Following a request from five European Nordic countries, the EFSA Panel on Nutrition, Novel Foods and Food
Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL) or a safe level of intake for dietary (total/added/free)
sugars based on available data on chronic
metabolic diseases, pregnancy-related endpoints and
dental caries. Specific
sugar types (
fructose) and sources of
sugars were also addressed. The intake of
dietary sugars is a well-established hazard in relation to
dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of
dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic
metabolic diseases or pregnancy-related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free
sugars and risk of some chronic
metabolic diseases: The level of certainty is moderate for
obesity and dyslipidaemia (> 50-75% probability), low for
non-alcoholic fatty liver disease and
type 2 diabetes (> 15-50% probability) and very low for
hypertension (0-15% probability). Health effects of added vs. free
sugars could not be compared. A level of
sugars intake at which the risk of
dental caries/chronic
metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free
sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free
sugars would decrease the intake of total
sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations.