng-2014-2015-rep.pdf (accessed 27 January 2016).
3. Public Health England. National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2012. A report on the prevalence and severity of dental decay. nwph.net/dentalhealth/Oral%20Health%205yr%20old%20children%202012%20final%20report%20gateway%20approved.pdf (accessed 27 January 2016).
4. Lader D, Chadwick B, Chesnutt I, Harker R, Morris J, Nuttall N, Pitts N, Steele J, White D. Children’s Dental Health Survey in the United Kingdom, 2003. Summary Report. ons.gov.uk/ons/guide-method/method-quality/specific/health-methodology/dental-health/dental-health-of-children/cdh-summary-2003.pdf (accessed 27 January 2016).
Ayela Spiro, Helena Gibson-Moore and Sarah Coe are all nutrition scientists at The British Nutrition Foundation. All three work together to be expert bloggers in the Nursing in Practice nutrition resources centre. Individual descriptions are below:
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